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

Question 1: A physical therapist notes that a patient on mechanical ventilation has a respiratory rate of 28 breaths/min, tidal volume of 350 mL, and dead space volume of 150 mL. What is the patient's alveolar ventilation per minute?

7,000 mL/min
9,800 mL/min
5,600 mL/min (Correct answer)
4,200 mL/min

Correct answer: 5,600 mL/min

Alveolar ventilation equals respiratory rate multiplied by the difference between tidal volume and dead space: 28 x (350 - 150) = 5,600 mL/min.

Question 2: In normal gait, at what percentage of the gait cycle does the opposite foot make initial contact (double support ends)?

10% (Correct answer)
25%
40%
50%

Correct answer: 10%

Initial double support occurs during approximately the first 10% of the gait cycle, ending when the opposite foot lifts off.

Question 3: A child with spastic diplegic cerebral palsy demonstrates a scissoring gait pattern. Which muscle group is PRIMARILY responsible for this pattern?

Hip abductors
Ankle dorsiflexors
Hip adductors and internal rotators (Correct answer)
Knee extensors (quadriceps)

Correct answer: Hip adductors and internal rotators

Spasticity of the hip adductors and internal rotators causes the legs to cross midline during the swing phase, producing the characteristic scissoring pattern.

Question 4: During a treatment session for a patient with a complete C6 spinal cord injury, which transfer technique is MOST appropriate to train?

Stand-pivot transfer with moderate assist
Dependent lift transfer only
Sliding board transfer with head-hips relationship (Correct answer)
Independent stand-pivot transfer

Correct answer: Sliding board transfer with head-hips relationship

A patient with C6 tetraplegia has sufficient upper extremity function to perform sliding board transfers using momentum and the head-hips relationship for weight shifting.

Question 5: A physical therapist is working with a patient diagnosed with moderate Chronic Obstructive Pulmonary Disease (COPD). The plan of care includes teaching the patient energy conservation and breathing techniques. Which of the following breathing techniques is MOST effective for reducing dyspnea during activities of daily living for this patient?

Glossopharyngeal breathing
Pursed-lip breathing (Correct answer)
Segmental breathing
Stacked breathing

Correct answer: Pursed-lip breathing

Pursed-lip breathing is a primary technique taught to patients with COPD to manage dyspnea. It helps to slow the respiratory rate, keep airways open longer, and improve the exchange of air by creating back-pressure in the airways, thus reducing the work of breathing during activity. Stacked and segmental breathing focus more on lung expansion, while glossopharyngeal breathing is typically for patients with high spinal cord injuries.

Question 6: What is the OPTIMAL period to initiate neuromuscular re-education following peripheral nerve repair surgery?

When early clinical or EMG signs of reinnervation appear, typically 3 or more months post-repair (Correct answer)
Immediately post-operatively with maximal resistance exercise
Only after full motor strength is documented at the target muscle
Exclusively as prehabilitation before surgery

Correct answer: When early clinical or EMG signs of reinnervation appear, typically 3 or more months post-repair

Re-education begins when reinnervation is detected (early voluntary signals or EMG activity) so the patient can practice facilitating the newly reconnected motor units before full recovery.

Question 7: Peter visited a physical therapy office for an evaluation since he was still experiencing post-concussion syndrome symptoms, such as visual and vestibular difficulties. The physical therapist wants to evaluate Peter's eye tracking skills as part of the visual portion of the evaluation. Which of the below eye movement test types effectively measures this metric?

Vestibulo-ocular reflex
Near-point convergence
Smooth pursuit (Correct answer)
Saccades

Correct answer: Smooth pursuit

Smooth pursuit eye movements are specifically designed to track a slowly moving target, allowing the eyes to maintain continuous gaze on the object. This test directly assesses the ability of the oculomotor system to follow a moving stimulus, which is a key component of overall eye tracking skills. Saccades involve rapid shifts between fixed points, near-point convergence assesses eye teaming for close objects, and the vestibulo-ocular reflex stabilizes gaze during head movements.

Question 8: A patient has decreased sensation on the medial forearm and weak elbow flexion after a humeral fracture. Which nerve is most likely injured?

Musculocutaneous nerve (Correct answer)
Radial nerve
Median nerve
Ulnar nerve

Correct answer: Musculocutaneous nerve

The musculocutaneous nerve innervates the biceps and coracobrachialis (elbow flexion/supination) and provides sensation to the lateral forearm via the lateral antebrachial cutaneous nerve — medial forearm loss suggests this nerve.

Question 9: A patient 10 days post-total knee arthroplasty lacks full knee extension and has a 15-degree extension lag. Which intervention is MOST appropriate to address this impairment?

High-intensity isokinetic strengthening of the quadriceps
Active-assisted knee flexion in supine
Prolonged low-load stretch into extension using a prone hang (Correct answer)
Joint mobilization grades III–IV into flexion

Correct answer: Prolonged low-load stretch into extension using a prone hang

A prolonged low-load stretch (e.g., prone hang) applies a sustained force that promotes viscoelastic creep and plastic deformation of the capsule and soft tissue, which is most effective for improving a fixed extension deficit after TKA.

Question 10: During percussion of a patient's chest, the PT notes a dull sound over the right lower lobe base. This finding is MOST consistent with which condition?

Emphysema
Pneumothorax
Pleural effusion or consolidation (Correct answer)
Normal lung parenchyma

Correct answer: Pleural effusion or consolidation

Dull percussion notes replace the normal resonance when fluid (pleural effusion) or solid tissue (consolidation, atelectasis) replaces air-filled lung tissue.

Question 11: A therapist observes fasciculations and muscle atrophy in a patient's right quadriceps. These findings are most consistent with a lesion of which structure?

Sensory cortex
Upper motor neuron
Corticospinal tract
Lower motor neuron (Correct answer)

Correct answer: Lower motor neuron

Fasciculations and muscle atrophy are classic lower motor neuron signs resulting from denervation of the muscle.

Question 12: A second-degree partial-thickness burn is characterized by which finding?

Leathery, insensate wound extending into subcutaneous tissue
Intact epidermis with erythema and pain
Dry, white, or charred appearance with no pain
Blistering, moist, and extremely painful wound (Correct answer)

Correct answer: Blistering, moist, and extremely painful wound

Partial-thickness (second-degree) burns involve the epidermis and superficial dermis, presenting as blistered, moist, and intensely painful wounds.

Question 13: A patient with T6 complete spinal cord injury is being repositioned from supine to sitting. The therapist observes the patient develop a pounding headache, blurred vision, and profuse sweating above the level of injury. The most appropriate immediate action is:

Lay the patient supine and elevate the legs
Call for an emergency code team immediately
Sit the patient upright and identify the noxious stimulus (Correct answer)
Administer oxygen at 6 L/min via nasal cannula

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

These are signs of autonomic dysreflexia; the first step is to sit the patient upright (to drop blood pressure) and quickly identify and remove the triggering noxious stimulus.

Question 14: Which tract is primarily responsible for carrying proprioceptive information from the lower extremities to the cerebral cortex?

Spinocerebellar tract
Dorsal column-medial lemniscal pathway (Correct answer)
Lateral spinothalamic tract
Anterior spinothalamic tract

Correct answer: Dorsal column-medial lemniscal pathway

The dorsal column-medial lemniscal pathway transmits proprioception, vibration, and discriminative touch from the body to the somatosensory cortex.

Question 15: Which neuromuscular junction disorder is characterized by antibodies against acetylcholine receptors, resulting in fluctuating weakness that worsens with repeated activity?

Lambert-Eaton syndrome
Amyotrophic lateral sclerosis
Myasthenia gravis (Correct answer)
Multiple sclerosis

Correct answer: Myasthenia gravis

Myasthenia gravis involves autoantibodies targeting postsynaptic acetylcholine receptors, causing fatigable weakness.

Question 16: A physical therapist observes that a patient has excessive foot pronation during midstance. Which muscle is MOST important to strengthen to control this motion?

Tibialis anterior
Tibialis posterior (Correct answer)
Peroneus longus
Gastrocnemius

Correct answer: Tibialis posterior

The tibialis posterior is the primary dynamic stabilizer of the medial longitudinal arch and controls pronation during the stance phase of gait.

Question 17: A physical therapist realizes mid-session that they made a documentation error in a patient's chart from the previous day that could affect treatment decisions. The MOST appropriate action is to:

Add a late entry or addendum clearly marked with the current date and time, correcting the error (Correct answer)
Delete the incorrect entry and rewrite it with the correct information
Ask a colleague to make the correction on their behalf
Leave the record unchanged to avoid drawing attention to the mistake

Correct answer: Add a late entry or addendum clearly marked with the current date and time, correcting the error

Proper medical record correction requires adding a clearly dated and timed addendum rather than altering or deleting original entries. Falsifying or destroying records violates legal and ethical standards and can constitute fraud.

Question 18: Which type of motor neuron disease is characterized by both upper and lower motor neuron signs occurring simultaneously?

Poliomyelitis
Multiple sclerosis
Guillain-Barré syndrome
Amyotrophic lateral sclerosis (Correct answer)

Correct answer: Amyotrophic lateral sclerosis

ALS (amyotrophic lateral sclerosis) is characterized by simultaneous degeneration of both upper motor neurons (corticospinal tract) and lower motor neurons (anterior horn cells).

Question 19: A PT uses pulsed shortwave diathermy (PSWD) over a patient's lumbar region. Which tissue type is MOST effectively heated by the inductive coil method?

Subcutaneous adipose tissue
Bone cortex
Highly hydrated tissues with high water content such as muscle (Correct answer)
Dry skin

Correct answer: Highly hydrated tissues with high water content such as muscle

Inductive coil PSWD generates eddy currents most effectively in tissues with high water and electrolyte content, such as muscle.

Question 20: A physical therapist is working with a patient who has Multiple Sclerosis (MS) and reports debilitating fatigue as their primary complaint. Which of the following represents the BEST evidence-based approach to managing this patient's fatigue?

Focusing solely on passive range of motion and modalities to conserve energy.
Implementing a customized program of aerobic and light resistance exercise. (Correct answer)
Advising the patient to take frequent, prolonged rest periods and avoid all exercise.
Recommending energy drinks and supplements to boost energy levels.

Correct answer: Implementing a customized program of aerobic and light resistance exercise.

Contrary to what might seem intuitive, research consistently shows that an appropriately designed exercise program is one of the most effective non-pharmacological interventions for managing MS-related fatigue. A combination of aerobic conditioning and resistance training can improve energy levels, endurance, and overall function. Advising complete rest can lead to deconditioning, which worsens fatigue. Passive modalities do not address the underlying physiological factors contributing to fatigue, and recommending supplements is outside the physical therapist's scope of practice.

Question 21: A patient, who is a well-known artist, is very grateful for their successful rehabilitation and offers the physical therapist an original painting valued at approximately $1,000 as a thank you gift. According to the APTA's Code of Ethics, what is the MOST appropriate response?

Suggest the patient donate the painting to the hospital's fundraising auction instead.
Politely decline the gift, explaining that professional guidelines discourage accepting high-value items to avoid any appearance of a conflict of interest. (Correct answer)
Accept the painting, as refusing it could offend the patient and damage the therapeutic relationship.
Accept the painting on behalf of the clinic and display it in the waiting room for all to enjoy.

Correct answer: Politely decline the gift, explaining that professional guidelines discourage accepting high-value items to avoid any appearance of a conflict of interest.

The APTA's Code of Ethics states that physical therapists shall not accept gifts or other considerations that influence or give an appearance of influencing their professional judgment. Accepting a gift of significant value can create a conflict of interest, exploit the patient-therapist relationship, or compromise professional boundaries. The most ethical response is to politely and graciously decline, providing a professional reason to depersonalize the refusal and uphold ethical standards.

Question 22: Which type of muscle contraction produces the greatest amount of force for a given level of muscle activation?

Isokinetic concentric
Isometric
Eccentric (Correct answer)
Concentric

Correct answer: Eccentric

Eccentric contractions allow muscles to produce greater force than isometric or concentric contractions due to passive elastic component contributions and cross-bridge mechanics.

Question 23: A patient with a pacemaker is referred for interferential current therapy. What is the most appropriate action?

Use a lower intensity setting to reduce risk
Apply the electrodes away from the pacemaker site and proceed
Substitute with ultrasound, which has no contraindication for pacemakers
Contact the referring physician and withhold treatment pending clearance (Correct answer)

Correct answer: Contact the referring physician and withhold treatment pending clearance

Electrical stimulation is contraindicated over or near a pacemaker; physician clearance must be obtained before proceeding.

Question 24: A patient is referred for cardiac rehabilitation after CABG surgery. At what METs level is most ADL activity (e.g., self-care, slow walking) performed?

1–2 METs
6–7 METs
2–3 METs (Correct answer)
4–5 METs

Correct answer: 2–3 METs

Basic ADLs and slow ambulation require approximately 2–3 METs, which is the target activity level for early Phase I cardiac rehabilitation.

Question 25: A physical therapist is monitoring a patient during cardiac rehabilitation. The patient's rate-pressure product (RPP) at rest is 8,400. Which combination of values reflects this RPP?

Heart rate 80 bpm and systolic BP 130 mmHg
Heart rate 60 bpm and systolic BP 110 mmHg
Heart rate 70 bpm and systolic BP 120 mmHg (Correct answer)
Heart rate 90 bpm and systolic BP 140 mmHg

Correct answer: Heart rate 70 bpm and systolic BP 120 mmHg

Rate-pressure product equals heart rate multiplied by systolic blood pressure, so 70 x 120 = 8,400.

Question 26: A physical therapist is assessing a 10-month-old child who cannot sit independently. According to normal developmental milestones, this finding is:

Within normal limits, as independent sitting occurs at 12 months
Delayed, as independent sitting typically occurs by 6-8 months (Correct answer)
Within normal limits, as independent sitting occurs at 10-12 months
Delayed, as independent sitting typically occurs by 4-5 months

Correct answer: Delayed, as independent sitting typically occurs by 6-8 months

Independent sitting typically develops between 6-8 months, so inability to sit independently at 10 months represents a gross motor delay requiring further evaluation.

Question 27: A physical therapist calculates the Ankle-Brachial Index (ABI) for a patient complaining of intermittent claudication. The highest systolic pressure in the right arm is 150 mmHg, and the highest systolic pressure in the left arm is 144 mmHg. The highest systolic pressure in the right ankle (dorsalis pedis) is 90 mmHg. What is the patient's right ABI, and how is it classified?

1.67, classified as non-compressible vessels.
0.60, classified as moderate peripheral artery disease. (Correct answer)
0.63, classified as mild peripheral artery disease.
0.96, classified as normal.

Correct answer: 0.60, classified as moderate peripheral artery disease.

The ABI is calculated by dividing the highest ankle systolic pressure by the highest brachial systolic pressure from either arm. In this case, Right ABI = 90 mmHg / 150 mmHg = 0.60. An ABI value between 0.41 and 0.70 is typically classified as moderate peripheral artery disease (PAD).

Question 28: A patient is admitted to the hospital with a suspected acute myocardial infarction (MI). The physical therapist reviews the patient's lab values in the electronic medical record. Which of the following cardiac biomarkers is the most sensitive and specific for myocardial cell death, making it the gold standard for diagnosing an MI?

Myoglobin
Creatine Kinase-MB (CK-MB)
Cardiac Troponin (cTnI or cTnT) (Correct answer)
Brain Natriuretic Peptide (BNP)

Correct answer: Cardiac Troponin (cTnI or cTnT)

Cardiac troponins (I and T) are regulatory proteins that are highly specific to cardiac muscle. When myocardial necrosis occurs, troponins are released into the bloodstream and remain elevated for several days. Their high sensitivity and specificity make them the preferred and gold-standard biomarker for diagnosing acute MI. While CK-MB was previously used, it is less specific, and myoglobin is not specific to cardiac muscle.

Question 29: Beta-blockers affect PT exercise prescription primarily because they:

Increase blood glucose during exercise
Blunt the heart rate response to exercise (Correct answer)
Cause excessive tachycardia
Improve exercise tolerance significantly

Correct answer: Blunt the heart rate response to exercise

Beta-blockers block adrenergic stimulation of the heart, preventing the normal rise in heart rate, so RPE-based prescriptions are preferred.

Question 30: A patient is suffering SOB, calf pain, and warmth across the posterior calf, a physical therapist on an ICU unit notices. Which of the following medical disorders could all of these point to?

Patient may be in the late phases of CHF
Patient may be exhibiting signs of dermatitis
Patient may be experiencing anxiety after surgery.
Patient may have a DVT (Correct answer)

Correct answer: Patient may have a DVT

The combination of shortness of breath (SOB), calf pain, and warmth across the posterior calf are classic signs and symptoms highly suggestive of a Deep Vein Thrombosis (DVT). A DVT in the calf can cause localized pain and warmth, and if a part of the clot dislodges and travels to the lungs (pulmonary embolism), it can cause sudden SOB, which is a medical emergency.

Question 31: A physical therapist is using body-weight-supported treadmill training for a patient with an incomplete spinal cord injury classified as ASIA C. What is the PRIMARY rationale for this intervention?

To improve cardiovascular endurance as the primary goal
To reduce lower extremity edema through hydrostatic pressure
To strengthen the hip flexors through progressive resistance
To activate central pattern generators and promote locomotor recovery (Correct answer)

Correct answer: To activate central pattern generators and promote locomotor recovery

Body-weight-supported treadmill training is used in incomplete SCI to activate spinal central pattern generators, facilitating repetitive stepping patterns that promote neuroplastic locomotor recovery.

Question 32: A patient post-CVA demonstrates circumduction of the lower extremity during the swing phase. This compensatory movement most directly substitutes for inadequate:

Hip extension during terminal stance
Hip abductor strength during single-limb support
Knee flexion and ankle dorsiflexion during swing (Correct answer)
Plantarflexor push-off at pre-swing

Correct answer: Knee flexion and ankle dorsiflexion during swing

Circumduction is a compensatory arc of the limb to achieve foot clearance when the patient cannot adequately flex the knee or dorsiflex the ankle during swing. Both motions are needed to shorten the functional limb length for clearance.

Question 33: A physical therapist is teaching a patient with severe chronic obstructive pulmonary disease (COPD) a breathing technique to help relieve dyspnea by maintaining positive airway pressure during exhalation and preventing premature airway collapse. Which of the following techniques BEST accomplishes this goal?

Incentive spirometry
Pursed-lip breathing (Correct answer)
Segmental breathing
Diaphragmatic breathing

Correct answer: Pursed-lip breathing

Pursed-lip breathing is the most effective technique for patients with obstructive lung disease like COPD to manage dyspnea. By exhaling slowly through pursed lips, it creates a back-pressure (positive end-expiratory pressure or PEEP) that helps keep the smaller airways from collapsing, allowing for more complete emptying of trapped air.

Question 34: A physical therapist is auscultating the heart sounds of a patient and hears a distinct 'lub-dub' followed by a low-pitched sound early in diastole. This extra sound is MOST likely which of the following?

S4
S1
S3 (Correct answer)
S2

Correct answer: S3

An S3 heart sound, also known as a ventricular gallop, is a low-pitched sound that occurs in early diastole, following the S2 ('dub') sound. It is caused by the vibration of the ventricular walls as blood rushes in from the atria. While it can be normal in children and young adults, in older adults it often indicates heart failure. S1 is the 'lub' sound, and S4 is a late diastolic sound occurring just before S1.

Question 35: Which sensory system is primarily challenged when a patient performs balance exercises on a foam surface with eyes open?

Somatosensory system (Correct answer)
Vestibular system
Visual system
Auditory system

Correct answer: Somatosensory system

A foam surface provides inaccurate somatosensory input from the feet, forcing greater reliance on visual and vestibular systems for balance.

Question 36: Which outcome measure is MOST appropriate for assessing balance and fall risk across a broad range of neurological diagnoses?

Modified Ashworth Scale (MAS)
Fugl-Meyer Assessment (FMA)
Manual muscle test (MMT)
Berg Balance Scale (BBS) (Correct answer)

Correct answer: Berg Balance Scale (BBS)

The Berg Balance Scale assesses static and dynamic balance through 14 functional tasks and has strong validity and reliability as a fall-risk predictor in neurological populations.

Question 37: Which electrode placement during TENS application over the cervical spine region is CONTRAINDICATED due to risk of adverse physiological response?

Ipsilateral upper trapezius and rhomboid
Bilateral paraspinal muscles at C5-C6
Between the scapulae bilaterally
Over the anterior neck across the carotid sinus (Correct answer)

Correct answer: Over the anterior neck across the carotid sinus

Electrode placement over the carotid sinus can trigger a vasovagal response, causing bradycardia and hypotension.

Question 38: During rehabilitation of a rotator cuff repair, at what phase is it MOST appropriate to begin resisted external rotation exercises?

Immediately post-operatively in a sling
Only after 6 months when the patient returns to sport
After achieving full passive range of motion, typically around 10-12 weeks (Correct answer)
During the passive range of motion phase at 2 weeks

Correct answer: After achieving full passive range of motion, typically around 10-12 weeks

Resisted external rotation is typically initiated after full passive ROM is achieved around 10-12 weeks to allow adequate tendon healing before loading the repair.

Question 39: A patient with adhesive capsulitis of the shoulder would most likely demonstrate the greatest limitation in which motion?

Shoulder abduction
Shoulder internal rotation
Shoulder flexion
Shoulder external rotation (Correct answer)

Correct answer: Shoulder external rotation

External rotation is typically the most restricted motion in adhesive capsulitis due to tightening of the inferior glenohumeral ligament and capsule.

Question 40: A physical therapist observes that a patient with a stroke can initiate shoulder flexion only within a mass flexion synergy pattern. According to Brunnstrom's stages of motor recovery, this patient is in which stage?

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

Correct answer: Stage 3

Brunnstrom Stage 3 is characterized by voluntary movement that occurs only within synergy patterns.

Question 41: Which diaphragmatic breathing technique MOST effectively reduces accessory muscle use in a patient with COPD?

Glossopharyngeal breathing
Incentive spirometry
Controlled coughing technique
Pursed-lip breathing combined with diaphragmatic breathing (Correct answer)

Correct answer: Pursed-lip breathing combined with diaphragmatic breathing

Pursed-lip breathing slows expiration and maintains positive airway pressure to prevent dynamic airway collapse, and when combined with diaphragmatic breathing reduces accessory muscle recruitment.

Question 42: Which cranial nerve is tested by assessing the gag reflex?

Trigeminal (CN V)
Glossopharyngeal (CN IX) and Vagus (CN X) (Correct answer)
Facial (CN VII)
Hypoglossal (CN XII)

Correct answer: Glossopharyngeal (CN IX) and Vagus (CN X)

The gag reflex tests the sensory component via CN IX and the motor component via CN X.

Question 43: A physical therapist makes an error while writing a daily note in a patient's paper chart, documenting that the patient ambulated 150 feet when it was only 100 feet. What is the legally-accepted procedure for correcting this error?

Draw a single line through the incorrect entry, write "error," and then add the correct information followed by the therapist's initials and the date. (Correct answer)
Black out the entire incorrect entry with a marker so it is illegible and write the correct information in the margin.
Use correction fluid to completely cover the error and write the correct information over it.
Erase the incorrect entry carefully and rewrite the correct information in the same spot.

Correct answer: Draw a single line through the incorrect entry, write "error," and then add the correct information followed by the therapist's initials and the date.

A medical record is a legal document, and alterations must be transparent. The legally-defensible method for correcting an error in a paper chart is to draw a single line through the mistake, ensuring the original entry remains legible. The therapist should then write "error" or a similar notation, add the correct information, and then initial and date the correction. This method maintains the integrity of the record by showing what was changed, when, and by whom. Using correction fluid or completely obscuring the original entry can be interpreted as an attempt to conceal information.

Question 44: Which Universal Precaution guideline applies when a PT is treating a patient with an open wound?

Mask and gown are always required for open wound care
Gloves are only required if the PT has skin breaks
Gloves must be worn when contact with blood or body fluids is anticipated (Correct answer)
Gloves are optional if the wound is covered with a dressing

Correct answer: Gloves must be worn when contact with blood or body fluids is anticipated

Standard/Universal Precautions require gloves whenever contact with blood or body fluids is anticipated, regardless of infection status.

Question 45: Which situation best describes a conflict of interest that a PT must disclose or avoid?

Referring patients to a diagnostic imaging center in which the PT has a financial interest (Correct answer)
Using equipment purchased through a standard hospital procurement process
Accepting a published textbook as a continuing education resource
Treating a patient referred by a physician the PT has never met

Correct answer: Referring patients to a diagnostic imaging center in which the PT has a financial interest

Referring patients to services in which the PT has a financial interest is a conflict of interest that must be disclosed or avoided under the APTA Code of Ethics.

Question 46: According to the APTA's Guide to Physical Therapist Practice, which term describes the predicted optimal improvement a patient can reach in a given timeframe?

Evaluation
Outcome
Prognosis (Correct answer)
Diagnosis

Correct answer: Prognosis

Prognosis is defined as the predicted level of optimal improvement in function and the time needed to reach that level. Diagnosis is the clinical label assigned to the patient's condition, evaluation is the clinical judgment process, and outcome is the actual result achieved.

Question 47: When positioning a patient with SCI who has lower extremity flexor spasticity at night, which position BEST counteracts the spastic pattern?

Side-lying with hips and knees flexed to 90°
Hip extension, knee extension, and ankle in neutral with a splint (Correct answer)
Supine with pillows placed under the knees
Hip and knee flexion with ankle plantar flexion

Correct answer: Hip extension, knee extension, and ankle in neutral with a splint

Anti-spasticity positioning places joints in the opposite direction of the dominant spastic pattern; prolonged positioning in extension counteracts lower extremity flexor spasms.

Question 48: Which electrode configuration in electrical stimulation results in the deepest current penetration between electrodes?

Quadripolar — two channels with electrodes interleaved
Monopolar — active electrode over target, dispersive electrode distant (Correct answer)
Bipolar — both electrodes close together over the muscle
Monopolar — both electrodes adjacent to each other

Correct answer: Monopolar — active electrode over target, dispersive electrode distant

In monopolar configuration, current flows from the small active electrode through deep tissues to the large dispersive electrode placed at a distance, maximizing depth.

Question 49: Which ethical principle is MOST directly violated when a PT provides unnecessary treatments to increase billing?

Justice
Nonmaleficence (Correct answer)
Autonomy
Veracity

Correct answer: Nonmaleficence

Providing unnecessary treatments violates nonmaleficence (do no harm) by exposing patients to risk without therapeutic benefit.

Question 50: During ambulation with a post-surgical patient, the therapist notes a heart rate increase from 72 bpm at rest to 130 bpm with mild activity. The MOST appropriate interpretation is:

An abnormal response indicating cardiac pathology
Supraventricular tachycardia requiring ECG confirmation
Chronotropic incompetence requiring immediate cessation
A normal physiological response to exercise in a deconditioned patient (Correct answer)

Correct answer: A normal physiological response to exercise in a deconditioned patient

A heart rate of 130 bpm during mild activity in a deconditioned post-surgical patient is within an expected physiological range and does not alone indicate pathology.

Question 51: During gait analysis, a physical therapist observes excessive lateral trunk lean toward the stance limb. Which muscle weakness most likely causes this compensatory pattern?

Hamstrings
Gluteus medius (Correct answer)
Quadriceps
Tibialis anterior

Correct answer: Gluteus medius

Weakness of the gluteus medius causes a Trendelenburg sign, and the patient compensates with a lateral trunk lean toward the affected side.

Question 52: During gait analysis, a physical therapist observes excessive lateral trunk lean over the stance limb. Which muscle is most likely weak?

Tibialis anterior
Hamstrings
Gluteus medius (Correct answer)
Quadriceps femoris

Correct answer: Gluteus medius

A Trendelenburg gait pattern with lateral trunk lean indicates gluteus medius weakness on the stance side.

Question 53: Which intervention is MOST effective for treating myofascial trigger points in the upper trapezius?

Prolonged immobilization of the cervical spine
Cervical traction in full flexion
Dry needling combined with stretching (Correct answer)
Ultrasound at 3 MHz continuous for 10 minutes over the C-spine

Correct answer: Dry needling combined with stretching

Dry needling with subsequent stretching has strong evidence for deactivating myofascial trigger points and restoring muscle length in the upper trapezius.

Question 54: For a patient with chronic venous insufficiency and lower extremity edema, which physical agent modality is MOST appropriate to assist fluid mobilization?

Cryotherapy with compression wrap
Ultrasound over the posterior calf
Moist heat pack applied to bilateral lower legs
Intermittent pneumatic compression (IPC) (Correct answer)

Correct answer: Intermittent pneumatic compression (IPC)

Intermittent pneumatic compression mechanically mobilizes interstitial fluid proximally, reducing edema associated with chronic venous insufficiency.

Question 55: A physical therapist is setting up a TENS unit for postoperative pain. Which mode delivers a continuous high-frequency, low-intensity current most effective for immediate pain relief?

Burst mode TENS
Conventional (high-frequency) TENS (Correct answer)
Acupuncture-like TENS
Brief-intense TENS

Correct answer: Conventional (high-frequency) TENS

Conventional TENS (80–150 Hz, low intensity) activates gate control mechanisms for rapid, short-duration analgesia.

Question 56: A PT applies electrical stimulation using the Russian protocol (medium-frequency burst NMES) for quadriceps strengthening post-ACL reconstruction. The on:off duty cycle most commonly used is:

1:5 (short on, long rest) (Correct answer)
1:10 (minimal work)
1:1 (equal work and rest)
2:1 (more work than rest)

Correct answer: 1:5 (short on, long rest)

A 1:5 on:off ratio is standard for NMES strengthening protocols to allow muscle recovery and minimize fatigue during stimulated contractions.

Question 57: During ultrasound treatment, a patient reports pain under the transducer during stationary application. The MOST likely cause and correct response is:

Standing waves causing periosteal damage; move the transducer continuously (Correct answer)
Insufficient coupling gel; increase intensity
Normal periosteal stimulation; continue treatment
Incorrect frequency; switch from 1 MHz to 3 MHz

Correct answer: Standing waves causing periosteal damage; move the transducer continuously

Stationary transducer application creates standing waves that can cause periosteal burns; the transducer must be kept in continuous motion.

Question 58: During terminal stance in normal gait, which joint motion contributes most to forward propulsion?

Ankle plantarflexion (Correct answer)
Hip flexion
Subtalar inversion
Knee extension

Correct answer: Ankle plantarflexion

The gastrocnemius-soleus complex generates a powerful plantarflexion moment during terminal stance that provides the primary propulsive force for forward progression.

Question 59: A PT applies cryotherapy immediately after acute ankle inversion sprain. Which physiological effect is the PRIMARY goal in this phase?

Increasing nerve conduction velocity
Promoting collagen synthesis
Reducing secondary hypoxic injury by decreasing tissue metabolism (Correct answer)
Increasing local metabolic rate

Correct answer: Reducing secondary hypoxic injury by decreasing tissue metabolism

Cryotherapy reduces local tissue metabolism, limiting secondary hypoxic injury in cells surrounding the primary trauma zone.

Question 60: A reciprocal gait orthosis (RGO) is MOST appropriate for which patient population?

Transfemoral amputees requiring prosthetic alignment
Patients with bilateral lower extremity spasticity post-stroke
Patients with hemiplegia and severe foot drop
Patients with thoracic-level paraplegia for household ambulation (Correct answer)

Correct answer: Patients with thoracic-level paraplegia for household ambulation

The RGO enables reciprocal walking in patients with thoracic paraplegia by linking the hip joints with cables so hip extension on one side drives flexion on the other.

Question 61: A patient has a full-thickness wound on the sacrum measuring 4 cm × 3 cm × 2 cm deep. The wound is 80% granulation tissue and 20% slough. Which dressing combination is most appropriate?

Alginate rope to fill dead space and a foam secondary dressing (Correct answer)
Transparent film dressing only
Dry gauze packed tightly into the wound cavity
Hydrocolloid wafer only

Correct answer: Alginate rope to fill dead space and a foam secondary dressing

Deep wounds require a filler dressing (alginate rope) to manage exudate and eliminate dead space, with a secondary foam dressing to absorb drainage.

Question 62: Which proprioceptive neuromuscular facilitation technique uses alternating contractions of agonist and antagonist muscles without relaxation?

Contract-relax
Hold-relax
Rhythmic stabilization
Slow reversal (Correct answer)

Correct answer: Slow reversal

Slow reversal involves alternating isotonic contractions of opposing muscle groups without relaxation between contractions.

Question 63: A patient with a right transtibial amputation demonstrates lateral trunk bending toward the prosthetic side during stance. What is the MOST likely cause?

Prosthetic socket too loose proximally
Prosthesis aligned in excessive varus
Prosthetic shank too long (Correct answer)
Prosthetic foot set too far lateral

Correct answer: Prosthetic shank too long

Lateral trunk lean toward the prosthetic side during stance is most commonly caused by a prosthetic shank that is too long, causing the patient to lean over it.

Question 64: A premature infant in the NICU demonstrates oxygen desaturation, bradycardia, and pallor during a PT intervention. The therapist's MOST appropriate IMMEDIATE response is to:

Independently apply supplemental oxygen to correct the desaturation
Immediately stop the activity and allow the infant to recover to baseline while notifying nursing (Correct answer)
Continue the activity at reduced intensity to promote the infant's habituation to stimulation
Increase tactile and auditory stimulation to alert and arouse the infant

Correct answer: Immediately stop the activity and allow the infant to recover to baseline while notifying nursing

Physiologic stress signals (oxygen desaturation, bradycardia, color change) require immediate cessation of intervention and recovery support; the therapist notifies nursing rather than independently managing respiratory support.

Question 65: What is the primary purpose of negative pressure wound therapy (NPWT)?

To mechanically debride necrotic tissue from the wound
To promote granulation tissue formation by applying subatmospheric pressure (Correct answer)
To deliver topical antibiotics directly to the wound bed
To provide thermal insulation to the wound

Correct answer: To promote granulation tissue formation by applying subatmospheric pressure

Negative pressure wound therapy applies subatmospheric pressure to promote granulation tissue formation, reduce edema, and increase local blood flow to the wound.

Question 66: A patient post-CVA walks with the pelvis dropping on the unaffected side during stance on the affected leg. This is MOST consistent with weakness of which muscle?

Affected hip abductors (Correct answer)
Affected hip adductors
Unaffected hip extensors
Affected knee extensors

Correct answer: Affected hip abductors

Contralateral pelvic drop (Trendelenburg sign) during single-limb stance on the affected side indicates weakness of the ipsilateral hip abductors.

Question 67: A patient presents with intention tremor, dysmetria, and dysdiadochokinesia. Which brain structure is most likely affected?

Basal ganglia
Cerebellum (Correct answer)
Primary motor cortex
Thalamus

Correct answer: Cerebellum

Intention tremor, dysmetria, and dysdiadochokinesia are classic signs of cerebellar dysfunction.

Question 68: A patient recovering from an acute myocardial infarction is being assessed for exercise tolerance. Which metabolic equivalent (MET) level is generally considered safe for hospital discharge activities?

8-10 METs
6-7 METs
1-2 METs
3-4 METs (Correct answer)

Correct answer: 3-4 METs

Patients post-MI are typically cleared for discharge when they can safely tolerate activities at 3-4 METs, equivalent to slow walking or light household tasks.

Question 69: A patient recovering from a total knee arthroplasty is 6 weeks post-operative with persistent quadriceps inhibition. Which neuromuscular electrical stimulation (NMES) parameter setting is MOST appropriate to facilitate quadriceps re-education?

Frequency 100-150 Hz, ramp up 0 sec, on:off ratio 10:1
Frequency 2-4 Hz, ramp up 1 sec, on:off ratio 1:1
Frequency 1 Hz, ramp up 5 sec, on:off ratio 1:1
Frequency 35-50 Hz, ramp up 2-3 sec, on:off ratio 1:5 (Correct answer)

Correct answer: Frequency 35-50 Hz, ramp up 2-3 sec, on:off ratio 1:5

A frequency of 35-50 Hz produces a tetanic contraction suitable for strengthening, and the 1:5 on:off ratio prevents rapid fatigue in a weakened quadriceps.

Question 70: During gait assessment, a therapist notices the patient's pelvis drops on the left side during right stance phase. Which muscle is most likely weak?

Left hip abductor
Left hip adductor
Right hip abductor (Correct answer)
Right hip adductor

Correct answer: Right hip abductor

A contralateral pelvic drop (Trendelenburg sign) during stance indicates weakness of the stance-side hip abductors (right gluteus medius).

Question 71: A patient presents with a positive Romberg test. What does this finding indicate?

Proprioceptive deficit with visual compensation (Correct answer)
Cerebellar dysfunction
Vestibular dysfunction only
Upper motor neuron lesion

Correct answer: Proprioceptive deficit with visual compensation

A positive Romberg test indicates that the patient can maintain balance with eyes open (using vision) but loses balance with eyes closed, suggesting proprioceptive or dorsal column impairment.

Question 72: In a patient with right-sided heart failure, which of the following peripheral signs would the therapist MOST likely observe?

Cyanosis of the lips and reduced SpO2
Pulmonary crackles and orthopnea
Jugular venous distension and peripheral edema (Correct answer)
Frothy pink sputum and paroxysmal nocturnal dyspnea

Correct answer: Jugular venous distension and peripheral edema

Right-sided heart failure causes backpressure in the systemic venous circulation, leading to jugular venous distension, hepatomegaly, and dependent peripheral edema.

Question 73: Which term describes the phenomenon where repeated stimulation of a reflex leads to a diminished response over time?

Irradiation
Facilitation
Sensitization
Habituation (Correct answer)

Correct answer: Habituation

Habituation is the progressive decrease in reflex response amplitude with repeated, non-noxious stimulation of the same pathway.

Question 74: Which intervention has the STRONGEST evidence for producing long-term functional improvement in patients with upper motor neuron spasticity?

Prolonged low-load passive stretch
Task-specific training emphasizing active movement (Correct answer)
Electrical stimulation to antagonist muscles in isolation
Cryotherapy applied to spastic muscles before exercise

Correct answer: Task-specific training emphasizing active movement

Task-specific training drives neuroplasticity and functional carry-over; while stretching and modalities can temporarily reduce tone, active task practice produces the most durable functional gains.

Question 75: Which ligament is the primary restraint against anterior translation of the tibia on the femur?

Lateral collateral ligament
Anterior cruciate ligament (Correct answer)
Posterior cruciate ligament
Medial collateral ligament

Correct answer: Anterior cruciate ligament

The anterior cruciate ligament (ACL) is the primary stabilizer preventing anterior tibial translation relative to the femur.

Question 76: When using aquatic therapy for neuromuscular re-education, which property of water is MOST therapeutically beneficial for enabling movement practice that is not possible on land?

Hydrostatic pressure reducing peripheral edema
Turbulence providing variable proprioceptive challenges to balance
Buoyancy reducing effective body weight to allow movement with weak muscles (Correct answer)
Water viscosity providing resistance to strengthen muscles

Correct answer: Buoyancy reducing effective body weight to allow movement with weak muscles

Buoyancy reduces the load of gravity on the body, allowing patients with significant neuromuscular weakness to practice active movement and gait patterns that they cannot yet perform on land.

Question 77: A physical therapist working in a skilled nursing facility notices that the facility administrator is pressuring therapists to bill for services not rendered. What does the APTA Code of Ethics require?

Negotiate a compromise with the administrator
Document the directive but continue normal billing practices
Comply with the administrator's directive to maintain employment
Refuse to participate in fraudulent billing and report the activity through appropriate channels (Correct answer)

Correct answer: Refuse to participate in fraudulent billing and report the activity through appropriate channels

The APTA Code of Ethics requires physical therapists to maintain integrity in all business practices and report fraudulent billing activities through appropriate legal and institutional channels.

Question 78: A patient is referred for mechanical lumbar traction for a suspected herniated nucleus pulposus. Which of the following conditions in the patient's medical history is an absolute contraindication for this treatment?

Claustrophobia
Aortic aneurysm (Correct answer)
Ligamentous sprain
Chronic Obstructive Pulmonary Disease (COPD)

Correct answer: Aortic aneurysm

An aortic aneurysm is an absolute contraindication for mechanical traction. The pressure from the traction harness across the abdomen could potentially increase pressure on the weakened aortic wall, risking rupture, which is a medical emergency. While conditions like severe COPD or claustrophobia may require modification of the treatment or cause patient intolerance, they are considered relative contraindications or precautions. An acute ligamentous sprain is also a contraindication, but an aortic aneurysm represents a more severe, systemic risk.

Question 79: Which manual therapy technique is most appropriate for a patient with a stiff glenohumeral joint and limited external rotation?

Posterior glide of the humeral head (Correct answer)
Anterior glide of the humeral head
Inferior glide of the humeral head
Superior glide of the humeral head

Correct answer: Posterior glide of the humeral head

A posterior glide mobilization of the humeral head is used to improve glenohumeral external rotation based on the convex-concave rule.

Question 80: A child with Down syndrome is referred for PT evaluation. Which musculoskeletal finding is MOST commonly expected?

Spasticity primarily in the lower extremities
Muscle hypertonia and joint stiffness throughout all extremities
Ligamentous laxity and generalized hypotonia (Correct answer)
Rigid cervical spine with severely limited rotation

Correct answer: Ligamentous laxity and generalized hypotonia

Down syndrome (trisomy 21) is characteristically associated with generalized hypotonia and ligamentous laxity, contributing to delayed motor milestones and joint instability.

Question 81: Task-oriented gait training for stroke survivors should PRIMARILY emphasize which characteristic to maximize neuroplastic benefit?

High repetitions of the complete walking task practiced in variable real-world contexts (Correct answer)
Passive ambulation with maximal body weight support throughout recovery
Isolated strengthening of individual lower extremity muscle groups before walking
Stretching spastic muscles for 30 minutes before each gait session

Correct answer: High repetitions of the complete walking task practiced in variable real-world contexts

Neuroplasticity is driven by high-dose, task-specific, variable practice of the actual walking task; specificity of training and volume of practice are the primary drivers of cortical reorganization.

Question 82: A patient presents with a positive Thompson test (no plantar flexion with calf squeeze). This indicates rupture of which structure?

Posterior tibialis tendon
Achilles tendon (Correct answer)
Plantaris tendon
Flexor hallucis longus

Correct answer: Achilles tendon

The Thompson test assesses Achilles tendon continuity; absence of plantar flexion when the calf is squeezed indicates a complete Achilles tendon rupture.

Question 83: A patient recovering from a stroke presents with right-sided weakness. The examination reveals 2/5 strength in the ankle dorsiflexors and significant mediolateral instability at the ankle during weight-bearing. Which of the following ankle-foot orthoses (AFOs) is the MOST appropriate prescription for this patient?

Solid ankle AFO (Correct answer)
Articulating AFO with a plantar flexion stop
Posterior leaf spring AFO
Ground reaction AFO

Correct answer: Solid ankle AFO

A solid ankle AFO is the most appropriate choice because it provides maximum control in all three planes of motion (sagittal, frontal, and transverse). This is necessary to address both the severe dorsiflexion weakness (foot drop) and the significant mediolateral (frontal plane) instability. A posterior leaf spring only assists with dorsiflexion and offers minimal frontal plane control, while an articulating AFO allows for movement that may not be safe given the patient's instability.

Question 84: Which ECG finding is MOST consistent with left ventricular hypertrophy?

Tall R waves in V1-V2 with deep S waves in V5-V6
Peaked P waves greater than 2.5 mm in lead II
Deep Q waves in leads II, III, and aVF
Tall R waves in V5-V6 with deep S waves in V1-V2 (Correct answer)

Correct answer: Tall R waves in V5-V6 with deep S waves in V1-V2

Left ventricular hypertrophy produces tall R waves in lateral leads (V5-V6) and deep S waves in right precordial leads (V1-V2) due to the enlarged left ventricular mass.

Question 85: Which assistive device requires the GREATEST amount of upper extremity strength and coordination to use safely?

Hemi-walker
Axillary crutches (Correct answer)
Lofstrand (forearm) crutches
Standard walker

Correct answer: Axillary crutches

Axillary crutches require significant upper extremity strength, trunk stability, and coordination for safe swing-through gait patterns.

Question 86: Which special test is most specific for a posterior cruciate ligament (PCL) tear?

Lachman test
McMurray test
Valgus stress test
Posterior drawer test (Correct answer)

Correct answer: Posterior drawer test

The posterior drawer test is the most specific and sensitive test for PCL integrity, assessing posterior tibial translation on the femur.

Question 87: A physical therapist is treating a patient who develops sudden onset dyspnea, pleuritic chest pain, and hemoptysis after a total knee arthroplasty. What condition should be most suspected?

Pneumothorax
Acute bronchitis
Pulmonary embolism (Correct answer)
Myocardial infarction

Correct answer: Pulmonary embolism

The triad of sudden dyspnea, pleuritic chest pain, and hemoptysis following surgery is the classic presentation of pulmonary embolism.

Question 88: A physical therapist selects interferential current (IFC) therapy for a patient with deep hip joint pain. What is the PRIMARY advantage of IFC over conventional TENS for this application?

IFC produces less skin irritation
IFC uses lower amplitude settings
IFC has a greater depth of penetration due to higher carrier frequency (Correct answer)
IFC requires only one electrode

Correct answer: IFC has a greater depth of penetration due to higher carrier frequency

IFC uses a high carrier frequency (typically 4000 Hz) that penetrates deeper into tissue with less skin resistance, making it more effective for deep structures like the hip joint.

Question 89: A physical therapist is assessing a patient with suspected lateral epicondylitis. Which special test is MOST appropriate to confirm this diagnosis?

Cozen's test (Correct answer)
Tinel's sign at the elbow
Valgus stress test
Lateral pivot shift test

Correct answer: Cozen's test

Cozen's test (resisted wrist extension with the elbow extended) reproduces pain at the lateral epicondyle by stressing the extensor carpi radialis brevis, the muscle most commonly involved in lateral epicondylitis.

Question 90: A physical therapist is performing postural drainage for a patient with bronchiectasis affecting the right middle lobe. Which position should the therapist use?

Prone with the head of the bed elevated 30 degrees
Right side-lying with the bed flat
Left side-lying with the foot of the bed elevated 14–16 inches (Correct answer)
Supine with the hips elevated on a pillow

Correct answer: Left side-lying with the foot of the bed elevated 14–16 inches

The right middle lobe is drained with the patient in left side-lying (to bring the right middle lobe uppermost) and the foot of the bed elevated approximately 14–16 inches to use gravity to assist secretion drainage toward the central airways. Prone positioning drains the posterior segments of the upper lobes and superior segments of the lower lobes, while supine with hips elevated targets the anterior lower lobes.

Question 91: A patient presents with a blood pressure of 90/60 mmHg, jugular venous distension, and muffled heart sounds. Which condition does this triad indicate?

Congestive heart failure
Cardiac tamponade (Correct answer)
Tension pneumothorax
Aortic stenosis

Correct answer: Cardiac tamponade

Beck's triad of hypotension, JVD, and muffled heart sounds is the classic presentation of cardiac tamponade.

Question 92: A patient recovering from a stroke demonstrates hypertonicity with elbow flexion, wrist flexion, and finger flexion. This pattern is consistent with which synergy?

Upper extremity extensor synergy
Upper extremity flexor synergy (Correct answer)
Lower extremity flexor synergy
Lower extremity extensor synergy

Correct answer: Upper extremity flexor synergy

Elbow, wrist, and finger flexion are hallmarks of the upper extremity flexor synergy pattern seen post-stroke.

Question 93: In the previous month, Peter experienced a couple of briefs and unprovoked episodes of vertigo that lasted under 24 hours. He recently visited his primary care physician due to the development of tinnitus and a feeling of ear fullness. He noticed a change in the quality of his hearing in one ear, which was beginning to alarm him. Which of the following diagnoses for vestibular disorders best fits Peter's symptoms?

Meniere's disease (Correct answer)
Vestibular neuritis
BPPV
Cervicogenic dizziness

Correct answer: Meniere's disease

Peter's symptoms—sporadic, brief episodes of vertigo, tinnitus, a feeling of ear fullness, and fluctuating hearing changes in one ear—are the classic diagnostic triad for Meniere's disease. This inner ear disorder is characterized by an abnormal fluid balance within the labyrinth, leading to these specific and often debilitating symptoms. Other vestibular disorders typically present with different combinations or durations of symptoms.

Question 94: A PT applies cryotherapy using an ice massage technique to a patient's Achilles tendon. The correct sequence of sensations the patient should experience is:

Burning → cold → analgesia → numbness
Cold → aching → burning → analgesia (Correct answer)
Cold → warmth → aching → burning
Warmth → burning → analgesia → aching

Correct answer: Cold → aching → burning → analgesia

The CBAN sequence (Cold, Burning, Aching, Numbness/Analgesia) describes the progression of sensory changes during ice massage.

Question 95: A patient has weakness in the serratus anterior. Which movement pattern will be MOST impaired?

Glenohumeral internal rotation
Elbow flexion strength
Glenohumeral horizontal adduction
Scapular upward rotation and protraction during overhead reach (Correct answer)

Correct answer: Scapular upward rotation and protraction during overhead reach

Serratus anterior is the primary scapular protractor and contributes to upward rotation; weakness impairs overhead reaching and causes scapular winging.

Question 96: Which medication classification is MOST likely to cause a dry, nonproductive cough as a side effect relevant to cardiopulmonary PT monitoring?

Calcium channel blockers
Loop diuretics
ACE inhibitors (Correct answer)
Beta-1 selective blockers

Correct answer: ACE inhibitors

ACE inhibitors block bradykinin breakdown, allowing it to accumulate in the airways and stimulate cough receptors, causing a persistent dry cough in 10-15% of patients.

Question 97: A physical therapist is using the hold-relax proprioceptive neuromuscular facilitation (PNF) technique to increase hamstring flexibility. What are the correct parameters for the isometric contraction phase?

A submaximal contraction for 6-10 seconds (Correct answer)
A submaximal contraction for 20-30 seconds
A maximal contraction for 1-2 seconds
A concentric contraction through the full range of motion

Correct answer: A submaximal contraction for 6-10 seconds

The hold-relax PNF technique involves moving the limb to the point of tissue resistance, followed by a submaximal isometric contraction of the muscle being stretched (the hamstrings, in this case). Research and clinical guidelines suggest this contraction should be held for about 6-10 seconds to trigger autogenic inhibition via the Golgi tendon organs, allowing for a greater subsequent passive stretch.

Question 98: A therapist is treating a patient post-ACL reconstruction. During which phase of rehabilitation is it appropriate to initiate plyometric training?

Late phase when quad strength reaches at least 80–90% limb symmetry index (Correct answer)
Intermediate phase when quad strength reaches 60% limb symmetry index
Early phase when full passive ROM is achieved
Immediately post-op to prevent atrophy

Correct answer: Late phase when quad strength reaches at least 80–90% limb symmetry index

Plyometrics require neuromuscular control and strength sufficient to protect the graft; a limb symmetry index of at least 80–90% is the standard threshold.

Question 99: Which layer of the skin contains the Meissner's corpuscles and is responsible for most immune defense?

Hypodermis
Stratum corneum
Dermis (Correct answer)
Stratum granulosum

Correct answer: Dermis

The dermis houses mechanoreceptors such as Meissner's corpuscles, as well as immune cells, blood vessels, and collagen fibers.

Question 100: Which type of contracture results from prolonged immobilization and involves shortening of the musculotendinous unit without bony changes?

Myostatic contracture (Correct answer)
Pseudomyostatic contracture
Arthrogenic contracture
Fibrotic contracture

Correct answer: Myostatic contracture

Myostatic contracture occurs when a muscle is immobilized in a shortened position, reducing the number of sarcomeres in series; it responds well to stretching.

Question 101: A patient is 6 weeks post-ACL reconstruction using a bone-patellar tendon-bone autograft. Which intervention is MOST appropriate at this stage?

Open kinetic chain knee extension from 0-90 degrees
Deep squats beyond 90 degrees of knee flexion
Plyometric jump training
Closed kinetic chain exercises from 0-60 degrees of knee flexion (Correct answer)

Correct answer: Closed kinetic chain exercises from 0-60 degrees of knee flexion

Closed kinetic chain exercises in a limited range protect the graft while promoting quadriceps strengthening during early rehabilitation.

Question 102: A patient with a complete C6 spinal cord injury would be expected to have functional use of which muscle group?

Wrist extensors (Correct answer)
Intrinsic hand muscles
Triceps
Finger flexors

Correct answer: Wrist extensors

A C6 level injury preserves innervation to the wrist extensors (extensor carpi radialis longus and brevis), allowing tenodesis grasp.

Question 103: In a patient with Brown-Séquard syndrome (right-sided hemisection of cord at T6), which deficits would be expected?

Bilateral loss of pain and temperature below T6
Right-sided loss of pain/temperature, left-sided motor weakness
Bilateral motor weakness with preserved sensation
Left-sided loss of pain/temperature, right-sided motor weakness (Correct answer)

Correct answer: Left-sided loss of pain/temperature, right-sided motor weakness

In Brown-Séquard syndrome, ipsilateral motor loss and proprioception loss occur with contralateral pain and temperature loss because the spinothalamic tract decussates at the level of entry.

Question 104: A patient with peripheral arterial disease reports calf pain that occurs after walking two blocks and is relieved by rest. What is the appropriate ankle-brachial index (ABI) classification for moderate disease?

0.50-0.79 (Correct answer)
0.80-0.99
1.00-1.30
0.30-0.49

Correct answer: 0.50-0.79

An ABI of 0.50-0.79 indicates moderate peripheral arterial disease consistent with intermittent claudication symptoms.

Question 105: When fabricating a low-temperature thermoplastic orthosis, the material becomes too rigid before molding is complete. The MOST appropriate solution is:

Add padding to compensate for the poor fit
Increase water bath temperature above the recommended range
Discard and restart with a new piece of material
Apply a heat gun to the area that has hardened (Correct answer)

Correct answer: Apply a heat gun to the area that has hardened

A heat gun can selectively re-soften thermoplastic material to allow continued molding without overheating the entire piece or starting over.

Question 106: A patient with Parkinson's disease demonstrates festinating gait. Which description BEST characterizes this deviation?

Exaggerated knee and hip flexion during swing
Shuffling, accelerating steps with forward trunk lean (Correct answer)
Circumduction of the lower extremity during swing
Wide-based, ataxic stepping pattern

Correct answer: Shuffling, accelerating steps with forward trunk lean

Festinating gait in Parkinson's disease is characterized by short, shuffling steps that accelerate involuntarily with a forward-flexed trunk posture.

Question 107: A child with myelomeningocele at the L4-L5 level is evaluated for community ambulation. Which orthotic is MOST appropriate?

Hip-knee-ankle-foot orthosis (HKAFO)
Thoracic-lumbar-sacral orthosis (TLSO) without lower extremity component
Knee-ankle-foot orthosis (KAFO)
Ankle-foot orthosis (AFO) (Correct answer)

Correct answer: Ankle-foot orthosis (AFO)

An L4-L5 lesion preserves hip flexion, knee extension, and partial ankle dorsiflexion; AFOs provide the necessary ankle-foot stability for community ambulation without requiring more proximal support.

Question 108: Which Wagner classification grade describes a deep ulcer with abscess or osteomyelitis?

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

Correct answer: Grade 3

Wagner Grade 3 is characterized by a deep ulcer complicated by abscess formation, osteomyelitis, or joint sepsis.

Question 109: A patient recovering from a stroke demonstrates hyperreflexia and increased muscle tone in the right upper extremity. Which descending pathway is most likely damaged?

Corticospinal tract (Correct answer)
Vestibulospinal tract
Reticulospinal tract
Rubrospinal tract

Correct answer: Corticospinal tract

Damage to the corticospinal (pyramidal) tract causes upper motor neuron signs including hyperreflexia, spasticity, and increased muscle tone.

Question 110: A patient is participating in Phase II cardiac rehabilitation following a coronary artery bypass graft (CABG) 6 weeks ago. The physical therapist is monitoring the patient's response to treadmill walking. Which of the following RPE values on the Borg 6-20 scale is the MOST appropriate target for the main workout portion of the session?

9-10
6-8
12-14 (Correct answer)
17-18

Correct answer: 12-14

For the main workout in a cardiac rehabilitation setting, a Rating of Perceived Exertion (RPE) of 12-14 ('somewhat hard') on the Borg 6-20 scale is generally recommended. This intensity corresponds to a moderate level of exercise that is safe and effective for improving cardiovascular fitness post-surgery. An RPE of 6-8 is too low (no exertion), 9-10 is very light, and 17-18 is very hard and would be too strenuous for this phase of recovery.

Question 111: Which motor learning feedback schedule produces the BEST long-term retention of a motor skill in neurological rehabilitation?

No augmented feedback provided
Blocked feedback after every 10 trials
Faded feedback with reduced frequency over time (Correct answer)
Continuous feedback after every trial

Correct answer: Faded feedback with reduced frequency over time

Faded feedback (reducing frequency over time) promotes retention because it prevents dependency and forces the patient to self-evaluate, consistent with the guidance hypothesis.

Question 112: A physical therapist is using transcutaneous electrical nerve stimulation (TENS) for a patient with chronic low back pain. To activate the gate control mechanism for immediate pain relief, which parameter set is MOST appropriate?

Low frequency (2–4 Hz), low intensity, short pulse duration (50–80 µs)
High frequency (80–150 Hz), low to moderate intensity, short pulse duration (50–100 µs) (Correct answer)
Low frequency (2–4 Hz), high intensity, long pulse duration (200–300 µs)
High frequency (80–150 Hz), high intensity, long pulse duration (200–300 µs)

Correct answer: High frequency (80–150 Hz), low to moderate intensity, short pulse duration (50–100 µs)

Conventional (high-frequency) TENS at 80–150 Hz with short pulse duration activates large-diameter Aβ fibers, stimulating the gate control mechanism at the dorsal horn to inhibit pain signal transmission. This produces immediate but short-lasting analgesia and is the classic 'gate control' application.

Question 113: A patient is in the acute phase of recovery from Guillain-Barré syndrome (GBS) and is currently on a ventilator in the intensive care unit. The patient is medically stable but has profound, symmetrical ascending weakness. Which of the following is the MOST appropriate physical therapy intervention at this stage?

Functional mobility training, including bed-to-chair transfers
Overground gait training with a body-weight support system
Active-resistive exercises to prevent deconditioning
Passive range of motion and positioning to prevent contractures (Correct answer)

Correct answer: Passive range of motion and positioning to prevent contractures

In the acute, progressive phase of GBS, especially when a patient is ventilator-dependent, the primary goals are to maintain joint integrity, prevent skin breakdown, and manage respiratory complications. [13, 20] Gentle passive range of motion is crucial to prevent contractures, and proper positioning helps prevent pressure injuries. [17] Introducing active or resistive exercise at this stage is contraindicated as it can lead to overwork weakness and delay recovery. Functional mobility and gait training are not appropriate for a patient with profound weakness who requires mechanical ventilation. [13]

Question 114: Which nerve is tested by assessing sensation over the dorsal web space between the first and second toes?

Sural nerve
Superficial peroneal nerve
Deep peroneal nerve (Correct answer)
Saphenous nerve

Correct answer: Deep peroneal nerve

The deep peroneal nerve (deep fibular nerve) provides sensory innervation to the dorsal web space between the first and second toes.

Question 115: A physical therapist applies fluidotherapy to a patient's hand following a distal radius ORIF (3 months post-op, hardware retained). The patient reports comfortable warmth. Which of the following represents the PRIMARY therapeutic benefit of fluidotherapy compared to a paraffin bath at the same temperature?

Lower risk of thermal injury due to controlled air medium
Simultaneous superficial cooling via convective air flow
Greater depth of heat penetration into joint structures
Ability to perform active exercise during treatment (Correct answer)

Correct answer: Ability to perform active exercise during treatment

Fluidotherapy's primary clinical advantage over paraffin is that patients can perform active range-of-motion exercises during treatment, combining the benefits of heat and movement simultaneously. Depth of penetration is similar between superficial agents, and thermal risk depends on temperature settings in both cases.

Question 116: A physical therapist aims to specifically assess the contribution of the vestibular system to a patient's balance. According to the principles of the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), which condition would MOST effectively isolate and challenge this system?

Standing on a firm surface with eyes closed
Standing on a foam surface with eyes open
Standing on a foam surface with eyes closed (Correct answer)
Standing on a firm surface with eyes open

Correct answer: Standing on a foam surface with eyes closed

To challenge the vestibular system, input from the visual and somatosensory systems must be removed or made unreliable. Standing on a foam surface makes somatosensory input from the feet and ankles unreliable. Closing the eyes removes visual input. Therefore, standing on a foam surface with eyes closed forces the patient to rely primarily on their vestibular system to maintain balance.

Question 117: A patient presents with pain at the lateral epicondyle that worsens with resisted wrist extension and passive wrist flexion with elbow extended. Which structure is most likely involved?

Anconeus muscle
Extensor carpi radialis brevis (Correct answer)
Supinator muscle
Flexor carpi radialis

Correct answer: Extensor carpi radialis brevis

The extensor carpi radialis brevis (ECRB) is the most commonly affected tendon in lateral epicondylalgia (tennis elbow).

Question 118: Which cranial nerve is responsible for both the afferent and efferent limbs of the gag reflex?

CN V and CN VII
CN XI and CN XII
CN VII and CN IX
CN IX and CN X (Correct answer)

Correct answer: CN IX and CN X

The glossopharyngeal nerve (CN IX) carries the afferent signal, and the vagus nerve (CN X) mediates the efferent motor response of the gag reflex.

Question 119: A therapist performs joint mobilization at the glenohumeral joint. To increase shoulder abduction, which mobilization direction should be applied to the humeral head?

Posterior glide
Inferior glide (Correct answer)
Anterior glide
Superior glide

Correct answer: Inferior glide

According to the concave-convex rule, the convex humeral head glides inferiorly when the humerus is abducted, so inferior mobilization restores this motion.

Question 120: Constraint-induced movement therapy (CIMT) for a 4-year-old with spastic hemiplegia PRIMARILY achieves its therapeutic effect by:

Constraining the unaffected limb to force intensive use and motor learning in the hemiplegic limb (Correct answer)
Improving lower extremity function via cortical reorganization of the sensorimotor cortex
Strengthening the unaffected upper extremity through progressive resistive exercise
Reducing bilateral upper extremity spasticity through sustained prolonged stretching

Correct answer: Constraining the unaffected limb to force intensive use and motor learning in the hemiplegic limb

CIMT places a constraint (cast or mitt) on the stronger, unaffected limb to force intensive use of the weaker hemiplegic limb, driving cortical reorganization and functional improvement.

Question 121: A patient who has just completed a successful rehabilitation program for a total knee arthroplasty offers the physical therapist a $300 gift certificate to a fine-dining restaurant. According to the APTA's ethical guidelines, what is the MOST appropriate action for the therapist to take?

Accept the gift, as it does not influence the now-completed plan of care.
Accept the certificate and share it with the entire clinic staff to avoid a personal conflict of interest.
Politely decline the gift, explaining that professional guidelines discourage accepting gifts of significant value. (Correct answer)
Suggest the patient make a donation to a charity of the clinic's choice instead.

Correct answer: Politely decline the gift, explaining that professional guidelines discourage accepting gifts of significant value.

According to the APTA's Guide for Professional Conduct, physical therapists should not accept gifts that could be perceived as influencing the therapeutic relationship or creating a conflict of interest. While small tokens of appreciation may be acceptable, a gift of significant monetary value ($300) is not. The most appropriate action is to politely decline while thanking the patient, thereby upholding professional boundaries.

Question 122: What does the principle of 'beneficence' require of a PT in clinical practice?

Avoiding harm to the patient above all other considerations
Respecting the patient's right to make independent decisions
Treating all patients equally regardless of their condition
Acting in the patient's best interest and promoting their well-being (Correct answer)

Correct answer: Acting in the patient's best interest and promoting their well-being

Beneficence requires actively promoting the patient's well-being and acting in their best interest.

Question 123: A patient with chronic plantar fasciitis is treated with low-level laser therapy (LLLT). Which mechanism best explains its therapeutic effect?

Cavitation of plantar fascia fibers
Eddy current induction in superficial tissue
Thermal heating of deep tissue
Photobiomodulation promoting cellular ATP production (Correct answer)

Correct answer: Photobiomodulation promoting cellular ATP production

LLLT works through photobiomodulation, stimulating mitochondrial activity and increasing ATP production to promote healing.

Question 124: A physical therapist measures a patient's elbow flexion range of motion at 145 degrees. This finding is classified as which of the following?

Hypermobile
Within normal limits (Correct answer)
Hypomobile
Indicating joint contracture

Correct answer: Within normal limits

Normal elbow flexion range of motion is approximately 140-150 degrees, making 145 degrees within normal limits.

Question 125: During cervical spine assessment, Spurling's test (cervical quadrant test) is performed to reproduce which type of symptom?

Cervicogenic headache
Upper cervical instability
Vertebral artery insufficiency
Cervical radiculopathy (Correct answer)

Correct answer: Cervical radiculopathy

Spurling's test (cervical compression with ipsilateral side-bending and rotation) reproduces radicular arm pain by narrowing the neural foramen and compressing nerve roots.

Question 126: A physical therapist is treating a patient who is also a close personal friend. Which ethical concern is MOST significant in this situation?

Dual relationships can compromise clinical objectivity and professional boundaries (Correct answer)
The therapist must obtain special informed consent for treating acquaintances
State law prohibits treating individuals with whom one has a personal relationship
The therapist may not bill insurance for treating a friend

Correct answer: Dual relationships can compromise clinical objectivity and professional boundaries

Dual relationships between therapist and patient can impair clinical judgment and compromise professional boundaries, potentially affecting the quality of care provided.

Question 127: Which neuromuscular re-education technique uses quick stretch applied to a muscle to facilitate a contraction through the muscle spindle reflex?

Contract-relax
Rhythmic stabilization
Slow reversal hold
Quick stretch (tapping) (Correct answer)

Correct answer: Quick stretch (tapping)

Quick stretch or tapping activates the muscle spindle's Ia afferent fibers, producing a reflexive contraction in the stretched muscle through the monosynaptic stretch reflex.

Question 128: Which position should a patient with a burn across the anterior neck maintain to prevent contracture?

Neck extension without a pillow (Correct answer)
Neutral neck position with a large pillow
Neck lateral flexion toward the burned side
Neck flexion with chin tucked

Correct answer: Neck extension without a pillow

Neck extension without a pillow is the anti-contracture position for anterior neck burns, as it counteracts the natural pull of scar tissue toward flexion.

Question 129: Which method of wound debridement is considered LEAST selective and carries the highest risk of removing viable granulation tissue along with necrotic material?

Enzymatic debridement with collagenase ointment
Autolytic debridement using a moisture-retentive dressing
Sharp debridement using sterile scissors and forceps
Mechanical debridement with wet-to-dry gauze dressings (Correct answer)

Correct answer: Mechanical debridement with wet-to-dry gauze dressings

Wet-to-dry dressing changes are a non-selective mechanical debridement technique: the gauze adheres to both necrotic and viable tissue and removes both indiscriminately when pulled away, potentially damaging new granulation tissue.

Question 130: A physical therapist is applying intermittent pneumatic compression (IPC) to a patient's lower extremity to manage chronic lymphedema. The patient's resting blood pressure is 130/85 mmHg. To ensure safety and prevent occlusion of arterial blood flow, the inflation pressure of the IPC unit should NOT exceed which value?

100 mmHg
85 mmHg (Correct answer)
60 mmHg
130 mmHg

Correct answer: 85 mmHg

The maximum inflation pressure for an intermittent pneumatic compression device should be set below the patient's diastolic blood pressure to avoid occluding arterial circulation during the inflation cycle. In this case, the patient's diastolic pressure is 85 mmHg, so the pressure should be set at or below this value. Pressures exceeding diastolic BP can function as a tourniquet, impeding arterial flow and potentially causing harm.

Question 131: During assessment of a ventilated ICU patient, the physical therapist notes paradoxical inward movement of the abdomen during inspiration. This finding is MOST indicative of which condition?

Normal diaphragm function with high tidal volume
Accessory muscle overuse due to bronchospasm
Diaphragmatic fatigue or paralysis (Correct answer)
Increased intra-abdominal pressure from ascites

Correct answer: Diaphragmatic fatigue or paralysis

Normally, the diaphragm descends during inspiration, pushing the abdomen outward. Paradoxical inward abdominal movement during inspiration indicates the diaphragm is not contracting effectively — a hallmark of diaphragmatic fatigue, paresis, or paralysis — causing the passive diaphragm to be pulled upward by accessory muscle effort.

Question 132: A patient presents with a 'claw hand' deformity with hyperextension at the MCP joints and flexion at the IP joints of the ring and small fingers. Which nerve is injured?

Anterior interosseous nerve
Radial nerve
Median nerve
Ulnar nerve (Correct answer)

Correct answer: Ulnar nerve

Ulnar nerve injury causes claw hand of the ring and small fingers due to loss of intrinsic muscle function (lumbricals 3 and 4), resulting in unopposed extrinsic extensor and flexor forces.

Question 133: A patient has hyperreflexia, clonus, and a positive Babinski sign in the lower extremities. These findings indicate pathology at which level of the nervous system?

Peripheral nerve
Upper motor neuron (spinal cord or brain) (Correct answer)
Lower motor neuron
Nerve root (radiculopathy)

Correct answer: Upper motor neuron (spinal cord or brain)

Hyperreflexia, clonus, and a positive Babinski sign are upper motor neuron signs indicating a lesion in the spinal cord or higher CNS structures.

Question 134: During an initial evaluation, a patient tells the physical therapist they do not want a student physical therapist involved in their care. What is the appropriate response?

Allow the student to observe only without informing the patient
Discharge the patient for being uncooperative
Honor the patient's request and ensure the student does not participate in their care (Correct answer)
Inform the patient that student involvement is mandatory at a teaching facility

Correct answer: Honor the patient's request and ensure the student does not participate in their care

Patients have the right to refuse care from students, and this preference must be honored as part of respecting patient autonomy and informed consent.

Question 135: When treating a patient with spasticity using cryotherapy, which effect on the muscle spindle explains the temporary reduction in tone?

Increased gamma motor neuron firing
Decreased afferent (Ia) firing from muscle spindle due to cooling (Correct answer)
Increased Golgi tendon organ sensitivity
Direct inhibition of alpha motor neurons at the spinal cord

Correct answer: Decreased afferent (Ia) firing from muscle spindle due to cooling

Cooling slows the firing rate of muscle spindle afferents (Ia fibers), temporarily reducing the excitatory drive and decreasing spastic tone.

Question 136: A patient with left hemiplegia following stroke presents with increased upper extremity tone that is limiting the initiation of active movement training. The physical therapist decides to use a PNF technique to reduce hypertonia before beginning active exercise. Which technique is MOST appropriate?

Contract-relax
Rhythmic initiation
Repeated contractions
Rhythmic rotation (Correct answer)

Correct answer: Rhythmic rotation

Rhythmic rotation involves passively rotating the limb in a rhythmic pattern, which is specifically used to reduce hypertonia and spasticity before active movement training. Rhythmic initiation teaches movement patterns, contract-relax improves ROM through autogenic inhibition, and repeated contractions are used to strengthen weak muscles.

Question 137: Which special test is most appropriate for assessing the integrity of the anterior cruciate ligament?

Lachman test (Correct answer)
Posterior drawer test
McMurray test
Valgus stress test

Correct answer: Lachman test

The Lachman test is considered the most sensitive clinical test for detecting anterior cruciate ligament tears.

Question 138: A patient recovering from a stroke demonstrates difficulty initiating voluntary movements despite intact strength. Which area of the brain is most likely affected?

Basal ganglia (Correct answer)
Cerebellum
Parietal lobe
Primary motor cortex

Correct answer: Basal ganglia

The basal ganglia are responsible for the initiation and scaling of voluntary movements; damage results in bradykinesia and difficulty starting movements.

Question 139: A physical therapist is treating a patient with multiple sclerosis who reports increased fatigue during afternoon sessions. Which modification to the exercise program is MOST appropriate?

Switch all exercises to high-intensity intervals to build endurance
Discontinue active exercise and use only passive range of motion
Increase session duration to improve exercise tolerance over time
Schedule therapy sessions in the morning and incorporate energy conservation techniques (Correct answer)

Correct answer: Schedule therapy sessions in the morning and incorporate energy conservation techniques

Patients with MS commonly experience fatigue that worsens with heat and activity; scheduling sessions during cooler morning hours and teaching energy conservation strategies optimizes participation.

Question 140: Which gait deviation is MOST commonly associated with excessive foot pronation in the stance phase?

Hip hiking
Scissor gait
Medial collapse of the knee (dynamic valgus) (Correct answer)
Lateral trunk lean

Correct answer: Medial collapse of the knee (dynamic valgus)

Excessive foot pronation during stance causes internal tibial rotation, which is transmitted proximally, resulting in dynamic knee valgus.

Question 141: A patient with T6 complete spinal cord injury is performing wheelchair propulsion and suddenly develops pounding headache, diaphoresis above the lesion, and hypertension. What is the most appropriate immediate action?

Apply a cold pack to the forehead
Administer oxygen and monitor vitals
Place the patient supine and call emergency services
Sit the patient upright and identify the noxious stimulus (Correct answer)

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

Autonomic dysreflexia management begins with sitting the patient upright to lower BP reflexively and immediately identifying and removing the offending noxious stimulus below the level of injury.

Question 142: During a manual muscle test, a patient can move through full ROM against gravity but fails with minimal resistance. What grade is assigned?

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

Correct answer: Grade 4

Grade 4 (Good) indicates full ROM against gravity with some but not full resistance.

Question 143: A PT is treating a patient with post-mastectomy lymphedema using complete decongestive therapy (CDT). Which adjunct physical agent modality is CONTRAINDICATED in this condition?

Manual lymphatic drainage
Compression bandaging
Therapeutic heat applied to the affected extremity (Correct answer)
Remedial exercises

Correct answer: Therapeutic heat applied to the affected extremity

Heat increases local blood flow and protein-rich fluid filtration into the interstitium, worsening lymphedema in an already compromised lymphatic system.

Question 144: A physical therapist is screening a patient 5 months post-stroke with right hemiplegia for constraint-induced movement therapy (CIMT). Which criterion MUST the patient meet to qualify for the standard CIMT protocol?

Modified Ashworth Scale score of 0 throughout the affected upper extremity
Ability to extend the wrist at least 10° and extend the digits at least 10° from a fully flexed position (Correct answer)
Bilateral upper extremity involvement with symmetrical weakness
Full active range of motion in the affected upper extremity

Correct answer: Ability to extend the wrist at least 10° and extend the digits at least 10° from a fully flexed position

Standard CIMT requires a minimum motor criterion: volitional wrist extension of at least 10° and digit extension of at least 10° from a fully flexed position. This threshold ensures the patient has enough residual motor control to engage in the intensive repetitive task practice that drives cortical reorganization. Full ROM and complete absence of spasticity are not required.

Question 145: When performing airway clearance with postural drainage, which position is used to drain the right middle lobe?

Prone with pillow under abdomen
Left side-lying with bed tilted head-down (Correct answer)
Right side-lying with bed flat
Supine with bed tilted head-down

Correct answer: Left side-lying with bed tilted head-down

The right middle lobe is drained with the patient in left side-lying position with a slight head-down tilt to use gravity effectively.

Question 146: A patient who has had a right-hemisphere stroke consistently pushes strongly with their left arm and leg, leaning to their paretic right side and resisting any attempts at passive correction to midline. Which intervention strategy is MOST appropriate for this patient?

Strengthening the left-side musculature to prevent over-pushing.
Passively pushing the patient back to the midline position repeatedly.
Having the patient practice reaching for objects on their strong (left) side.
Using a mirror to provide visual feedback of their body position and alignment. (Correct answer)

Correct answer: Using a mirror to provide visual feedback of their body position and alignment.

This patient is demonstrating 'pusher syndrome' or lateropulsion, a condition where their perception of vertical is skewed. The most effective interventions focus on helping the patient become aware of their altered posture. Using visual feedback, such as a mirror or aligning themselves with a vertical reference like a doorframe, allows them to see the mismatch between their perceived vertical and true vertical, facilitating active correction. Passively pushing them often increases their resistance. Reaching to the strong side would reinforce the pushing behavior. Strengthening the non-paretic side is not the primary issue; the problem is one of altered perception of verticality.

Question 147: A patient with thoracic outlet syndrome experiences symptoms primarily due to compression of neurovascular structures. Which structure passes between the anterior and middle scalene muscles?

Brachial plexus and subclavian artery (Correct answer)
Internal jugular vein
Subclavian vein
Vertebral artery

Correct answer: Brachial plexus and subclavian artery

The brachial plexus and subclavian artery pass through the interscalene triangle between the anterior and middle scalene muscles.

Question 148: A patient with an upper motor neuron lesion would most likely demonstrate which of the following signs?

Fasciculations
Positive Babinski sign (Correct answer)
Hyporeflexia
Muscle atrophy early in the disease course

Correct answer: Positive Babinski sign

A positive Babinski sign (extensor plantar response) is a hallmark of upper motor neuron dysfunction.

Question 149: During auscultation, a physical therapist hears a high-pitched, continuous musical sound during expiration. This is best described as:

Rhonchi
Stridor
Wheezing (Correct answer)
Crackles

Correct answer: Wheezing

Wheezing is a high-pitched, continuous, musical sound caused by narrowed airways, most commonly heard during expiration.

Question 150: A patient with a C6 spinal cord injury is being evaluated for wheelchair prescription. Which type of wheelchair is MOST appropriate for long-term community mobility?

Power wheelchair with tilt-in-space seating
Standard weight manual wheelchair with fixed armrests
Reclining manual wheelchair with elevating leg rests
Lightweight rigid-frame manual wheelchair with quick-release wheels (Correct answer)

Correct answer: Lightweight rigid-frame manual wheelchair with quick-release wheels

A patient with C6 tetraplegia typically retains sufficient upper extremity function for manual propulsion, and a lightweight rigid-frame chair maximizes efficiency for community mobility.

Question 151: A therapist uses neuromuscular electrical stimulation (NMES) for quadriceps re-education two weeks after ACL reconstruction. Which on:off time ratio BEST reduces muscle fatigue while still eliciting a training contraction during early rehabilitation?

1:5 (one second on, five seconds off) (Correct answer)
1:3 (one second on, three seconds off)
2:1 (twice as much on-time as off-time)
1:1 (equal on and off time)

Correct answer: 1:5 (one second on, five seconds off)

A 1:5 on:off ratio allows five times more rest than stimulation time, which is critical in early rehabilitation when the quadriceps is deconditioned and fatigues rapidly. As strength and endurance improve, the ratio is progressively advanced toward 1:3 and then 1:1. Ratios with more on-time (2:1 or 1:1) cause rapid fatigue and reduce overall training volume.

Question 152: A physical therapist is evaluating a 4-month-old infant and performs the Galeazzi test (Allis sign). The therapist observes that the infant's left knee is lower than the right knee. What is the MOST likely clinical implication of this finding?

Femoral anteversion on the left
Bilateral hip dislocations
Developmental dysplasia of the left hip (Correct answer)
Congenital tibial shortening on the right

Correct answer: Developmental dysplasia of the left hip

The Galeazzi test, or Allis sign, is used to screen for developmental dysplasia of the hip (DDH). The test is performed with the infant supine and hips and knees flexed. A positive sign is an observed asymmetry in knee height, which suggests a unilateral hip dislocation or femoral shortening on the side with the lower knee. In this case, the lower left knee points towards potential DDH on the left side. Bilateral dislocations may present with a false negative test.

Question 153: A 45-year-old patient reports cervical spine pain radiating into the thumb, index finger, and middle finger with associated weakness of elbow flexion. Which cervical nerve root is MOST likely compressed?

C5
C6 (Correct answer)
C4
C7

Correct answer: C6

C6 nerve root compression produces sensory changes in the thumb, index, and middle fingers (lateral forearm and hand) and weakness of elbow flexors (biceps) and wrist extensors. The biceps reflex may also be diminished.

Question 154: During fluidotherapy treatment, the therapist notices the patient has an open wound on the treated extremity. What is the MOST appropriate action?

Increase the cellulose particle agitation to improve circulation
Lower the temperature setting below 38°C
Continue treatment with a water-proof dressing
Discontinue treatment immediately (Correct answer)

Correct answer: Discontinue treatment immediately

Open wounds are a contraindication to fluidotherapy due to risk of infection from the circulating cellulose particles.

Question 155: Which spinal cord tract carries conscious proprioception and vibration sense to the brain?

Spinothalamic tract
Spinocerebellar tract
Corticospinal tract
Dorsal columns (posterior funiculus) (Correct answer)

Correct answer: Dorsal columns (posterior funiculus)

The dorsal columns (medial lemniscal pathway) carry fine touch, vibration, and conscious proprioception to the sensory cortex via the thalamus.

Question 156: Which of the following manual therapy grades (Maitland) is most appropriate for treating pain in an acutely inflamed joint?

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

Correct answer: Grade I

Grade I oscillations are small-amplitude movements at the beginning of range, appropriate for acute pain management with minimal stress on inflamed tissue.

Question 157: Which type of muscle contraction occurs in the quadriceps during the lowering phase of a squat?

Concentric
Isokinetic
Eccentric (Correct answer)
Isometric

Correct answer: Eccentric

The quadriceps undergo eccentric contraction as they lengthen under tension to control knee flexion during the descent of a squat.

Question 158: When measuring for axillary crutches, which measurement most accurately determines proper crutch length?

Arm span divided by 2
Distance from anterior axillary fold to a point 6 inches lateral to the fifth toe (Correct answer)
Standing height from floor to the axilla
Patient height minus 16 inches

Correct answer: Distance from anterior axillary fold to a point 6 inches lateral to the fifth toe

Proper crutch length is measured from the anterior axillary fold to a point 6 inches lateral and 2 inches anterior to the fifth toe with the patient standing.

Question 159: When using crutches, the non-weight-bearing (NWB) three-point gait pattern requires the patient to advance the crutches and affected limb simultaneously, then swing:

The uninvolved leg first, then bring crutches forward
Both legs through simultaneously
The uninvolved leg forward to a point even with or past the crutches (Correct answer)
The involved leg first, then the uninvolved

Correct answer: The uninvolved leg forward to a point even with or past the crutches

In three-point gait for NWB, crutches and affected limb advance together, then the uninvolved leg swings forward to or past the crutch tips.

Question 160: A patient with unilateral vestibular hypofunction is prescribed gaze stabilization exercises. What is the PRIMARY mechanism of these exercises?

Promoting adaptation of the vestibulo-ocular reflex (VOR) (Correct answer)
Strengthening the extra-ocular muscles for better tracking
Habituating the patient to motion-induced nausea
Improving central visual acuity

Correct answer: Promoting adaptation of the vestibulo-ocular reflex (VOR)

Gaze stabilization exercises (head moving while eyes stay fixed on a target) drive VOR adaptation so the brain recalibrates the reflex to compensate for vestibular hypofunction.

Question 161: A patient with chronic obstructive pulmonary disease (COPD) reports improved breathing with which position?

Standing with arms crossed at chest
Lying on uninvolved side
Supine with legs elevated
Sitting forward leaning on forearms (forward lean sitting) (Correct answer)

Correct answer: Sitting forward leaning on forearms (forward lean sitting)

Forward lean sitting fixes the shoulder girdle, allowing accessory breathing muscles to act on the thorax rather than the shoulder, reducing dyspnea in COPD patients.

Question 162: A person with a left CVA and right lower extremity hemiparesis is being taught how to utilize a quad cane by a physical therapist. Which of the following gait patterns is appropriate?

Place the cane in the patient's left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence. (Correct answer)
Place the cane in the patient's right upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.
Place the cane in the patient's right upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.
Place the cane in the patient's left upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.

Correct answer: Place the cane in the patient's left upper extremity, encourage cane, then right lower extremity, then left upper extremity gait sequence.

For a patient with hemiparesis, a cane should be held in the hand opposite the affected leg to provide a wider base of support. With right lower extremity hemiparesis, the cane goes in the left hand. The correct gait pattern is to move the cane forward with the affected leg, then follow with the unaffected leg: cane (left hand), then right lower extremity (affected), then left upper extremity (unaffected).

Question 163: A physical therapist is assessing a patient with left-sided heart failure. Which clinical finding would MOST likely be observed during auscultation of the lung fields?

Unilateral coarse rhonchi at the right apex
Pleural friction rub at the right base
Bilateral fine crackles at the lung bases (Correct answer)
High-pitched inspiratory stridor over the trachea

Correct answer: Bilateral fine crackles at the lung bases

Left-sided heart failure causes pulmonary venous congestion and fluid transudation into the alveoli, producing bilateral fine (Velcro-like) crackles most prominent at the bases due to gravity-dependent fluid accumulation.

Question 164: A patient receiving radiation therapy develops radiodermatitis with moist desquamation. Which intervention is contraindicated?

Wet-to-dry gauze dressings (Correct answer)
Gentle cleansing with saline
Application of a non-adherent dressing
Maintaining a moist wound environment

Correct answer: Wet-to-dry gauze dressings

Wet-to-dry dressings are contraindicated in moist desquamation because removal causes trauma and further tissue damage to already fragile irradiated skin.

Question 165: Which test is used to assess the integrity of the cerebellum by having the patient stand with feet together and eyes closed?

Heel-shin test
Fukuda stepping test
Romberg test (Correct answer)
Finger-nose test

Correct answer: Romberg test

The Romberg test assesses proprioception and vestibular function; a positive result (increased sway with eyes closed) indicates sensory ataxia, often pointing to posterior column or cerebellar involvement.

Question 166: A physical therapist is treating a patient with a stage III pressure injury. Which of the following best describes this wound?

Intact skin with non-blanchable erythema
Full-thickness skin loss with visible subcutaneous tissue (Correct answer)
Full-thickness tissue loss with exposed bone
Partial-thickness skin loss involving the dermis

Correct answer: Full-thickness skin loss with visible subcutaneous tissue

Stage III pressure injuries involve full-thickness skin loss where subcutaneous fat is visible but bone, tendon, and muscle are not exposed.

Question 167: The normal cadence for an adult walking at comfortable speed is approximately:

60–70 steps/minute
130–150 steps/minute
90–120 steps/minute (Correct answer)
40–55 steps/minute

Correct answer: 90–120 steps/minute

Normal comfortable walking cadence in adults is approximately 90–120 steps per minute (steps, not strides).

Question 168: A patient presents with acute subacromial impingement syndrome with significant pain during active range of motion. A physical therapist decides to use joint mobilization to decrease pain. Which Maitland grade of mobilization is MOST appropriate?

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

Correct answer: Grade II

Maitland Grades I and II are used primarily for pain modulation. Grade II mobilizations are large-amplitude movements performed within the pain-free range of motion. Since the patient is pain-dominant, a Grade II mobilization would be appropriate to reduce pain and improve mobility without provoking symptoms. Grades III and IV are used to address stiffness and stretch into tissue resistance, which would be too aggressive for an acute, painful condition.

Question 169: Which breathing pattern is characterized by alternating periods of hyperpnea and apnea, often seen in patients with heart failure or neurological damage?

Biot's breathing
Cheyne-Stokes respiration (Correct answer)
Apneustic breathing
Kussmaul breathing

Correct answer: Cheyne-Stokes respiration

Cheyne-Stokes respiration features a cyclic pattern of gradual increase and decrease in tidal volume followed by apnea, associated with heart failure or brain injury.

Question 170: A 6-Minute Walk Test is performed on a patient with pulmonary fibrosis. The MOST important physiologic variable to monitor during this test is:

Blood pressure
Respiratory rate
Rate of perceived exertion only
Oxygen saturation via pulse oximetry (Correct answer)

Correct answer: Oxygen saturation via pulse oximetry

Patients with pulmonary fibrosis are prone to severe exercise-induced desaturation, making continuous SpO2 monitoring essential during the 6MWT.

Question 171: A patient with L5 nerve root compromise will MOST likely demonstrate which gait deviation?

Antalgic gait due to hip joint pain
Trendelenburg gait due to weak hip abductors (Correct answer)
Foot drop due to weak dorsiflexors
Hyperextended knee due to quadriceps weakness

Correct answer: Trendelenburg gait due to weak hip abductors

L5 innervates the gluteus medius (hip abductor); weakness causes a Trendelenburg gait with contralateral pelvic drop during ipsilateral stance.

Question 172: Which of the following sets of clinical findings is MOST consistent with a diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS)?

Clearly defined episodes of new or worsening neurologic symptoms followed by periods of partial or complete recovery. (Correct answer)
A slow, progressive worsening of symptoms from onset, which is later followed by the development of distinct relapses.
A steady, continuous worsening of symptoms from onset without distinct relapses.
Initial relapsing-remitting course followed by a progressive worsening of disability with or without occasional relapses.

Correct answer: Clearly defined episodes of new or worsening neurologic symptoms followed by periods of partial or complete recovery.

Relapsing-Remitting Multiple Sclerosis (RRMS) is the most common form of MS and is characterized by distinct attacks (relapses) of new or increasing neurologic symptoms. [25] These relapses are followed by periods of partial or complete recovery (remissions). [25] A steady worsening from onset describes Primary-Progressive MS. A progressive course from onset with later relapses describes Progressive-Relapsing MS (a less common term now often included under PPMS). An initial relapsing course that becomes steadily progressive describes Secondary-Progressive MS.

Question 173: A physical therapist is preparing to administer iontophoresis to treat calcific tendinitis in the shoulder using acetic acid. To deliver the medication effectively, how should the therapist set up the electrodes?

Place the acetic acid under either electrode, as polarity does not matter
Place the acetic acid under the cathode (negative electrode) (Correct answer)
Place the acetic acid under the anode (positive electrode)
Place a saline solution under the cathode (negative electrode)

Correct answer: Place the acetic acid under the cathode (negative electrode)

Iontophoresis works on the principle of electrostatic repulsion, where like charges repel each other to drive medication into the tissue. Acetic acid is a negatively charged ion (acetate). Therefore, it must be placed under the active electrode with the same polarity, which is the cathode (negative pole), to be repelled and driven into the underlying tissue.

Question 174: A patient with a complete C6 spinal cord injury would be expected to have functional use of which muscle group?

Finger flexors
Triceps
Intrinsic hand muscles
Wrist extensors (Correct answer)

Correct answer: Wrist extensors

A C6 level injury preserves innervation to the extensor carpi radialis, allowing active wrist extension.

Question 175: A patient with a venous leg ulcer has a resting ABI of 0.55. Which treatment is contraindicated?

High-compression bandaging (40 mmHg) (Correct answer)
Elevation of the extremity
Gentle exercise program
Moist wound dressings

Correct answer: High-compression bandaging (40 mmHg)

An ABI below 0.8 indicates significant arterial insufficiency; high-compression bandaging is contraindicated because it further reduces arterial blood flow.

Question 176: A patient presents with weakness of the deltoid and inability to abduct the shoulder beyond 15 degrees. Which nerve is most likely injured?

Radial nerve
Suprascapular nerve
Axillary nerve (Correct answer)
Musculocutaneous nerve

Correct answer: Axillary nerve

The axillary nerve innervates the deltoid muscle, which is the primary shoulder abductor beyond the initial 15 degrees initiated by the supraspinatus.

Question 177: In the step-down unit, a patient is receiving care from a physical therapist. There are indicators of elevated intracranial pressure in the patient. Of the following, which does not indicate elevated intracranial pressure?

Change in LOC
Vomiting
Increased pupil size bilaterally (Correct answer)
Bradycardia

Correct answer: Increased pupil size bilaterally

Elevated intracranial pressure (ICP) typically causes pupillary changes such as unequal pupil size (anisocoria) or fixed and dilated pupils (blown pupil) due to oculomotor nerve compression. Increased pupil size bilaterally without other specific signs of CN III compression is not a primary indicator of elevated ICP. Bradycardia, vomiting, and changes in the level of consciousness (LOC) are all well-recognized signs of increased ICP.

Question 178: A therapist is performing a Special Test and applies a posterior-to-anterior force on the proximal tibia with the knee at 90° of flexion. A positive result suggests injury to which structure?

Lateral collateral ligament
Posterior cruciate ligament (Correct answer)
Medial collateral ligament
Anterior cruciate ligament

Correct answer: Posterior cruciate ligament

The Posterior Drawer Test is performed with the knee at 90° of flexion; the examiner pushes the tibia posteriorly. Excessive posterior translation indicates posterior cruciate ligament (PCL) laxity or rupture.

Question 179: Which assessment tool is most appropriate for measuring functional mobility and fall risk in a patient with neurological deficits?

Manual Muscle Testing
Berg Balance Scale (Correct answer)
Modified Ashworth Scale
Fugl-Meyer Assessment

Correct answer: Berg Balance Scale

The Berg Balance Scale is a validated 14-item functional balance assessment widely used to quantify balance ability and predict fall risk in neurological populations.

Question 180: A patient presents with a positive Hawkins-Kennedy test. This finding is most consistent with which condition?

Subacromial impingement syndrome (Correct answer)
Glenohumeral anterior instability
Acromioclavicular joint sprain
Biceps tendon rupture

Correct answer: Subacromial impingement syndrome

The Hawkins-Kennedy test internally rotates the shoulder at 90° of flexion, compressing the supraspinatus tendon under the coracoacromial ligament. A positive test — pain with this maneuver — strongly implicates subacromial impingement syndrome.

Question 181: A physical therapist maintains a social media profile and occasionally posts about interesting clinical cases to engage with professional peers. Which practice BEST aligns with HIPAA and the APTA Code of Ethics?

Share only de-identified information that could not reasonably be used to re-identify the patient, and avoid details that might identify the patient even indirectly (Correct answer)
Never reference any clinical case in any form on social media, even in a purely educational context
Obtain explicit written patient authorization before sharing any case detail, even if fully de-identified, to ensure complete ethical compliance
Share de-identified case details only if the post is visible solely to confirmed healthcare professional followers

Correct answer: Share only de-identified information that could not reasonably be used to re-identify the patient, and avoid details that might identify the patient even indirectly

HIPAA permits sharing de-identified health information, but de-identification must be thorough — removing not just names but any details that could reasonably allow re-identification (rare diagnoses, unusual circumstances, small geographic areas). Restricting visibility to professional followers does not satisfy HIPAA, and blanket prohibition on educational case discussion is not required. Robust de-identification is the operative standard.

Question 182: A 55-year-old patient presents with progressive thoracic kyphosis, loss of height, and a recent vertebral compression fracture at T12. Which condition is the MOST likely underlying cause?

Osteoarthritis
Osteoporosis (Correct answer)
Ankylosing spondylitis
Scheuermann disease

Correct answer: Osteoporosis

Osteoporosis is the most common cause of atraumatic vertebral compression fractures with progressive kyphosis in postmenopausal and older adults.

Question 183: A physical therapist receives a subpoena for a patient's treatment records. The appropriate response is to:

Refuse to release any records regardless of the legal order
Immediately release all records without notifying the patient
Destroy any potentially damaging records before responding
Comply with the legal process while following facility policy and notifying the patient as appropriate (Correct answer)

Correct answer: Comply with the legal process while following facility policy and notifying the patient as appropriate

A subpoena is a legal order that must be addressed; the therapist should follow facility policy, consult legal counsel if needed, and ensure the patient is notified as appropriate.

Question 184: Which special test is MOST specific for a supraspinatus tendon tear?

Drop arm test (Correct answer)
Speed's test
Neer impingement sign
Yergason's test

Correct answer: Drop arm test

The drop arm test has high specificity for a full-thickness supraspinatus tear, as the patient cannot slowly lower the arm from 90° abduction.

Question 185: A patient presents with rotator cuff tendinopathy confirmed by MRI. Strengthening exercises are prescribed. Which approach is BEST supported by current evidence?

Open-kinetic-chain internal and external rotation at 0° of abduction only
Isometric contractions performed at 70% MVC to reduce pain immediately, followed by isotonic strengthening (Correct answer)
High-repetition concentric exercise at end-range elevation
Progressive heavy slow resistance (HSR) training

Correct answer: Isometric contractions performed at 70% MVC to reduce pain immediately, followed by isotonic strengthening

Isometric contractions at high intensity (≥70% MVC) have strong evidence for immediate pain reduction in tendinopathy via cortical pain inhibition, and progressive isotonic loading follows to drive tendon adaptation. HSR is also effective but the combination described reflects best current evidence.

Question 186: After receiving a cystic fibrosis diagnosis, Sarah is receiving physical therapy to help her eliminate pulmonary secretions. Her therapist has instructed her in the active cycle of breathing techniques, which also include forceful expiration, thoracic expansion exercises, and breathing regulation. What method of teaching a thoracic expansion technique is the MOST effective?

Inhale deeply, followed by a forced series of two coughs
Inhale slowly, exhale slowly, with a focus on relaxation of the body and a slowing of the breathing rate.
Inhale followed by an exhale of moderate force with an open glottis
Inhale deeply, hold the breath for 2-3 seconds, then gently exhale as if sighing (Correct answer)

Correct answer: Inhale deeply, hold the breath for 2-3 seconds, then gently exhale as if sighing

The thoracic expansion technique, as part of the Active Cycle of Breathing Techniques (ACBT), involves a deep inhalation followed by a 2-3 second breath hold and then a gentle, relaxed exhale. This method maximizes lung volume, promotes collateral air filling behind secretions, and helps to mobilize mucus without causing airway collapse. The gentle exhale prevents bronchospasm and allows for effective secretion clearance.

Question 187: A physical therapist reviews an ECG rhythm strip and notes a heart rate of 150 bpm with no identifiable P waves and an irregular R-R interval. This finding is most consistent with:

Ventricular tachycardia
First-degree AV block
Atrial fibrillation (Correct answer)
Sinus tachycardia

Correct answer: Atrial fibrillation

Atrial fibrillation is characterized by the absence of organized P waves, an irregularly irregular R-R interval, and often a rapid ventricular rate.

Question 188: A PT is selecting ultrasound parameters for treating a superficial trigger point at 1 cm depth in the upper trapezius. Which frequency is MOST appropriate?

1 MHz
0.5 MHz
5 MHz
3 MHz (Correct answer)

Correct answer: 3 MHz

3 MHz ultrasound has a shallower depth of penetration (1–2 cm), making it ideal for superficial structures like trigger points near the surface.

Question 189: A patient with multiple sclerosis reports worsening of neurological symptoms during a physical therapy session on a warm day. Which intervention modification is MOST appropriate?

Discontinue all exercise and refer back to neurology
Increase exercise intensity to build heat tolerance over time
Schedule all sessions in the afternoon to match the patient's peak energy
Apply cooling strategies, schedule sessions in cooler environments, and use energy conservation techniques (Correct answer)

Correct answer: Apply cooling strategies, schedule sessions in cooler environments, and use energy conservation techniques

Uhthoff's phenomenon describes transient worsening of MS symptoms with increased body temperature; cooling vests, cool environments, and energy conservation prevent this during rehabilitation.

Question 190: A patient reports dyspnea at rest, orthopnea requiring 3 pillows to sleep, and has a chest X-ray showing an enlarged cardiac silhouette. These findings are MOST consistent with:

Pulmonary fibrosis
Acute asthma exacerbation
Congestive heart failure (Correct answer)
Spontaneous pneumothorax

Correct answer: Congestive heart failure

Dyspnea at rest, orthopnea, and an enlarged cardiac silhouette on chest X-ray are classic hallmarks of congestive heart failure.

Question 191: A physical therapist working in a home health setting suspects that the home environment poses a significant fall risk to the patient. The BEST course of action is to:

Document the hazards, educate the patient and caregivers, and recommend modifications (Correct answer)
Continue treatment without addressing the environment since it is the patient's home
Refuse to treat the patient until all hazards are removed
Contact local authorities to inspect the home

Correct answer: Document the hazards, educate the patient and caregivers, and recommend modifications

Therapists have a responsibility to identify environmental safety hazards, educate patients and caregivers, and recommend appropriate modifications to reduce fall risk.

Question 192: During manual muscle testing of hip flexion, a patient can complete full range of motion against gravity but cannot tolerate any additional resistance. What muscle grade should be assigned?

3/5 (Correct answer)
4/5
2+/5
3+/5

Correct answer: 3/5

A grade of 3/5 indicates the patient can move through full range against gravity but cannot hold against any manual resistance.

Question 193: A physical therapist suspects that a patient is experiencing domestic abuse based on unexplained bruising and inconsistent explanations. The patient explicitly asks the therapist not to report anything. What is the MOST appropriate action?

Honor the patient's autonomy by keeping the information confidential, since the patient is a competent adult who has the right to make their own decisions
Document the observation in the chart only and take no further action unless the patient explicitly asks for help
Assess mandatory reporting obligations under applicable state law, provide the patient with safety resources, and report if legally required regardless of patient preference (Correct answer)
Immediately call law enforcement without informing the patient, to ensure their safety above all else

Correct answer: Assess mandatory reporting obligations under applicable state law, provide the patient with safety resources, and report if legally required regardless of patient preference

Physical therapists must be aware of their state's mandatory reporting laws, which may require reporting suspected abuse even when the patient objects. Beyond legal compliance, the APTA Code of Ethics requires promoting patient safety and well-being. The therapist should provide resources and support while fulfilling any mandatory reporting duty — patient autonomy does not override mandatory legal reporting obligations.

Question 194: When assessing scoliosis with the Adam's forward bend test, a positive result is indicated by:

Increased lumbar lordosis during forward bending
Pelvic obliquity when standing upright
Lateral trunk shift during forward bending
Rib hump or paraspinal prominence on one side (Correct answer)

Correct answer: Rib hump or paraspinal prominence on one side

A rib hump or paraspinal prominence during forward bending indicates rotational deformity consistent with structural scoliosis.

Question 195: A PT applies a hot pack and the patient reports increasing pain and skin redness within minutes. What is the priority action?

Reduce the number of towel layers and continue treatment
Apply cold water over the hot pack area and continue
Remove the hot pack immediately, assess the skin, and document the adverse response (Correct answer)
Reassure the patient that initial discomfort is normal and continue

Correct answer: Remove the hot pack immediately, assess the skin, and document the adverse response

Increasing pain and redness indicate a potential burn; the hot pack must be removed immediately and the skin assessed.

Question 196: When assessing a wound using the RYB (Red-Yellow-Black) classification, which color indicates the presence of infection or fibrinous slough requiring cleaning?

Yellow (Correct answer)
Black
Pink
Red

Correct answer: Yellow

In the RYB system, yellow indicates the presence of fibrinous slough, purulent exudate, or infection that must be cleaned before healing can progress.

Question 197: Which of the following findings is MOST consistent with a complete rotator cuff tear rather than tendinopathy?

Positive Neer sign with pain
Positive Hawkins-Kennedy test
Painful arc between 60-120 degrees
Significant weakness with resisted shoulder abduction (Correct answer)

Correct answer: Significant weakness with resisted shoulder abduction

Significant weakness with resisted abduction (supraspinatus) is a hallmark of a full-thickness rotator cuff tear, as the muscle-tendon unit is no longer intact.

Question 198: A physical therapist is employed by an orthopedic outpatient clinic. The patient states, "I tore 3 of my 4 Rotator cuff muscles in the past," throughout the patient's history. Which of the following muscles can never be thought to be torn?

Supraspinatus
Infraspinatus
Teres major (Correct answer)
Teres minor

Correct answer: Teres major

The rotator cuff muscles consist of four muscles: Supraspinatus, Infraspinatus, Teres minor, and Subscapularis (SITS muscles). The Teres major muscle is not part of the rotator cuff; it primarily adducts and internally rotates the arm but does not contribute to stabilizing the glenohumeral joint in the same way as the SITS muscles.

Question 199: A physical therapist is treating a patient with acute lateral epicondylitis. Which therapeutic modality is MOST appropriate for pain management during the inflammatory phase?

Continuous ultrasound at 1.5 W/cm²
Fluidotherapy at 118°F
Phonophoresis with hydrocortisone (Correct answer)
Paraffin wax bath

Correct answer: Phonophoresis with hydrocortisone

Phonophoresis with hydrocortisone delivers anti-inflammatory medication transdermally to the inflamed tendon using ultrasound as the driving force.

Question 200: Which of the following BEST describes the concept of informed consent in physical therapy?

Verbally telling the patient what exercises they will perform that day
Explaining the diagnosis, proposed treatment, risks, benefits, and alternatives so the patient can make a voluntary decision (Correct answer)
Having the patient sign a standard liability waiver before treatment
Obtaining consent from the referring physician on behalf of the patient

Correct answer: Explaining the diagnosis, proposed treatment, risks, benefits, and alternatives so the patient can make a voluntary decision

Informed consent requires that the patient receives and understands information about their condition, proposed interventions, risks, benefits, and alternatives before agreeing to treatment.

Question 201: The APTA Code of Ethics principle of 'compassion and caring' is MOST closely aligned with which ethical principle?

Veracity
Autonomy
Justice
Beneficence (Correct answer)

Correct answer: Beneficence

Beneficence — acting in the patient's best interest — aligns most closely with compassion and caring as described in the APTA Code of Ethics.

Question 202: A physical therapist is performing a sensory evaluation and finds that a patient has lost light-touch sensation along the medial aspect of the lower leg and the great toe. Which nerve root level is most likely compromised?

L5
L4 (Correct answer)
L3
S1

Correct answer: L4

The L4 dermatome covers the medial lower leg and the medial aspect of the foot including the great toe. Loss of light-touch sensation in this distribution, combined with potential weakness of the tibialis anterior and diminished patellar reflex, indicates L4 nerve root involvement.

Question 203: Which cranial nerve is tested when a patient is asked to shrug their shoulders against resistance?

CN XI (Correct answer)
CN XII
CN X
CN IX

Correct answer: CN XI

The accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid muscles, which are tested with shoulder shrugging and head rotation.

Question 204: A physical therapist is asked by a patient's employer to provide a detailed report of the patient's diagnosis and treatment progress without the patient's authorization. The therapist should:

Provide only general information about functional limitations relevant to work
Contact the patient's attorney before responding
Provide the report since the employer is paying for treatment
Refuse to release any information without a signed patient authorization (Correct answer)

Correct answer: Refuse to release any information without a signed patient authorization

Under HIPAA, protected health information cannot be disclosed to a third party, including an employer, without a valid signed authorization from the patient. The source of payment does not grant the payer unlimited access to clinical details.

Question 205: A patient demonstrates weakness in toe extension (hallux) and foot drop. Which nerve is most likely injured?

Superficial peroneal nerve
Femoral nerve
Tibial nerve
Common peroneal nerve (deep branch) (Correct answer)

Correct answer: Common peroneal nerve (deep branch)

The deep peroneal (fibular) nerve innervates the tibialis anterior and extensor hallucis longus; injury causes foot drop and inability to extend the great toe.

Question 206: During wound assessment, a physical therapist inserts a sterile cotton-tipped applicator at the wound margin and advances it 4 cm in a narrow, distinct channel before meeting tissue resistance. This finding is BEST documented as:

Undermining
Wound dehiscence
Fistula formation
Tunneling (Correct answer)

Correct answer: Tunneling

Tunneling (also called a sinus tract) is a narrow, channel-like extension from the wound base or edge that travels in one direction. Undermining, by contrast, is a broad, shelf-like area of tissue destruction beneath the wound edges measured circumferentially around the wound.

Question 207: The ankle-brachial index (ABI) is 0.55 in a patient referred for cardiac rehabilitation. The therapist should:

Refer directly to vascular surgery before any exercise
Avoid all lower extremity exercise
Modify exercise intensity and monitor for claudication symptoms (Correct answer)
Proceed with full aerobic exercise program

Correct answer: Modify exercise intensity and monitor for claudication symptoms

An ABI of 0.55 indicates moderate peripheral arterial disease; exercise is beneficial but must be adjusted in intensity with close monitoring for intermittent claudication.

Question 208: A physical therapist is treating a patient with acute pain using conventional Transcutaneous Electrical Nerve Stimulation (TENS). According to the Gate Control Theory of pain, which parameters are MOST effective for this mode of TENS?

High frequency (150 Hz), long pulse duration (250 µs), high intensity (to tolerance)
Low frequency (2-4 Hz), long pulse duration (200 µs), high intensity (to motor contraction)
Low frequency (10 Hz), short pulse duration (50 µs), high intensity (to motor contraction)
High frequency (80-100 Hz), short pulse duration (50-100 µs), low intensity (sensory level) (Correct answer)

Correct answer: High frequency (80-100 Hz), short pulse duration (50-100 µs), low intensity (sensory level)

Conventional TENS for acute pain management operates based on the Gate Control Theory. This is best achieved by stimulating large-diameter A-beta sensory fibers without causing muscle contraction. The optimal parameters for this are a high frequency (typically 50-100 Hz), a short pulse duration (50-200 µs), and a comfortable sensory-level intensity. The other options describe parameters for acupuncture-like TENS or brief-intense TENS, which operate via different mechanisms.

Question 209: A physical therapist is documenting a patient's treatment in a shared office space. The therapist is called away to an emergency and minimizes the electronic medical record (EMR) screen, which contains protected health information (PHI), but does not log out of the computer terminal. This action is a violation of which of the following principles?

Fidelity
Veracity
Beneficence
Confidentiality (Correct answer)

Correct answer: Confidentiality

This is a direct violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules, which are based on the ethical principle of confidentiality. HIPAA requires healthcare providers to implement reasonable safeguards to protect patient health information (PHI) from unauthorized access. Leaving a workstation logged into an EMR system in a shared area, even if minimized, fails to secure PHI and creates an opportunity for a breach of confidentiality.

Question 210: During the Functional Reach Test (FRT), what is being measured that makes it a valid clinical indicator of dynamic balance and fall risk?

The maximum forward distance a patient can reach while maintaining a fixed base of support standing (Correct answer)
The number of steps taken before requiring a balance correction
The maximum weight a patient can shift laterally while seated
The time required to complete a 360° turn from a standing position

Correct answer: The maximum forward distance a patient can reach while maintaining a fixed base of support standing

The FRT measures the maximum distance (in inches or centimeters) a patient can reach forward with an outstretched arm beyond arm's length while maintaining a standing fixed base of support. A reach of less than 6 inches (15 cm) is associated with a significantly elevated fall risk. It quantifies the limits of the anterior stability boundary.

Question 211: A PT is treating a patient with a fresh (48-hour-old) quadriceps contusion. Which physical agent is MOST appropriate at this stage?

Cryotherapy with compression (Correct answer)
Shortwave diathermy
Moist heat pack for 20 minutes
Continuous ultrasound at 1.5 W/cm²

Correct answer: Cryotherapy with compression

Cryotherapy with compression is the standard acute-phase treatment to reduce inflammation, hemorrhage, and secondary hypoxic injury.

Question 212: A patient taking lithium for bipolar disorder reports muscle tremors and confusion during a PT session. The PT should:

Administer water and rest the patient for 10 minutes
Decrease exercise intensity and monitor
Attribute symptoms to exercise fatigue and continue
Stop treatment, assess vitals, and contact the physician immediately (Correct answer)

Correct answer: Stop treatment, assess vitals, and contact the physician immediately

Tremors and confusion in a lithium patient may signal lithium toxicity, a medical emergency requiring immediate physician contact.

Question 213: Which constraint-induced movement therapy principle is ESSENTIAL for promoting cortical reorganization in a patient with chronic stroke?

Passive range of motion of the affected limb for six hours daily
Massed practice with the affected limb combined with restraint of the unaffected limb (Correct answer)
Restraint of the affected limb for 90% of waking hours
Bilateral upper extremity training with rhythmic auditory cueing

Correct answer: Massed practice with the affected limb combined with restraint of the unaffected limb

Constraint-induced movement therapy requires restraining the less-affected limb while engaging in intensive, repetitive massed practice with the affected limb to drive use-dependent cortical reorganization.

Question 214: Which type of traction is MOST appropriate for a patient with acute cervical radiculopathy who cannot tolerate positional changes?

Manual traction in supine (Correct answer)
Continuous mechanical traction
Positional traction
Intermittent mechanical traction

Correct answer: Manual traction in supine

Manual traction in supine allows the therapist to control force precisely and immediately release if symptoms worsen, making it safest for acute conditions.

Question 215: A patient is performing a seated leg press exercise. According to the ACSM guidelines for resistance training, what is the recommended rest interval between sets for muscular strength development?

8–10 minutes
30–60 seconds
2–5 minutes (Correct answer)
15–30 seconds

Correct answer: 2–5 minutes

ACSM recommends 2–5 minutes of rest between sets when training for maximal muscular strength to allow adequate phosphocreatine replenishment.

Question 216: A patient reports that pain decreases with walking and worsens with prolonged sitting. This pattern is MOST consistent with:

Discogenic low back pain (Correct answer)
Sacroiliac joint dysfunction
Lumbar spinal stenosis
Lumbar facet joint syndrome

Correct answer: Discogenic low back pain

Discogenic pain typically worsens with flexion-loaded postures like prolonged sitting and improves with extension activities such as walking.

Question 217: Which medication side effect should prompt a PT to immediately stop exercise and notify the physician?

Mild ankle swelling
Dry mouth
Mild muscle soreness
Chest pain and dyspnea during exertion (Correct answer)

Correct answer: Chest pain and dyspnea during exertion

Chest pain and dyspnea during exercise may indicate cardiac ischemia or pulmonary compromise requiring immediate medical evaluation.

Question 218: During a 6-minute walk test, a patient with heart failure demonstrates exertional dyspnea at 3 minutes and a 12-point increase on the Borg RPE scale. Which physiological mechanism BEST explains the early onset of symptoms?

Reduced cardiac output limiting oxygen delivery to working muscles (Correct answer)
Excessive sympathetic nervous system withdrawal
Increased anatomical dead space ventilation
Decreased peripheral vascular resistance

Correct answer: Reduced cardiac output limiting oxygen delivery to working muscles

In heart failure, the heart cannot adequately increase cardiac output during exercise, leading to insufficient oxygen delivery and early onset of dyspnea and fatigue.

Question 219: A therapist uses fluidotherapy on a patient's hand following Dupuytren's contracture release. Which unique benefit does fluidotherapy offer over paraffin bath?

Ability to perform active exercise during treatment (Correct answer)
Lower treatment temperature range
Shorter treatment duration required
Greater depth of thermal penetration

Correct answer: Ability to perform active exercise during treatment

Fluidotherapy allows the patient to actively move and exercise the extremity during treatment, combining heat with functional activity.

Question 220: During ultrasound treatment of a chronic Achilles tendinopathy, the therapist selects 1 MHz over 3 MHz. The rationale is that 1 MHz:

Produces more non-thermal effects
Heats more superficial tissue effectively
Requires a smaller applicator head
Penetrates deeper into tissue (up to 5 cm) (Correct answer)

Correct answer: Penetrates deeper into tissue (up to 5 cm)

1 MHz ultrasound has a longer wavelength that allows penetration to approximately 3–5 cm, reaching deeper structures like the Achilles tendon.

Question 221: A therapist is instructing a patient in stair climbing with bilateral Lofstrand crutches using a 3-point non-weight-bearing gait. When going UP stairs, the correct sequence is:

Crutches first, then uninvolved leg, then involved leg
Uninvolved leg first, then crutches and involved leg together (Correct answer)
Crutches and uninvolved leg simultaneously, then involved leg
Involved leg first, then uninvolved leg, then crutches

Correct answer: Uninvolved leg first, then crutches and involved leg together

Going up stairs with NWB: the uninvolved leg leads ('good goes up to heaven'), then crutches and the involved extremity follow.

Question 222: A patient in the ICU has a pulmonary artery catheter showing a pulmonary capillary wedge pressure (PCWP) of 22 mmHg. This value is MOST consistent with which condition?

Right ventricular failure
Hypovolemic shock
Left ventricular failure (Correct answer)
Pulmonary embolism

Correct answer: Left ventricular failure

A PCWP above 18 mmHg indicates elevated left atrial pressure, which is characteristic of left ventricular failure causing pulmonary congestion.

Question 223: Which reflex would be expected to be ABSENT in a healthy 12-month-old infant?

Protective extension to the side
Parachute reaction
Asymmetrical tonic neck reflex (Correct answer)
Landau reflex

Correct answer: Asymmetrical tonic neck reflex

The asymmetrical tonic neck reflex is typically integrated by 6 months of age and should be absent by 12 months.

Question 224: Which special test is used to assess for a torn acetabular labrum of the hip?

FABER test
Thomas test
Ober test
FADIR test (Correct answer)

Correct answer: FADIR test

The FADIR test (Flexion, ADduction, Internal Rotation) is the most sensitive provocative test for acetabular labral tears and hip impingement.

Question 225: A physical therapy student is providing treatment under the supervision of a licensed PT. Who holds ultimate legal responsibility for the care provided?

The facility administrator
The clinical education coordinator at the university
The supervising licensed physical therapist (Correct answer)
The student, because they are the one providing hands-on treatment

Correct answer: The supervising licensed physical therapist

The supervising licensed physical therapist retains ultimate legal responsibility for all patient care delivered under their supervision.

Question 226: During a gait analysis, a physical therapist observes a patient with painful right hip osteoarthritis. The therapist notes that the step length of the left leg is significantly shorter than the step length of the right leg. What is the MOST likely reason for this gait deviation?

Limited extension of the left hip
A desire to decrease stance time on the painful right leg (Correct answer)
Weakness of the left hip flexors
Weakness of the right gluteus medius

Correct answer: A desire to decrease stance time on the painful right leg

This gait pattern is known as an antalgic gait. The patient shortens the step length of the non-painful (left) leg to minimize the amount of time they must spend in the single-limb stance phase on the painful (right) leg. This is a compensatory strategy to reduce joint loading and pain on the affected side.

Question 227: A physical therapist is treating a patient with left-sided heart failure. Which pulmonary finding is MOST expected on auscultation?

Absent breath sounds at the apex
Bilateral basilar crackles (Correct answer)
Expiratory wheezes bilaterally
Pleural friction rub

Correct answer: Bilateral basilar crackles

Left-sided heart failure causes pulmonary edema, leading to bilateral basilar crackles from fluid accumulation in the lung bases.

Question 228: A physical therapist is applying cryotherapy to an acute ankle sprain. Which of the following is a contraindication for this treatment?

Presence of mild edema
Patient has a history of Raynaud's phenomenon (Correct answer)
The injury occurred less than 24 hours ago
Patient reports pain level of 7/10

Correct answer: Patient has a history of Raynaud's phenomenon

Raynaud's phenomenon is a contraindication for cryotherapy because cold exposure triggers excessive vasospasm, potentially causing tissue ischemia and damage.

Question 229: A patient with chronic obstructive pulmonary disease (COPD) demonstrates a barrel chest deformity. Which physiological change best explains this structural adaptation?

Calcification of the costal cartilages due to aging
Hypertrophy of the diaphragm from increased workload
Increased elastic recoil of the lung parenchyma
Chronic air trapping leading to hyperinflation of the lungs (Correct answer)

Correct answer: Chronic air trapping leading to hyperinflation of the lungs

Barrel chest in COPD results from chronic air trapping that causes persistent lung hyperinflation, gradually reshaping the thorax.

Question 230: A patient is 4 weeks post-arthroscopic partial meniscectomy of the right knee. The patient presents with minimal effusion and full active range of motion. Which of the following interventions is MOST appropriate to add at this stage?

Isokinetic testing for return to sport
Deep squats with heavy resistance
High-impact plyometric drills
Closed-chain quadriceps strengthening, such as mini-squats (Correct answer)

Correct answer: Closed-chain quadriceps strengthening, such as mini-squats

At 4 weeks post-partial meniscectomy, with good ROM and minimal swelling, the focus should shift to developing strength. Closed-chain exercises like mini-squats are appropriate for improving quadriceps strength and control in a functional manner. High-impact activities, heavy resistance, and isokinetic testing are typically introduced much later in the rehabilitation process.

Question 231: During the swing phase of gait, which muscle is primarily responsible for maintaining foot clearance?

Soleus
Tibialis anterior (Correct answer)
Gastrocnemius
Peroneus longus

Correct answer: Tibialis anterior

The tibialis anterior dorsiflexes the ankle during swing phase to prevent the foot from dragging on the ground.

Question 232: A patient has a wound with 100% yellow slough covering the wound bed. Which debridement method is most appropriate when the patient has poor circulation and cannot tolerate sharp debridement?

Wet-to-dry dressing
Sharp/surgical debridement
UV-C therapy
Enzymatic debridement (Correct answer)

Correct answer: Enzymatic debridement

Enzymatic debridement uses topical agents (e.g., collagenase) to selectively dissolve necrotic tissue and is appropriate when sharp debridement is contraindicated.

Question 233: A patient with a pulmonary embolism has a PaO2 of 58 mmHg and PaCO2 of 30 mmHg. The primary mechanism of hypoxemia in this case is:

Hypoventilation
Diffusion impairment
Ventilation-perfusion mismatch (Correct answer)
Right-to-left shunt

Correct answer: Ventilation-perfusion mismatch

Pulmonary embolism creates dead space (ventilated but unperfused alveoli), causing a V/Q mismatch that leads to hypoxemia despite a low PaCO2 from compensatory hyperventilation.

Question 234: A newly licensed physical therapist is asked by their supervisor to perform joint mobilization techniques they learned in school but have never performed on an actual patient. What is the MOST ethical response?

Inform the supervisor of their limited experience and request supervision or mentorship before performing the technique independently (Correct answer)
Perform the technique since they learned it in an accredited program
Refuse to perform the technique entirely and refer the patient elsewhere
Ask another therapist to perform the technique instead without informing the supervisor

Correct answer: Inform the supervisor of their limited experience and request supervision or mentorship before performing the technique independently

Ethical practice requires therapists to practice within their competence level and to seek appropriate supervision when transitioning from academic training to independent clinical practice.

Question 235: A physical therapist is asked by an attorney to provide an expert opinion in a legal case involving a patient who was never under the therapist's care. The therapist has no direct knowledge of the patient. What does the APTA Code of Ethics require in this situation?

Provide testimony only if compensated at a standard expert witness rate approved by the state licensing board
Ensure that any opinion rendered is based on sound professional judgment, accurate information, and falls within the therapist's area of competence (Correct answer)
Refuse to participate entirely, as physical therapists cannot serve as expert witnesses outside of their own patient relationships
Participate and provide opinions based on the records provided, relying on general professional knowledge

Correct answer: Ensure that any opinion rendered is based on sound professional judgment, accurate information, and falls within the therapist's area of competence

The APTA Code of Ethics permits physical therapists to serve as expert witnesses but requires that testimony be based on sound professional judgment and accurate information. The therapist must only opine within their area of competence and must not misrepresent their credentials or knowledge. Expert witness work is a legitimate professional role when conducted ethically.

Question 236: Which type of muscle contraction generates the greatest force output?

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

Correct answer: Eccentric contraction

Eccentric contractions produce the greatest force because passive elastic elements (titin) contribute alongside active cross-bridge cycling, resulting in supramaximal force.

Question 237: During TENS application for pain relief using the conventional (high-rate) mode, which sensory response indicates correct electrode placement and intensity?

Visible muscle twitch with mild discomfort
Strong noxious sensation without muscle contraction
Comfortable tingling or paresthesia without muscle contraction (Correct answer)
Mild burning sensation over the electrodes

Correct answer: Comfortable tingling or paresthesia without muscle contraction

Conventional high-rate TENS targets large-diameter sensory fibers, producing comfortable paresthesia without motor activation.

Question 238: Which of the following actions by a PT MOST clearly demonstrates the principle of social responsibility?

Limiting practice hours to maximize income
Referring all complex cases to physicians
Volunteering at community health screenings to improve public access to care (Correct answer)
Treating only patients with premium insurance plans

Correct answer: Volunteering at community health screenings to improve public access to care

Social responsibility calls on PTs to promote health and wellness in the community, including providing services that expand equitable access to care.

Question 239: A physical therapist is providing care for a child with spinal muscular atrophy (SMA) Type II and the family. Which principle BEST reflects family-centered care?

The physical therapist independently determines all treatment goals and progression based on clinical expertise
The therapist collaborates with the family to identify and prioritize goals aligned with the child's and family's values and daily life (Correct answer)
A standardized SMA Type II protocol is applied to all patients regardless of individual family input
Parent education is minimized to reduce caregiver anxiety about the progressive nature of SMA

Correct answer: The therapist collaborates with the family to identify and prioritize goals aligned with the child's and family's values and daily life

Family-centered care requires active partnership with the family in goal-setting and decision-making, ensuring interventions are meaningful and reflect the family's priorities and the child's daily context.

Question 240: Which gait deviation is most commonly associated with quadriceps weakness during the loading response phase?

Genu recurvatum
Steppage gait
Circumduction
Excessive knee flexion with compensatory forward trunk lean (Correct answer)

Correct answer: Excessive knee flexion with compensatory forward trunk lean

Quadriceps weakness during loading response causes the knee to buckle into flexion, and patients often compensate by leaning the trunk forward to move the ground reaction force anterior to the knee.

Question 241: For the process of informed consent to be considered valid and ethically sound prior to initiating physical therapy treatment, which of the following elements is ESSENTIAL?

The patient's voluntary agreement after being informed of the treatment's nature, potential risks, benefits, and reasonable alternatives.
The approval of the patient's primary care physician for the specific interventions planned.
A detailed explanation of the therapist's educational background and years of experience. (Correct answer)
A signed and witnessed legal document for every intervention performed during the plan of care.

Correct answer: A detailed explanation of the therapist's educational background and years of experience.

The core of informed consent is ensuring the patient can make an autonomous decision about their care. This requires providing clear information about the proposed treatment, its benefits, any significant risks, and available alternatives (including no treatment). The consent must be given voluntarily by a competent individual. While written consent is common practice for the overall episode of care, it is the process of communication and understanding that is essential, not just a signature.

Question 242: Which muscle is the primary restraint controlling forward tibial progression during midstance, preventing excessive ankle dorsiflexion and maintaining upright posture?

Soleus (Correct answer)
Tibialis anterior
Peroneus longus
Gastrocnemius

Correct answer: Soleus

The soleus, with its origin on the tibia and fibula, acts as a posterior restraint on the tibia during midstance. It works eccentrically to control how quickly the tibia advances over the fixed foot. The gastrocnemius assists but is less active at this phase because the knee remains relatively extended.

Question 243: A child with cerebral palsy is classified as GMFCS Level III. Which functional description BEST applies to this child?

Walks using a hand-held mobility device indoors and uses wheeled mobility for longer community distances (Correct answer)
Has no means of independent self-mobility and is transported in a manual wheelchair
Walks without limitations in all community settings
Achieves self-mobility primarily using a powered wheelchair

Correct answer: Walks using a hand-held mobility device indoors and uses wheeled mobility for longer community distances

GMFCS Level III describes children who walk with a hand-held assistive device indoors but rely on wheeled mobility for longer distances or uneven terrain.

Question 244: A physical therapist is using iontophoresis to deliver dexamethasone to treat lateral epicondylitis. Given that dexamethasone sodium phosphate has a negative polarity, which of the following setups is correct?

The medication should be placed on the anode (+), and the dispersive pad should be the cathode (-).
The medication should be placed on the anode (+), and the current intensity should be set to 1.0 mA.
The medication should be placed on the cathode (-), and the dispersive pad should be the anode (+). (Correct answer)
The medication should be placed on the cathode (-), and the dispersive pad should also be negative.

Correct answer: The medication should be placed on the cathode (-), and the dispersive pad should be the anode (+).

The principle of iontophoresis is based on the concept that like charges repel. Since dexamethasone is a negatively charged ion, it must be placed under the negative electrode (cathode) to be repelled and driven into the underlying tissues. The dispersive pad must have the opposite polarity, making it the anode (+), to complete the electrical circuit.

Question 245: Which ethical principle is MOST directly violated when a physical therapist provides treatment beyond their scope of competence without seeking additional training or referral?

Autonomy
Nonmaleficence (Correct answer)
Justice
Beneficence

Correct answer: Nonmaleficence

Nonmaleficence, the duty to do no harm, is most directly violated when a therapist practices beyond their competence, as it places patients at risk of injury.

Question 246: Which electrocardiogram finding is MOST characteristic of atrial fibrillation?

Wide QRS complexes greater than 0.12 seconds
Prolonged PR interval greater than 0.20 seconds
Irregularly irregular R-R intervals with absence of distinct P waves (Correct answer)
Regular R-R intervals with sawtooth-shaped flutter waves

Correct answer: Irregularly irregular R-R intervals with absence of distinct P waves

Atrial fibrillation is identified by irregularly irregular ventricular rhythm and the absence of organized P waves, replaced by fibrillatory baseline activity.

Question 247: A patient presents with pain and tenderness directly over the lateral epicondyle of the humerus that worsens with resisted wrist extension. Which condition does this most likely represent?

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

Correct answer: Lateral epicondylitis

Lateral epicondylitis (tennis elbow) is characterized by pain at the lateral epicondyle that is reproduced or worsened by resisted wrist extension, because the wrist extensor muscles (especially extensor carpi radialis brevis) originate at that site. Medial epicondylitis involves the flexor-pronator origin on the medial side.

Question 248: During nerve conduction velocity testing, which finding is most consistent with demyelinating neuropathy rather than axonal neuropathy?

Positive sharp waves on EMG
Significantly reduced conduction velocity (Correct answer)
Reduced amplitude with normal conduction velocity
Fibrillation potentials on EMG

Correct answer: Significantly reduced conduction velocity

Demyelinating neuropathies characteristically show markedly reduced conduction velocity due to impaired saltatory conduction.

Question 249: A physical therapist intends to use conventional transcutaneous electrical nerve stimulation (TENS) to modulate a patient's acute low back pain, based on the gate control theory. Which parameter settings are MOST consistent with this therapeutic goal?

Low frequency (2-10 pps), long pulse duration (>200 microseconds)
High frequency (80-150 pps), short pulse duration (50-100 microseconds) (Correct answer)
High frequency (80-150 pps), long pulse duration (>200 microseconds)
Low frequency (2-10 pps), short pulse duration (50-100 microseconds)

Correct answer: High frequency (80-150 pps), short pulse duration (50-100 microseconds)

Conventional TENS, which operates on the gate control theory of pain, uses a high frequency (e.g., 80-150 pps) and a short pulse duration (e.g., 50-100 microseconds) at a comfortable sensory-level intensity. This selectively stimulates large-diameter A-beta nerve fibers to 'close the gate' to nociceptive signals from A-delta and C fibers. Low-frequency, long-duration TENS is used to elicit an opioid-mediated analgesic effect.

Question 250: Which proprioceptive exercise progression is MOST appropriate for a patient in the late stage of ankle sprain rehabilitation?

Double-leg stance on a firm surface with eyes open
Seated ankle pumps with a resistance band
Supine ankle alphabet exercises
Single-leg stance on a foam surface with eyes closed (Correct answer)

Correct answer: Single-leg stance on a foam surface with eyes closed

Single-leg stance on an unstable surface with eyes closed maximally challenges the somatosensory system, appropriate for late-stage proprioceptive retraining.

NPTE-PT (National Physical Therapy Exam)

The NPTE-PT (National Physical Therapy Exam) exam validates essential knowledge and skills required for certification or licensure in this field.

250

Questions

300 min

Time Limit

65%

To Pass

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