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

Question 1: A PT is asked by a patient to sign a document stating treatment was provided on a date when the patient was not seen. The PT should:

Refuse and explain that falsifying records is fraud (Correct answer)
Sign if the patient insists and it avoids conflict
Amend the existing records to reflect the requested date
Consult with the billing department first

Correct answer: Refuse and explain that falsifying records is fraud

Falsifying medical records constitutes fraud and a violation of professional ethics; the PT must refuse regardless of pressure.

Question 2: A physical therapist is treating a patient with acute lateral epicondylitis. Which therapeutic modality is MOST appropriate for pain management during the inflammatory phase?

Fluidotherapy at 118°F
Phonophoresis with hydrocortisone (Correct answer)
Continuous ultrasound at 1.5 W/cm²
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 3: A patient is 6 weeks post-ACL reconstruction using a bone-patellar tendon-bone autograft. Which intervention is MOST appropriate at this stage?

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

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 4: When applying iontophoresis with dexamethasone to treat plantar fasciitis, which electrode placement is correct?

Dexamethasone under the positive electrode, dispersive pad on the dorsum
Dexamethasone under the negative electrode, dispersive pad on the calf
Dexamethasone under the negative electrode, dispersive pad on the dorsum (Correct answer)
Dexamethasone under the positive electrode, dispersive pad on the calf

Correct answer: Dexamethasone under the negative electrode, dispersive pad on the dorsum

Dexamethasone is negatively charged and must be placed under the negative (cathode) electrode so that like charges repel the medication into the tissue.

Question 5: 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
The injury occurred less than 24 hours ago
Patient has a history of Raynaud's phenomenon (Correct answer)
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 6: 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 7: A PT discovers that a colleague is billing for services not rendered. What is the MOST appropriate initial action?

Confront the colleague and report to the supervisor or compliance officer (Correct answer)
Report directly to the state licensing board
Ignore it to avoid conflict
Notify the patient immediately

Correct answer: Confront the colleague and report to the supervisor or compliance officer

The PT should first address the concern internally by confronting the colleague and reporting to a supervisor or compliance officer, which follows proper channels before external reporting.

Question 8: A patient demonstrates a steppage gait pattern. Which muscle group is MOST likely weak?

Hip abductors
Hip extensors
Ankle plantarflexors
Ankle dorsiflexors (Correct answer)

Correct answer: Ankle dorsiflexors

Steppage gait (exaggerated hip and knee flexion during swing) compensates for weak ankle dorsiflexors causing foot drop.

Question 9: A patient presents with a lower extremity wound that has irregular borders, moderate to heavy exudate, and is located near the medial malleolus. What is the MOST likely etiology?

Venous insufficiency ulcer (Correct answer)
Pressure injury
Neuropathic ulcer
Arterial insufficiency ulcer

Correct answer: Venous insufficiency ulcer

Venous insufficiency ulcers typically present near the medial malleolus with irregular borders and moderate to heavy exudate due to venous hypertension.

Question 10: A physical therapist is prescribing low-level laser therapy (LLLT) for a patient with lateral knee pain and delayed soft-tissue healing following a grade II LCL sprain. Which of the following represents an ABSOLUTE contraindication that would require the therapist to withhold treatment?

Direct irradiation over the patient's closed eyes (Correct answer)
Use of LLLT within 72 hours of the initial injury
Application over an area of reduced sensation
Presence of a titanium tibial plate 4 cm distal to the treatment site

Correct answer: Direct irradiation over the patient's closed eyes

Direct irradiation of the eyes with laser, even at low levels, is an absolute contraindication because laser energy can cause irreversible retinal damage regardless of power class. Protective eyewear for both the patient and therapist is mandatory. Metal implants outside the field, reduced sensation, and acute injuries are not absolute contraindications to LLLT.

Question 11: A physical therapist is treating a patient with urinary stress incontinence using neuromuscular electrical stimulation (NMES) to the pelvic floor. Which parameter is MOST critical for achieving a muscle-strengthening effect rather than a fatigue-reduction effect?

Pulse duration below 50 µs to avoid sensory recruitment
Frequency of 2–5 Hz to facilitate endurance of slow-twitch fibers
Frequency of 35–50 Hz to elicit a tetanic contraction of fast-twitch fibers (Correct answer)
On:off ratio of 1:1 with continuous delivery

Correct answer: Frequency of 35–50 Hz to elicit a tetanic contraction of fast-twitch fibers

To elicit a strengthening tetanic contraction, NMES frequencies of 35–50 Hz are required to produce smooth, fused contractions that recruit fast-twitch (type II) muscle fibers. Low frequencies (2–5 Hz) produce twitch contractions targeting endurance, which is appropriate for fatigue-reduction but not strengthening.

Question 12: A physical therapist auscultates a patient's lungs and hears a high-pitched, musical sound during expiration that is audible without a stethoscope. Which term best describes this adventitious breath sound?

Wheezing (Correct answer)
Stridor
Crackles
Rhonchi

Correct answer: Wheezing

Wheezing is a continuous, high-pitched, musical sound produced by air flowing through narrowed airways, most commonly heard during expiration. It is characteristic of conditions such as asthma and COPD. Stridor is a similar sound but occurs during inspiration and indicates upper airway obstruction. Crackles are discontinuous sounds associated with fluid or atelectasis, and rhonchi are low-pitched sounds from secretions in larger airways.

Question 13: A patient with chronic obstructive pulmonary disease (COPD) reports improved breathing with which position?

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

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 14: 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?

Confidentiality (Correct answer)
Fidelity
Beneficence
Veracity

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 15: A patient demonstrates an inability to oppose the thumb and has wasting of the thenar eminence. Which nerve is most likely compressed?

Radial nerve at the elbow
Median nerve at the wrist (Correct answer)
Ulnar nerve at the wrist
Anterior interosseous nerve

Correct answer: Median nerve at the wrist

Carpal tunnel syndrome involves median nerve compression at the wrist, causing thenar wasting and loss of thumb opposition due to opponens pollicis weakness.

Question 16: Which of the following is the CORRECT interpretation of a PaO2 of 55 mmHg and PaCO2 of 55 mmHg on arterial blood gas?

Normal ventilation with mild hypoxemia
Hypoxemia with respiratory alkalosis
Hypoxemia with hypercapnic respiratory failure (Correct answer)
Metabolic acidosis with compensatory hyperventilation

Correct answer: Hypoxemia with hypercapnic respiratory failure

PaO2 of 55 mmHg indicates hypoxemia and PaCO2 of 55 mmHg indicates CO2 retention (hypercapnia), together consistent with type II (hypercapnic/ventilatory) respiratory failure.

Question 17: A patient with a pressure injury (Stage III) on the ischium is receiving electrical stimulation for wound healing. Which waveform is FDA-cleared and MOST evidence-supported for this application?

Symmetrical biphasic pulsed current
High-voltage pulsed current (HVPC) (Correct answer)
Russian stimulation
Interferential current (IFC)

Correct answer: High-voltage pulsed current (HVPC)

High-voltage pulsed current (HVPC) has the strongest evidence and FDA clearance for promoting healing of chronic wounds including pressure injuries.

Question 18: Which breathing exercise is MOST appropriate for a patient with a flail chest to improve ventilatory mechanics?

Glossopharyngeal breathing
Pursed-lip breathing
Incentive spirometry
Diaphragmatic breathing with manual stabilization (Correct answer)

Correct answer: Diaphragmatic breathing with manual stabilization

Manual stabilization of the paradoxical segment during diaphragmatic breathing reduces the inefficiency caused by the floating chest wall segment in flail chest.

Question 19: Andrew is conducting an examination on a patient undergoing rehabilitation following a catastrophic brain injury. Cranial nerve VI is dysfunctional, according to Andrew's evaluation. Which of the following complaints would you anticipate witnessing in this patient's situation?

Difficulty swallowing
Difficulty biting and chewing
Difficulty with the sense of smell
Difficulty moving the affected eyes(s) laterally (Correct answer)

Correct answer: Difficulty moving the affected eyes(s) laterally

Cranial nerve VI is the Abducens nerve, which is solely responsible for innervating the lateral rectus muscle of the eye. This muscle's function is to abduct the eye, meaning to move it laterally away from the midline. Therefore, dysfunction of the Abducens nerve would directly result in difficulty moving the affected eye(s) laterally.

Question 20: During the Functional Reach Test (FRT), what is being measured that makes it a valid clinical indicator of dynamic balance and fall risk?

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

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

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

Correct answer: Grade 3

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

Question 22: A PT treating a patient for low back pain discovers the patient is using opioids prescribed by another provider without disclosing this. The MOST appropriate action is to:

Stop treatment immediately and report the patient
Incorporate this information into the treatment plan and communicate with the prescribing provider (Correct answer)
Notify the patient's employer
Ignore the information as it is outside the PT's scope

Correct answer: Incorporate this information into the treatment plan and communicate with the prescribing provider

Knowledge of opioid use is clinically relevant and must be integrated into care planning with appropriate interprofessional communication.

Question 23: The Ober test is used to assess tightness of which structure?

Adductor magnus
Piriformis muscle
Iliotibial band and tensor fascia latae (Correct answer)
Hip flexor complex

Correct answer: Iliotibial band and tensor fascia latae

The Ober test assesses the flexibility of the iliotibial band (IT band) and tensor fascia latae by observing hip adduction from a side-lying position.

Question 24: During wound irrigation, which pressure range is recommended to effectively remove bacteria and debris without damaging granulation tissue?

16-25 psi
26-35 psi
1-4 psi
4-15 psi (Correct answer)

Correct answer: 4-15 psi

The recommended wound irrigation pressure is 4-15 psi, which is sufficient to remove debris without traumatizing fragile granulation tissue.

Question 25: Which type of electrical stimulation parameter is MOST appropriate for preventing disuse atrophy in a patient with an immobilized limb?

High-volt pulsed current (HVPC) for edema control
Microcurrent (MENS) at subsensory levels
Neuromuscular electrical stimulation (NMES) with sufficient intensity to elicit a visible contraction (Correct answer)
Conventional TENS at high frequency for pain relief

Correct answer: Neuromuscular electrical stimulation (NMES) with sufficient intensity to elicit a visible contraction

NMES at motor-level intensity produces muscle contractions that maintain muscle bulk and prevent disuse atrophy.

Question 26: Which of the following BEST defines 'informed refusal' in physical therapy?

A competent patient declining recommended treatment after being informed of risks and benefits (Correct answer)
A PT refusing to treat a patient
A patient refusing to sign consent forms
A patient refusing to pay for services

Correct answer: A competent patient declining recommended treatment after being informed of risks and benefits

Informed refusal is a competent patient's right to decline treatment after receiving adequate information about the risks, benefits, and alternatives.

Question 27: During the scapular winging test, medial scapular winging during a wall push-up is caused by weakness of which muscle?

Rhomboid major
Serratus anterior (Correct answer)
Trapezius (lower fibers)
Subscapularis

Correct answer: Serratus anterior

Serratus anterior weakness (long thoracic nerve palsy) causes medial scapular winging during pushing activities as the medial border lifts off the thorax.

Question 28: During iontophoresis for calcific tendinitis, a physical therapist uses acetic acid (acetate ion, CH₃COO⁻). Under which electrode should the medication be placed?

Anode (positive electrode), because opposite charges attract the ion into tissue
Either electrode, because polarity does not affect ion migration
The dispersive pad, because it distributes current more evenly
Cathode (negative electrode), because like charges repel the ion into tissue (Correct answer)

Correct answer: Cathode (negative electrode), because like charges repel the ion into tissue

Acetic acid dissociates into the negatively charged acetate ion. In iontophoresis, ions are driven into tissue by repulsion from the same-polarity electrode. Because acetate is negative, it is placed under the cathode (negative electrode), which repels it into the underlying tissue.

Question 29: 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?

Hypovolemic shock
Right ventricular failure
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 30: Which goniometric measurement represents normal passive range of motion for shoulder external rotation with the arm at the side?

45°
60° (Correct answer)
90°
120°

Correct answer: 60°

Normal passive shoulder external rotation measured with the arm at the side is approximately 60°. Values of 90° are sometimes cited for athletes or with scapular stabilization, but the standard normative reference for clinical testing with the arm adducted is 60°.

Question 31: Which special test is most appropriate for assessing the integrity of the anterior cruciate ligament?

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

Correct answer: Lachman test

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

Question 32: A patient requests that their PT not document a specific treatment technique in the record. The PT should:

Omit the documentation to avoid upsetting the patient
Ask the patient to sign a waiver before omitting the entry
Honor the request to maintain therapeutic rapport
Explain that accurate documentation is required and cannot be omitted (Correct answer)

Correct answer: Explain that accurate documentation is required and cannot be omitted

Complete and accurate documentation is both a legal requirement and an ethical obligation; omitting clinical information at a patient's request is not permissible.

Question 33: A PT is treating a patient with a full-thickness burn to the anterior trunk and both anterior lower extremities. Using the Rule of Nines, what percentage of total body surface area (TBSA) is burned?

27%
45%
36% (Correct answer)
54%

Correct answer: 36%

The anterior trunk = 18% and each anterior lower extremity = 9% (×2 = 18%), totaling 36% TBSA using the Rule of Nines.

Question 34: During a 6-minute walk test, a patient with pulmonary arterial hypertension stops at 4 minutes due to severe dyspnea and an oxygen saturation drop from 96% to 84%. Which action should the physical therapist take first?

Measure blood pressure and document the finding
Administer supplemental oxygen and have the patient sit or lie down (Correct answer)
Notify the referring physician before any further action
Encourage the patient to continue at a slower pace

Correct answer: Administer supplemental oxygen and have the patient sit or lie down

An oxygen saturation drop to 84% represents significant hypoxemia (generally, desaturation below 88–90% is a stopping criterion for exercise testing). The immediate priority is patient safety: stopping the exertion, positioning the patient comfortably, and providing supplemental oxygen if available. Documenting vitals and notifying the physician are important subsequent steps, but correcting hypoxemia takes precedence.

Question 35: A patient presents with impaired vibration sense and proprioception but intact pain and temperature sensation. Which spinal cord pathway is most likely affected?

Anterior spinothalamic tract
Lateral spinothalamic tract
Corticospinal tract
Dorsal columns (Correct answer)

Correct answer: Dorsal columns

The dorsal columns (posterior funiculi) carry vibration and proprioception, while the lateral spinothalamic tract carries pain and temperature.

Question 36: A patient with a Stage III pressure injury on the sacrum has significant wound exudate. Which therapeutic modality is MOST appropriate to promote wound healing?

Continuous ultrasound at 1 MHz
Continuous shortwave diathermy
Cryotherapy
Pulsed lavage with suction (Correct answer)

Correct answer: Pulsed lavage with suction

Pulsed lavage with suction provides effective wound debridement and exudate management while promoting granulation tissue formation in pressure injuries.

Question 37: A PT receives a referral to treat a patient for a condition outside the PT's area of competence. What is the most ethical course of action?

Accept the referral but limit treatment to techniques the PT knows
Accept the referral and learn as treatment progresses
Consult with a colleague informally and proceed with treatment
Decline the referral and direct the patient to a qualified provider (Correct answer)

Correct answer: Decline the referral and direct the patient to a qualified provider

Practicing outside one's competence violates the APTA Code of Ethics; the PT should refer the patient to a practitioner with appropriate expertise.

Question 38: A patient with a C5 spinal cord injury would be expected to retain which of the following motor functions?

Full hand grip
Wrist extension only
Shoulder abduction and elbow flexion (Correct answer)
Elbow extension

Correct answer: Shoulder abduction and elbow flexion

C5 innervates the deltoid and biceps, so shoulder abduction and elbow flexion are preserved at this level of injury.

Question 39: A patient presents with a wound that has edges that are raised, rolled under (epibole), and not advancing across the wound bed. This indicates:

Superficial wound requiring no treatment
Newly formed epithelium migrating correctly
Active wound healing progressing normally
Chronic wound with rolled edges requiring intervention (Correct answer)

Correct answer: Chronic wound with rolled edges requiring intervention

Epibole (rolled wound edges) indicates a stalled chronic wound where epithelial cells have rolled under the edge and must be disrupted to allow healing.

Question 40: When using therapeutic ultrasound over an area with a metal implant, which of the following is TRUE?

Metal reflects ultrasound waves, creating dangerous hot spots at the metal-tissue interface
Ultrasound is absolutely contraindicated over all metal implants
The ultrasound beam passes through metal without any interaction
Pulsed ultrasound at low intensity can be safely used if the implant is well-fixed and asymptomatic (Correct answer)

Correct answer: Pulsed ultrasound at low intensity can be safely used if the implant is well-fixed and asymptomatic

Current evidence supports that pulsed ultrasound at low intensity can be safely applied over well-fixed, asymptomatic metal implants, as the thermal effects are minimal and manageable.

Question 41: Which type of medication requires a PT to use the Rating of Perceived Exertion (RPE) scale instead of target heart rate for exercise intensity monitoring?

ACE inhibitors
Statins
Beta-blockers (Correct answer)
Calcium channel blockers (dihydropyridine type)

Correct answer: Beta-blockers

Beta-blockers blunt the cardiac chronotropic response, making heart-rate-based exercise targets inaccurate; RPE is the validated alternative.

Question 42: During gait analysis, loading response (initial double support) is characterized by which combination of joint events?

Hip flexion, knee extension, ankle dorsiflexion
Hip extension, knee flexion, ankle plantarflexion
Hip flexion, knee flexion, ankle plantarflexion (Correct answer)
Hip extension, knee extension, ankle dorsiflexion

Correct answer: Hip flexion, knee flexion, ankle plantarflexion

During loading response, the hip flexes slightly, the knee flexes 15–20° for shock absorption, and the ankle plantarflexes to lower the foot to the floor.

Question 43: Which type of muscle contraction occurs in the quadriceps during the lowering phase of a squat?

Isometric
Isokinetic
Concentric
Eccentric (Correct answer)

Correct answer: Eccentric

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

Question 44: During the loading response phase of gait (0–12% of the gait cycle), the quadriceps act eccentrically primarily to:

Dorsiflex the ankle to prevent foot slap
Control knee flexion and absorb impact forces (Correct answer)
Extend the hip and propel the body forward
Stabilize the subtalar joint in neutral

Correct answer: Control knee flexion and absorb impact forces

During loading response, the knee flexes approximately 15–20° to absorb shock. The quadriceps contract eccentrically to control this flexion and prevent the knee from collapsing. Failure results in a knee-flexion gait deviation or 'buckling knee' pattern.

Question 45: A physical therapist discovers a billing error where services were coded at a higher level than what was actually provided. What should the therapist do?

Ignore it since billing is handled by the administrative staff
Adjust future billing to compensate for the overcharge
Wait until an audit identifies the discrepancy
Report the error to the billing department and request immediate correction (Correct answer)

Correct answer: Report the error to the billing department and request immediate correction

Upcoding is a form of fraud; the therapist has an ethical and legal obligation to report billing errors promptly and ensure they are corrected.

Question 46: Which Universal Precaution guideline applies when a PT is treating a patient with an open wound?

Gloves are only required if the PT has skin breaks
Mask and gown are always required for open wound care
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 47: 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?

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

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 48: Which modality uses high-frequency alternating current (>100,000 Hz) and produces NO neuromuscular stimulation because it is above the threshold for nerve depolarization?

Diathermy (shortwave) (Correct answer)
NMES
TENS
Interferential current

Correct answer: Diathermy (shortwave)

Shortwave diathermy operates at frequencies (27.12 MHz) far above the neuromuscular excitation threshold, so it heats tissue without stimulating nerves or muscles.

Question 49: Which standardized assessment tool is MOST appropriate to evaluate functional balance in a school-age child with cerebral palsy?

Neonatal Behavioral Assessment Scale (NBAS)
Ages and Stages Questionnaire, 3rd Edition (ASQ-3)
Apgar Score
Pediatric Balance Scale (PBS) (Correct answer)

Correct answer: Pediatric Balance Scale (PBS)

The Pediatric Balance Scale is a 14-item functional balance measure validated for children aged 5-15 with motor impairments, directly adapted from the adult Berg Balance Scale.

Question 50: Which of the following BEST represents an example of a dual relationship that a PT should avoid?

Treating patients of different insurance types
Providing PT services to a close friend or family member as a primary therapist (Correct answer)
Treating a patient referred by a colleague
Consulting with a physician about a patient's progress

Correct answer: Providing PT services to a close friend or family member as a primary therapist

Dual relationships — such as treating close friends or family — compromise professional objectivity and create ethical conflicts of interest.

Question 51: Which sensory test involves placing a familiar object in the patient's hand (without vision) and asking them to identify it?

Two-point discrimination
Vibration sense
Graphesthesia
Stereognosis (Correct answer)

Correct answer: Stereognosis

Stereognosis tests the ability to identify objects by touch alone and depends on intact parietal lobe cortical processing.

Question 52: Which phase of wound healing is characterized by formation of granulation tissue and angiogenesis?

Proliferation (Correct answer)
Hemostasis
Inflammation
Remodeling

Correct answer: Proliferation

The proliferative phase involves fibroblast migration, collagen synthesis, angiogenesis, and formation of granulation tissue to fill the wound defect.

Question 53: Which gait deviation is most commonly associated with quadriceps weakness during the loading response phase?

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

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 54: Due to subacromial pain syndrome, Jessica is assisting a patient who is close to being discharged after completing a physical therapy treatment plan. This patient will have to perform open and closed kinetic chain upper extremity workouts as part of their application to the police academy. Which of the following is a closed-chain workout for the upper extremities?

Pull-ups (Correct answer)
Bench press
Standing lateral shoulder raises
Biceps curls

Correct answer: Pull-ups

A closed kinetic chain (CKC) exercise is characterized by the distal segment of the limb being fixed or stabilized against an immovable object, causing the proximal segments to move. In a pull-up, the hands are fixed on the bar, and the body moves towards the hands, making it a classic closed-chain exercise for the upper extremities. In contrast, bench presses, biceps curls, and lateral raises are open kinetic chain exercises where the distal segment (hand/forearm) moves freely in space.

Question 55: 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?

A detailed explanation of the therapist's educational background and years of experience. (Correct answer)
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 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 56: 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?

Bilateral upper extremity involvement with symmetrical weakness
Full active range of motion in 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)
Modified Ashworth Scale score of 0 throughout 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 57: 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
12-14 (Correct answer)
6-8
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 58: 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 a saline solution under the cathode (negative electrode)
Place the acetic acid under the cathode (negative electrode) (Correct answer)
Place the acetic acid under the anode (positive electrode)
Place the acetic acid under either electrode, as polarity does not matter

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 59: A PT suspects a colleague is practicing while impaired by alcohol. What is the most appropriate first action?

Report directly to the state licensing board
Confront the colleague privately and document the interaction
Assume the colleague will self-report and take no action
Follow the facility's protocol for reporting impaired practitioners (Correct answer)

Correct answer: Follow the facility's protocol for reporting impaired practitioners

The first step is to follow the facility's established impaired-practitioner reporting protocol, which then guides subsequent actions.

Question 60: A patient with COPD is being assessed for home oxygen therapy. According to standard clinical guidelines, supplemental oxygen is indicated if resting SpO2 on room air is at or below which threshold?

90%
88% (Correct answer)
94%
92%

Correct answer: 88%

Medicare and major clinical guidelines indicate long-term oxygen therapy when resting SpO2 is ≤88% (or PaO2 ≤55 mmHg) on room air, as this level is associated with significant tissue hypoxia and has demonstrated mortality benefit with supplementation.

Question 61: A PT is using interferential current (IFC) for pain modulation in a post-operative knee patient. The beat frequency most effective for endorphin release is:

150–200 Hz
1–10 Hz (Correct answer)
50–100 Hz
80–150 Hz

Correct answer: 1–10 Hz

Low beat frequencies of 1–10 Hz stimulate endogenous opioid (endorphin) release for longer-lasting pain relief.

Question 62: 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 63: 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)
Ask a colleague to make the correction on their behalf
Leave the record unchanged to avoid drawing attention to the mistake
Delete the incorrect entry and rewrite it with the correct information

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 64: Which nerve root is primarily responsible for the patellar tendon (knee jerk) reflex?

L4 (Correct answer)
L5
L3
L2

Correct answer: L4

The patellar tendon reflex is primarily mediated by the L4 nerve root (with L3 contribution). Diminution or absence of this reflex is a key clinical indicator of L4 nerve root pathology, such as from an L3–L4 disc herniation.

Question 65: Which area of the brain is primarily responsible for the learning and coordination of skilled, sequential movements?

Basal ganglia
Prefrontal cortex
Thalamus
Cerebellum (Correct answer)

Correct answer: Cerebellum

The cerebellum coordinates the timing, sequencing, and precision of skilled voluntary movements and is critical for motor learning.

Question 66: 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
Lateral pivot shift test
Valgus stress 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 67: 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)
Erase the incorrect entry carefully and rewrite the correct information in the same spot.
Use correction fluid to completely cover the error and write the correct information over it.
Black out the entire incorrect entry with a marker so it is illegible and write the correct information in the margin.

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 68: A patient recovering from a total knee arthroplasty is using a continuous passive motion (CPM) machine. Which parameter should be progressed FIRST during the initial postoperative phase?

Duration of treatment session
Speed of motion
End-range extension
Flexion range of motion (Correct answer)

Correct answer: Flexion range of motion

Flexion range of motion is typically progressed first with CPM after total knee arthroplasty, as regaining knee flexion is a primary early rehabilitation goal.

Question 69: The normal cadence for an adult walking at comfortable speed is approximately:

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

Correct answer: 90–120 steps/minute

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

Question 70: Which ASIA Impairment Scale classification describes a patient with motor and sensory function preserved below the neurological level of injury, with more than half of key muscles below the level having a grade less than 3?

ASIA D
ASIA A
ASIA C (Correct answer)
ASIA B

Correct answer: ASIA C

ASIA C indicates motor-incomplete injury where motor function is preserved below the neurological level, but more than half of key muscle functions below the level have a muscle grade less than 3.

Question 71: A physical therapist plans to perform postural drainage on a patient to clear secretions from the posterior basal segments of the lower lobes. Which is the MOST appropriate patient position to target these specific lung segments?

Sitting upright and leaning forward over a pillow.
Sidelying with the head of the bed flat.
Prone with the foot of the bed elevated 18 inches. (Correct answer)
Supine with the foot of the bed elevated 18 inches.

Correct answer: Prone with the foot of the bed elevated 18 inches.

To drain the posterior basal segments of the lower lobes using gravity, the patient should be positioned prone (on their stomach) in a Trendelenburg position, with the foot of the bed or table elevated approximately 18-20 inches (about 30 degrees). This orients the target segments vertically to allow secretions to move towards the larger airways.

Question 72: During nerve conduction velocity testing, which finding is most consistent with demyelinating neuropathy rather than axonal neuropathy?

Significantly reduced conduction velocity (Correct answer)
Fibrillation potentials on EMG
Positive sharp waves on EMG
Reduced amplitude with normal conduction velocity

Correct answer: Significantly reduced conduction velocity

Demyelinating neuropathies characteristically show markedly reduced conduction velocity due to impaired saltatory conduction.

Question 73: A patient recovering from a total knee arthroplasty is two weeks post-surgery and has 75 degrees of knee flexion. What is the MOST appropriate intervention to improve flexion range of motion?

Low-load prolonged stretching (Correct answer)
Aggressive passive range of motion beyond pain tolerance
Isotonic quadriceps strengthening in full range
High-velocity thrust manipulation

Correct answer: Low-load prolonged stretching

Low-load prolonged stretching is the safest and most effective method to increase knee flexion after total knee arthroplasty by promoting tissue creep.

Question 74: A patient with lower extremity wounds has an ankle-brachial index (ABI) of 0.45. Which clinical decision is MOST appropriate based on this finding?

Withhold compression therapy due to severe arterial insufficiency (Correct answer)
Recommend elevation of the limb and elastic bandaging
Initiate whirlpool hydrotherapy to promote circulation
Apply graduated compression therapy to manage edema

Correct answer: Withhold compression therapy due to severe arterial insufficiency

An ABI below 0.5 indicates severe arterial insufficiency. Compression therapy is contraindicated because it would further impede already critically reduced arterial perfusion, risking tissue ischemia and limb loss.

Question 75: During a gait analysis, a patient demonstrates excessive trunk lateral flexion toward the stance limb. Which muscle weakness is most likely responsible?

Gluteus medius (Correct answer)
Iliopsoas
Gluteus maximus
Tensor fasciae latae

Correct answer: Gluteus medius

Gluteus medius weakness causes a Trendelenburg gait; the trunk laterally flexes toward the weak side to bring the center of gravity over the stance limb.

Question 76: 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 77: A 68-year-old male with a 5-year history of idiopathic Parkinson's disease is referred to physical therapy to address progressive difficulty with walking and frequent freezing episodes. Which of the following interventions would be MOST effective for improving gait initiation and continuity?

Use of external visual and auditory cues (Correct answer)
High-amplitude, low-repetition strengthening exercises for the quadriceps
Prolonged static stretching of the hip flexors and pectorals
Massed practice of sit-to-stand transfers without cues

Correct answer: Use of external visual and auditory cues

Patients with Parkinson's disease have difficulty with internally generated movements due to basal ganglia dysfunction. [15, 16] External cues, such as rhythmic auditory stimulation (e.g., a metronome beat) or visual cues (e.g., lines on the floor), can bypass the defective basal ganglia circuitry and utilize alternative pathways to facilitate movement, thereby improving gait initiation, stride length, and reducing freezing of gait. [14, 23] While strengthening and stretching are important components of a comprehensive plan, they do not directly address the mechanism of freezing of gait as effectively as external cueing strategies.

Question 78: 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 cathode (-), and the dispersive pad should be the anode (+). (Correct answer)
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 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 79: A physical therapist is treating a patient with cerebellar ataxia secondary to multiple sclerosis who demonstrates dysmetria and gait instability. Which intervention has the STRONGEST evidence for improving limb coordination in this patient?

Plyometric training emphasizing rapid force production
High-speed treadmill training with body weight support
Frenkel exercises progressing from supine to sitting to standing (Correct answer)
Progressive maximal resistance strengthening of the lower extremities

Correct answer: Frenkel exercises progressing from supine to sitting to standing

Frenkel exercises are specifically designed to address cerebellar ataxia. They use slow, precise movements with visual feedback to compensate for proprioceptive and coordination deficits, progressing systematically from supine to sitting to standing as control improves. Plyometrics and maximal resistance training are contraindicated because they demand rapid, high-load movements the ataxic patient cannot control.

Question 80: A second-degree partial-thickness burn is characterized by which finding?

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

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

Superficial peroneal nerve
Deep peroneal nerve (Correct answer)
Sural nerve
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 82: 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 83: 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?

S2
S4
S3 (Correct answer)
S1

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

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

Correct answer: Positive Babinski sign

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

Question 85: Which gait deviation is MOST commonly associated with excessive foot pronation in the stance phase?

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

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 86: 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?

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

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 87: A patient with acute respiratory distress syndrome (ARDS) is positioned prone by the ICU team. What is the PRIMARY therapeutic rationale for prone positioning?

Improved ventilation-perfusion matching in dorsal lung regions (Correct answer)
Enhanced mucociliary clearance from posterior airways
Decreased venous return to reduce cardiac preload
Increased functional residual capacity by compressing anterior segments

Correct answer: Improved ventilation-perfusion matching in dorsal lung regions

Prone positioning recruits collapsed dorsal lung regions and improves ventilation-perfusion matching, which is the primary mechanism for improving oxygenation in ARDS.

Question 88: Which layer of the skin contains the Meissner's corpuscles and is responsible for most immune defense?

Stratum corneum
Stratum granulosum
Dermis (Correct answer)
Hypodermis

Correct answer: Dermis

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

Question 89: A reciprocal gait orthosis (RGO) is MOST appropriate for which patient population?

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

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 90: A patient with cerebellar ataxia and coordination deficits is treated with Frenkel's exercises. What is the PRIMARY mechanism of this approach?

Building aerobic capacity to reduce fatigue-related ataxia
Stretching tight antagonist muscles to allow smoother movement
Proprioceptive facilitation through joint compression
Visual compensation and cognitive attention to substitute for impaired cerebellar error correction (Correct answer)

Correct answer: Visual compensation and cognitive attention to substitute for impaired cerebellar error correction

Frenkel's exercises use careful visual attention and slow, graded movement to teach patients to substitute visual and cognitive feedback for lost cerebellar coordination.

Question 91: A patient with lateral epicondylalgia has pain with gripping. Which exercise is BEST supported by evidence for this condition?

Isometric shoulder internal rotation
Eccentric wrist extension with a slow lowering phase (Correct answer)
Passive stretching of the finger flexors
Concentric wrist flexion with maximal resistance

Correct answer: Eccentric wrist extension with a slow lowering phase

Eccentric wrist extensor strengthening has strong evidence for reducing pain and improving function in lateral epicondylalgia.

Question 92: Which dressing type provides a moist wound environment, is self-adhesive, and is most appropriate for a clean stage 2 pressure injury with minimal exudate?

Calcium alginate rope
Hydrocolloid dressing (Correct answer)
Alginate dressing
Wet-to-dry gauze

Correct answer: Hydrocolloid dressing

Hydrocolloid dressings maintain a moist environment, are self-adhesive, and are ideal for low-exudate wounds such as stage 2 pressure injuries.

Question 93: A patient with a T6 complete spinal cord injury uses a KAFO with forearm crutches. Which gait pattern is MOST energy-efficient for this patient over short distances?

Reciprocal gait
Four-point gait
Swing-through gait (Correct answer)
Swing-to gait

Correct answer: Swing-through gait

Swing-through gait is the fastest and most energy-efficient pattern for patients with thoracic SCI using bilateral KAFOs and crutches, despite its high-energy demands.

Question 94: A physical therapist is treating a patient who suddenly discloses that they are experiencing thoughts of self-harm. What is the MOST appropriate first action?

Continue the treatment session and document the disclosure at the end
Discharge the patient from physical therapy services
Immediately notify the supervising physician or appropriate mental health professional (Correct answer)
Reassure the patient that these feelings are normal and proceed with therapy

Correct answer: Immediately notify the supervising physician or appropriate mental health professional

When a patient discloses suicidal ideation or self-harm thoughts, the therapist has an ethical and legal duty to act immediately by notifying the appropriate provider (physician, mental health professional, or emergency services) to ensure patient safety. Continuing treatment or dismissing the concern places the patient at risk.

Question 95: During terminal stance, the center of mass moves anterior to the base of support. Which muscle group is MOST critical for controlling forward progression at this point?

Quadriceps
Hip extensors
Hip flexors
Ankle plantarflexors (Correct answer)

Correct answer: Ankle plantarflexors

The ankle plantarflexors (gastrocnemius and soleus) undergo lengthening contraction during terminal stance to control forward progression and generate propulsive force.

Question 96: A patient underwent an arthroscopic Bankart repair for anterior shoulder instability 8 weeks ago. The patient has achieved full passive range of motion and demonstrates good initial strength of the rotator cuff. Which of the following activities should the patient continue to AVOID?

Coupled motion of 90 degrees of abduction and 90 degrees of external rotation (Correct answer)
Active-assisted supine external rotation to 90 degrees
Resisted internal rotation in the scapular plane
Isometrics for the deltoid and rotator cuff

Correct answer: Coupled motion of 90 degrees of abduction and 90 degrees of external rotation

Following a Bankart repair, the 'at-risk' position of combined abduction and external rotation places significant stress on the repaired anterior labrum and capsule. This position is typically avoided for at least 12 weeks post-operatively to protect the healing tissues. The other activities listed are generally appropriate and part of the progressive strengthening phase at 8 weeks post-op.

Question 97: A physical therapist discovers that a colleague is treating patients while under the influence of alcohol. What is the most appropriate initial course of action?

Ignore the situation to avoid conflict
Report the colleague to the state licensing board (Correct answer)
Discuss the matter with other coworkers first
Confront the colleague privately and ask them to stop

Correct answer: Report the colleague to the state licensing board

Licensed physical therapists have a mandatory duty to report impaired practitioners to the appropriate licensing authority to protect patient safety.

Question 98: In order to treat Karen's stress urine incontinence, she is undergoing physical therapy, and one of the objectives of her therapist is to teach her how to contract her pelvic floor musculature. Which of the following uses of biofeedback for pelvic floor retraining is well-established?

A pressure biofeedback unit placed under the lumbar spine in supine position
Electrodermography
Rehabilitative ultrasound imaging (Correct answer)
Verbal and manual tactile cues

Correct answer: Rehabilitative ultrasound imaging

Rehabilitative ultrasound imaging (RUSI) provides real-time visual feedback of muscle contractions, allowing both the therapist and patient to observe the activation and relaxation of deep muscles, including the pelvic floor. This direct visualization helps patients learn to correctly isolate and contract their pelvic floor musculature, making it a well-established and effective biofeedback method for retraining in conditions like stress urinary incontinence. Other options like electrodermography or pressure biofeedback units are less specific for directly visualizing pelvic floor muscle activity.

Question 99: A positive Hoffman sign is indicative of:

Carpal tunnel syndrome
Upper motor neuron dysfunction in the upper extremity (Correct answer)
Peripheral neuropathy
Lower motor neuron lesion

Correct answer: Upper motor neuron dysfunction in the upper extremity

A positive Hoffman sign (reflex finger flexion when the middle finger nail is flicked) suggests an upper motor neuron lesion affecting the cervical spinal cord or brain.

Question 100: During quiet standing, which system provides the PRIMARY sensory input for balance in a well-lit environment on a firm surface?

Vestibular
Cerebellar
Visual
Proprioceptive/somatosensory (Correct answer)

Correct answer: Proprioceptive/somatosensory

On a firm, stable surface, the proprioceptive/somatosensory system provides the dominant input for balance control.

Question 101: A physical therapist is about to initiate an exercise session with a new patient in an outpatient setting. A review of the patient's chart reveals a recent diagnosis of symptomatic, severe aortic stenosis. Which of the following is the MOST appropriate action for the therapist to take?

Hold the exercise session and contact the referring physician. (Correct answer)
Begin with resistance training using light weights.
Perform active range of motion and stretching only.
Proceed with low-intensity aerobic exercise.

Correct answer: Hold the exercise session and contact the referring physician.

Symptomatic severe aortic stenosis is an absolute contraindication to exercise testing and training. Patients with this condition have a fixed cardiac output and cannot increase blood flow to meet the demands of exercise, which can lead to syncope or sudden death. Therefore, initiating an exercise session would be unsafe. The therapist must hold the session and communicate with the physician for clarification and guidance.

Question 102: 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:

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

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

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

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 104: In a patient with Achilles tendinopathy, which clinical finding would indicate a chronic degenerative (tendinosis) pattern rather than acute reactive tendinopathy?

Severe pain at rest with marked swelling
Nodular thickening and pain mid-tendon with load (Correct answer)
Diffuse warmth and swelling along the tendon
Pain worse in the morning that eases with activity

Correct answer: Nodular thickening and pain mid-tendon with load

Nodular mid-tendon thickening and load-dependent pain are characteristic of chronic tendinosis (degenerative collagen disarray) rather than acute reactive changes.

Question 105: Which of the following BEST describes the end-feel of a normal elbow extension?

Firm (capsular)
Empty
Soft (soft tissue approximation)
Hard (bony) (Correct answer)

Correct answer: Hard (bony)

Normal elbow extension has a hard/bony end-feel due to the olecranon process contacting the olecranon fossa, abruptly stopping motion.

Question 106: Which ligament is the PRIMARY restraint against anterior tibial translation on the femur?

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

Correct answer: Anterior cruciate ligament

The anterior cruciate ligament is the primary static stabilizer preventing anterior translation of the tibia relative to the femur.

Question 107: A patient with a cardiac pacemaker presents for shoulder rehabilitation. Which modality is SAFE to apply to the ipsilateral shoulder?

Therapeutic ultrasound (Correct answer)
Neuromuscular electrical stimulation (NMES)
Shortwave diathermy
Transcutaneous electrical nerve stimulation (TENS)

Correct answer: Therapeutic ultrasound

Therapeutic ultrasound does not generate electrical current and does not interfere with pacemaker function when applied away from the chest.

Question 108: 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
Discard and restart with a new piece of material
Increase water bath temperature above the recommended range
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 109: A patient recovering from a stroke demonstrates hypertonicity with elbow flexion, wrist flexion, and finger flexion. This pattern is consistent with which synergy?

Lower extremity flexor synergy
Upper extremity flexor synergy (Correct answer)
Upper extremity extensor 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 110: 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 111: When using high-volt pulsed current (HVPC) for wound healing, which polarity is typically used in the proliferative phase to promote fibroblast activity?

Positive polarity (Correct answer)
Alternating polarity every session
Polarity has no effect in wound healing
Negative polarity

Correct answer: Positive polarity

Positive polarity HVPC attracts fibroblasts and promotes collagen synthesis during the proliferative phase of wound healing.

Question 112: A patient with COPD is completing pulmonary rehabilitation. Target SpO2 during exercise should be maintained at a minimum of:

88%
85%
92% (Correct answer)
95%

Correct answer: 92%

Exercise should be modified or supplemental oxygen provided if SpO2 drops below 88–90%; 88% is the clinical threshold, but 92% is the safe exercise target.

Question 113: 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 4
Stage 5
Stage 2
Stage 3 (Correct answer)

Correct answer: Stage 3

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

Question 114: Which dermatome corresponds to sensation over the lateral aspect of the foot and the fifth toe?

L5
S1 (Correct answer)
L4
S2

Correct answer: S1

The S1 dermatome supplies sensation to the lateral foot and the fifth (little) toe. L4 covers the medial lower leg and foot, L5 covers the dorsum of the foot and great toe, and S2 covers the posterior thigh and calf.

Question 115: A therapist is treating a patient with lumbar spinal stenosis. Which position will most likely relieve the patient's symptoms during exercise?

Standing upright
Prone extension
Lumbar rotation
Lumbar flexion (e.g., seated or supine knee-to-chest) (Correct answer)

Correct answer: Lumbar flexion (e.g., seated or supine knee-to-chest)

Lumbar flexion increases the spinal canal diameter, relieving neural compression and symptoms in patients with lumbar stenosis.

Question 116: Which skin condition is characterized by a chronic autoimmune blistering disorder primarily affecting skin folds and mucous membranes in older adults?

Psoriasis vulgaris
Contact dermatitis
Eczema herpeticum
Pemphigus vulgaris (Correct answer)

Correct answer: Pemphigus vulgaris

Pemphigus vulgaris is an autoimmune blistering disease affecting mucous membranes and skin in older adults, caused by antibodies against desmogleins.

Question 117: A 55-year-old male presents with a chief complaint of sharp, stabbing pain at the medial aspect of his heel, which is most intense with his first steps in the morning. The physical therapist's examination reveals pes planus and excessive subtalar joint pronation during gait. Which of the following orthotic interventions would be MOST beneficial?

A metatarsal pad placed just proximal to the metatarsal heads
A full-length insert with medial longitudinal arch support and a medial heel post (Correct answer)
A cushioned heel lift to offload the Achilles tendon
A lateral forefoot post to encourage supination

Correct answer: A full-length insert with medial longitudinal arch support and a medial heel post

The patient's presentation is classic for plantar fasciitis, which is often exacerbated by pes planus (flat feet) and excessive pronation. A full-length orthotic with substantial medial longitudinal arch support will help to support the plantar fascia and reduce tensile stress. A medial heel post helps to control the excessive pronation at the subtalar joint, addressing the underlying biomechanical fault contributing to the condition.

Question 118: 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 slowly, exhale slowly, with a focus on relaxation of the body and a slowing of the breathing rate.
Inhale deeply, hold the breath for 2-3 seconds, then gently exhale as if sighing (Correct answer)
Inhale deeply, followed by a forced series of two coughs
Inhale followed by an exhale of moderate force with an open glottis

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

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

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 120: A PT patient newly started on selective serotonin reuptake inhibitors (SSRIs) reports dizziness upon standing. The BEST PT intervention is:

Apply abdominal binders and compression stockings
Teach sit-to-stand safety techniques and allow time for postural adaptation (Correct answer)
Discontinue gait training until medication is stopped
Refer immediately to the emergency department

Correct answer: Teach sit-to-stand safety techniques and allow time for postural adaptation

SSRIs can cause orthostatic hypotension early in treatment; teaching position-change strategies reduces fall risk during this adaptation period.

Question 121: A patient's knee joint effusion is best detected using which clinical test?

Ballottement test (Correct answer)
Valgus stress test
Lachman test
McMurray test

Correct answer: Ballottement test

The ballottement (patellar tap) test detects large knee effusions by compressing the suprapatellar pouch and feeling the patella bounce off the femur.

Question 122: Which class of medication is most likely to cause orthostatic hypotension and increase fall risk during PT sessions?

Antibiotics
Statins
Proton pump inhibitors
Antihypertensives (Correct answer)

Correct answer: Antihypertensives

Antihypertensives reduce blood pressure and can cause drops in BP upon position changes, increasing fall risk.

Question 123: A patient with a C5-C6 disc herniation would MOST likely present with weakness in which movement?

Finger flexion and wrist flexion
Wrist extension and elbow flexion (Correct answer)
Intrinsic hand muscles
Elbow extension and wrist flexion

Correct answer: Wrist extension and elbow flexion

C5-C6 nerve roots innervate the biceps (elbow flexion) and wrist extensors; a herniation at this level typically impairs these movements.

Question 124: A PT is treating a patient with a venous insufficiency ulcer. Which characteristic finding is most consistent with this diagnosis?

Pale, punched-out ulcer on the heel
Shallow ulcer with irregular edges around the medial malleolus (Correct answer)
Deep ulcer with undermining over a bony prominence
Dry, gangrenous tissue on the toes

Correct answer: Shallow ulcer with irregular edges around the medial malleolus

Venous insufficiency ulcers classically appear as shallow, irregular wounds around the medial malleolus with surrounding hemosiderin staining and edema.

Question 125: A patient with a right CVA presents with left neglect. During ADL training, what is the BEST initial strategy?

Increase proprioceptive input to the right limbs
Train the patient to actively scan to the left side (Correct answer)
Place all functional items on the patient's right side
Use a mirror to provide visual feedback

Correct answer: Train the patient to actively scan to the left side

Training the patient to actively scan toward the neglected side is the primary treatment strategy for unilateral spatial neglect.

Question 126: Surface EMG biofeedback is used with a post-stroke patient. What is the PRIMARY therapeutic goal?

Provide real-time sensory information to facilitate volitional muscle activation (Correct answer)
Accurately measure absolute muscle force
Replace the need for manual muscle testing
Assess peripheral nerve conduction velocity

Correct answer: Provide real-time sensory information to facilitate volitional muscle activation

EMG biofeedback gives patients visual or auditory representation of muscle activity, helping them learn to volitionally activate muscles that they may not be able to sense or control.

Question 127: A therapist performing a Spurling's test applies downward compression and lateral flexion of the cervical spine toward the symptomatic side. A positive test is indicated by:

Reproduction of radicular symptoms into the ipsilateral arm (Correct answer)
Bilateral upper extremity numbness
Increased range of cervical rotation
Reproduction of local neck pain only

Correct answer: Reproduction of radicular symptoms into the ipsilateral arm

Spurling's test is positive when the maneuver reproduces radicular (nerve root) symptoms — pain, numbness, or tingling — radiating into the ipsilateral arm. Local neck pain alone does not constitute a positive finding for foraminal compression.

Question 128: A physical therapist is treating a patient with acute lateral epicondylitis using therapeutic ultrasound. Which duty cycle setting would BEST minimize thermal effects while still delivering mechanical benefits to the tissue?

50% pulsed
100% continuous
75% pulsed
20% pulsed (Correct answer)

Correct answer: 20% pulsed

A 20% pulsed duty cycle (1:4 on:off ratio) minimizes heat accumulation in tissue while still delivering non-thermal mechanical effects such as cavitation and acoustic streaming. Continuous (100%) and higher duty cycles generate significant thermal effects, which are contraindicated during acute inflammation.

Question 129: When is it appropriate for a PT to terminate a therapeutic relationship with a patient?

When the patient is non-compliant for a single session
When the patient has achieved goals, plateaued, or when continuing care is no longer in their best interest (Correct answer)
When the patient files an insurance claim that is denied
When the patient questions the PT's treatment choices

Correct answer: When the patient has achieved goals, plateaued, or when continuing care is no longer in their best interest

Termination is appropriate when goals are met, progress has plateaued, or continuing care would not benefit the patient.

Question 130: A patient with cystic fibrosis is receiving postural drainage in a Trendelenburg position. Which lung segments are being targeted?

Lower lobe basal segments (Correct answer)
Left lingula
Right middle lobe
Upper lobe apical segments

Correct answer: Lower lobe basal segments

Trendelenburg positioning with head lower than feet uses gravity to drain secretions from the lower lobe basal segments.

Question 131: A child with spastic diplegic cerebral palsy demonstrates a scissoring gait pattern. Which muscle group is PRIMARILY responsible for this pattern?

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

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 132: 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?

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

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 133: A patient with a T4 spinal cord injury suddenly complains of a pounding headache, and the physical therapist notes profuse sweating and flushing of the skin above the level of the lesion. The therapist measures the patient's blood pressure and finds it to be significantly elevated. Which of the following should be the therapist's IMMEDIATE course of action?

Sit the patient upright, loosen any restrictive clothing, and check for noxious stimuli. (Correct answer)
Continue with the planned therapeutic exercise to see if the symptoms subside.
Lay the patient down flat to help lower their blood pressure.
Administer a prescribed fast-acting vasodilator without further assessment.

Correct answer: Sit the patient upright, loosen any restrictive clothing, and check for noxious stimuli.

The patient is exhibiting classic signs of autonomic dysreflexia, a medical emergency common in individuals with spinal cord injuries at T6 or above. The initial and most crucial steps are to sit the patient upright to help lower blood pressure via orthostatic hypotension, remove any tight clothing or binders, and then immediately search for and remove the offending noxious stimulus, which is most commonly a distended bladder or bowel. Laying the patient flat would dangerously increase their blood pressure. Continuing exercise or administering medication without first trying to remove the stimulus is inappropriate.

Question 134: Which auscultation finding at the lung bases is most commonly associated with congestive heart failure?

Diminished breath sounds unilaterally
Bilateral inspiratory crackles (Correct answer)
Pleural friction rub
Expiratory wheezing

Correct answer: Bilateral inspiratory crackles

Bilateral basilar crackles heard on inspiration indicate fluid accumulation in the alveoli, which is characteristic of congestive heart failure.

Question 135: A PT is evaluating the periwound skin and observes maceration. Which of the following is the most likely cause?

Wound drying out due to inadequate moisture
Excessive wound exudate saturating the periwound skin (Correct answer)
Arterial insufficiency reducing skin perfusion
Radiation damage to the epidermis

Correct answer: Excessive wound exudate saturating the periwound skin

Maceration is caused by excessive moisture (typically from heavy wound exudate) that softens and breaks down periwound skin, making it white, soft, and friable.

Question 136: A therapist performs a Maitland Grade III mobilization. Which description BEST defines this technique?

Large amplitude at the beginning of range
Small amplitude at the end of range
Large amplitude into resistance, not reaching end range (Correct answer)
Small amplitude at the beginning of range

Correct answer: Large amplitude into resistance, not reaching end range

Maitland Grade III is a large-amplitude oscillatory mobilization that moves into the resistance barrier but does not reach the absolute end of range.

Question 137: The Epley canalith repositioning maneuver is the first-line treatment for which condition?

Posterior canal BPPV causing brief positional vertigo (Correct answer)
Vestibular neuritis causing continuous vertigo
Meniere's disease with endolymphatic hydrops
Central vertigo from cerebellar stroke

Correct answer: Posterior canal BPPV causing brief positional vertigo

The Epley maneuver uses gravity and head positioning to move displaced otoconia from the posterior semicircular canal back into the utricle, resolving posterior canal BPPV.

Question 138: During TENS application for pain relief using the conventional (high-rate) mode, which sensory response indicates correct electrode placement and intensity?

Comfortable tingling or paresthesia without muscle contraction (Correct answer)
Visible muscle twitch with mild discomfort
Strong noxious sensation without muscle contraction
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 139: 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:

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

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 140: Which finding in a patient taking digoxin should cause the PT to immediately stop treatment?

Resting heart rate below 50 bpm with nausea and visual changes (Correct answer)
Mild fatigue with exercise
Resting HR of 72 bpm
Mild ankle edema

Correct answer: Resting heart rate below 50 bpm with nausea and visual changes

Bradycardia below 60 bpm combined with nausea and visual disturbances are classic signs of digoxin toxicity requiring immediate medical attention.

Question 141: Which muscle is the primary mover for scapular upward rotation during shoulder elevation?

Rhomboids
Upper trapezius alone
Levator scapulae
Serratus anterior and lower trapezius acting as a force couple (Correct answer)

Correct answer: Serratus anterior and lower trapezius acting as a force couple

Scapular upward rotation is produced by the force couple of the upper trapezius, lower trapezius, and serratus anterior working together.

Question 142: A patient who has recently been diagnosed with COPD and fibromyalgia is being treated by a physical therapist. Which of the ensuing duties need should the physical therapist assign to an assistant?

Ambulating the patient for the first time
Taking the patient's vital sign while setting up an exercise program
Transferring the patient during the third visit (Correct answer)
Educating the patient on monitoring fatigue

Correct answer: Transferring the patient during the third visit

Physical therapist assistants (PTAs) can perform interventions that are part of the established plan of care and do not require complex decision-making. Transferring a patient during their third visit, assuming the patient's condition is stable and the PTA is trained, is an appropriate task. Initial ambulation, setting up exercise programs, and educating on fatigue monitoring typically require the clinical judgment of a physical therapist.

Question 143: 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?

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

Correct answer: 0.50-0.79

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

Question 144: During manual muscle testing, a patient can move the shoulder through full range of motion against gravity but cannot tolerate any additional resistance. What grade would a physical therapist assign to this muscle?

Grade 2 (Poor)
Grade 5 (Normal)
Grade 3 (Fair) (Correct answer)
Grade 4 (Good)

Correct answer: Grade 3 (Fair)

Grade 3 (Fair) is assigned when the patient can complete full range of motion against gravity but cannot tolerate any additional manual resistance. Grade 4 requires movement against some resistance, and Grade 5 requires movement against full resistance.

Question 145: According to Maitland's joint mobilization classification, a Grade IV technique is best described as:

A single high-velocity thrust at the end of range
Small-amplitude oscillations at the end of the available range (Correct answer)
Large-amplitude oscillations through the full available range
Small-amplitude oscillations at the beginning of the available range

Correct answer: Small-amplitude oscillations at the end of the available range

Maitland Grade IV consists of small-amplitude rhythmic oscillations performed at the end of the available range of motion, used to address stiffness and restricted joint mobility. Grade III is large amplitude reaching the end of range, while Grade V is the manipulation thrust.

Question 146: What is the primary purpose of negative pressure wound therapy (NPWT)?

To promote granulation tissue formation by applying subatmospheric pressure (Correct answer)
To provide thermal insulation to the wound
To deliver topical antibiotics directly to the wound bed
To mechanically debride necrotic tissue from 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 147: A physical therapist evaluates a 4-year-old child who walks and runs age-appropriately but cannot hop on one foot. This finding is BEST characterized as:

Severely delayed, requiring immediate neurological referral and imaging
Within normal limits, as hopping on one foot develops between ages 5-6 years
Expected for a child who was premature regardless of current corrected age
A gross motor delay, as hopping on one foot typically emerges around age 3-4 years (Correct answer)

Correct answer: A gross motor delay, as hopping on one foot typically emerges around age 3-4 years

Hopping on one foot typically emerges around age 3-4 years, so inability to hop at age 4 represents a delay in fundamental motor skill development warranting intervention.

Question 148: 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?

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.
Politely decline the gift, explaining that professional guidelines discourage accepting high-value items to avoid any appearance of a conflict of interest. (Correct answer)
Suggest the patient donate the painting to the hospital's fundraising auction instead.

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 149: A patient presents with a shallow wound on the medial aspect of the lower leg with irregular edges, copious serous drainage, periwound edema, and brown hemosiderin staining of the surrounding skin. Which wound etiology is MOST consistent with this presentation?

Arterial (ischemic) ulcer
Venous stasis ulcer (Correct answer)
Pressure injury
Diabetic neuropathic ulcer

Correct answer: Venous stasis ulcer

Venous stasis ulcers classically occur on the medial lower leg near the gaiter area, are shallow with irregular borders, produce heavy serous exudate, and cause hemosiderin staining from red blood cell extravasation due to chronic venous hypertension. Arterial ulcers are typically punched-out, painful, and located distally.

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?

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

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 patient with adhesive capsulitis of the shoulder would MOST likely demonstrate which capsular pattern of restriction?

Abduction most limited, then external rotation, then internal rotation
Flexion most limited, then abduction, then external rotation
External rotation most limited, then abduction, then internal rotation (Correct answer)
Internal rotation most limited, then abduction, then external rotation

Correct answer: External rotation most limited, then abduction, then internal rotation

The glenohumeral capsular pattern restricts external rotation most, followed by abduction and then internal rotation.

Question 152: Which duty cycle parameter in NMES is MOST directly adjusted to manage muscle fatigue during functional electrical stimulation training?

On-to-off time ratio (Correct answer)
Peak current amplitude (mA)
Pulse frequency (Hz)
Pulse width (microseconds)

Correct answer: On-to-off time ratio

The duty cycle (on:off ratio) determines how long the muscle is actively contracting versus resting; longer off times reduce fatigue during repetitive NMES-assisted movement.

Question 153: During a manual muscle test, a patient can move a body segment through full range of motion against gravity but cannot tolerate any additional resistance. What grade is assigned?

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

Correct answer: Grade 3

Grade 3 (Fair) indicates the patient can complete full range of motion against gravity only, with no added resistance. Grade 2 requires gravity-eliminated positioning, Grade 4 tolerates some resistance, and Grade 5 tolerates full resistance.

Question 154: At what heart rate threshold should a PT terminate exercise in a patient on a beta-blocker, given the Karvonen formula cannot be used reliably?

220 minus age
130 bpm
Rate of perceived exertion of 13-15 on the Borg scale (Correct answer)
110 bpm

Correct answer: Rate of perceived exertion of 13-15 on the Borg scale

Beta-blockers blunt the heart rate response, making HR-based targets unreliable; RPE (Borg scale 13-15) is the preferred exercise intensity guide in these patients.

Question 155: Which intervention is CONTRAINDICATED for a child with juvenile idiopathic arthritis (JIA) during an acute joint flare?

Warm water aquatic therapy at a comfortable temperature
Resting splints to maintain optimal joint alignment
Gentle active-assisted range of motion exercises within a pain-free range
High-intensity resistive exercises targeting the acutely inflamed joint (Correct answer)

Correct answer: High-intensity resistive exercises targeting the acutely inflamed joint

High-intensity resistive exercise targeting an acutely inflamed joint increases intra-articular stress and worsens synovial inflammation, risking further joint damage.

Question 156: A PT student observes their clinical instructor performing a technique that appears to cause unnecessary patient discomfort. The student's BEST action is to:

Discuss observations with the clinical instructor or program coordinator (Correct answer)
Refuse to participate in future similar treatments
Remain silent to avoid jeopardizing the clinical placement
Immediately file a complaint with the state board

Correct answer: Discuss observations with the clinical instructor or program coordinator

Students should address clinical concerns through appropriate professional channels, starting with the clinical instructor or academic program coordinator.

Question 157: Constraint-induced movement therapy (CIMT) is MOST appropriate for which patient?

Bilateral upper extremity paresis of equal severity
Chronic stroke with at least 10° of active wrist extension in the paretic limb (Correct answer)
Patient within 48 hours of stroke onset with severe edema
Acute stroke with complete flaccid hemiplegia and no wrist movement

Correct answer: Chronic stroke with at least 10° of active wrist extension in the paretic limb

CIMT eligibility requires sufficient residual motor function (typically ≥10° wrist extension and ≥10° finger extension) to perform mass practice; complete hemiplegia does not meet this threshold.

Question 158: Which spirometry value is most useful for differentiating obstructive from restrictive pulmonary disease?

FEV1/FVC ratio (Correct answer)
RV
FVC
TLC

Correct answer: FEV1/FVC ratio

The FEV1/FVC ratio is reduced in obstructive disease (airflow limitation) but normal or elevated in restrictive disease.

Question 159: During lumbar spine assessment, a positive FABER (Patrick's) test suggests pathology in which structure?

Piriformis muscle
Sacroiliac joint or hip joint (Correct answer)
Lumbar disc
Lumbar facet joint

Correct answer: Sacroiliac joint or hip joint

The FABER test stresses both the sacroiliac joint and the hip joint; a positive test (groin or posterior pain) implicates pathology in either structure.

Question 160: Which of the following is a cardinal sign differentiating infected cellulitis from a deep vein thrombosis (DVT) in a patient with a lower extremity wound?

Localized warmth and erythema only
Pitting edema with a positive Homans' sign
Calf pain with dorsiflexion and normal skin temperature
Fever, ascending red streaks (lymphangitis), and purulent wound drainage (Correct answer)

Correct answer: Fever, ascending red streaks (lymphangitis), and purulent wound drainage

Lymphangitis (ascending red streaks), fever, and purulent drainage are signs of spreading wound infection/cellulitis rather than DVT.

Question 161: A therapist reviews a chest X-ray and notes opacification of the right lower lobe with an air bronchogram. This radiographic finding is MOST consistent with:

Lobar pneumonia (Correct answer)
Pleural effusion
Pulmonary embolism
Pneumothorax

Correct answer: Lobar pneumonia

Air bronchograms within an area of opacification indicate air-filled bronchi surrounded by consolidated (fluid-filled) lung tissue, characteristic of lobar pneumonia.

Question 162: A physical therapist is performing manual chest physiotherapy on a patient with cystic fibrosis. The MOST important contraindication to percussion and vibration is:

Barrel chest deformity
Recent rib fracture or osteoporosis (Correct answer)
Productive cough with thick sputum
Bronchiectasis

Correct answer: Recent rib fracture or osteoporosis

Recent rib fractures or severe osteoporosis are absolute contraindications to percussion and vibration because of the risk of further fracture or injury.

Question 163: Under the APTA Standards of Practice, supervision of a PTA by a PT requires that the PT:

Be available for consultation and conduct regular supervision per state law (Correct answer)
Be physically present in the same room at all times
Review and revise the PTA's plan of care independently
Cosign every treatment note written by the PTA

Correct answer: Be available for consultation and conduct regular supervision per state law

PT supervision of PTAs requires availability for consultation and regular supervisory contact, with specific requirements varying by state law.

Question 164: What does the principle of 'beneficence' require of a PT in clinical practice?

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

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

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

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 166: Which dermatome is tested by assessing sensation over the lateral forearm?

C5
T1
C7
C6 (Correct answer)

Correct answer: C6

The C6 dermatome covers the lateral forearm, thumb, and index finger, commonly affected in C6 radiculopathy.

Question 167: A patient using long-term corticosteroids is most at risk for which musculoskeletal complication relevant to PT?

Muscle hypertrophy
Joint effusion
Osteoporosis and fracture risk (Correct answer)
Ligament laxity

Correct answer: Osteoporosis and fracture risk

Chronic corticosteroid use suppresses bone formation and accelerates bone resorption, leading to osteoporosis.

Question 168: A patient presents with weakness of the deltoid and inability to abduct the shoulder beyond 15 degrees. Which nerve is most likely injured?

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

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 169: When performing a posterior drawer test of the knee, the physical therapist places the patient supine with the hip at 45 degrees and knee at 90 degrees, then pushes the tibia posteriorly. Excessive posterior translation indicates injury to which structure?

Anterior cruciate ligament
Posterior cruciate ligament (Correct answer)
Medial collateral ligament
Posterolateral corner complex

Correct answer: Posterior cruciate ligament

The posterior drawer test specifically stresses the posterior cruciate ligament (PCL). Posterior force on the proximal tibia at 90 degrees of knee flexion causes excessive posterior tibial translation when the PCL is torn.

Question 170: A patient with a skin sensitivity complaint after treatment states the skin feels hot and looks red after cryotherapy. Which term describes this paradoxical hunting response?

Raynaud's phenomenon
Reactive hyperemia
Lewis hunting reaction (Correct answer)
Vasoconstriction rebound

Correct answer: Lewis hunting reaction

The Lewis hunting reaction is a cyclical vasoconstriction and vasodilation that prevents tissue freezing during prolonged cold application.

Question 171: A patient demonstrates difficulty walking on heels and foot drop. Which nerve root level is most likely affected?

L4
L5 (Correct answer)
L3
S1

Correct answer: L5

L5 nerve root innervates the tibialis anterior and extensor hallucis longus; an L5 lesion causes dorsiflexion weakness and foot drop.

Question 172: Which type of traction is MOST appropriate for a patient with acute cervical radiculopathy who cannot tolerate positional changes?

Continuous mechanical traction
Positional traction
Manual traction in supine (Correct answer)
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 173: A physical therapist performs a FABER test on a patient complaining of hip and groin pain. The patient reports sharp, anterior hip pain during the maneuver. This finding is MOST indicative of which of the following conditions?

Piriformis syndrome
Sacroiliac joint dysfunction
Lumbar radiculopathy
Intra-articular hip pathology (Correct answer)

Correct answer: Intra-articular hip pathology

The FABER (Flexion, ABduction, External Rotation) test, also known as Patrick's test, stresses the hip joint. Pain elicited in the anterior hip or groin region is suggestive of intra-articular hip pathology, such as femoroacetabular impingement (FAI), a labral tear, or osteoarthritis. Pain in the posterior pelvis or buttock region during this test would be more indicative of sacroiliac joint dysfunction.

Question 174: When applying cervical traction using a mechanical unit, what is the recommended treatment angle to target the lower cervical segments (C5-C7)?

45 degrees of flexion
0 degrees of flexion
25-30 degrees of flexion (Correct answer)
15 degrees of flexion

Correct answer: 25-30 degrees of flexion

Approximately 25-30 degrees of cervical flexion is recommended to effectively target the lower cervical segments during mechanical traction.

Question 175: What is the MOST appropriate dressing for a wound with heavy exudate and a clean granulating base?

Transparent film
Hydrogel sheet
Alginate dressing (Correct answer)
Hydrocolloid dressing

Correct answer: Alginate dressing

Alginate dressings are highly absorbent and ideal for managing wounds with heavy exudate while maintaining a moist wound environment.

Question 176: Which ethical principle is MOST directly violated when a PT provides unnecessary treatments to increase billing?

Autonomy
Veracity
Justice
Nonmaleficence (Correct answer)

Correct answer: Nonmaleficence

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

Question 177: A patient status post-coronary artery bypass graft (CABG) has sternal precautions. Which activity is CONTRAINDICATED in early rehabilitation?

Pushing up from a chair using both arms simultaneously (Correct answer)
Ankle pumps in supine
Diaphragmatic breathing exercises
Bilateral shoulder flexion to 90 degrees

Correct answer: Pushing up from a chair using both arms simultaneously

Pushing up with both arms simultaneously creates bilateral sternal stress and risks sternal dehiscence, which is contraindicated with sternal precautions after CABG.

Question 178: During gait analysis, a physical therapist observes excessive lateral trunk lean toward the stance limb. Which muscle weakness most likely causes this compensatory pattern?

Gluteus medius (Correct answer)
Hamstrings
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 179: A patient recovering from coronary artery bypass graft surgery reports sternal pain with deep breathing and a productive cough. The physical therapist observes paradoxical sternal movement on palpation. Which complication should be most suspected?

Pericarditis
Pneumothorax
Sternal wound dehiscence (Correct answer)
Pleural effusion

Correct answer: Sternal wound dehiscence

Paradoxical sternal movement — where the sternum moves inward rather than outward during inspiration, or shows instability with palpation — is a hallmark sign of sternal dehiscence (separation of the surgically wired sternum). This is a serious post-CABG complication that requires immediate cessation of activities that stress the sternum and urgent surgical consultation. Pericarditis causes pleuritic chest pain but not sternal instability; pleural effusion and pneumothorax present with respiratory and auscultatory findings rather than sternal movement abnormalities.

Question 180: During the swing phase of gait, a patient with a below-knee brace (AFO) exhibits toe drag. Which AFO adjustment would BEST correct this?

Widen the AFO footplate
Reduce the height of the AFO trim lines
Add a dorsiflexion assist spring (Correct answer)
Increase plantarflexion stop resistance

Correct answer: Add a dorsiflexion assist spring

A dorsiflexion assist spring in the AFO helps lift the foot during swing phase, preventing toe drag caused by inadequate dorsiflexion.

Question 181: For a patient with chronic venous insufficiency and lower extremity edema, which physical agent modality is MOST appropriate to assist fluid mobilization?

Ultrasound over the posterior calf
Cryotherapy with compression wrap
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 182: A patient with a C6 spinal cord injury would be expected to have intact function of which muscle group?

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

Correct answer: Wrist extensors

C6 innervates the wrist extensors (extensor carpi radialis longus and brevis), which remain functional at this level.

Question 183: A PT is treating a patient who reveals plans to harm a specific person. The PT's MOST appropriate response is to:

Warn the intended victim and appropriate authorities (Correct answer)
Consult with the patient's insurance company
Immediately discharge the patient
Maintain confidentiality and continue treatment

Correct answer: Warn the intended victim and appropriate authorities

Under the duty to warn (Tarasoff principle), clinicians must take reasonable steps to protect identifiable third parties from serious credible threats.

Question 184: Which neuromuscular junction disorder is characterized by antibodies against acetylcholine receptors, resulting in fluctuating weakness that worsens with repeated activity?

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

Correct answer: Myasthenia gravis

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

Question 185: A patient 6 weeks post total knee arthroplasty is having difficulty achieving full knee extension. Which intervention should be prioritized?

Aquatic therapy for knee flexion
Terminal knee extension exercises and prone knee extension stretching (Correct answer)
Electrical stimulation for quadriceps only
Aggressive high-load knee flexion

Correct answer: Terminal knee extension exercises and prone knee extension stretching

Achieving full knee extension after TKA is critical to prevent flexion contracture; terminal knee extension exercises and prolonged low-load stretching in prone are prioritized.

Question 186: A physical therapist assistant (PTA) is treating a patient with low back pain. During the session, the patient reports a significant increase in pain and new-onset foot drop. The PTA contacts the supervising PT, who is off-site. Which of the following is the MOST appropriate instruction for the PT to give the PTA?

Direct the PTA to discontinue the treatment session, document the patient's report, and ensure the patient is scheduled for an immediate re-evaluation with the physical therapist. (Correct answer)
Instruct the PTA to modify the treatment to include only gentle stretching and modalities.
Tell the PTA to perform a straight leg raise test and a basic neurological screen to gather more data.
Advise the PTA to continue with the planned treatment but to avoid any activities that cause pain.

Correct answer: Direct the PTA to discontinue the treatment session, document the patient's report, and ensure the patient is scheduled for an immediate re-evaluation with the physical therapist.

New-onset foot drop is a red flag indicating a potential serious neurological change that requires immediate assessment by the physical therapist. The PTA's scope of practice does not include performing evaluative tests, interpreting findings, or modifying the plan of care based on a significant change in patient status. The safest and most appropriate action is for the supervising PT to direct the PTA to stop treatment and facilitate a re-evaluation by the PT before any further intervention is provided.

Question 187: A patient presents with a positive Phalen's test. Which nerve is most likely compressed?

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

Correct answer: Median nerve

Phalen's test provokes symptoms of carpal tunnel syndrome by compressing the median nerve at the wrist.

Question 188: 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?

Posterior cruciate ligament (Correct answer)
Medial collateral ligament
Lateral 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 189: 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?

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

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 190: Which principle of therapeutic exercise states that training adaptations are specific to the type, speed, and range of motion used during training?

SAID principle (Specific Adaptation to Imposed Demands) (Correct answer)
Overload principle
Progressive resistance principle
Reversibility principle

Correct answer: SAID principle (Specific Adaptation to Imposed Demands)

The SAID principle states that the body adapts specifically to the demands placed upon it; training must mimic the target activity's mechanics for optimal transfer.

Question 191: A patient with chronic kidney disease has an elevated serum potassium level (6.2 mEq/L). The PT should be MOST concerned about:

Muscle hypertrophy from high potassium
Cardiac arrhythmia risk during exercise (Correct answer)
Dehydration during exercise
Hypoglycemia during exercise

Correct answer: Cardiac arrhythmia risk during exercise

Hyperkalemia destabilizes cardiac cell membranes and can trigger life-threatening arrhythmias, making vigorous exercise potentially dangerous.

Question 192: 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?

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

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

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

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 194: When Julia walks into a patient room at an outpatient physical therapy facility, she discovers an unconscious patient who has collapsed on the floor. She calls a staff member right away and instructs them to dial 911 and get the automated external defibrillator (AED). Julia examines the patient, who has a pulse but is not breathing normally. She turns the patient over on their back. What is the following best action in the chain of survival decision-making?

Wait for the AED to arrive and apply it to the patient
Immediately begin chest compressions at a rate of 100-120/minute
Begin rescue breaths, delivering one every 6 seconds (Correct answer)
Monitor the patient's breathing and pulse until the emergency responders arrive

Correct answer: Begin rescue breaths, delivering one every 6 seconds

The patient has a pulse but is not breathing normally, indicating respiratory arrest rather than cardiac arrest. In this scenario, the immediate priority is to provide rescue breaths to oxygenate the patient's blood. According to current American Heart Association (AHA) guidelines for an adult with a pulse but not breathing normally, rescue breaths should be delivered at a rate of one breath every 5-6 seconds (approximately 10-12 breaths per minute).

Question 195: Which intervention has the STRONGEST evidence for producing long-term functional improvement in patients with upper motor neuron spasticity?

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

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 196: A therapist is applying ultrasound over a bony prominence. Which parameter should be adjusted to reduce periosteal heating?

Increase frequency to 3 MHz
Decrease duty cycle (Correct answer)
Switch to continuous mode
Increase intensity

Correct answer: Decrease duty cycle

Decreasing the duty cycle (using pulsed mode) reduces the total energy delivered and minimizes periosteal heating near bony surfaces.

Question 197: Which phase of the normal gait cycle occupies approximately 60% of the total cycle?

Stance phase (Correct answer)
Swing phase
Double support phase
Single limb support phase

Correct answer: Stance phase

The stance phase (from initial contact to toe off) constitutes approximately 60% of the normal gait cycle at comfortable walking speed.

Question 198: A patient with unilateral vestibular hypofunction is prescribed gaze stabilization exercises. What is the PRIMARY mechanism of these exercises?

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

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 199: A therapist is selecting a prosthetic foot component for a K3-level transtibial amputee who wants to return to jogging. Which foot is MOST appropriate?

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

Correct answer: Energy-storing/returning carbon fiber foot

Energy-storing and returning (ESR) carbon fiber feet store energy during loading and release it at push-off, enabling higher activity levels including jogging.

Question 200: During a treatment session, a patient's blood pressure rises to 190/110 mmHg. What is the most appropriate immediate action?

Immediately call 911 without first reassessing
Document the finding and notify the physician at the end of the day
Stop exercise, have the patient rest, and reassess blood pressure within 5 minutes (Correct answer)
Continue the exercise at a lower intensity

Correct answer: Stop exercise, have the patient rest, and reassess blood pressure within 5 minutes

Stage 2 hypertension during exercise requires stopping activity and reassessing; if BP remains elevated or symptoms develop, medical referral is warranted.

Question 201: Which of the following BEST describes 'clinical competence' as an ethical obligation for PTs?

Continuously updating knowledge and skills to provide current, evidence-based care (Correct answer)
Passing the NPTE once and maintaining licensure
Limiting practice to conditions treated during internships
Treating only conditions covered by one's employer

Correct answer: Continuously updating knowledge and skills to provide current, evidence-based care

Ethical competence requires ongoing professional development and lifelong learning to maintain current evidence-based practice.

Question 202: 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?

Parent education is minimized to reduce caregiver anxiety about the progressive nature of SMA
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
The physical therapist independently determines all treatment goals and progression based on clinical expertise

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 203: Which ABCDE criterion for melanoma assessment refers to a lesion having two or more distinct colors?

Color (Correct answer)
Asymmetry
Border
Diameter

Correct answer: Color

The 'C' in the ABCDE melanoma screening criteria stands for Color variation, which includes multiple shades of brown, black, red, or white within a single lesion.

Question 204: Which pharmacological agent used in the treatment of hypertension can cause exercise-induced hypotension and blunt the heart rate response to exercise?

Diuretics
Calcium channel blockers
Beta-blockers (Correct answer)
ACE inhibitors

Correct answer: Beta-blockers

Beta-blockers blunt sympathetic-mediated heart rate increase and can cause exertional hypotension, requiring rate of perceived exertion (RPE) rather than heart rate for exercise intensity monitoring.

Question 205: When applying a commercially prepared moist heat pack to a patient's lumbar spine, what is the recommended minimum number of towel layers between the pack and the patient's skin to prevent burns?

10–12 layers
1–2 layers
6–8 layers (Correct answer)
3–4 layers

Correct answer: 6–8 layers

Standard clinical guidelines recommend 6–8 layers of dry toweling between a hydrocollator moist heat pack and the skin. Hydrocollator packs can reach temperatures of 70–75°C (158–167°F), and this layering is necessary to reduce the surface temperature to a therapeutically safe range of approximately 40–45°C.

Question 206: Which type of muscle contraction produces the greatest amount of force for a given level of muscle activation?

Eccentric (Correct answer)
Concentric
Isometric
Isokinetic 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 207: Which factor most significantly impairs wound healing in a patient who is malnourished?

Impaired collagen synthesis due to inadequate protein and vitamin C (Correct answer)
Excessive platelet aggregation at the wound site
Increased inflammatory cytokine production
Accelerated keratinocyte migration across the wound surface

Correct answer: Impaired collagen synthesis due to inadequate protein and vitamin C

Protein deficiency impairs collagen synthesis, and vitamin C deficiency (a cofactor for proline hydroxylation) further weakens collagen crosslinking, delaying healing.

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?

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)
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)

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: Which exercise is considered CLOSED kinetic chain for the lower extremity?

Seated leg extension machine
Prone hip extension
Supine straight leg raise
Wall squat (wall slide) (Correct answer)

Correct answer: Wall squat (wall slide)

A wall squat is a closed kinetic chain exercise because the foot remains in contact with a fixed surface, causing simultaneous multi-joint motion under load.

Question 210: A patient with L4 nerve root dysfunction will MOST likely require which orthotic device?

Solid ankle AFO
AFO with dorsiflexion assist (Correct answer)
Knee-ankle-foot orthosis (KAFO)
Swedish knee cage

Correct answer: AFO with dorsiflexion assist

L4 innervates the tibialis anterior (dorsiflexors); weakness causes foot drop, best managed with a dorsiflexion-assist AFO.

Question 211: A patient with left-sided heart failure presents with orthopnea and paroxysmal nocturnal dyspnea. Which pathophysiological mechanism most directly causes these positional symptoms?

Increased venous return to the right heart when supine elevating pulmonary hydrostatic pressure (Correct answer)
Reduced diaphragmatic excursion due to abdominal ascites
Decreased systemic vascular resistance when supine
Increased sympathetic activation during recumbency

Correct answer: Increased venous return to the right heart when supine elevating pulmonary hydrostatic pressure

When a patient with left heart failure lies supine, gravity no longer pools blood in the lower extremities, resulting in increased venous return to the right side of the heart. The failing left ventricle cannot accommodate this increased preload, causing pulmonary venous congestion and elevated hydrostatic pressure, which leads to pulmonary edema and dyspnea. This is the direct mechanism for both orthopnea (dyspnea when lying flat) and paroxysmal nocturnal dyspnea.

Question 212: A patient with Parkinson's disease exhibits a festinating gait. Which characteristic best describes this pattern?

Steppage gait with high knee flexion
Involuntary acceleration with short shuffling steps (Correct answer)
Wide base with lateral trunk sway
Unilateral circumduction of the lower extremity

Correct answer: Involuntary acceleration with short shuffling steps

Festination is an involuntary increase in gait speed with progressively shorter shuffling steps, characteristic of Parkinson's disease.

Question 213: A patient presents with numbness in the fourth and fifth digits and weakness of the intrinsic hand muscles. Tapping at the medial elbow reproduces symptoms. Which nerve is MOST likely affected?

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

Correct answer: Ulnar nerve

The ulnar nerve passes through the cubital tunnel at the medial elbow and innervates the fourth and fifth digits along with most intrinsic hand muscles.

Question 214: A patient with Guillain-Barré syndrome typically presents with which pattern of weakness?

Unilateral weakness affecting one limb
Descending weakness starting in the cranial nerves
Ascending bilateral weakness starting in the distal lower extremities (Correct answer)
Proximal upper extremity weakness only

Correct answer: Ascending bilateral weakness starting in the distal lower extremities

Guillain-Barré syndrome classically presents with ascending, symmetric weakness beginning in the feet and legs.

Question 215: A therapist observes fasciculations and muscle atrophy in a patient's right quadriceps. These findings are most consistent with a lesion of which structure?

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

Correct answer: Lower motor neuron

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

Question 216: 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?

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

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 217: The Bobath (NDT) approach primarily aims to achieve which therapeutic outcome?

Maximal resistance training to hypertrophied weak muscles
Repetitive task practice regardless of movement quality
Strengthening through progressive resistive exercise protocols
Inhibition of abnormal tone and facilitation of normal movement patterns through handling (Correct answer)

Correct answer: Inhibition of abnormal tone and facilitation of normal movement patterns through handling

NDT focuses on normalizing postural tone and facilitating typical movement patterns through therapist handling, key points of control, and preparation of the neuromuscular system.

Question 218: A wound swab culture returns positive for Pseudomonas aeruginosa. Which clinical sign is most associated with this organism?

Sulfur-yellow granules in the wound
Black eschar with surrounding crepitus
White, cottony surface growth
Blue-green exudate with a fruity odor (Correct answer)

Correct answer: Blue-green exudate with a fruity odor

Pseudomonas aeruginosa characteristically produces blue-green (pyocyanin) pigmented exudate with a fruity or grape-like odor.

Question 219: Which outcome measure uses a 6-item test including single-leg stance and tandem walking to assess fall risk?

Timed Up and Go (TUG)
Tinetti POMA (Correct answer)
Dynamic Gait Index (DGI)
Functional Reach Test

Correct answer: Tinetti POMA

The Tinetti Performance-Oriented Mobility Assessment (POMA) includes balance and gait subscales, and is widely used to assess fall risk in older adults.

Question 220: A patient with Parkinson disease demonstrates a shuffling gait pattern. Which neurotransmitter deficiency is primarily responsible for this motor dysfunction?

GABA
Serotonin
Acetylcholine
Dopamine (Correct answer)

Correct answer: Dopamine

Parkinson disease results from degeneration of dopaminergic neurons in the substantia nigra, leading to characteristic motor deficits.

Question 221: 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?

High frequency (80-150 pps), long pulse duration (>200 microseconds)
Low frequency (2-10 pps), long pulse duration (>200 microseconds)
Low frequency (2-10 pps), short pulse duration (50-100 microseconds)
High frequency (80-150 pps), short pulse duration (50-100 microseconds) (Correct answer)

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 222: A patient sustained a burn from spilling hot coffee on their forearm. The area is bright red, moist, and has several intact blisters. The patient reports significant pain, and the area blanches with pressure. Based on these findings, how should the physical therapist classify this burn?

Superficial partial-thickness burn (Correct answer)
Deep partial-thickness burn
Superficial burn
Full-thickness burn

Correct answer: Superficial partial-thickness burn

A superficial partial-thickness burn (second-degree) involves the epidermis and the upper dermis. Its key characteristics include intact blisters, a moist and weeping appearance, significant pain, and blanching with pressure. A superficial burn would be red without blisters. A deep partial-thickness burn is often mottled white or red, may not have blisters, and has less pain due to nerve damage. A full-thickness burn appears leathery or charred and is insensate.

Question 223: A patient presents with foot drop, weakness of ankle dorsiflexion, and sensory loss over the dorsum of the foot. Which nerve is most likely injured?

Sural nerve
Common peroneal nerve (Correct answer)
Saphenous nerve
Tibial nerve

Correct answer: Common peroneal nerve

The common peroneal nerve innervates the muscles responsible for ankle dorsiflexion and eversion, and provides sensation to the dorsum of the foot.

Question 224: A patient recovering from a stroke demonstrates difficulty initiating voluntary movements despite intact strength. Which area of the brain is most likely affected?

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

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

Irradiation
Habituation (Correct answer)
Facilitation
Sensitization

Correct answer: Habituation

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

Question 226: A 45-year-old construction worker presents with lumbar radiculopathy and a positive straight leg raise at 40 degrees. Which treatment approach has the STRONGEST evidence for this presentation?

Aggressive trunk flexion exercises
High-velocity lumbar manipulation in full flexion
Prolonged bed rest for 2 weeks
Mechanical traction combined with directional preference exercises (Correct answer)

Correct answer: Mechanical traction combined with directional preference exercises

Mechanical traction combined with directional preference exercises (often extension-based) can centralize symptoms and reduce nerve root compression in acute lumbar radiculopathy.

Question 227: A physical therapist is working with an 80-year-old patient who has early-stage dementia. The patient's adult child, who holds a durable power of attorney for healthcare, insists the therapist perform a painful stretching procedure that the patient is verbally refusing. What is the therapist's MOST appropriate initial action?

Perform the stretching procedure but document the patient's verbal refusal for legal protection.
Follow the directive of the adult child, as they hold legal authority for healthcare decisions.
Refuse to treat the patient and initiate discharge from physical therapy due to non-adherence.
Pause the intervention, document the conflict, and consult with the referring physician or the facility's ethics committee for guidance. (Correct answer)

Correct answer: Pause the intervention, document the conflict, and consult with the referring physician or the facility's ethics committee for guidance.

This situation presents an ethical conflict between the patient's expressed wish (autonomy) and the legal authority of the substitute decision-maker. Even if a patient has diminished capacity, their refusal should not be ignored. Forcing treatment on a refusing patient could be considered battery. The most prudent and ethical action is to pause, document the dilemma, and seek guidance from appropriate resources like an ethics committee or the physician to formally clarify the patient's decision-making capacity and mediate the conflict.

Question 228: Which tract is primarily responsible for carrying proprioceptive information from the lower extremities to the cerebral cortex?

Dorsal column-medial lemniscal pathway (Correct answer)
Lateral spinothalamic tract
Anterior spinothalamic tract
Spinocerebellar 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 229: A patient presents with a resting heart rate of 52 bpm, no symptoms, and is on atenolol. What is the most appropriate action?

Withhold exercise and contact the physician
Perform a graded exercise test before any activity
Proceed with exercise using RPE to monitor intensity (Correct answer)
Immediately call emergency services

Correct answer: Proceed with exercise using RPE to monitor intensity

Beta-blockers like atenolol lower resting heart rate, so RPE is a more reliable measure of exercise intensity than heart rate.

Question 230: A patient is 4 months post-total hip arthroplasty via a posterior approach and has been cleared for full activity. Which exercise should STILL be avoided?

Prone hip extension
Hip abduction with resistance band in standing
Supine bridging with a ball between the knees
Seated hip flexion beyond 90 degrees combined with adduction and internal rotation (Correct answer)

Correct answer: Seated hip flexion beyond 90 degrees combined with adduction and internal rotation

The combination of hip flexion beyond 90 degrees with adduction and internal rotation places the posterior hip capsule at risk for dislocation even in later stages of posterior approach recovery.

Question 231: 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?

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

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 232: 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?

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

Correct answer: Extensor carpi radialis brevis

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

Question 233: 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?

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

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 234: A patient with chronic low back pain is being treated with transcutaneous electrical nerve stimulation (TENS). Which parameter adjustment would MOST likely increase the depth of current penetration?

Increase the pulse duration (Correct answer)
Decrease the electrode size without changing amplitude
Increase the pulse frequency
Decrease the amplitude

Correct answer: Increase the pulse duration

Increasing pulse duration allows more charge to be delivered per pulse, which increases the depth of current penetration into tissue.

Question 235: Which laboratory value would cause a physical therapist to withhold exercise for a patient undergoing chemotherapy?

Hematocrit of 38%
Hemoglobin of 11 g/dL
White blood cell count of 6,000/mm3
Platelet count below 20,000/mm3 (Correct answer)

Correct answer: Platelet count below 20,000/mm3

A platelet count below 20,000/mm3 is a contraindication to exercise due to a significantly elevated risk of spontaneous bleeding.

Question 236: A therapist applies interferential current (IFC) using two medium-frequency carrier currents of 4,000 Hz and 4,080 Hz. What beat frequency is produced within the tissue, and which physiological effect does this range BEST target?

4,000 Hz — sensory nerve depolarization only
8,080 Hz — primarily used for muscle strengthening
80 Hz — pain modulation via gate control theory (Correct answer)
4,040 Hz — deep tissue heating

Correct answer: 80 Hz — pain modulation via gate control theory

The beat frequency in IFC equals the arithmetic difference between the two carrier frequencies (4,080 − 4,000 = 80 Hz). Beat frequencies in the 80–150 Hz range activate large-diameter Aβ sensory fibers, producing analgesia through the gate control mechanism.

Question 237: A patient presents with insidious onset of cervical pain and numbness radiating into the ring and little fingers with weakness of grip. Which cervical level is most likely involved?

C5
C7
C8 (Correct answer)
C6

Correct answer: C8

C8 radiculopathy produces sensory changes in the ring and little fingers (ulnar two digits) and weakness in hand intrinsics and grip.

Question 238: A physical therapist is treating a patient with chronic supraspinatus tendinopathy. The therapeutic goal is to increase tissue temperature and extensibility in the target tissue prior to stretching exercises. Which of the following ultrasound parameters is MOST appropriate?

Pulsed at 3 MHz, 0.8 W/cm²
Pulsed at 1 MHz, 1.0 W/cm²
Continuous at 3 MHz, 1.2 W/cm² (Correct answer)
Continuous at 1 MHz, 1.5 W/cm²

Correct answer: Continuous at 3 MHz, 1.2 W/cm²

To achieve thermal effects (heating) for increased tissue extensibility, a continuous duty cycle is required. The supraspinatus tendon is a superficial structure, making the 3 MHz frequency the most appropriate choice as it targets tissue depths of 1-2 cm. A 1 MHz frequency penetrates deeper (up to 5 cm) and would be less effective for this specific tendon. Pulsed ultrasound is used for non-thermal effects, such as promoting tissue healing.

Question 239: A physical therapist receives a subpoena requesting a patient's therapy records for a legal proceeding. The patient has not authorized release. What is the MOST appropriate action?

Refuse to release records under any circumstances
Consult with legal counsel and notify the patient before responding to the subpoena (Correct answer)
Release only the records that support the patient's case
Immediately release all records as legally required by the subpoena

Correct answer: Consult with legal counsel and notify the patient before responding to the subpoena

When receiving a subpoena, the therapist should consult legal counsel and notify the patient, as a subpoena alone may not override HIPAA protections without a valid court order or patient authorization.

Question 240: A PT documents treatment in a patient's medical record and later realizes an error was made. What is the correct way to amend the record?

Use correction fluid to cover the error and rewrite the correct information
Delete the original entry and replace it with the corrected version
Leave the error and add a separate note explaining the mistake at the end of the record
Draw a single line through the error, write 'error,' initial and date it, then add the correct entry (Correct answer)

Correct answer: Draw a single line through the error, write 'error,' initial and date it, then add the correct entry

The correct procedure is to draw a single line through the error, note 'error,' initial and date it, preserving the original entry's legibility.

Question 241: A physical therapist selects a warm whirlpool for a patient with peripheral vascular disease and a non-healing wound on the lower extremity. The water temperature should NOT exceed which value?

102°F (38.9°C)
98°F (36.7°C)
92°F (33°C) (Correct answer)
110°F (43.3°C)

Correct answer: 92°F (33°C)

For patients with peripheral vascular disease, water temperature should not exceed 92°F (33°C) because impaired circulation limits the ability to dissipate heat, increasing burn risk.

Question 242: 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 35-50 Hz, ramp up 2-3 sec, on:off ratio 1:5 (Correct answer)
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

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 243: Which diuretic side effect most directly requires modification of a PT exercise program?

Hypokalemia causing muscle weakness (Correct answer)
Mild headache
Increased urine output at night
Reduced thirst sensation

Correct answer: Hypokalemia causing muscle weakness

Hypokalemia from diuretics impairs skeletal muscle function and can cause weakness, cramping, and arrhythmias affecting exercise safety.

Question 244: Which electrotherapy parameter describes the number of pulses delivered per second?

Phase charge
Frequency (Correct answer)
Pulse duration
Amplitude

Correct answer: Frequency

Frequency, measured in hertz (Hz) or pulses per second (pps), describes how many electrical pulses are delivered each second.

Question 245: Which intervention is MOST appropriate as first-line treatment for an infant diagnosed with congenital muscular torticollis (CMT)?

Mechanical cervical traction applied by the physical therapist
Strengthening of the ipsilateral sternocleidomastoid to balance tension
Passive cervical stretching, active range of motion facilitation, and caregiver education in positioning (Correct answer)
Surgical release of the sternocleidomastoid at 3 months of age

Correct answer: Passive cervical stretching, active range of motion facilitation, and caregiver education in positioning

Conservative management with passive stretching, active movement facilitation, and caregiver education in positioning and carrying is the evidence-based first-line treatment for CMT.

Question 246: Amanda has chosen to use mechanical traction as a treatment option for a patient who suffers from neck pain and upper extremity paresthesia. Which of the following situations makes the use of mechanical cervical traction contraindicated?

Osteoporosis (Correct answer)
Cervical spondylosis
Cervical foraminal stenosis
Cervical radiculopathy

Correct answer: Osteoporosis

Osteoporosis is a condition characterized by decreased bone density, making the bones fragile and susceptible to fractures. Applying mechanical cervical traction, which involves a tensile force on the cervical spine, to an osteoporotic patient significantly increases the risk of vertebral fracture or other serious injury. Therefore, osteoporosis is a strong contraindication for the use of mechanical cervical traction.

Question 247: A therapist applies shortwave diathermy to a patient with a total knee replacement. Why is this contraindicated?

Shortwave diathermy is only contraindicated for pacemakers
The magnetic field demagnetizes the implant
Metal implants concentrate electromagnetic energy, causing excessive heating (Correct answer)
Diathermy increases joint effusion around implants

Correct answer: Metal implants concentrate electromagnetic energy, causing excessive heating

Metal implants reflect and concentrate shortwave diathermy energy, creating dangerous temperature elevations in surrounding tissue.

Question 248: A patient is in Stage 3 of Brunnstrom's stages of recovery following a stroke. Which of the following clinical findings is MOST characteristic of this stage?

Spasticity begins to decrease, and isolated joint movements become possible.
The patient begins to demonstrate movement that is not dominated by synergistic patterns.
The patient exhibits marked spasticity and can perform voluntary movements only within synergy patterns. (Correct answer)
The patient's affected limbs are completely flaccid with no voluntary movement.

Correct answer: The patient exhibits marked spasticity and can perform voluntary movements only within synergy patterns.

Brunnstrom's Stage 3 is characterized by the peak of spasticity. During this stage, the patient gains voluntary control of the abnormal movement synergies that appeared in Stage 2, but they are unable to move outside of these stereotyped patterns. Flaccidity is Stage 1. Moving outside of synergy patterns begins in Stage 4, which is also when spasticity starts to decrease.

Question 249: 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
Plantarflexor push-off at pre-swing
Hip abductor strength during single-limb support
Knee flexion and ankle dorsiflexion during swing (Correct answer)

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 250: A physical therapist is applying therapeutic ultrasound to treat soft tissue shortening of the hip joint capsule. To achieve a vigorous thermal effect in this deep tissue, which of the following parameter settings is MOST appropriate?

Frequency: 1 MHz, Duty Cycle: 100% (Continuous), Intensity: 1.5 W/cm² (Correct answer)
Frequency: 1 MHz, Duty Cycle: 20% (Pulsed), Intensity: 0.5 W/cm²
Frequency: 3 MHz, Duty Cycle: 100% (Continuous), Intensity: 0.8 W/cm²
Frequency: 3 MHz, Duty Cycle: 50% (Pulsed), Intensity: 1.2 W/cm²

Correct answer: Frequency: 1 MHz, Duty Cycle: 100% (Continuous), Intensity: 1.5 W/cm²

To achieve a thermal effect in deep tissues (up to 5 cm), a frequency of 1 MHz is required. A 100% continuous duty cycle ensures constant energy delivery for heating. An intensity of 1.5 to 2.0 W/cm² is typically needed to produce vigorous heating at this depth. The other options are incorrect because 3 MHz is for superficial tissues, and pulsed duty cycles (20%, 50%) are used for non-thermal effects.

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%

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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