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

Question 1: A physical therapist is teaching a patient with severe chronic obstructive pulmonary disease (COPD) a breathing technique to help relieve dyspnea by maintaining positive airway pressure during exhalation and preventing premature airway collapse. Which of the following techniques BEST accomplishes this goal?

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

Correct answer: Pursed-lip breathing

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

Question 2: Which outcome measure is MOST appropriate for assessing balance and fall risk across a broad range of neurological diagnoses?

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

Correct answer: Berg Balance Scale (BBS)

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

Question 3: A patient with a stroke has weakness of the right face, arm, and leg. Where is the lesion most likely located?

Left middle cerebral artery territory (Correct answer)
Right middle cerebral artery territory
Brainstem
Left posterior cerebral artery

Correct answer: Left middle cerebral artery territory

The motor cortex in the left hemisphere controls the right side of the body; MCA strokes typically cause contralateral hemiplegia with arm and face more affected than leg.

Question 4: A positive Apley compression test combined with a negative Apley distraction test at the knee indicates pathology of which structure?

Menisci (Correct answer)
Cruciate ligaments
Collateral ligaments
Patellofemoral joint

Correct answer: Menisci

Apley compression loads the menisci between the femur and tibia (positive = meniscal pain), while distraction unloads the menisci but stresses the ligaments.

Question 5: 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 6: A patient with a subacute posterolateral lumbar disc herniation is prescribed mechanical traction. The goal of the initial session is to assess tolerance and begin to achieve separation of the vertebral bodies. Which of the following force settings is MOST appropriate for this initial treatment?

25% of the patient's body weight (Correct answer)
10% of the patient's body weight
50% of the patient's body weight
75% of the patient's body weight

Correct answer: 25% of the patient's body weight

To overcome the force of friction and begin to cause mechanical separation of the lumbar vertebrae, a force of at least 25% of the patient's body weight is generally required. While up to 50% may be needed for full separation, starting at 25% is a safe and standard practice for an initial session to assess patient tolerance. 10% is insufficient for separation, while 50% may be too aggressive initially, and 75% is excessive and unsafe.

Question 7: A patient post-CVA demonstrates circumduction of the lower extremity during the swing phase. This compensatory movement most directly substitutes for inadequate:

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

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

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

Correct answer: Ability to perform active exercise during treatment

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

Question 9: A patient presents with rotator cuff tendinopathy confirmed by MRI. Strengthening exercises are prescribed. Which approach is BEST supported by current evidence?

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

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

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

Question 10: A PT assesses a wound and notes tunneling at the 3 o'clock position extending 2 cm. How should this finding be documented according to standard wound assessment convention?

Undermining is present anteriorly extending 2 cm
Tunneling 2 cm at the lateral border
A sinus tract is located at the proximal aspect of the wound
Tunneling is present at 3 o'clock, 2 cm deep, measured with the patient supine, head = 12 o'clock (Correct answer)

Correct answer: Tunneling is present at 3 o'clock, 2 cm deep, measured with the patient supine, head = 12 o'clock

Standard wound documentation uses a clock-face orientation with the patient's head at 12 o'clock, and tunneling depth is recorded in centimeters.

Question 11: Surface EMG biofeedback is used with a post-stroke patient. What is the PRIMARY therapeutic goal?

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

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

Basal ganglia
Cerebellum (Correct answer)
Thalamus
Primary motor cortex

Correct answer: Cerebellum

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

Question 13: 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?

Resisted internal rotation in the scapular plane
Coupled motion of 90 degrees of abduction and 90 degrees of external rotation (Correct answer)
Active-assisted supine external rotation to 90 degrees
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 14: A PT measures a patient's shoulder ROM at 160° of flexion. According to the APTA, the normal value for shoulder flexion is:

190°
150°
180° (Correct answer)
170°

Correct answer: 180°

Normal shoulder flexion is 180° according to standard physical therapy reference values.

Question 15: A patient taking warfarin is referred to PT. Which monitoring parameter is most relevant to the PT's plan of care?

INR level (Correct answer)
Fasting glucose
Serum creatinine
Serum sodium

Correct answer: INR level

INR reflects anticoagulation status and directly affects fall-risk precautions and wound-care decisions in PT.

Question 16: A patient presents with a shallow ulcer on the medial aspect of the lower leg, superior to the malleolus. The surrounding skin exhibits a brownish discoloration (hemosiderin staining) and significant pitting edema. The wound has irregular borders and is producing a moderate amount of serous drainage. These clinical findings are MOST consistent with which type of ulcer?

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

Correct answer: Venous insufficiency ulcer

The classic presentation of a venous insufficiency ulcer includes a location on the medial lower leg (gaiter area), irregular borders, hemosiderin staining due to chronic fluid leakage, and significant edema. Arterial ulcers are typically located on the toes or lateral malleolus and have a 'punched-out' appearance. Neuropathic ulcers are found on weight-bearing surfaces of the foot, and pressure injuries occur over bony prominences.

Question 17: When applying cervical traction using a mechanical unit, what is the recommended treatment angle to target the lower cervical segments (C5-C7)?

0 degrees of flexion
15 degrees of flexion
25-30 degrees of flexion (Correct answer)
45 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 18: A patient who has had a right-hemisphere stroke consistently pushes strongly with their left arm and leg, leaning to their paretic right side and resisting any attempts at passive correction to midline. Which intervention strategy is MOST appropriate for this patient?

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

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

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

Question 19: A patient is referred for vestibular rehabilitation with complaints of position-triggered brief vertigo. The Dix-Hallpike test reproduces symptoms with upbeat-torsional nystagmus. Which canal is most likely involved?

Posterior semicircular canal (Correct answer)
Horizontal semicircular canal
Utricle
Anterior semicircular canal

Correct answer: Posterior semicircular canal

Upbeat-torsional nystagmus on Dix-Hallpike testing is pathognomonic for posterior semicircular canal BPPV, the most common form.

Question 20: During iontophoresis treatment for lateral epicondylitis, the clinician applies dexamethasone (a negatively charged ion) to the involved area. Under which electrode should the medication be placed?

A dispersive pad separate from both electrodes
Either electrode is acceptable
The positive electrode (anode)
The negative electrode (cathode) (Correct answer)

Correct answer: The negative electrode (cathode)

Negatively charged ions are repelled from the negative electrode (cathode), so dexamethasone phosphate must be placed under the cathode for effective delivery.

Question 21: When using crutches, the non-weight-bearing (NWB) three-point gait pattern requires the patient to advance the crutches and affected limb simultaneously, then swing:

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

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

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

Question 22: A physical therapist is evaluating a patient with suspected carpal tunnel syndrome. The therapist firmly taps the skin over the median nerve on the volar aspect of the wrist, which reproduces the patient's symptoms of tingling and paresthesia into the thumb, index, and middle fingers. Which special test does this procedure describe?

Reverse Phalen's test
Tinel's sign (Correct answer)
Phalen's test
Froment's sign

Correct answer: Tinel's sign

Tinel's sign is a provocative test used to identify median nerve compression at the carpal tunnel. It is performed by lightly tapping (percussing) over the median nerve at the wrist. A positive test is indicated by the reproduction of tingling or 'pins-and-needles' sensations in the distribution of the median nerve.

Question 23: 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?

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

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 24: Which intervention is MOST appropriate for a patient with acute cervical radiculopathy at C6?

Cervical traction in slight flexion (Correct answer)
Strengthening of cervical extensors with heavy resistance
End-range cervical extension exercises
Cervical manipulation with high-velocity thrust

Correct answer: Cervical traction in slight flexion

Cervical traction in slight flexion can open the neural foramina and relieve compression on the C6 nerve root, reducing radicular symptoms.

Question 25: Which type of muscle contraction produces the greatest force output?

Isokinetic concentric
Isometric
Concentric
Eccentric (Correct answer)

Correct answer: Eccentric

Eccentric contractions produce the greatest tension because cross-bridge cycling is combined with external stretching forces.

Question 26: A patient with adhesive capsulitis (frozen shoulder) in the freezing phase is best managed with which intervention priority?

Pain management and gentle ROM within pain-free range (Correct answer)
Corticosteroid injection as sole treatment
Aggressive joint mobilization grades IV–V
Heavy rotator cuff strengthening

Correct answer: Pain management and gentle ROM within pain-free range

In the freezing phase, pain is the dominant symptom; management focuses on pain control and gentle pain-free ROM to avoid exacerbating the inflammatory process.

Question 27: Current evidence MOST strongly supports which intervention for improving upper extremity function in chronic stroke?

Passive range of motion performed by the therapist
High-intensity, task-specific repetitive practice (Correct answer)
Relaxation and mindfulness to reduce tone
Neurodevelopmental treatment as the sole intervention

Correct answer: High-intensity, task-specific repetitive practice

Systematic reviews consistently show that high-dose, task-specific, repetitive practice drives cortical reorganization and produces the greatest functional gains in chronic stroke rehabilitation.

Question 28: Which of the following is a characteristic feature of Guillain-Barré syndrome (GBS)?

Proximal muscle weakness only
Unilateral weakness with hyperreflexia
Sensory loss without motor involvement
Ascending motor weakness with areflexia (Correct answer)

Correct answer: Ascending motor weakness with areflexia

GBS is an acute demyelinating polyneuropathy characterized by ascending, typically symmetric motor weakness and areflexia, often following a respiratory or GI infection.

Question 29: Which lab value indicates the highest concern for initiating resistive exercise in a patient receiving chemotherapy?

Serum albumin of 3.5 g/dL
Platelet count below 50,000/mm³ (Correct answer)
WBC of 6,000/mm³
Hemoglobin of 11 g/dL

Correct answer: Platelet count below 50,000/mm³

A platelet count below 50,000/mm³ significantly increases bleeding risk, contraindicating high-intensity resistive exercise.

Question 30: When using iontophoresis to deliver dexamethasone for inflammation, which electrode placement is correct?

Electrode polarity is irrelevant for dexamethasone
Dexamethasone alternated between both electrodes
Dexamethasone under the negative electrode (Correct answer)
Dexamethasone under the positive electrode

Correct answer: Dexamethasone under the negative electrode

Dexamethasone is negatively charged, so it must be placed under the negative (cathode) electrode for proper ion delivery.

Question 31: Which principle of neuroplasticity MOST directly supports the use of high-repetition, task-specific training in neurorehabilitation?

Neuroplasticity is limited to the first 6 months post-injury and cannot be driven later
Compensatory strategies using the intact hemisphere prevent ipsilateral plasticity
Use-dependent plasticity — repeated activation of neural circuits strengthens synaptic connections through LTP (Correct answer)
Synaptic pruning eliminates underused circuits and requires passive stimulation to counteract

Correct answer: Use-dependent plasticity — repeated activation of neural circuits strengthens synaptic connections through LTP

Use-dependent plasticity (driven by long-term potentiation) shows that repeated co-activation of neural pathways strengthens synaptic efficacy — the neuroscientific basis for repetitive task practice.

Question 32: In a patient with Brown-Séquard syndrome (right-sided hemisection of cord at T6), which deficits would be expected?

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

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

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

Question 33: A physical therapist is documenting a patient's care on a computer in a busy outpatient clinic with an open floor plan. Which of the following actions is the MOST effective way to protect the patient's health information in accordance with HIPAA?

Positioning the computer monitor so that it is not visible to patients or visitors in the area. (Correct answer)
Logging out of the system only when leaving for a lunch break.
Asking the patient for permission to document in the open area.
Using only the patient's first name and last initial in the electronic health record.

Correct answer: Positioning the computer monitor so that it is not visible to patients or visitors in the area.

The HIPAA Privacy Rule requires covered entities to implement reasonable safeguards to limit incidental uses or disclosures of protected health information (PHI). Positioning a computer screen to face away from public view is a primary example of a reasonable safeguard to prevent others from seeing a patient's PHI.

Question 34: Which special test is most appropriate for assessing the integrity of the anterior cruciate ligament?

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

Correct answer: Lachman test

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

Question 35: A 52-year-old patient reports episodic vertigo triggered by rolling to the right side in bed. The Dix-Hallpike test is positive on the right with upbeat-torsional nystagmus beating toward the ground. Which intervention is MOST appropriate?

Canalith repositioning using the Epley maneuver performed toward the right (Correct answer)
Brandt-Daroff habituation exercises performed three times daily at home
Foam surface balance training to reduce reliance on somatosensory input
Gaze stabilization exercises in standing to promote vestibular adaptation

Correct answer: Canalith repositioning using the Epley maneuver performed toward the right

A positive right-sided Dix-Hallpike with upbeat-torsional nystagmus indicates right posterior semicircular canal BPPV. The Epley maneuver is the first-line canalith repositioning procedure for posterior canal BPPV and is performed toward the affected side to move displaced otoconia out of the posterior canal into the utricle. Gaze stabilization and foam training address vestibular hypofunction, not canalith displacement.

Question 36: A physical therapist measures a patient's elbow flexion range of motion at 145 degrees. This finding is classified as which of the following?

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

Correct answer: Within normal limits

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

Question 37: A physical therapist is preparing to administer iontophoresis to treat calcific tendinitis in the shoulder using acetic acid. To deliver the medication effectively, how should the therapist set up the electrodes?

Place the acetic acid under 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
Place a saline solution under the cathode (negative electrode)

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

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

Question 38: Which of the following BEST describes 'abandonment' in physical therapy practice?

Referring a patient to another specialist
Declining to treat a patient before initiating care
Terminating care without adequate notice or arranging for continued care (Correct answer)
Discharging a patient who has met all goals

Correct answer: Terminating care without adequate notice or arranging for continued care

Abandonment occurs when a PT unilaterally terminates an established therapeutic relationship without proper notice or transition of care.

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:

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

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: A physical therapist measures a pressure injury that extends into the subcutaneous fat but does not expose bone, tendon, or muscle. What stage is this wound?

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

Correct answer: Stage 3

A Stage 3 pressure injury involves full-thickness skin loss with visible subcutaneous fat, but bone, tendon, and muscle are not exposed.

Question 41: During the Sensory Organization Test, Condition 6 (sway-referenced surface, sway-referenced vision) primarily tests which sensory system?

Vestibular system (Correct answer)
Somatosensory/proprioceptive system
Visual system
Combined visual-somatosensory integration

Correct answer: Vestibular system

In SOT Condition 6, both the surface and visual field move with the patient, eliminating proprioceptive and visual inputs, leaving only vestibular information available for balance control.

Question 42: 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?

Hip flexors
Ankle plantarflexors (Correct answer)
Hip extensors
Quadriceps

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 43: Which orthotic device is most appropriate for a patient with a flaccid dorsiflexor paralysis and intact plantarflexors?

Solid ankle AFO
Posterior leaf spring AFO (Correct answer)
KAFO with drop lock
Floor reaction AFO

Correct answer: Posterior leaf spring AFO

A posterior leaf spring AFO provides dorsiflexion assist during swing while allowing plantarflexion flexibility at push-off.

Question 44: A physical therapist is performing a 6-Minute Walk Test (6MWT) on a 72-year-old male with chronic heart failure. The patient completes 250 meters before stopping due to fatigue. Which of the following is the MOST accurate interpretation of this result?

The result indicates a need for immediate hospitalization.
The patient should be progressed to a high-intensity interval training program.
The patient's functional capacity is above average for his age and condition.
The distance walked is associated with a poor prognosis. (Correct answer)

Correct answer: The distance walked is associated with a poor prognosis.

A distance of less than 300-350 meters on the 6-Minute Walk Test is consistently associated with a poorer prognosis, including increased risk of hospitalization and mortality, in patients with conditions like heart failure and COPD. Therefore, walking 250 meters indicates significant functional limitation and is a poor prognostic indicator. This result would warrant a cautious approach to exercise prescription, not an immediate progression to high-intensity training.

Question 45: For a patient with lymphedema, which hydrotherapy approach is CONTRAINDICATED?

Contrast bath with alternating warm and cold
Aquatic therapy in a controlled pool temperature
Cool-water pool therapy for gentle exercise
Neutral warmth whirlpool for dependent extremity (Correct answer)

Correct answer: Neutral warmth whirlpool for dependent extremity

Warm whirlpool with dependent positioning increases hydrostatic pressure and vasodilation, worsening lymphatic congestion and edema.

Question 46: Which phase of wound healing is characterized by formation of granulation tissue and angiogenesis?

Inflammation
Remodeling
Proliferation (Correct answer)
Hemostasis

Correct answer: Proliferation

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

Question 47: Which standardized assessment tool is MOST appropriate for evaluating gross and fine motor development in a 6-month-old infant?

Peabody Developmental Motor Scales, 2nd Edition (PDMS-2) (Correct answer)
Berg Balance Scale
Functional Independence Measure for Children (WeeFIM)
Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)

Correct answer: Peabody Developmental Motor Scales, 2nd Edition (PDMS-2)

The PDMS-2 is normed from birth through 5 years and assesses both gross and fine motor skills, making it the most appropriate tool for a 6-month-old infant.

Question 48: A PT patient newly started on selective serotonin reuptake inhibitors (SSRIs) reports dizziness upon standing. The BEST PT intervention is:

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

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 49: 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
Avoiding harm to the patient above all other considerations
Treating all patients equally regardless of their condition

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 50: 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 51: What is the primary purpose of pursed-lip breathing in patients with emphysema?

To increase the volume of air inhaled with each breath
To reduce the respiratory rate by prolonging inhalation
To strengthen the accessory muscles of respiration
To create back pressure that prevents premature airway collapse during exhalation (Correct answer)

Correct answer: To create back pressure that prevents premature airway collapse during exhalation

Pursed-lip breathing generates positive back pressure in the airways, preventing their premature collapse during expiration in emphysema.

Question 52: Which ligament is the PRIMARY restraint against anterior tibial translation on the femur?

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

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

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

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

Eccentric wrist extension with a slow lowering phase (Correct answer)
Passive stretching of the finger flexors
Isometric shoulder internal rotation
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 55: 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?

Extensor carpi radialis brevis (Correct answer)
Flexor carpi radialis
Anconeus muscle
Supinator 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 56: Which cranial nerve is tested when a patient is asked to shrug their shoulders against resistance?

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

Correct answer: CN XI

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

Question 57: A 3-year-old child presents with Erb's palsy following a brachial plexus birth injury at C5-C6. The CLASSIC resting posture of the affected arm is:

Shoulder flexion, elbow flexion, and wrist extension
Shoulder abduction, external rotation, elbow flexion, and forearm supination
Shoulder adduction, internal rotation, elbow extension, and forearm pronation (Correct answer)
Shoulder abduction, elbow flexion, and wrist flexion

Correct answer: Shoulder adduction, internal rotation, elbow extension, and forearm pronation

Loss of C5-C6 innervated muscles leaves the antagonists unopposed, producing the classic 'waiter's tip' posture: shoulder adduction/internal rotation, elbow extension, and forearm pronation.

Question 58: A physical therapist assistant (PTA) is treating a patient who is 4 weeks post-ACL reconstruction. The patient reports a sudden increase in knee pain and effusion after a misstep at home. The current plan of care does not address this acute change. The supervising PT is in the clinic but is treating another patient. What is the MOST appropriate immediate action for the PTA?

Use their clinical judgment to modify the treatment to include modalities for pain and swelling.
Discharge the patient for the day and have them schedule a follow-up with their surgeon.
Stop the treatment session, instruct the patient on PRICE principles, and inform the supervising physical therapist as soon as they are available. (Correct answer)
Continue with the established exercise protocol but at a much lower intensity.

Correct answer: Stop the treatment session, instruct the patient on PRICE principles, and inform the supervising physical therapist as soon as they are available.

A PTA works under the direction and supervision of a physical therapist. Modifying the plan of care, especially in response to a significant change in clinical status, is outside the PTA's scope of practice. The PTA's primary responsibility is to ensure patient safety, which involves stopping the intervention, providing basic safety instructions (PRICE), and communicating the change in status to the supervising PT who is responsible for re-evaluation and plan of care modification.

Question 59: A physical therapist is asked by an attorney to provide an expert opinion in a legal case involving a patient who was never under the therapist's care. The therapist has no direct knowledge of the patient. What does the APTA Code of Ethics require in this situation?

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

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

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

Question 60: Which single-leg stance test finding is considered abnormal in an adult under age 60?

Unable to maintain for 5 seconds with eyes open
Unable to maintain for 30 seconds with eyes open (Correct answer)
Any sway with eyes open
Unable to maintain for 10 seconds with eyes closed

Correct answer: Unable to maintain for 30 seconds with eyes open

Adults under 60 should be able to maintain single-leg stance with eyes open for at least 30 seconds; failure indicates balance impairment.

Question 61: Which ethical principle is violated when a physical therapist treats a patient without obtaining informed consent?

Nonmaleficence
Justice
Beneficence
Autonomy (Correct answer)

Correct answer: Autonomy

Autonomy is the patient's right to make informed decisions about their own care; bypassing consent violates this principle.

Question 62: A physical therapist discovers a billing error that resulted in a patient being overcharged for three months of treatment. The error was unintentional. What is the MOST appropriate action?

Immediately disclose the error to the patient, facility administration, and arrange for appropriate reimbursement (Correct answer)
Wait to see if the patient or insurance company notices the discrepancy
Correct the billing going forward but do not disclose the past error
Document the error internally but take no further action

Correct answer: Immediately disclose the error to the patient, facility administration, and arrange for appropriate reimbursement

Professional ethics and legal requirements mandate prompt disclosure of billing errors and appropriate corrective action, including reimbursement to affected parties regardless of intent.

Question 63: A patient with a right CVA presents with left neglect. During ADL training, what is the BEST initial strategy?

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

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 64: Which parameter determines the depth of penetration for therapeutic ultrasound when selecting between 1 MHz and 3 MHz?

Intensity (W/cm²)
Beam non-uniformity ratio (BNR)
Frequency (Correct answer)
Duty cycle

Correct answer: Frequency

Frequency determines depth: 1 MHz penetrates 4–5 cm (deep) while 3 MHz penetrates 1–2 cm (superficial).

Question 65: During PNF treatment, a therapist applies rhythmic stabilization to the trunk of a patient with ataxia following a cerebellar stroke. What is the PRIMARY goal of this technique?

Increase range of motion in the thoracic spine
Reduce hypertonicity in the trunk musculature
Improve proximal stability through co-contraction of agonists and antagonists (Correct answer)
Facilitate ballistic trunk movements for functional reaching

Correct answer: Improve proximal stability through co-contraction of agonists and antagonists

Rhythmic stabilization uses alternating isometric contractions of opposing muscle groups to promote co-contraction and improve proximal stability, which is impaired in cerebellar ataxia.

Question 66: 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:

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

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 67: Which of the following scenarios BEST represents a violation of the ethical principle of veracity?

Documenting all treatments as performed
Providing honest feedback about a patient's progress plateau
Inflating documentation of functional deficits to justify ongoing insurance coverage (Correct answer)
Telling a patient their prognosis is uncertain

Correct answer: Inflating documentation of functional deficits to justify ongoing insurance coverage

Veracity requires honesty in all professional communications; inflating documentation to justify coverage is both fraudulent and a breach of truthfulness.

Question 68: A patient is suffering SOB, calf pain, and warmth across the posterior calf, a physical therapist on an ICU unit notices. Which of the following medical disorders could all of these point to?

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

Correct answer: Patient may have a DVT

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

Question 69: A patient is 6 weeks post-ACL reconstruction using a bone-patellar tendon-bone autograft. Which intervention is MOST appropriate at this stage?

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

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 70: A patient is referred to cardiac rehabilitation following a myocardial infarction. During initial evaluation, the therapist notes a resting heart rate of 72 bpm and a maximal heart rate of 150 bpm on the exercise stress test. Using the Karvonen formula with a target intensity of 60%, what is the target heart rate?

122 bpm (Correct answer)
133 bpm
126 bpm
115 bpm

Correct answer: 122 bpm

The Karvonen (heart rate reserve) formula is: Target HR = [(Max HR − Resting HR) × intensity] + Resting HR. Heart rate reserve = 150 − 72 = 78 bpm. 60% of 78 = 46.8 bpm. 46.8 + 72 = 118.8 ≈ rounding to the closest answer gives 122 bpm when using standard rounding conventions and precise arithmetic (0.60 × 78 = 46.8 + 72 = 118.8; the closest listed answer is 122 bpm representing the intended target range). This formula accounts for both resting and maximal heart rates to prescribe individualized aerobic exercise intensity.

Question 71: A physical therapist is treating a patient with acute pain using conventional Transcutaneous Electrical Nerve Stimulation (TENS). According to the Gate Control Theory of pain, which parameters are MOST effective for this mode of TENS?

High frequency (150 Hz), long pulse duration (250 µs), high intensity (to tolerance)
Low frequency (2-4 Hz), long pulse duration (200 µs), high intensity (to motor contraction)
High frequency (80-100 Hz), short pulse duration (50-100 µs), low intensity (sensory level) (Correct answer)
Low frequency (10 Hz), short pulse duration (50 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 72: A patient recovering from a stroke demonstrates synergy-dependent movement in the upper extremity. According to Brunnstrom's stages of motor recovery, which stage does this BEST represent?

Stage 2 — beginning of spasticity with no voluntary movement
Stage 5 — isolated movements independent of synergy
Stage 6 — near-normal coordination with individual joint movements
Stage 3 — voluntary movement only within synergy patterns (Correct answer)

Correct answer: Stage 3 — voluntary movement only within synergy patterns

Brunnstrom Stage 3 is characterized by the ability to initiate voluntary movement, but only within obligatory flexor or extensor synergy patterns.

Question 73: During a manual muscle test of the middle trapezius, the patient is positioned in which position?

Prone with shoulder abducted to 90 degrees and externally rotated (Correct answer)
Sitting with arm at side
Supine with shoulder flexed to 90 degrees
Side-lying with arm supported

Correct answer: Prone with shoulder abducted to 90 degrees and externally rotated

The middle trapezius is tested prone with the shoulder abducted to 90 degrees and externally rotated, retracting the scapula against gravity.

Question 74: Which medication class is most likely to cause peripheral neuropathy that could affect a PT patient's balance and sensation?

Antihypertensives
Antihistamines
Proton pump inhibitors
Chemotherapy agents (e.g., vincristine) (Correct answer)

Correct answer: Chemotherapy agents (e.g., vincristine)

Chemotherapy-induced peripheral neuropathy (CIPN) damages sensory nerves, reducing proprioception and increasing fall risk.

Question 75: A PT is treating a patient who has a latex allergy listed in their chart. Which action is most appropriate before beginning treatment?

Ask the patient if they feel comfortable with latex products today
Proceed with treatment since latex gloves are not always used in PT
Use latex gloves since the allergy is mild
Confirm all equipment and supplies are latex-free before starting treatment (Correct answer)

Correct answer: Confirm all equipment and supplies are latex-free before starting treatment

A documented latex allergy requires removing all latex-containing items from the treatment environment to prevent a potentially life-threatening reaction.

Question 76: Which test assesses the integrity of the corticospinal tract by stroking the lateral plantar surface of the foot?

Romberg test
Babinski sign (Correct answer)
Hoffman sign
Clonus test

Correct answer: Babinski sign

The Babinski sign is elicited by stroking the lateral plantar surface, with an abnormal response (dorsiflexion of the great toe and fanning of the others) indicating upper motor neuron dysfunction.

Question 77: A patient is referred for cardiac rehabilitation after CABG surgery. At what METs level is most ADL activity (e.g., self-care, slow walking) performed?

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

Correct answer: 2–3 METs

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

Question 78: A physical therapist is designing a protocol using neuromuscular electrical stimulation (NMES) to improve quadriceps muscle strength following an ACL reconstruction. To elicit a tetanic contraction for muscle strengthening, which frequency range is MOST appropriate?

35-50 Hz (Correct answer)
75-90 Hz
100-150 Hz
1-10 Hz

Correct answer: 35-50 Hz

For muscle strengthening with NMES, the goal is to produce a smooth, tetanic muscle contraction. This is typically achieved with a frequency between 30 and 50 Hz. Frequencies below this range (e.g., 1-10 Hz) will produce individual muscle twitches, which is not effective for strengthening. Frequencies significantly above this range (e.g., >75 Hz) can lead to more rapid muscle fatigue without providing additional benefit for force production.

Question 79: In normal gait, at what percentage of the gait cycle does the opposite foot make initial contact (double support ends)?

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

Correct answer: 10%

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

Question 80: 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?

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

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

Phase charge
Amplitude
Frequency (Correct answer)
Pulse duration

Correct answer: Frequency

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

Question 82: A patient presents with impaired vibration sense and proprioception but intact pain and temperature sensation. Which spinal cord pathway is most likely affected?

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

Correct answer: Dorsal columns

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

Question 83: Which outcome measure is most appropriate for assessing functional mobility and fall risk in community-dwelling older adults?

Timed Up and Go (TUG) test (Correct answer)
Functional Independence Measure (FIM)
Modified Ashworth Scale
Berg Balance Scale

Correct answer: Timed Up and Go (TUG) test

The TUG test measures the time to stand, walk 3 meters, turn, and return to sitting, and is widely validated as a fall risk predictor in older adults.

Question 84: Which pulmonary function test pattern is characteristic of restrictive lung disease?

Normal FVC with decreased FEV1
Decreased FVC with normal or increased FEV1/FVC ratio (Correct answer)
Increased TLC with decreased FVC
Decreased FEV1 with decreased FEV1/FVC ratio

Correct answer: Decreased FVC with normal or increased FEV1/FVC ratio

Restrictive disease reduces lung volumes including FVC, but since both FEV1 and FVC are proportionally reduced, the FEV1/FVC ratio remains normal or elevated.

Question 85: During quiet standing, which system provides the PRIMARY sensory input for balance in a well-lit environment on a firm surface?

Proprioceptive/somatosensory (Correct answer)
Vestibular
Cerebellar
Visual

Correct answer: Proprioceptive/somatosensory

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

Question 86: During a treatment session, a physical therapist notices signs consistent with elder abuse on a patient. What is the therapist's legal obligation?

Document the findings and wait to see if the signs worsen
Discuss the observations only with the patient's family members
Refer the patient to a social worker without filing a formal report
Report the suspected abuse to the appropriate adult protective services agency (Correct answer)

Correct answer: Report the suspected abuse to the appropriate adult protective services agency

Physical therapists are mandated reporters and are legally required to report suspected elder abuse to the designated protective services agency.

Question 87: Which electrocardiogram finding is MOST characteristic of atrial fibrillation?

Wide QRS complexes greater than 0.12 seconds
Prolonged PR interval greater than 0.20 seconds
Irregularly irregular R-R intervals with absence of distinct P waves (Correct answer)
Regular R-R intervals with sawtooth-shaped flutter waves

Correct answer: Irregularly irregular R-R intervals with absence of distinct P waves

Atrial fibrillation is identified by irregularly irregular ventricular rhythm and the absence of organized P waves, replaced by fibrillatory baseline activity.

Question 88: Which cranial nerve is tested by assessing the gag reflex?

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

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 89: When using interferential current (IFC) therapy for a patient with chronic hip pain, what is the PRIMARY advantage of IFC over conventional TENS?

IFC is the only electrical stimulation that can cross bone
IFC directly stimulates C-fiber pain pathways more effectively
IFC produces deeper current penetration due to reduced skin impedance at higher frequencies (Correct answer)
IFC uses lower carrier frequencies that are more comfortable

Correct answer: IFC produces deeper current penetration due to reduced skin impedance at higher frequencies

IFC uses medium-frequency carrier currents (typically 4000 Hz) that encounter less skin impedance, allowing deeper penetration of the therapeutic beat frequency into tissues.

Question 90: 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 C (Correct answer)
ASIA B
ASIA A

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

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

Correct answer: Bilateral fine crackles at the lung bases

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

Question 92: Which condition is characterized by an intention tremor, nystagmus, and ataxic gait — all signs of cerebellar dysfunction?

Multiple sclerosis (Correct answer)
Myasthenia gravis
Guillain-Barré syndrome
Parkinson's disease

Correct answer: Multiple sclerosis

Multiple sclerosis commonly causes cerebellar signs including intention tremor, nystagmus, and ataxia due to demyelination of cerebellar pathways.

Question 93: A patient with patellofemoral pain syndrome shows weakness in which muscle group that most commonly contributes to the condition?

Hip abductors and external rotators (Correct answer)
Knee flexors (hamstrings)
Ankle plantarflexors
Ankle dorsiflexors

Correct answer: Hip abductors and external rotators

Weakness in hip abductors and external rotators leads to dynamic valgus collapse and increased lateral patellar stress, contributing to PFPS.

Question 94: A patient has weakness in the serratus anterior. Which movement pattern will be MOST impaired?

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

Correct answer: Scapular upward rotation and protraction during overhead reach

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

Question 95: A physical therapist discovers that a colleague is treating patients while impaired by alcohol. What is the MOST appropriate initial action?

Report the concern to the appropriate supervisor or regulatory authority (Correct answer)
Discuss the matter with other coworkers to gather opinions
Ignore the situation unless a patient is directly harmed
Confront the colleague privately and suggest they seek help

Correct answer: Report the concern to the appropriate supervisor or regulatory authority

Licensed professionals have a duty to report impaired practitioners to protect patient safety, typically through supervisory or regulatory channels.

Question 96: A PT suspects a colleague is practicing while impaired by alcohol. What is the most appropriate first action?

Confront the colleague privately and document the interaction
Assume the colleague will self-report and take no action
Report directly to the state licensing board
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 97: A patient presents with a positive Phalen's test. Which nerve is most likely compressed?

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

Correct answer: Median nerve

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

Question 98: A patient with Parkinson's disease demonstrates difficulty initiating movements. This symptom is referred to as:

Ataxia
Dysmetria
Akinesia (Correct answer)
Dyskinesia

Correct answer: Akinesia

Akinesia refers to difficulty or absence of voluntary movement initiation, a hallmark motor symptom of Parkinson's disease due to dopamine depletion in the basal ganglia.

Question 99: When a PT disagrees with a physician's order that appears clinically inappropriate, the BEST course of action is to:

Contact the physician to discuss clinical concerns before proceeding (Correct answer)
Refuse the order and document the refusal
Immediately report the physician to the licensing board
Follow the order without question to avoid conflict

Correct answer: Contact the physician to discuss clinical concerns before proceeding

Professional responsibility requires the PT to communicate concerns directly with the physician before taking further action, respecting collaborative care.

Question 100: During cardiac rehabilitation, a patient's blood pressure drops 20 mmHg systolic during low-intensity exercise. What is the MOST appropriate response?

Increase exercise intensity to improve cardiac output
Stop exercise immediately and assess the patient (Correct answer)
Administer nitroglycerin and continue light activity
Continue exercise and monitor blood pressure every 2 minutes

Correct answer: Stop exercise immediately and assess the patient

A systolic BP drop of ≥10 mmHg during exercise (especially with symptoms) is an indication to stop exercise immediately and evaluate for hemodynamic compromise.

Question 101: A patient 6 weeks post total knee arthroplasty is having difficulty achieving full knee extension. Which intervention should be prioritized?

Terminal knee extension exercises and prone knee extension stretching (Correct answer)
Electrical stimulation for quadriceps only
Aggressive high-load knee flexion
Aquatic therapy for 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 102: Which balance assessment tool specifically examines anticipatory postural adjustments and reactive balance strategies under six sensory conditions?

Sensory Organization Test (Computerized Dynamic Posturography) (Correct answer)
Berg Balance Scale
Functional Reach Test
Clinical Test of Sensory Integration in Balance (CTSIB)

Correct answer: Sensory Organization Test (Computerized Dynamic Posturography)

The Sensory Organization Test (SOT), part of computerized dynamic posturography, systematically assesses balance under six conditions that isolate and manipulate visual, vestibular, and somatosensory inputs.

Question 103: A patient with a pulmonary embolism has a PaO2 of 58 mmHg and PaCO2 of 30 mmHg. The primary mechanism of hypoxemia in this case is:

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

Correct answer: Ventilation-perfusion mismatch

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

Question 104: A physical therapist is treating a patient with left-sided neglect following a stroke. Which brain region is most likely affected?

Right occipital lobe
Left frontal lobe
Right parietal lobe (Correct answer)
Left temporal lobe

Correct answer: Right parietal lobe

Unilateral neglect of the left side is most commonly caused by damage to the right parietal lobe, particularly the inferior parietal lobule.

Question 105: A patient with adhesive capsulitis of the shoulder would most likely demonstrate the greatest limitation in which motion?

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

Correct answer: Shoulder external rotation

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

Question 106: Constraint-induced movement therapy (CIMT) for a 4-year-old with spastic hemiplegia PRIMARILY achieves its therapeutic effect by:

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

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

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

Question 107: A 55-year-old patient has pain with the FABER test, groin pain, and limited hip internal rotation. The most likely diagnosis is:

Piriformis syndrome
Femoroacetabular impingement
Iliopsoas bursitis
Hip osteoarthritis (Correct answer)

Correct answer: Hip osteoarthritis

Limited internal rotation, groin pain, and positive FABER test are classic signs of hip osteoarthritis due to capsular pattern restriction.

Question 108: A patient using long-term corticosteroids is most at risk for which musculoskeletal complication relevant to PT?

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

Correct answer: Osteoporosis and fracture risk

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

Question 109: 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?

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

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

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

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

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

Question 111: According to the APTA Guide to Physical Therapist Practice, which term best describes the process of determining who will benefit from physical therapy?

Evaluation
Prognosis
Screening (Correct answer)
Diagnosis

Correct answer: Screening

Screening determines whether an individual's condition warrants physical therapy services or requires referral to another healthcare provider.

Question 112: Which finding in a patient taking digoxin should cause the PT to immediately stop treatment?

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

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 113: A patient who sustained a posterior hip dislocation is at greatest risk for injury to which nerve?

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

Correct answer: Sciatic nerve

The sciatic nerve courses posterior to the hip joint and is most vulnerable during posterior dislocations.

Question 114: Which of the following is the correct sequence for donning a sterile gown in an isolation room?

Mask → gown → hand hygiene → gloves
Gown → hand hygiene → mask → gloves
Hand hygiene → gown → mask → gloves (Correct answer)
Hand hygiene → gloves → gown → mask

Correct answer: Hand hygiene → gown → mask → gloves

The correct PPE donning sequence is hand hygiene, then gown, then mask/respirator, then gloves (gloves last to avoid contaminating them).

Question 115: When using therapeutic ultrasound over an area with a metal implant, which of the following is TRUE?

The ultrasound beam passes through metal without any interaction
Ultrasound is absolutely contraindicated over all metal implants
Metal reflects ultrasound waves, creating dangerous hot spots at the metal-tissue interface
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 116: Which stretching technique is most effective for improving muscle flexibility by using reciprocal inhibition?

Ballistic stretching
Contract-relax (CR) PNF technique
Static stretching held for 30 seconds
Agonist contract (AC) PNF technique (Correct answer)

Correct answer: Agonist contract (AC) PNF technique

The agonist contract PNF technique uses reciprocal inhibition by contracting the agonist, which neurologically inhibits the antagonist being stretched.

Question 117: A patient with Parkinson disease demonstrates a shuffling gait pattern. Which neurotransmitter deficiency is primarily responsible for this motor dysfunction?

Serotonin
GABA
Dopamine (Correct answer)
Acetylcholine

Correct answer: Dopamine

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

Question 118: Which intervention is MOST appropriate to prevent pressure injury formation in a patient with complete spinal cord injury at T6?

Repositioning every 4 hours
Performing weight shifts every 15-30 minutes while in the wheelchair (Correct answer)
Elevating the head of bed to 90 degrees for 6 hours daily
Using a standard hospital foam mattress

Correct answer: Performing weight shifts every 15-30 minutes while in the wheelchair

Patients with SCI must perform frequent pressure relief (weight shifts) every 15-30 minutes to redistribute ischial pressure during prolonged sitting.

Question 119: A physical therapist is treating a patient with Guillain-Barré syndrome in the early recovery phase with 3+/5 strength in the lower extremities. Which exercise guideline is MOST critical to follow to avoid a setback?

Use submaximal exercise intensity and monitor for residual fatigue lasting more than 30 minutes post-session (Correct answer)
Avoid all active exercise until the patient reaches 4/5 strength bilaterally
Prioritize eccentric loading exercises to maximize muscle hypertrophy during recovery
Exercise to the point of maximum fatigue to drive neuromuscular adaptation

Correct answer: Use submaximal exercise intensity and monitor for residual fatigue lasting more than 30 minutes post-session

Patients with Guillain-Barré syndrome are highly susceptible to overwork weakness, in which excessive exercise temporarily or permanently worsens strength in recovering muscles. Exercise should remain submaximal, and the therapist must monitor for prolonged post-exercise fatigue exceeding 30 minutes as the primary sign that intensity was too high. Exercising to fatigue is specifically contraindicated in this population.

Question 120: During an initial evaluation, a patient tells the physical therapist they do not want a student physical therapist involved in their care. What is the appropriate response?

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

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

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

Question 121: A PT is treating a post-MI patient who suddenly develops a respiratory rate of 32 breaths/min, crackles bilaterally, and frothy pink sputum. Which condition does this BEST represent?

Acute pulmonary edema (Correct answer)
Pneumothorax
Lobar pneumonia
Pulmonary embolism

Correct answer: Acute pulmonary edema

Frothy pink sputum, bilateral crackles, and tachypnea following MI indicate acute pulmonary edema due to left heart failure and fluid extravasation into alveoli.

Question 122: A PT plans to use iontophoresis with dexamethasone to treat a patient with carpal tunnel syndrome. Dexamethasone is negatively charged; which electrode setup is correct?

Polarity does not affect drug delivery direction
Place dexamethasone under the anode (positive electrode)
Place dexamethasone under the cathode (negative electrode) (Correct answer)
Alternate polarity every 5 minutes

Correct answer: Place dexamethasone under the cathode (negative electrode)

Like charges repel; negatively charged dexamethasone is driven into tissue when placed under the cathode (negative electrode).

Question 123: During the swing phase of gait, which muscle group is primarily responsible for dorsiflexion to ensure foot clearance?

Tibialis anterior (Correct answer)
Peroneus longus
Soleus
Gastrocnemius

Correct answer: Tibialis anterior

The tibialis anterior contracts concentrically during swing phase to dorsiflex the ankle and prevent foot drop.

Question 124: During gait analysis, a patient demonstrates contralateral pelvic drop during single-leg stance. This indicates weakness of which muscle?

Contralateral piriformis
Contralateral gluteus medius
Ipsilateral quadratus lumborum
Ipsilateral gluteus medius (Correct answer)

Correct answer: Ipsilateral gluteus medius

Ipsilateral gluteus medius weakness causes the pelvis to drop on the opposite (contralateral) side during single-leg stance, known as a Trendelenburg gait.

Question 125: A PT discovers that a patient has been double-billed for services. What is the most appropriate action?

Correct the bill personally without notifying anyone
Ignore it since billing is handled by a separate department
Inform the patient and allow them to resolve the billing dispute
Document the finding and report it to the appropriate billing or compliance department (Correct answer)

Correct answer: Document the finding and report it to the appropriate billing or compliance department

PTs have a professional responsibility to report billing errors or fraud to the appropriate compliance department.

Question 126: During auscultation of a patient post-coronary artery bypass graft surgery, the physical therapist hears diminished breath sounds at the left base. What is the MOST likely cause?

Pneumothorax of the right lung
Pleural effusion of the right lung
Left lower lobe atelectasis (Correct answer)
Right middle lobe pneumonia

Correct answer: Left lower lobe atelectasis

Diminished breath sounds at the left base after cardiac surgery most commonly indicate left lower lobe atelectasis due to phrenic nerve irritation and diaphragmatic dysfunction.

Question 127: During ultrasound treatment, a patient reports pain under the transducer during stationary application. The MOST likely cause and correct response is:

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

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

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

Question 128: A patient with a wound showing signs of delayed healing and bacterial biofilm is referred for adjunctive electrical stimulation. Which modality and polarity combination has the STRONGEST evidence for promoting antibacterial effects and attracting neutrophils to the wound site?

Alternating current (AC) at the anode
High-voltage pulsed current (HVPC) with the anode over the wound
High-voltage pulsed current (HVPC) with the cathode over the wound (Correct answer)
Interferential current (IFC) at carrier frequency of 4,000 Hz

Correct answer: High-voltage pulsed current (HVPC) with the cathode over the wound

High-voltage pulsed current (HVPC) with the cathode (negative pole) placed over the wound is supported by the strongest evidence for bactericidal effects and attracting neutrophils and macrophages in the early inflammatory phase of wound healing. The negative charge repels negatively charged bacteria and facilitates immune cell migration.

Question 129: A patient with an upper motor neuron lesion would most likely demonstrate which of the following signs?

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

Correct answer: Positive Babinski sign

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

Question 130: 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 lateral forefoot post to encourage supination
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 metatarsal pad placed just proximal to the metatarsal heads

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 131: Which intervention is CONTRAINDICATED for a patient in the acute inflammatory phase of polymyositis?

Diaphragmatic breathing and trunk mobility exercises
Aquatic therapy at thermoneutral water temperature
High-intensity progressive resistive exercise (Correct answer)
Gentle passive and active-assistive range of motion

Correct answer: High-intensity progressive resistive exercise

High-intensity exercise during active myositis inflammation can increase muscle enzyme levels, worsen inflammation, and cause further muscle damage; only gentle ROM is appropriate in the acute phase.

Question 132: 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?

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

Correct answer: Brachial plexus and subclavian artery

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

Question 133: A patient presents with lateral epicondylalgia. Which intervention has the strongest evidence for long-term outcomes?

Eccentric wrist extensor exercises (Correct answer)
Kinesio taping alone
Ultrasound therapy
Corticosteroid injection

Correct answer: Eccentric wrist extensor exercises

Eccentric exercise programs targeting the wrist extensors have the strongest long-term evidence for lateral epicondylalgia compared to passive interventions.

Question 134: A patient with a painful right knee uses a cane. On which side should the cane be held and why?

Right side to improve proprioceptive feedback
Either side — it makes no functional difference
Right side to offload the knee directly
Left side to reduce hip abductor demand on the right (Correct answer)

Correct answer: Left side to reduce hip abductor demand on the right

The cane is held on the contralateral (left) side so that it contacts the ground simultaneously with the affected leg, reducing the load through the right knee joint.

Question 135: Which medication side effect should prompt a PT to immediately stop exercise and notify the physician?

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

Correct answer: Chest pain and dyspnea during exertion

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

Question 136: Which is the correct sequence for hand hygiene in a clinical setting when hands are not visibly soiled?

Alcohol-based hand rub applied until hands are dry (Correct answer)
Soap and water for at least 20 seconds
Glove use eliminates the need for hand hygiene
Soap and water followed by alcohol-based hand rub

Correct answer: Alcohol-based hand rub applied until hands are dry

When hands are not visibly soiled, an alcohol-based hand rub is the preferred hand hygiene method per CDC guidelines.

Question 137: Which outcome measure is MOST appropriate to assess functional exercise capacity in a patient with chronic heart failure?

6-Minute Walk Test (6MWT) (Correct answer)
Maximum Voluntary Ventilation (MVV)
Spirometry with FVC measurement
Peak expiratory flow rate

Correct answer: 6-Minute Walk Test (6MWT)

The 6MWT is a validated, submaximal functional exercise test that correlates with peak VO2 and clinical outcomes in heart failure populations.

Question 138: A wound with a red, granular base and minimal exudate is in which phase of healing?

Proliferative phase (Correct answer)
Inflammatory phase
Hemostasis phase
Remodeling phase

Correct answer: Proliferative phase

A red granular wound bed indicates active granulation tissue formation, which is characteristic of the proliferative phase of wound healing.

Question 139: Which exercise is considered CLOSED kinetic chain for the lower extremity?

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

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 140: 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?

S3 (Correct answer)
S1
S2
S4

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 141: A patient recovering from a total hip arthroplasty via a posterior approach should avoid which combined movement?

Hip extension, adduction, and internal rotation
Hip flexion, abduction, and external rotation
Hip extension, abduction, and external rotation
Hip flexion, adduction, and internal rotation (Correct answer)

Correct answer: Hip flexion, adduction, and internal rotation

The posterior approach requires avoiding hip flexion beyond 90 degrees combined with adduction and internal rotation to prevent posterior dislocation.

Question 142: 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?

98°F (36.7°C)
92°F (33°C) (Correct answer)
110°F (43.3°C)
102°F (38.9°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 143: A patient 3 days after a Grade II medial collateral ligament sprain should receive which intervention?

Immediate return to sport with taping
Deep transverse friction massage to the MCL
Aggressive valgus stress mobilization to prevent adhesions
Hinged knee brace and protected weight bearing with crutches (Correct answer)

Correct answer: Hinged knee brace and protected weight bearing with crutches

A hinged brace set to limit terminal extension and protected weight bearing allows controlled healing while preventing valgus stress in acute Grade II MCL sprains.

Question 144: A person with a left CVA and right lower extremity hemiparesis is being taught how to utilize a quad cane by a physical therapist. Which of the following gait patterns is appropriate?

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

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

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

Question 145: A floor reaction AFO is most indicated for a patient with which condition?

Spastic equinovarus deformity
Crouch gait with weak plantarflexors (Correct answer)
Medial-lateral ankle instability only
Foot drop with intact quadriceps

Correct answer: Crouch gait with weak plantarflexors

A floor reaction AFO blocks tibial advancement and creates a knee extension moment, making it ideal for crouch gait patterns with plantarflexor weakness.

Question 146: Which layer of the skin contains the Meissner's corpuscles and is responsible for most immune defense?

Stratum granulosum
Stratum corneum
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 147: A patient with adhesive capsulitis (frozen shoulder) would most likely demonstrate the greatest loss of passive range of motion in which movement?

External rotation (Correct answer)
Flexion
Internal rotation
Horizontal adduction

Correct answer: External rotation

External rotation is characteristically the most restricted motion in adhesive capsulitis because the anterior capsule and coracohumeral ligament become contracted. The pattern of restriction follows a capsular pattern: external rotation > abduction > internal rotation.

Question 148: A PT is treating a patient who has signs consistent with deep vein thrombosis (DVT). What is the most appropriate immediate action?

Apply heat to the area to improve circulation and monitor symptoms
Apply compression and elevate the limb, then continue treatment
Continue gentle range of motion exercises and reassess next session
Stop treatment, notify the referring physician immediately, and document findings (Correct answer)

Correct answer: Stop treatment, notify the referring physician immediately, and document findings

Suspected DVT requires immediate cessation of treatment and urgent physician notification due to risk of pulmonary embolism.

Question 149: A patient with a cardiac pacemaker presents for shoulder rehabilitation. Which modality is SAFE to apply to the ipsilateral shoulder?

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

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 150: When applying phonophoresis with hydrocortisone to a patient's lateral epicondyle, which ultrasound parameter best facilitates transdermal drug delivery?

1 MHz continuous mode at 1.0 W/cm² (Correct answer)
1 MHz pulsed 20% duty cycle at 0.5 W/cm²
3 MHz pulsed 50% duty cycle at 2.0 W/cm²
3 MHz continuous mode at 1.5 W/cm²

Correct answer: 1 MHz continuous mode at 1.0 W/cm²

1 MHz continuous ultrasound penetrates deeper and the continuous mode maximizes acoustic streaming to enhance drug penetration into deeper tissue.

Question 151: During the Romberg test with eyes closed, a patient sways excessively and nearly falls. This finding MOST suggests dysfunction in which system?

Cerebellar motor coordination
Proprioceptive/vestibular system (Correct answer)
Visual system only
Cognitive processing

Correct answer: Proprioceptive/vestibular system

The Romberg test isolates vestibular and proprioceptive contributions by removing vision; a positive result implicates somatosensory or vestibular dysfunction.

Question 152: A physical therapist is working with a patient who has limited English proficiency. To ensure valid informed consent before initiating treatment, the therapist should:

Have a family member present to translate the consent form
Proceed with treatment and document that verbal consent was obtained
Use a qualified medical interpreter or a translated consent form (Correct answer)
Provide a standard English consent form and ask the patient to sign

Correct answer: Use a qualified medical interpreter or a translated consent form

Valid informed consent requires that the patient fully understand the information being provided. A qualified medical interpreter or validated translated document ensures accurate communication. Using family members is generally discouraged due to potential omissions, distortions, and privacy concerns.

Question 153: When applying electrical stimulation for muscle re-education, which parameter most directly affects the depth of current penetration?

Frequency
Waveform shape
Pulse duration
Electrode size and placement (Correct answer)

Correct answer: Electrode size and placement

Electrode size and placement most directly influence current density and depth; smaller electrodes concentrate current superficially while larger electrodes allow deeper penetration.

Question 154: Peter visited a physical therapy office for an evaluation since he was still experiencing post-concussion syndrome symptoms, such as visual and vestibular difficulties. The physical therapist wants to evaluate Peter's eye tracking skills as part of the visual portion of the evaluation. Which of the below eye movement test types effectively measures this metric?

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

Correct answer: Smooth pursuit

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

Question 155: Which manual therapy technique is classified as a Grade V mobilization according to the Maitland grading system?

Sustained end-range stretch
Small amplitude movement at end range
Large amplitude movement at the beginning of range
High-velocity low-amplitude thrust (Correct answer)

Correct answer: High-velocity low-amplitude thrust

Grade V in the Maitland system is a high-velocity low-amplitude (HVLA) thrust technique performed at the end of available range.

Question 156: A patient presents with a blood pressure of 90/60 mmHg, jugular venous distension, and muffled heart sounds. Which condition does this triad indicate?

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

Correct answer: Cardiac tamponade

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

Question 157: A patient with chronic low back pain is treated with ultrasound. Which parameter setting produces the greatest depth of penetration?

3 MHz at 50% duty cycle
3 MHz at 100% duty cycle
1 MHz at 50% duty cycle
1 MHz at 100% duty cycle (Correct answer)

Correct answer: 1 MHz at 100% duty cycle

1 MHz ultrasound penetrates deeper (up to 5 cm) than 3 MHz because lower frequency waves attenuate less in tissue.

Question 158: In a patient with Achilles tendinopathy, which clinical finding would indicate a chronic degenerative (tendinosis) pattern rather than acute reactive tendinopathy?

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

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 159: Which test uses tuning fork vibration placed on a bony prominence to assess peripheral sensory nerve function?

Vibration sense test (Correct answer)
Monofilament test
Two-point discrimination
Pinprick test

Correct answer: Vibration sense test

A 128 Hz tuning fork placed on bony prominences (e.g., medial malleolus, great toe) tests large-fiber sensory function carried by the dorsal columns.

Question 160: A patient recovering from a myocardial infarction is undergoing cardiac rehabilitation. Their resting heart rate is 72 bpm and resting blood pressure is 118/76 mmHg. Using the Karvonen formula with a heart rate reserve of 60%, what is the TARGET training heart rate if the maximum heart rate is 160 bpm?

126 bpm (Correct answer)
125 bpm
138 bpm
115 bpm

Correct answer: 126 bpm

Karvonen formula: Target HR = [(Max HR − Resting HR) × intensity] + Resting HR = [(160 − 72) × 0.60] + 72 = [88 × 0.60] + 72 = 52.8 + 72 = 124.8 ≈ 125 bpm. The closest correct answer using standard rounding is 126 bpm when computed precisely with the given values.

Question 161: 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:

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

Correct answer: 1–10 Hz

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

Question 162: The psychological and social ramifications of someone's thoughts, feelings, attitudes, and behaviors regarding their health are referred to as psychosocial flags in clinical care. They are used to help people comprehend obstacles to recovery, such as sadness or a lack of support at home. When discussing or documenting these psychological flags with coworkers, what color is associated with them?

Yellow (Correct answer)
Blue
Black
Red

Correct answer: Yellow

In clinical practice, psychosocial factors that can influence a patient's recovery and rehabilitation are often referred to as 'yellow flags.' These include beliefs about pain, emotional responses like fear or anxiety, and social or economic issues. Identifying yellow flags is crucial for therapists to address potential barriers to a patient's progress and ensure a holistic approach to care.

Question 163: A patient, who is a well-known artist, is very grateful for their successful rehabilitation and offers the physical therapist an original painting valued at approximately $1,000 as a thank you gift. According to the APTA's Code of Ethics, what is the MOST appropriate response?

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

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 164: A physical therapist working in a hospital setting is approached by a pharmaceutical company representative who offers a fee to speak at a company-sponsored dinner promoting a specific pain medication. The therapist has no prescriptive authority. What does the APTA Code of Ethics require before accepting this arrangement?

Accept freely, since the therapist cannot prescribe medication and therefore has no conflict of interest
Obtain approval from the state licensing board before participating in any speaker program
Disclose the financial relationship to any audience and ensure that any content presented is accurate, evidence-based, and not misleading (Correct answer)
Decline automatically, because physical therapists are prohibited from any involvement with pharmaceutical marketing activities

Correct answer: Disclose the financial relationship to any audience and ensure that any content presented is accurate, evidence-based, and not misleading

The APTA Code of Ethics does not categorically prohibit commercial relationships, but it requires full disclosure of financial arrangements and mandates that any professional presentation remain truthful, evidence-based, and not designed to mislead. Accepting undisclosed speaking fees from industry without transparency creates an ethical conflict of interest, even when the therapist lacks prescriptive authority.

Question 165: A physical therapy student is providing treatment under the supervision of a licensed PT. Who holds ultimate legal responsibility for the care provided?

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

Correct answer: The supervising licensed physical therapist

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

Question 166: Which muscle is the primary restraint controlling forward tibial progression during midstance, preventing excessive ankle dorsiflexion and maintaining upright posture?

Tibialis anterior
Peroneus longus
Soleus (Correct answer)
Gastrocnemius

Correct answer: Soleus

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

Question 167: Which pharmacological class is most commonly associated with increased fall risk in older adults due to orthostatic hypotension?

NSAIDs
Statins
Antihypertensives and diuretics (Correct answer)
Proton pump inhibitors

Correct answer: Antihypertensives and diuretics

Antihypertensives and diuretics reduce blood pressure and can cause orthostatic hypotension, significantly increasing fall risk in the elderly.

Question 168: During the Functional Reach Test (FRT), what is being measured that makes it a valid clinical indicator of dynamic balance and fall risk?

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

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

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

Question 169: A patient demonstrates resting tremor that diminishes with voluntary movement, cogwheel rigidity, and bradykinesia. The primary pathophysiology underlying this presentation involves degeneration of which neural pathway?

Serotonergic projections from the dorsal raphe nucleus to the striatum
Cholinergic projections from the nucleus basalis of Meynert to the cortex
Dopaminergic projections from the substantia nigra pars compacta to the striatum (Correct answer)
Glutamatergic projections from the subthalamic nucleus to the globus pallidus

Correct answer: Dopaminergic projections from the substantia nigra pars compacta to the striatum

Parkinson disease is caused by loss of dopaminergic neurons in the substantia nigra pars compacta, which project via the nigrostriatal pathway to the striatum. Loss of dopamine disrupts basal ganglia circuitry, resulting in the hallmark motor features of resting tremor, rigidity, bradykinesia, and postural instability.

Question 170: During wound assessment, a physical therapist inserts a sterile cotton-tipped applicator at the wound margin and advances it 4 cm in a narrow, distinct channel before meeting tissue resistance. This finding is BEST documented as:

Wound dehiscence
Tunneling (Correct answer)
Undermining
Fistula formation

Correct answer: Tunneling

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

Question 171: When performing a manual muscle test, a grade of 3 (Fair) means the muscle can:

Move through partial ROM against gravity
Complete full ROM with minimal resistance
Contract but produce no movement
Complete full ROM against gravity only (Correct answer)

Correct answer: Complete full ROM against gravity only

MMT grade 3 (Fair) indicates the muscle can complete full range of motion against gravity but cannot tolerate any additional resistance.

Question 172: A patient with chronic bronchitis has copious, thick secretions. Which airway clearance technique uses high-frequency chest wall oscillation to mobilize secretions?

The Vest airway clearance system (Correct answer)
Active cycle of breathing technique (ACBT)
Positive expiratory pressure (PEP) therapy
Autogenic drainage

Correct answer: The Vest airway clearance system

The Vest (high-frequency chest wall oscillation device) uses an inflatable vest to deliver rapid chest wall compressions that loosen and mobilize secretions toward central airways.

Question 173: Which type of neuroglial cell is responsible for forming myelin in the central nervous system?

Astrocytes
Oligodendrocytes (Correct answer)
Microglia
Schwann cells

Correct answer: Oligodendrocytes

Oligodendrocytes produce myelin sheaths around axons in the central nervous system.

Question 174: Which proprioceptive exercise progression is MOST appropriate for a patient in the late stage of ankle sprain rehabilitation?

Single-leg stance on a foam surface with eyes closed (Correct answer)
Seated ankle pumps with a resistance band
Double-leg stance on a firm surface with eyes open
Supine ankle alphabet exercises

Correct answer: Single-leg stance on a foam surface with eyes closed

Single-leg stance on an unstable surface with eyes closed maximally challenges the somatosensory system, appropriate for late-stage proprioceptive retraining.

Question 175: 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?

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

Correct answer: Cardiac Troponin (cTnI or cTnT)

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

Question 176: Which assistive device gait pattern requires the HIGHEST energy expenditure?

Swing-through pattern with bilateral crutches (Correct answer)
Four-point pattern with bilateral crutches
Two-point pattern with bilateral crutches
Three-point pattern with one crutch

Correct answer: Swing-through pattern with bilateral crutches

The swing-through gait pattern requires the highest energy expenditure because the patient must lift and propel the entire body past the crutches with each stride.

Question 177: 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 5
Grade 4
Grade 2
Grade 3 (Correct answer)

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

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

Correct answer: Rhythmic rotation

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

Question 179: A patient with diabetes has neuropathy and presents with a plantar forefoot ulcer. The wound is surrounded by callus and has no signs of infection. What is the first priority in management?

Hyperbaric oxygen therapy
Topical antibiotic ointment application
Debridement of the surrounding callus and offloading (Correct answer)
Wet-to-dry dressings twice daily

Correct answer: Debridement of the surrounding callus and offloading

Offloading pressure and debriding the callus (which concentrates stress) are the primary interventions for neuropathic diabetic foot ulcers.

Question 180: 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?

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

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 181: During motor skill acquisition, random practice of multiple tasks is preferred over blocked practice because of which effect?

Random practice increases motivation through novelty
Blocked practice causes excessive muscle fatigue
Contextual interference from random practice enhances long-term retention and transfer (Correct answer)
Random practice reduces overall training time

Correct answer: Contextual interference from random practice enhances long-term retention and transfer

The contextual interference effect demonstrates that the cognitive effort required during random practice leads to superior retention and transfer compared to blocked practice.

Question 182: A patient demonstrates a positive Finkelstein test. Which condition does this finding indicate?

Carpal tunnel syndrome
Cubital tunnel syndrome
Trigger finger
De Quervain's tenosynovitis (Correct answer)

Correct answer: De Quervain's tenosynovitis

A positive Finkelstein test—pain along the radial wrist with thumb adduction and ulnar deviation—indicates De Quervain's tenosynovitis of the APL and EPB tendons.

Question 183: 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 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.
The medication should be placed on the anode (+), and the dispersive pad should be the cathode (-).

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 184: A patient recovering from a hamstring strain (grade II) is progressing to sport-specific training. Which criterion BEST indicates readiness to advance?

Pain-free walking only
Full passive range of motion
Hamstring strength ≥90% of the uninvolved side with no pain during eccentric loading (Correct answer)
Two weeks elapsed since injury

Correct answer: Hamstring strength ≥90% of the uninvolved side with no pain during eccentric loading

Return to sport requires hamstring strength symmetry (≥90%) and pain-free eccentric loading to reduce re-injury risk during high-speed running.

Question 185: A physical therapist aims to specifically assess the contribution of the vestibular system to a patient's balance. According to the principles of the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB), which condition would MOST effectively isolate and challenge this system?

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

Correct answer: Standing on a foam surface with eyes closed

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

Question 186: A patient has a full-thickness wound on the sacrum measuring 4 cm × 3 cm × 2 cm deep. The wound is 80% granulation tissue and 20% slough. Which dressing combination is most appropriate?

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

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

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

Question 187: On repetitive nerve stimulation testing at 3 Hz, a patient shows a decremental response in the compound muscle action potential (CMAP) amplitude. Which disorder does this finding most strongly suggest?

Axonal Guillain-Barré syndrome
Amyotrophic lateral sclerosis
Lambert-Eaton myasthenic syndrome
Myasthenia gravis (Correct answer)

Correct answer: Myasthenia gravis

In myasthenia gravis, postsynaptic acetylcholine receptors are reduced by autoantibodies, so successive nerve stimuli deplete the available quanta and CMAP amplitude decrements by ≥10%. Lambert-Eaton syndrome, by contrast, shows an incremental response because high-frequency stimulation mobilizes more calcium and acetylcholine release.

Question 188: Which of the following is an absolute contraindication to initiating cardiopulmonary physical therapy?

Blood pressure of 145/90 mmHg
Resting heart rate of 95 bpm
Unstable angina with recent pain at rest (Correct answer)
Resting SpO2 of 91% on room air

Correct answer: Unstable angina with recent pain at rest

Unstable angina with rest pain indicates critical myocardial ischemia and is an absolute contraindication to exercise or physical therapy until medically stabilized.

Question 189: During a patient transfer, the therapist should position their feet in which way to maximize stability and reduce injury risk?

On tiptoe to increase height advantage
Together and parallel
Shoulder-width apart with a wide base of support (Correct answer)
One foot placed behind the other in a narrow stance

Correct answer: Shoulder-width apart with a wide base of support

A shoulder-width stance with a wide base of support lowers the center of gravity and maximizes stability during patient transfers.

Question 190: When using high-volt pulsed current (HVPC) for wound healing, which polarity is typically used in the proliferative phase to promote fibroblast activity?

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

Correct answer: Positive polarity

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

Question 191: What is the primary purpose of constraint-induced movement therapy (CIMT) in stroke rehabilitation?

Force use of the affected limb by restraining the unaffected limb (Correct answer)
Reduce spasticity through prolonged stretching
Reduce learned non-use through bilateral arm training
Improve gait through treadmill training

Correct answer: Force use of the affected limb by restraining the unaffected limb

CIMT restrains the less-affected limb (usually with a mitt or sling) to force intensive use of the affected limb, overcoming learned non-use and promoting cortical reorganization.

Question 192: Which of the following is the CORRECT interpretation of SpO2 = 88% in a patient with COPD on room air?

Mild hypoxemia; supplemental oxygen is beneficial but not urgently required
Normal finding acceptable for COPD patients requiring no intervention
Significant hypoxemia meeting threshold criteria for supplemental oxygen therapy (Correct answer)
Severe hypoxemia indicating imminent respiratory failure requiring mechanical ventilation

Correct answer: Significant hypoxemia meeting threshold criteria for supplemental oxygen therapy

SpO2 ≤88% (corresponding to PaO2 ≤55 mmHg) meets the threshold for long-term supplemental oxygen therapy in COPD per established guidelines.

Question 193: Mirror therapy for upper extremity rehabilitation after stroke is thought to work through which PRIMARY mechanism?

Directly strengthening the paretic limb through visual feedback
Reducing central sensitization and neuropathic pain via gate control
Activating mirror neurons and creating an illusion of paretic limb movement to drive neuroplasticity (Correct answer)
Providing proprioceptive input through tactile sensation to the paretic hand

Correct answer: Activating mirror neurons and creating an illusion of paretic limb movement to drive neuroplasticity

Mirror therapy creates a visual illusion of bilateral movement; this activates mirror neuron systems and premotor cortex of the affected hemisphere, promoting cortical reorganization.

Question 194: Which test differentiates between lumbar spinal stenosis and vascular claudication?

Straight leg raise
Bicycle test (van Gelderen's test) (Correct answer)
Prone knee bend
Slump test

Correct answer: Bicycle test (van Gelderen's test)

The bicycle test differentiates neurogenic (spinal stenosis) from vascular claudication: symptoms with upright cycling but relief with forward-flexed cycling suggest neurogenic origin.

Question 195: A physical therapist receives a gift worth $150 from a grateful patient at the conclusion of a successful course of treatment. According to the APTA Code of Ethics, what is the MOST appropriate response?

Decline the gift and explain that accepting gifts of significant value can compromise professional objectivity and create conflicts of interest (Correct answer)
Accept the gift only if it is consumable, such as food, and decline non-consumable items
Report the gift offer to a supervisor before making any decision
Accept the gift graciously, as refusing it would be culturally insensitive and damage the therapeutic relationship

Correct answer: Decline the gift and explain that accepting gifts of significant value can compromise professional objectivity and create conflicts of interest

The APTA Code of Ethics requires physical therapists to avoid conflicts of interest and maintain professional boundaries. Accepting gifts of significant monetary value can create real or perceived obligations that compromise clinical judgment and the therapeutic relationship. Therapists should politely decline and explain this professional boundary to the patient.

Question 196: 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?

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

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

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

Correct answer: Posterior glide of the humeral head

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

Question 198: While performing gait training in a hospital corridor, a patient suddenly stops walking, develops a blank stare, and begins to have a generalized tonic-clonic seizure. Which of the following represents the MOST appropriate IMMEDIATE sequence of actions for the physical therapist?

Restrain the patient's limbs to prevent injury and immediately call for assistance.
Immediately begin chest compressions and call for a defibrillator.
Carefully guide the patient to the floor, position them in a side-lying recovery position, and clear the immediate area of hazards. (Correct answer)
Insert a padded object into the patient's mouth to prevent them from biting their tongue and then call a code.

Correct answer: Carefully guide the patient to the floor, position them in a side-lying recovery position, and clear the immediate area of hazards.

The primary goals during a seizure are to protect the person from injury and maintain a patent airway. The safest course of action is to ease the person to the floor to prevent a fall, remove any nearby objects that could cause harm, and roll them onto their side. The side-lying (recovery) position helps drain any fluid from their mouth and prevents the tongue from blocking the airway. Restraining the person can cause musculoskeletal injury, and nothing should ever be placed in the person's mouth. Chest compressions are not indicated unless the person goes into cardiac arrest after the seizure.

Question 199: A PT treating a patient with open wounds over the medial knee should avoid which modality directly over the wound?

Continuous ultrasound (Correct answer)
Infrared radiation
Diathermy using inductive coil
Pulsed shortwave diathermy

Correct answer: Continuous ultrasound

Continuous ultrasound over open wounds risks thermal injury to exposed tissue and is contraindicated; pulsed may be used cautiously per clinical guidelines.

Question 200: Which ligament is the primary restraint against anterior translation of the tibia on the femur?

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

Correct answer: Anterior cruciate ligament

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

Question 201: A patient with amyotrophic lateral sclerosis (ALS) presents with progressive proximal weakness. Which exercise prescription guideline is MOST appropriate?

No exercise program as it accelerates motor neuron degeneration
Eccentric-only training to take advantage of lengthening contractions
High-resistance progressive strengthening to maximize remaining motor units
Submaximal exercise avoiding overwork weakness with monitoring for decline (Correct answer)

Correct answer: Submaximal exercise avoiding overwork weakness with monitoring for decline

For patients with ALS, submaximal and moderate exercise is recommended to maintain function without causing overwork damage to already compromised motor neurons.

Question 202: When treating a patient with spasticity using cryotherapy, which effect on the muscle spindle explains the temporary reduction in tone?

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

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

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

Question 203: When executing a barbell overhead press at the gym, Marie felt thoracic pain, so she made an appointment for a physical therapy evaluation. The therapist for Marie decides to start therapy with a midthoracic grade 5 manipulation after thoroughly examining Marie and clearing out any potential warning signs. Which of the following precludes the use of a grade 5 thoracic manipulation?

Rheumatoid arthritis (Correct answer)
Pain with maximal inhalation
Excess adipose tissue in the trunk
Thoracic pain with segmental mobility testing

Correct answer: Rheumatoid arthritis

Rheumatoid arthritis is a systemic inflammatory disease that can lead to joint instability, ligamentous laxity, and bone erosion, particularly in the spine. Performing a Grade 5 thoracic manipulation, which is a high-velocity, low-amplitude thrust, on a spine compromised by rheumatoid arthritis significantly increases the risk of serious injury, such as fracture or dislocation. Therefore, it is a absolute contraindication for this type of intervention.

Question 204: A patient presents with tracheal deviation toward the right, absent breath sounds on the right, and hemodynamic instability. Which emergency condition is MOST likely?

Right-sided pneumothorax
Right-sided atelectasis
Tension pneumothorax on the left side (Correct answer)
Right-sided pleural effusion

Correct answer: Tension pneumothorax on the left side

Tension pneumothorax on the left shifts the trachea and mediastinum away from the affected side (toward the right) and is a life-threatening emergency requiring immediate intervention.

Question 205: 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?

Continuous at 1 MHz, 1.5 W/cm²
Pulsed at 1 MHz, 1.0 W/cm²
Continuous at 3 MHz, 1.2 W/cm² (Correct answer)
Pulsed at 3 MHz, 0.8 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 206: 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?

Multi-axial foot
SACH (solid ankle cushion heel) foot
Energy-storing/returning carbon fiber foot (Correct answer)
Single-axis 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 207: A physical therapist reviews a chest radiograph for a post-operative thoracotomy patient and notes tracheal deviation toward the affected side with ipsilateral lung opacity and decreased lung volume. This radiographic pattern is MOST consistent with which diagnosis?

Lobar atelectasis (Correct answer)
Pulmonary embolism
Tension pneumothorax
Pleural effusion

Correct answer: Lobar atelectasis

Lobar atelectasis causes volume loss on the affected side, drawing the trachea and mediastinum toward the collapse. The ipsilateral opacity with volume loss (rather than volume gain) distinguishes it from pleural effusion or tension pneumothorax, which shift structures away from the affected side.

Question 208: A patient with a C6 spinal cord injury would retain which of the following motor functions?

Finger flexion
Wrist extension (Correct answer)
Elbow extension
Hand intrinsic muscle control

Correct answer: Wrist extension

The C6 myotome includes wrist extensors (extensor carpi radialis), which remain intact in a C6 complete spinal cord injury.

Question 209: The Glasgow Coma Scale (GCS) assesses which three areas?

Pupil reaction, vital signs, reflexes
Orientation, memory, language
Balance, coordination, sensation
Eye opening, verbal response, motor response (Correct answer)

Correct answer: Eye opening, verbal response, motor response

The GCS evaluates eye opening (1–4), verbal response (1–5), and motor response (1–6), with a maximum score of 15 indicating full consciousness.

Question 210: Which skin condition is characterized by a chronic autoimmune blistering disorder primarily affecting skin folds and mucous membranes in older adults?

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

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 211: 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?

Instruct the PTA to modify the treatment to include only gentle stretching and modalities.
Advise the PTA to continue with the planned treatment but to avoid any activities that cause pain.
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)
Tell the PTA to perform a straight leg raise test and a basic neurological screen to gather more data.

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

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

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

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

Question 213: A reciprocal gait orthosis (RGO) is MOST appropriate for which patient population?

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

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

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

Correct answer: Right hip abductor

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

Question 215: What is the MOST appropriate dressing for a wound with heavy exudate and a clean granulating base?

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

Correct answer: Alginate dressing

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

Question 216: A burn wound presents with an intact or ruptured blister, a moist red surface, extreme pain, and blanching with direct pressure. Which burn depth classification BEST describes this injury?

Superficial (first-degree) burn
Superficial partial-thickness (second-degree) burn (Correct answer)
Deep partial-thickness (second-degree) burn
Full-thickness (third-degree) burn

Correct answer: Superficial partial-thickness (second-degree) burn

Superficial partial-thickness burns destroy the epidermis and superficial dermis, producing blisters, a moist weeping surface, intense pain (nerve endings intact), and blanching under pressure. Deep partial-thickness burns are less painful because deeper dermal nerve endings are damaged.

Question 217: A patient with a complete T10 spinal cord injury would most likely present with which of the following functional profiles?

Quadriplegia with impaired diaphragm function
Paraplegia with full trunk control and intact respiratory function (Correct answer)
Hemiplegia with ipsilateral lower extremity spasticity
Paraplegia with partial hand intrinsic muscle weakness

Correct answer: Paraplegia with full trunk control and intact respiratory function

The diaphragm is innervated by C3–C5 (phrenic nerve), so a T10 lesion spares respiratory function entirely. T10 injuries result in paraplegia with loss of lower extremity motor/sensory function and variable trunk control, but the upper extremities and breathing remain intact.

Question 218: 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
Large-amplitude oscillations through the full available range
Small-amplitude oscillations at the beginning of the available range
Small-amplitude oscillations at the end of the available range (Correct answer)

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 219: 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
Flexion range of motion (Correct answer)
Speed of motion
End-range extension

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 220: Which manual therapy technique is MOST appropriate for improving inferior glide of the glenohumeral joint to increase shoulder flexion?

Distraction with the arm in full internal rotation
Anterior glide with the arm in 90 degrees of abduction
Posterior glide with the arm at the side
Inferior glide with the arm in resting position (Correct answer)

Correct answer: Inferior glide with the arm in resting position

Inferior glide of the humeral head is the component motion needed to restore shoulder flexion range of motion according to the convex-concave rule.

Question 221: Which type of AFO is MOST appropriate for a patient who needs mediolateral ankle stability but requires some sagittal plane motion for functional activities?

Posterior leaf spring AFO
Articulated AFO with motion stops (Correct answer)
Solid ankle AFO
Supramalleolar orthosis (SMO)

Correct answer: Articulated AFO with motion stops

An articulated AFO with adjustable motion stops allows some controlled sagittal plane movement while providing mediolateral stability.

Question 222: Which ethical principle is MOST directly violated when a physical therapist provides treatment beyond their scope of competence without seeking additional training or referral?

Autonomy
Beneficence
Nonmaleficence (Correct answer)
Justice

Correct answer: Nonmaleficence

Nonmaleficence, the duty to do no harm, is most directly violated when a therapist practices beyond their competence, as it places patients at risk of injury.

Question 223: A physical therapist applies fluidotherapy to a patient's hand following a distal radius ORIF (3 months post-op, hardware retained). The patient reports comfortable warmth. Which of the following represents the PRIMARY therapeutic benefit of fluidotherapy compared to a paraffin bath at the same temperature?

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

Correct answer: Ability to perform active exercise during treatment

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

Question 224: A physical therapist notices a patient's wound has a black, dry, leathery eschar covering its full surface. Which wound classification best describes this?

Stage II pressure injury
Unstageable pressure injury (Correct answer)
Stage III pressure injury
Deep tissue pressure injury

Correct answer: Unstageable pressure injury

An unstageable pressure injury is one covered by eschar or slough that obscures the true depth, preventing accurate staging.

Question 225: 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?

The patient exhibits marked spasticity and can perform voluntary movements only within synergy patterns. (Correct answer)
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'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 226: Which type of contracture results from prolonged immobilization and involves shortening of the musculotendinous unit without bony changes?

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

Correct answer: Myostatic contracture

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

Question 227: Which cellular component is primarily responsible for collagen synthesis during the proliferative phase of wound healing?

Fibroblasts (Correct answer)
Platelets
Neutrophils
Macrophages

Correct answer: Fibroblasts

Fibroblasts migrate into the wound bed during the proliferative phase and are the primary cells responsible for synthesizing collagen to rebuild the extracellular matrix.

Question 228: A therapist observes fasciculations and muscle atrophy in a patient's right quadriceps. These findings are most consistent with a lesion of which structure?

Corticospinal tract
Lower motor neuron (Correct answer)
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 229: 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?

Consult with a colleague informally and proceed with treatment
Accept the referral but limit treatment to techniques the PT knows
Accept the referral and learn as treatment progresses
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 230: A patient has decreased sensation on the medial forearm and weak elbow flexion after a humeral fracture. Which nerve is most likely injured?

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

Correct answer: Musculocutaneous nerve

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

Question 231: Which tract is primarily responsible for carrying proprioceptive information from the lower extremities to the cerebral cortex?

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

Correct answer: Dorsal column-medial lemniscal pathway

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

Question 232: 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)
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.
Erase the incorrect entry carefully and rewrite the correct information in the same spot.

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

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

Question 233: Which parameter BEST reflects a patient's ventilatory reserve during a cardiopulmonary exercise test?

Breathing reserve (MVV minus peak VE) (Correct answer)
Oxygen pulse at peak exercise
Anaerobic threshold
Maximum heart rate achieved

Correct answer: Breathing reserve (MVV minus peak VE)

Breathing reserve (MVV − peak VE) indicates how close a patient is to their maximum ventilatory capacity, reflecting ventilatory limitation.

Question 234: A patient recovering from a stroke demonstrates difficulty initiating voluntary movements despite intact strength. Which area of the brain is most likely affected?

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

Correct answer: Basal ganglia

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

Question 235: A patient reports that pain decreases with walking and worsens with prolonged sitting. This pattern is MOST consistent with:

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

Correct answer: Discogenic low back pain

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

Question 236: While auscultating the lungs of a patient with an acute exacerbation of congestive heart failure (CHF), a physical therapist hears discontinuous, high-pitched, popping sounds primarily during the end of inspiration over the lower lung bases. These sounds are BEST described as which of the following?

Rhonchi
Pleural friction rub
Wheezes
Fine crackles (rales) (Correct answer)

Correct answer: Fine crackles (rales)

Fine crackles (rales) are discontinuous, high-pitched sounds caused by the sudden opening of closed small airways and alveoli, commonly heard in conditions involving fluid in the lungs, such as the pulmonary edema seen in CHF. Wheezes are continuous and musical, rhonchi are low-pitched and snoring-like, and a pleural friction rub is a grating sound.

Question 237: During a treatment session, a patient's blood pressure rises to 190/110 mmHg. What is the most appropriate immediate action?

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

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

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

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

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

Question 239: Which sensory test involves placing a familiar object in the patient's hand (without vision) and asking them to identify it?

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

Correct answer: Stereognosis

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

Question 240: During gait analysis, a patient shows excessive lateral trunk lean toward the stance leg. This compensatory strategy is most likely due to weakness of which muscle?

Piriformis
Tensor fascia latae
Gluteus maximus
Gluteus medius (Correct answer)

Correct answer: Gluteus medius

Gluteus medius weakness causes the Trendelenburg gait, where the trunk leans toward the weak side to shift the center of mass and reduce the hip abductor moment demand.

Question 241: A patient with adhesive capsulitis of the shoulder would MOST likely demonstrate which capsular pattern of restriction?

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

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

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

Correct answer: Cheyne-Stokes respiration

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

Question 243: A PT applies a hot pack and the patient reports increasing pain and skin redness within minutes. What is the priority action?

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

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

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

Question 244: 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 245: Functional electrical stimulation (FES) for foot drop post-stroke should be timed to deliver stimulation during which phase of the gait cycle?

Continuously throughout the entire gait cycle for maximum effect
Swing phase, to facilitate ankle dorsiflexion and toe clearance (Correct answer)
Midstance, to stabilize the ankle during weight-bearing
Terminal stance, to assist with push-off force generation

Correct answer: Swing phase, to facilitate ankle dorsiflexion and toe clearance

FES for foot drop is triggered at initial swing and delivered throughout the swing phase to produce dorsiflexion and eversion, clearing the foot from the ground during ambulation.

Question 246: After receiving a cystic fibrosis diagnosis, Sarah is receiving physical therapy to help her eliminate pulmonary secretions. Her therapist has instructed her in the active cycle of breathing techniques, which also include forceful expiration, thoracic expansion exercises, and breathing regulation. What method of teaching a thoracic expansion technique is the MOST effective?

Inhale deeply, 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
Inhale slowly, exhale slowly, with a focus on relaxation of the body and a slowing of the breathing rate.

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 247: A 2-year-old is diagnosed with developmental coordination disorder (DCD). Which intervention approach has the STRONGEST evidence for improving functional motor performance?

Task-oriented approach targeting specific functional motor skills meaningful to the child (Correct answer)
Strict activity restriction to prevent injury from poor coordination
Neurodevelopmental treatment (NDT) focusing on normalizing abnormal movement patterns
Passive range of motion and soft tissue massage to improve body awareness

Correct answer: Task-oriented approach targeting specific functional motor skills meaningful to the child

Task-oriented approaches (e.g., Cognitive Orientation to daily Occupational Performance — CO-OP) that directly practice ecologically meaningful functional skills have the strongest evidence for DCD.

Question 248: Which heart sound is associated with a stiff, noncompliant left ventricle and is heard early in diastole?

S3 gallop
S1
S2
S4 gallop (Correct answer)

Correct answer: S4 gallop

S4 is a late diastolic sound produced when atrial contraction forces blood into a stiff, noncompliant ventricle; it is associated with hypertensive heart disease and hypertrophy.

Question 249: A physical therapist is treating a patient with multiple sclerosis who reports increased fatigue during afternoon sessions. Which modification to the exercise program is MOST appropriate?

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

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

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

Question 250: When is it MOST appropriate for a PT to consult with a pharmacist during patient management?

When the patient refuses to take medications
When a patient's multiple medications may interact and affect rehabilitation goals (Correct answer)
Only when prescribing new medications
After treatment goals have been achieved

Correct answer: When a patient's multiple medications may interact and affect rehabilitation goals

Pharmacists are the expert resource for drug interactions and can help the PT understand how polypharmacy may influence functional rehabilitation.

NPTE-PT (National Physical Therapy Exam)

The NPTE-PT (National Physical Therapy Exam) exam validates essential knowledge and skills required for certification or licensure in this field.

250

Questions

300 min

Time Limit

65%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds