NPTE-PT Test Therapeutic Modalities Application Questions and Answers — Questions and Answers
Question 1: A physical therapist is treating a patient with chronic supraspinatus tendinopathy. The therapeutic goal is to increase tissue temperature and extensibility in the target tissue prior to stretching exercises. Which of the following ultrasound parameters is MOST appropriate?
- Pulsed at 1 MHz, 1.0 W/cm²
- Continuous at 1 MHz, 1.5 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 2: A physical therapist intends to use conventional transcutaneous electrical nerve stimulation (TENS) to modulate a patient's acute low back pain, based on the gate control theory. Which parameter settings are MOST consistent with this therapeutic goal?
- Low frequency (2-10 pps), long pulse duration (>200 microseconds)
- High frequency (80-150 pps), short pulse duration (50-100 microseconds) (Correct answer)
- High frequency (80-150 pps), long pulse duration (>200 microseconds)
- Low frequency (2-10 pps), short pulse duration (50-100 microseconds)
Correct answer: High frequency (80-150 pps), short pulse duration (50-100 microseconds)
Conventional TENS, which operates on the gate control theory of pain, uses a high frequency (e.g., 80-150 pps) and a short pulse duration (e.g., 50-100 microseconds) at a comfortable sensory-level intensity. This selectively stimulates large-diameter A-beta nerve fibers to 'close the gate' to nociceptive signals from A-delta and C fibers. Low-frequency, long-duration TENS is used to elicit an opioid-mediated analgesic effect.
Question 3: A patient is referred to physical therapy for management of acute right ankle swelling following an inversion sprain 24 hours ago. The therapist considers using cryotherapy. Which of the following findings in the patient's medical history is an absolute contraindication to this modality?
- History of hypertension
- An open wound over the dorsum of the foot
- Raynaud's phenomenon (Correct answer)
- Impaired sensation due to diabetic neuropathy
Correct answer: Raynaud's phenomenon
Raynaud's phenomenon is a vasospastic disorder causing an exaggerated response to cold, which is an absolute contraindication for cryotherapy. Applying cold could trigger severe vasoconstriction, leading to pain and potential tissue damage. Hypertension is a precaution, requiring blood pressure monitoring. An open wound and impaired sensation are also contraindications, but Raynaud's is a systemic vascular condition that represents the greatest absolute contraindication among the choices.
Question 4: 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 anode (positive electrode)
- Place a saline solution under the cathode (negative electrode)
- Place the acetic acid under either electrode, as polarity does not matter
- Place the acetic acid under the cathode (negative electrode) (Correct answer)
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 5: A physical therapist is applying intermittent pneumatic compression (IPC) to a patient's lower extremity to manage chronic lymphedema. The patient's resting blood pressure is 130/85 mmHg. To ensure safety and prevent occlusion of arterial blood flow, the inflation pressure of the IPC unit should NOT exceed which value?
- 100 mmHg
- 85 mmHg (Correct answer)
- 130 mmHg
- 60 mmHg
Correct answer: 85 mmHg
The maximum inflation pressure for an intermittent pneumatic compression device should be set below the patient's diastolic blood pressure to avoid occluding arterial circulation during the inflation cycle. In this case, the patient's diastolic pressure is 85 mmHg, so the pressure should be set at or below this value. Pressures exceeding diastolic BP can function as a tourniquet, impeding arterial flow and potentially causing harm.
Question 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?
- 10% of the patient's body weight
- 50% of the patient's body weight
- 25% of the patient's body weight (Correct answer)
- 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.
NPTE-PT Test Therapeutic Modalities Application Questions and Answers
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?