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

Question 1: A patient with heart failure has a New York Heart Association (NYHA) Class III classification. What does this indicate about their functional capacity?

No symptoms; ordinary activity is well tolerated
Symptoms at rest; unable to carry on any activity without discomfort
Symptoms with ordinary activity; marked limitation (Correct answer)
Symptoms with less-than-ordinary activity; comfortable only at rest

Correct answer: Symptoms with ordinary activity; marked limitation

NYHA Class III denotes marked limitation of physical activity, with symptoms occurring during ordinary activity such as walking short distances, though comfortable at rest.

Question 2: A patient presents with numbness in the fourth and fifth digits and weakness of the intrinsic hand muscles. Tapping at the medial elbow reproduces symptoms. Which nerve is MOST likely affected?

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

Correct answer: Ulnar nerve

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

Question 3: Which ethical principle is MOST directly violated when a PT provides unnecessary treatments to increase billing?

Veracity
Justice
Nonmaleficence (Correct answer)
Autonomy

Correct answer: Nonmaleficence

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

Question 4: A therapist reviews a chest X-ray and notes opacification of the right lower lobe with an air bronchogram. This radiographic finding is MOST consistent with:

Pulmonary embolism
Lobar pneumonia (Correct answer)
Pneumothorax
Pleural effusion

Correct answer: Lobar pneumonia

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

Question 5: A patient with chronic obstructive pulmonary disease (COPD) reports improved breathing with which position?

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

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

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

Question 6: A therapist uses proprioceptive neuromuscular facilitation (PNF) hold-relax technique. Which neurophysiological mechanism is primarily utilized?

Autogenic inhibition via Golgi tendon organ (Ib afferents) (Correct answer)
Stretch reflex via muscle spindle activation
Reciprocal inhibition via Ia afferents
Flexor withdrawal reflex

Correct answer: Autogenic inhibition via Golgi tendon organ (Ib afferents)

Hold-relax uses an isometric contraction of the tight muscle followed by relaxation, which activates the GTO and triggers autogenic inhibition to allow greater ROM.

Question 7: A physical therapist is treating a patient with left-sided neglect following a stroke. Which brain region is most likely affected?

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

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 8: A patient with Guillain-Barré syndrome is in the acute progressive phase. Which intervention is the HIGHEST priority?

Neuromuscular electrical stimulation at maximum tolerable intensity
Aggressive strengthening to prevent muscle atrophy
High-intensity aerobic conditioning on a stationary bike
Respiratory monitoring and positioning to prevent skin breakdown (Correct answer)

Correct answer: Respiratory monitoring and positioning to prevent skin breakdown

During the acute progressive phase of GBS, aggressive exercise is contraindicated; the priority is respiratory monitoring, positioning, and preventing secondary complications such as pressure injuries.

Question 9: A physical therapist notices a patient's wound has a black, dry, leathery eschar covering its full surface. Which wound classification best describes this?

Unstageable pressure injury (Correct answer)
Deep tissue pressure injury
Stage III pressure injury
Stage II 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 10: A patient with SLAP (superior labrum anterior to posterior) tear would most likely test positive on which examination?

Speed's test and O'Brien's active compression test (Correct answer)
Sulcus sign
Drop arm test
Empty can test

Correct answer: Speed's test and O'Brien's active compression test

Speed's test (resisted shoulder flexion with elbow extended) and O'Brien's test are commonly positive with SLAP lesions involving the biceps anchor.

Question 11: 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?

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

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 12: In which scenario would a physical therapist be MOST justified in breaching patient confidentiality without the patient's consent?

A family member asks about the patient's treatment progress
An insurance company requests additional clinical documentation
The patient reveals they plan to physically harm a specific individual (Correct answer)
The patient's employer requests information about work restrictions

Correct answer: The patient reveals they plan to physically harm a specific individual

The duty to warn or protect overrides confidentiality when a patient presents a credible, imminent threat of serious harm to an identifiable third party.

Question 13: A physical therapist is evaluating a patient who presents with flaccid paralysis, significant muscle atrophy, and fasciculations in the right lower extremity. Deep tendon reflexes are diminished (1+). Sensation is intact. These signs are MOST indicative of a lesion in which of the following locations?

Basal ganglia
Anterior horn cell (Correct answer)
Cerebral cortex
Dorsal column

Correct answer: Anterior horn cell

The clinical presentation of flaccid paralysis, significant muscle atrophy, fasciculations, and hyporeflexia are classic signs of a lower motor neuron (LMN) lesion. [2, 8] The anterior horn cell is the location of the cell body for lower motor neurons. A lesion here would produce these findings. Lesions in the cerebral cortex (upper motor neuron) would result in spasticity and hyperreflexia. [10] Basal ganglia lesions are associated with movement disorders like Parkinson's disease, characterized by rigidity and bradykinesia. Dorsal column lesions would primarily affect sensory modalities like vibration and proprioception, not motor function in this manner.

Question 14: During phase II of cardiac rehabilitation, a patient's heart rate should generally not exceed what threshold above resting heart rate?

40-50 bpm above resting
20-30 bpm above resting (Correct answer)
60-70 bpm above resting
10-15 bpm above resting

Correct answer: 20-30 bpm above resting

Phase II cardiac rehab typically limits heart rate to 20-30 bpm above resting to ensure safe exercise progression.

Question 15: A patient presents with insidious onset of cervical pain and numbness radiating into the ring and little fingers with weakness of grip. Which cervical level is most likely involved?

C8 (Correct answer)
C5
C6
C7

Correct answer: C8

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

Question 16: A physical therapist is treating a patient with acute pain using conventional Transcutaneous Electrical Nerve Stimulation (TENS). According to the Gate Control Theory of pain, which parameters are MOST effective for this mode of TENS?

Low frequency (10 Hz), short pulse duration (50 µs), high intensity (to motor contraction)
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)
High frequency (150 Hz), long pulse duration (250 µs), high intensity (to tolerance)

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

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

Correct answer: 88%

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

Question 18: A second-degree partial-thickness burn is characterized by which finding?

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

Correct answer: Blistering, moist, and extremely painful wound

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

Question 19: A patient with a T6 complete spinal cord injury uses a KAFO with forearm crutches. Which gait pattern is MOST energy-efficient for this patient over short distances?

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

Correct answer: Swing-through gait

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

Question 20: A physical therapist is treating a patient with cerebellar ataxia secondary to multiple sclerosis who demonstrates dysmetria and gait instability. Which intervention has the STRONGEST evidence for improving limb coordination in this patient?

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

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

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

Question 21: Which electrotherapy parameter describes the number of pulses delivered per second?

Amplitude
Pulse duration
Frequency (Correct answer)
Phase charge

Correct answer: Frequency

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

Question 22: Which of the following BEST describes the end-feel found in an acutely inflamed joint?

Empty end-feel (Correct answer)
Springy or boggy end-feel
Firm capsular end-feel
Hard bony end-feel

Correct answer: Empty end-feel

An empty end-feel occurs when the patient stops the examiner before the true end of range due to severe pain, with no tissue resistance reached — typical of acute inflammation or serious pathology.

Question 23: Which pulmonary function test pattern is characteristic of restrictive lung disease?

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

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 24: 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 25: A patient with lymphedema in the right lower extremity is prescribed intermittent pneumatic compression (IPC). To effectively reduce the edema, which of the following treatment parameters is MOST appropriate and safe?

Inflation pressure of 90 mmHg, on:off cycle of 15:15 seconds, treatment time of 20 minutes
Inflation pressure below diastolic blood pressure, on:off cycle of 30:10 seconds, treatment time of 15 minutes
Inflation pressure of 45 mmHg, on:off cycle of 90:30 seconds, treatment time of 60 minutes (Correct answer)
Inflation pressure of 110 mmHg, on:off cycle of 60:60 seconds, treatment time of 30 minutes

Correct answer: Inflation pressure of 45 mmHg, on:off cycle of 90:30 seconds, treatment time of 60 minutes

Evidence suggests that for lymphedema, effective IPC treatment involves pressures between 30-60 mmHg, applied for 45-60 minutes. A longer inflation time (e.g., 90 seconds) followed by a shorter deflation time (e.g., 30 seconds) in a 3:1 ratio is a common and effective protocol. Pressures should not exceed the patient's diastolic blood pressure to avoid occluding arterial flow. Pressures as high as 90 or 110 mmHg are generally considered excessive and potentially unsafe for lymphedema.

Question 26: Which tract is primarily responsible for carrying proprioceptive information from the lower extremities to the cerebral cortex?

Anterior spinothalamic tract
Dorsal column-medial lemniscal pathway (Correct answer)
Spinocerebellar tract
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 27: Which ethical principle is MOST directly violated when a physical therapist provides treatment beyond their scope of competence without seeking additional training or referral?

Justice
Beneficence
Nonmaleficence (Correct answer)
Autonomy

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 28: A physical therapist performs a FABER test on a patient complaining of hip and groin pain. The patient reports sharp, anterior hip pain during the maneuver. This finding is MOST indicative of which of the following conditions?

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

Correct answer: Intra-articular hip pathology

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

Question 29: Which of the following findings is MOST consistent with a complete rotator cuff tear rather than tendinopathy?

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

Correct answer: Significant weakness with resisted shoulder abduction

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

Question 30: During rehabilitation of a rotator cuff repair, at what phase is it MOST appropriate to begin resisted external rotation exercises?

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

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

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

Question 31: When performing chest physical therapy, postural drainage for the posterior basal segments of the lower lobes requires the patient to be positioned in which way?

Side-lying with the affected side up
Prone with the foot of the bed elevated 18 inches (Correct answer)
Supine with the foot of the bed elevated 18 inches
Sitting upright leaning forward

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

The posterior basal segments are drained with the patient prone and the bed tilted so the foot end is elevated approximately 18 inches.

Question 32: A PT receives a subpoena requesting patient records. The MOST appropriate response is to:

Consult legal counsel and release only what is legally required (Correct answer)
Refuse the subpoena and notify the patient
Immediately release all records to the requesting party
Destroy the records to protect patient privacy

Correct answer: Consult legal counsel and release only what is legally required

A subpoena is a legal demand, and the PT should consult legal counsel to ensure proper compliance while protecting patient rights.

Question 33: Which type of muscle contraction occurs in the quadriceps when a person slowly lowers into a squat position?

Isokinetic
Isometric
Eccentric (Correct answer)
Concentric

Correct answer: Eccentric

During the lowering phase of a squat, the quadriceps lengthen while producing force to control the descent, which defines an eccentric contraction.

Question 34: Which type of AFO is MOST appropriate for a patient who needs mediolateral ankle stability but requires some sagittal plane motion for functional activities?

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

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 35: A therapist observes paradoxical inward movement of the abdomen during inspiration in a supine patient. This sign indicates dysfunction of which muscle?

Diaphragm (Correct answer)
Scalenes
External intercostals
Serratus anterior

Correct answer: Diaphragm

When the diaphragm is weak or paralyzed, it is drawn upward during inspiration by negative intrathoracic pressure, causing paradoxical inward abdominal movement.

Question 36: Which finding in a patient taking digoxin should cause the PT to immediately stop treatment?

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

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

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

Question 37: 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
Shoulder-width apart with a wide base of support (Correct answer)
Together and parallel
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 38: A physical therapist is assessing a patient with suspected lateral epicondylitis. Which special test is MOST appropriate to confirm this diagnosis?

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

Correct answer: Cozen's test

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

Question 39: Which diaphragmatic breathing technique MOST effectively reduces accessory muscle use in a patient with COPD?

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

Correct answer: Pursed-lip breathing combined with diaphragmatic breathing

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

Question 40: A reciprocal gait orthosis (RGO) is MOST appropriate for which patient population?

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

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

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

Question 41: Which exercise intensity zone is RECOMMENDED for most patients in Phase II cardiac rehabilitation according to American Heart Association guidelines?

40-50% of heart rate reserve
Less than 40% of heart rate reserve
80-90% of heart rate reserve
50-80% of heart rate reserve (Correct answer)

Correct answer: 50-80% of heart rate reserve

Phase II cardiac rehabilitation targets 50-80% of heart rate reserve (or VO2 reserve) to provide a safe and effective cardiovascular training stimulus.

Question 42: Which heart sound is associated with a stiff, noncompliant left ventricle and is heard early in diastole?

S1
S3 gallop
S4 gallop (Correct answer)
S2

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

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

Correct answer: Pulsed lavage with suction

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

Question 44: During a treatment session, a physical therapist notices signs consistent with elder abuse on a patient. What is the therapist's legal obligation?

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)
Document the findings and wait to see if the signs worsen

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 45: A PT working in a school setting identifies a child who may have developmental delays beyond the current referral. What is the best action?

Begin treatment for the additional concerns without further referral
Notify the parents and recommend appropriate specialist referral (Correct answer)
Ignore findings unrelated to the current referral diagnosis
Document the observations only and not discuss with parents

Correct answer: Notify the parents and recommend appropriate specialist referral

PTs are obligated to communicate relevant clinical findings to caregivers and recommend referral to appropriate specialists.

Question 46: 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)
Modified Ashworth Scale (MAS)
Fugl-Meyer Assessment (FMA)
Manual muscle test (MMT)

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

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

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

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

Question 48: A physical therapist maintains a social media profile and occasionally posts about interesting clinical cases to engage with professional peers. Which practice BEST aligns with HIPAA and the APTA Code of Ethics?

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

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

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

Question 49: A patient with a C6 spinal cord injury would retain which of the following motor functions?

Wrist extension (Correct answer)
Elbow extension
Finger flexion
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 50: A patient with spastic hemiplegia walks with the knee in hyperextension throughout stance. This MOST likely results from:

Weak quadriceps with compensatory locking
Excessive dorsiflexion range of motion
Spastic plantarflexors causing a rigid forefoot rocker (Correct answer)
Hip flexor spasticity driving anterior pelvic tilt

Correct answer: Spastic plantarflexors causing a rigid forefoot rocker

Spastic plantarflexors create a rigid equinus foot that acts as a lever, pushing the tibia posteriorly and forcing the knee into hyperextension during stance.

Question 51: During a physical therapy session, a patient suddenly develops tracheal deviation toward the right side, absent breath sounds on the left, and hypotension. The therapist should suspect:

Left-sided tension pneumothorax (Correct answer)
Pulmonary embolism
Right-sided pleural effusion
Left-sided pneumonia

Correct answer: Left-sided tension pneumothorax

Tension pneumothorax causes tracheal deviation away from the affected side due to mediastinal shift, along with absent breath sounds and hemodynamic compromise.

Question 52: Trina went to physical therapy complaining of right low back pain that had been bothering her for the previous two weeks, which had spread to her posterior right leg and down to her knee. Her therapist saw a diminished patellar reflex on the side that was injured. When she lays down to attempt to fall asleep at night and when she bends forward, her agony is at its worst. Which of the following fits the facts above as a reasonable diagnostic theory?

Lumbar radiculopathy (Correct answer)
Vascular claudication
Lumbar stenosis
Spinal neoplasm

Correct answer: Lumbar radiculopathy

Trina's symptoms, including low back pain radiating down the posterior leg to the knee, a diminished patellar reflex (L3/L4 nerve root), and pain worsened by lying down or bending forward, are classic indicators of lumbar radiculopathy. This condition typically involves compression or irritation of a spinal nerve root, often due to a disc herniation, which can be exacerbated by positions that increase intradiscal pressure. Other options like vascular claudication or lumbar stenosis present with different symptom patterns and aggravating/alleviating factors.

Question 53: Which outcome measure uses a 6-minute walk test (6MWT) as a primary functional assessment in patients with cardiopulmonary conditions?

MRC Dyspnea Scale
Borg RPE Scale
Distance walked as a measure of functional exercise capacity (Correct answer)
FEV1/FVC ratio

Correct answer: Distance walked as a measure of functional exercise capacity

The 6MWT measures the distance a patient walks in 6 minutes, providing a valid, reliable measure of submaximal functional exercise capacity.

Question 54: A patient requests access to their complete medical record including the physical therapist's personal session notes. Under HIPAA, what is the therapist's obligation?

Require the patient to obtain a court order
Provide access only if the patient's physician approves
Deny access because session notes are private
Provide the patient access to their designated record set, which may exclude psychotherapy-equivalent notes (Correct answer)

Correct answer: Provide the patient access to their designated record set, which may exclude psychotherapy-equivalent notes

Under HIPAA, patients have the right to access their designated record set, though certain psychotherapy-equivalent process notes may be excluded from this right.

Question 55: For a patient with lymphedema, which hydrotherapy approach is CONTRAINDICATED?

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

Correct answer: Neutral warmth whirlpool for dependent extremity

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

Question 56: Which Berg Balance Scale score BEST indicates a high fall risk in a community-dwelling older adult?

41–45
Above 45
Below 41 (Correct answer)
Exactly 56

Correct answer: Below 41

A Berg Balance Scale score below 41 is associated with a significantly high fall risk in older adults.

Question 57: A patient presents with a wound that has edges that are raised, rolled under (epibole), and not advancing across the wound bed. This indicates:

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

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 58: A patient presents with shoulder pain that is reproduced with overhead activities. The physical therapist performs a cluster of special tests for shoulder impingement syndrome. Which of the following combinations of tests has been shown to have the highest diagnostic utility when clustered together for subacromial impingement?

Hawkins-Kennedy test, Painful Arc sign, and Infraspinatus muscle test (Correct answer)
Adson's test, Wright test, and Roos test
Apprehension test, Relocation test, and Sulcus sign
Speed's test, Yergason's test, and O'Brien's test

Correct answer: Hawkins-Kennedy test, Painful Arc sign, and Infraspinatus muscle test

Research has identified a cluster of tests that, when positive, significantly increases the likelihood of subacromial impingement syndrome. This cluster includes the Hawkins-Kennedy test, the Painful Arc sign, and the Infraspinatus muscle test (resisted external rotation). The other answer choices represent clusters for different pathologies: bicipital tendinopathy/labral tears (A), glenohumeral instability (B), and thoracic outlet syndrome (D).

Question 59: Which spirometry value is most useful for differentiating obstructive from restrictive pulmonary disease?

FEV1/FVC ratio (Correct answer)
FVC
TLC
RV

Correct answer: FEV1/FVC ratio

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

Question 60: A patient with Parkinson disease demonstrates a festinating gait pattern. Which intervention is MOST appropriate to address this impairment?

Ankle-foot orthoses to improve foot clearance
Proprioceptive neuromuscular facilitation rhythmic initiation
Visual cues such as floor markers to regulate step length (Correct answer)
High-speed treadmill training to increase cadence

Correct answer: Visual cues such as floor markers to regulate step length

Visual cueing strategies, such as placing tape lines on the floor, help patients with Parkinson disease regulate step length and reduce festination.

Question 61: A PT working in a school setting suspects a student has been physically abused. The FIRST action should be to:

Notify child protective services as required by mandatory reporting laws (Correct answer)
Document findings and wait to see if the situation resolves
Contact the parents for clarification
Consult with the school principal before any action

Correct answer: Notify child protective services as required by mandatory reporting laws

PTs are mandatory reporters in all U.S. states, requiring immediate reporting of suspected child abuse to the appropriate authorities.

Question 62: On the Berg Balance Scale (BBS), a score below which threshold is most strongly associated with high fall risk and likely dependence on an assistive device for safe ambulation?

36 out of 56
20 out of 56
45 out of 56 (Correct answer)
50 out of 56

Correct answer: 45 out of 56

A BBS score below 45/56 is the widely cited threshold for significantly elevated fall risk. Scores of 0–20 suggest wheelchair dependence, 21–40 suggest ambulatory with assistance, and 41–56 suggest independent, with the 45-point cut-off being the clinically actionable fall-risk marker.

Question 63: Which pharmacological agent used in the treatment of hypertension can cause exercise-induced hypotension and blunt the heart rate response to exercise?

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

Correct answer: Beta-blockers

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

Question 64: When applying the PNF technique of approximation at the shoulder, what is the PRIMARY physiological mechanism?

Joint distraction to reduce pain and allow relaxation
Muscle spindle stretch reflex activation through quick lengthening
Golgi tendon organ inhibition to allow greater ROM
Joint compression stimulating mechanoreceptors to facilitate co-contraction and postural stability (Correct answer)

Correct answer: Joint compression stimulating mechanoreceptors to facilitate co-contraction and postural stability

Approximation compresses joint surfaces, stimulating articular mechanoreceptors and muscle spindles, which reflexively facilitates simultaneous contraction of muscles surrounding the joint for stability.

Question 65: Which balance assessment tool specifically examines anticipatory postural adjustments and reactive balance strategies under six sensory conditions?

Berg Balance Scale
Functional Reach Test
Sensory Organization Test (Computerized Dynamic Posturography) (Correct answer)
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 66: 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?

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

Correct answer: Ability to perform active exercise during treatment

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

Question 67: A patient with T6 complete spinal cord injury is performing wheelchair propulsion and suddenly develops pounding headache, diaphoresis above the lesion, and hypertension. What is the most appropriate immediate action?

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

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

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

Question 68: Constraint-induced movement therapy (CIMT) is MOST appropriate for which patient?

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

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

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

Question 69: Which outcome measure is most appropriate for assessing functional mobility and fall risk in community-dwelling older adults?

Functional Independence Measure (FIM)
Timed Up and Go (TUG) test (Correct answer)
Berg Balance Scale
Modified Ashworth 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 70: A patient presents with a shallow wound on the medial aspect of the lower leg with irregular edges, copious serous drainage, periwound edema, and brown hemosiderin staining of the surrounding skin. Which wound etiology is MOST consistent with this presentation?

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

Correct answer: Venous stasis ulcer

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

Question 71: Which medication side effect should prompt a PT to immediately stop exercise and notify the physician?

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

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 72: Which stage of Brunnstrom's Motor Recovery Scale describes the appearance of spasticity and stereotyped limb synergies in a stroke patient?

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

Correct answer: Stage 2

Stage 2 of Brunnstrom's recovery is characterized by the onset of spasticity and the emergence of limb synergy patterns following a flaccid Stage 1.

Question 73: A physical therapist notes that a patient on mechanical ventilation has a respiratory rate of 28 breaths/min, tidal volume of 350 mL, and dead space volume of 150 mL. What is the patient's alveolar ventilation per minute?

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

Correct answer: 5,600 mL/min

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

Question 74: A patient with COPD is completing pulmonary rehabilitation. Target SpO2 during exercise should be maintained at a minimum of:

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

Correct answer: 92%

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

Question 75: A PT applies cryotherapy immediately after acute ankle inversion sprain. Which physiological effect is the PRIMARY goal in this phase?

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

Correct answer: Reducing secondary hypoxic injury by decreasing tissue metabolism

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

Question 76: Which parameter determines the depth of penetration for therapeutic ultrasound when selecting between 1 MHz and 3 MHz?

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

Correct answer: Frequency

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

Question 77: A patient is prescribed opioid analgesics post-surgery. Which PT consideration is MOST important?

Restrict range-of-motion exercises
Withhold treatment until opioids are discontinued
Monitor for sedation and respiratory depression that could impair exercise safety (Correct answer)
Avoid all weight-bearing activities

Correct answer: Monitor for sedation and respiratory depression that could impair exercise safety

Opioids cause CNS depression and sedation, which can impair balance, coordination, and safe participation in PT.

Question 78: A physical therapist selects interferential current (IFC) therapy for a patient with deep hip joint pain. What is the PRIMARY advantage of IFC over conventional TENS for this application?

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

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

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

Question 79: Which gait deviation is MOST commonly associated with excessive foot pronation in the stance phase?

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

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

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

Question 80: In normal gait, at what percentage of the gait cycle does the opposite foot make initial contact (double support ends)?

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

Correct answer: 10%

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

Question 81: A patient with a venous leg ulcer has a resting ABI of 0.55. Which treatment is contraindicated?

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

Correct answer: High-compression bandaging (40 mmHg)

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

Question 82: A patient is 4 months post-total hip arthroplasty via a posterior approach and has been cleared for full activity. Which exercise should STILL be avoided?

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

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

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

Question 83: A PT student observes their clinical instructor performing a technique that appears to cause unnecessary patient discomfort. The student's BEST action is to:

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

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

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

Question 84: A patient presents with weakness of shoulder abduction and external rotation following a traumatic injury to the neck. Which nerve root level is most likely affected?

C6
C5 (Correct answer)
C7
C4

Correct answer: C5

C5 innervates the deltoid (shoulder abduction) and infraspinatus/teres minor (external rotation) via the axillary and suprascapular nerves.

Question 85: A PT documents passive ROM as 'WFL.' This abbreviation means:

Within full length
Without functional loss
Without force loading
Within functional limits (Correct answer)

Correct answer: Within functional limits

WFL stands for 'within functional limits,' indicating ROM is sufficient for the patient's functional needs even if not full normal ROM.

Question 86: When applying phonophoresis with hydrocortisone to a patient's lateral epicondyle, which ultrasound parameter best facilitates transdermal drug delivery?

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

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

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

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

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

Question 88: During a graded exercise test on a treadmill, a physical therapist observes the following changes on a patient's ECG: the R-R interval shortens, the P-R interval shortens, and the QRS complex duration remains unchanged. Which of the following is the BEST interpretation of these findings?

Evidence of a heart block.
A normal physiological response to exercise. (Correct answer)
A sign of developing ventricular arrhythmia.
Indicative of myocardial ischemia.

Correct answer: A normal physiological response to exercise.

These ECG changes are all expected, normal physiological responses to exercise. The R-R interval shortens as heart rate increases. The P-R interval shortens due to faster atrioventricular conduction. The QRS complex, representing ventricular depolarization, typically remains stable in duration during exercise. Pathological changes would include significant ST-segment depression (ischemia) or premature ventricular contractions (arrhythmia).

Question 89: During motor skill acquisition, random practice of multiple tasks is preferred over blocked practice because of which effect?

Contextual interference from random practice enhances long-term retention and transfer (Correct answer)
Blocked practice causes excessive muscle fatigue
Random practice increases motivation through novelty
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 90: During wound irrigation, which pressure range is recommended to effectively remove bacteria and debris without damaging granulation tissue?

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

Correct answer: 4-15 psi

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

Question 91: Which ligament is the primary restraint against anterior translation of the tibia on the femur?

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

Correct answer: Anterior cruciate ligament

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

Question 92: A physical therapist performs the Thomas test on a patient and observes that the contralateral thigh rises off the table. This MOST likely indicates tightness of which structure?

Hamstring muscle group
Piriformis muscle
Hip flexor musculature (iliopsoas) (Correct answer)
Iliotibial band

Correct answer: Hip flexor musculature (iliopsoas)

The Thomas test detects hip flexor tightness. When the non-tested leg is pulled to the chest to flatten the lumbar spine, a tight iliopsoas on the tested side prevents the thigh from resting flat on the table, causing it to rise.

Question 93: A patient with L4 nerve root dysfunction will MOST likely require which orthotic device?

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

Correct answer: AFO with dorsiflexion assist

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

Question 94: Which of the following is a characteristic feature of Guillain-Barré syndrome (GBS)?

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

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

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

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

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

Question 96: 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)
1:1 (equal on and off time)
2:1 (twice as much on-time as 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 97: A patient is participating in Phase II cardiac rehabilitation following a coronary artery bypass graft (CABG) 6 weeks ago. The physical therapist is monitoring the patient's response to treadmill walking. Which of the following RPE values on the Borg 6-20 scale is the MOST appropriate target for the main workout portion of the session?

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

Correct answer: 12-14

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

Question 98: Under HIPAA, which scenario represents a permissible disclosure of PHI without patient authorization?

Releasing records to the patient's attorney without a subpoena
Sharing records with the patient's employer
Disclosing information to a marketing company
Providing records to a treating physician for continuity of care (Correct answer)

Correct answer: Providing records to a treating physician for continuity of care

HIPAA permits disclosure of PHI for treatment purposes, including sharing with other treating healthcare providers without explicit authorization.

Question 99: When measuring passive knee extension with a goniometer, the stationary arm of the goniometer should align with which landmark?

Greater trochanter to lateral femoral condyle (Correct answer)
Head of the fibula to lateral malleolus
Lateral femoral condyle
Tibial tuberosity

Correct answer: Greater trochanter to lateral femoral condyle

For knee extension ROM, the stationary arm aligns along the femur from the greater trochanter to the lateral femoral condyle, with the axis at the lateral femoral condyle.

Question 100: Which stage of pressure injury involves full-thickness skin and tissue loss with visible or palpable fascia, muscle, tendon, ligament, or bone?

Stage 4 (Correct answer)
Stage 3
Unstageable
Stage 2

Correct answer: Stage 4

Stage 4 pressure injuries involve full-thickness tissue loss exposing deep structures such as fascia, muscle, tendon, or bone.

Question 101: Which type of traction is MOST appropriate for a patient with acute cervical radiculopathy who cannot tolerate positional changes?

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

Correct answer: Manual traction in supine

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

Question 102: A patient recovering from a right cerebrovascular accident (CVA) exhibits significant left-sided weakness and pushes strongly toward the left side when sitting, walking, or transferring. The patient resists any attempt at passive correction toward midline. This clinical presentation is BEST described as:

Pusher Syndrome (Contraversive Pushing) (Correct answer)
Unilateral Neglect
Apraxia
Ataxia

Correct answer: Pusher Syndrome (Contraversive Pushing)

Pusher Syndrome, or contraversive pushing, is a disorder of postural control where the patient actively pushes with their non-paretic side toward their paretic side due to a mismatch between their visual vertical and their perceived postural vertical. [19] This results in a loss of lateral balance and resistance to passive correction. Ataxia is uncoordinated movement. Apraxia is the inability to perform purposeful movements despite intact motor and sensory function. Unilateral neglect is the failure to report or respond to stimuli presented on the contralateral side of a brain lesion.

Question 103: A physical therapist is developing a plan of care for a patient who has elected for non-operative management of a complete Achilles tendon rupture. According to current evidence-based protocols, which of the following is the MOST likely instruction for the first two weeks?

Immobilization in a cast or boot in a position of plantar flexion, non-weight-bearing (Correct answer)
Full weight-bearing as tolerated with bilateral crutches
Gentle active range of motion into dorsiflexion to prevent contractures
Partial weight-bearing in a neutral walking boot

Correct answer: Immobilization in a cast or boot in a position of plantar flexion, non-weight-bearing

Non-operative management of an acute Achilles tendon rupture initially requires immobilization with the foot in a plantar flexed position to approximate the torn ends of the tendon. This is typically done in a cast or a boot with heel lifts, and the patient is kept non-weight-bearing for the initial 2 weeks to allow healing to begin.

Question 104: A PT observes that the medical record contains a physician's order with unclear dosage instructions relevant to the patient's rehabilitation. What should the PT do?

Document uncertainty in the chart and proceed cautiously
Proceed with treatment using clinical judgment about the dosage
Clarify the order directly with the prescribing physician before proceeding (Correct answer)
Ask the nursing staff to interpret the order on the physician's behalf

Correct answer: Clarify the order directly with the prescribing physician before proceeding

Ambiguous orders must be clarified directly with the prescribing physician to ensure patient safety before proceeding.

Question 105: A patient with de Quervain's tenosynovitis is referred for physical therapy. Which intervention is MOST appropriate initially?

Aggressive resisted thumb strengthening
Joint manipulation of the CMC joint
Thumb spica splinting and activity modification (Correct answer)
High-load tendon loading exercises

Correct answer: Thumb spica splinting and activity modification

Initial management of de Quervain's tenosynovitis includes thumb spica splinting to rest the APL and EPB tendons and activity modification to reduce irritation.

Question 106: 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:

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

Correct answer: 1–10 Hz

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

Question 107: Which test assesses the integrity of the corticospinal tract by stroking the lateral plantar surface of the foot?

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

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 108: Which balance assessment tool specifically measures anticipatory postural control during self-initiated perturbations?

Sensory Organization Test
Romberg Test
Functional Reach Test (Correct answer)
Timed Up and Go

Correct answer: Functional Reach Test

The Functional Reach Test measures the maximal distance a person can reach forward beyond arm's length while maintaining a fixed base of support, assessing anticipatory postural adjustments.

Question 109: A patient with a stroke has weakness of the right face, arm, and leg. Where is the lesion most likely located?

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

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

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

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

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

Question 111: Which of the following BEST represents an example of a dual relationship that a PT should avoid?

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

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

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

Question 112: A patient with a C6 spinal cord injury would be expected to have intact function of which muscle group?

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

Correct answer: Wrist extensors

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

Question 113: Which cranial nerve is responsible for both the afferent and efferent limbs of the gag reflex?

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

Correct answer: CN IX and CN X

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

Question 114: Which skin change is an early sign of deep tissue pressure injury (DTI)?

Purple or maroon intact skin that may be painful or boggy (Correct answer)
White, waxy slough with surrounding erythema
Full-thickness wound with black eschar
Partial-thickness skin loss with serous exudate

Correct answer: Purple or maroon intact skin that may be painful or boggy

Deep tissue pressure injury presents as an area of persistent purple or maroon discoloration of intact skin, indicating underlying soft tissue damage.

Question 115: A patient with a complete C6 spinal cord injury would be expected to have functional use of which muscle group?

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

Correct answer: Wrist extensors

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

Question 116: 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)
Using only the patient's first name and last initial in the electronic health record.
Logging out of the system only when leaving for a lunch break.
Asking the patient for permission to document in the open area.

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 117: Which soft tissue mobilization technique involves applying pressure perpendicular to the muscle fiber direction to break up adhesions?

Petrissage
Tapotement
Cross-friction massage (Correct answer)
Effleurage

Correct answer: Cross-friction massage

Cross-friction massage (Cyriax technique) applies transverse pressure perpendicular to tissue fibers to break adhesions and promote proper collagen remodeling.

Question 118: A patient with a right transtibial amputation demonstrates lateral trunk bending toward the prosthetic side during stance. What is the MOST likely cause?

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

Correct answer: Prosthetic shank too long

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

Question 119: A physical therapist is using PNF techniques with a patient post-stroke. Which PNF technique involves alternating isometric contractions of agonist and antagonist without joint movement?

Contract-relax
Slow reversal
Rhythmic stabilization (Correct answer)
Repeated contractions

Correct answer: Rhythmic stabilization

Rhythmic stabilization involves alternating isometric contractions of opposing muscle groups to improve stability, motor control, and cocontractions without movement.

Question 120: When is it MOST appropriate for a PT to consult with a pharmacist during patient management?

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

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.

Question 121: A physical therapist is prescribing low-level laser therapy (LLLT) for a patient with lateral knee pain and delayed soft-tissue healing following a grade II LCL sprain. Which of the following represents an ABSOLUTE contraindication that would require the therapist to withhold treatment?

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

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

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

Question 122: A PT in private practice receives a referral bonus from a specialist for each patient sent for imaging. This MOST likely violates:

HIPAA privacy regulations
The PT Practice Act only
The Stark Law and anti-kickback statutes (Correct answer)
Medicare documentation requirements only

Correct answer: The Stark Law and anti-kickback statutes

Receiving financial incentives for referrals violates the federal Anti-Kickback Statute and potentially Stark Law, which prohibit such arrangements.

Question 123: A patient with a T4 spinal cord injury suddenly complains of a pounding headache, and the physical therapist notes profuse sweating and flushing of the skin above the level of the lesion. The therapist measures the patient's blood pressure and finds it to be significantly elevated. Which of the following should be the therapist's IMMEDIATE course of action?

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

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

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

Question 124: A patient in the ICU has a pulmonary artery catheter showing a pulmonary capillary wedge pressure (PCWP) of 22 mmHg. This value is MOST consistent with which condition?

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

Correct answer: Left ventricular failure

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

Question 125: Which of the following is an example of patient abandonment?

Discharging a patient without notice or appropriate follow-up when they still require care (Correct answer)
Ending treatment after a patient achieves their discharge goals
Transferring care to another PT with proper documentation and handoff
Referring a patient to a specialist more qualified to address their needs

Correct answer: Discharging a patient without notice or appropriate follow-up when they still require care

Abruptly ending care without notice, referral, or alternative arrangements when the patient still requires treatment constitutes abandonment.

Question 126: A patient demonstrates a positive Trendelenburg sign on the right side during single-limb stance. Which muscle is most likely weak?

Right gluteus medius (Correct answer)
Left gluteus medius
Left iliopsoas
Right quadratus lumborum

Correct answer: Right gluteus medius

A positive Trendelenburg sign indicates weakness of the gluteus medius on the stance limb side, causing the pelvis to drop on the swing side.

Question 127: Which cranial nerve is responsible for the gag reflex (afferent limb)?

Cranial nerve X
Cranial nerve XII
Cranial nerve IX (Correct answer)
Cranial nerve V

Correct answer: Cranial nerve IX

CN IX (glossopharyngeal) carries the afferent signal from the posterior pharynx for the gag reflex, while CN X carries the efferent motor response.

Question 128: When is whirlpool hydrotherapy MOST appropriate?

Acute ankle sprain within the first 24 hours
Burns covering more than 20% body surface area
Management of wounds with necrotic tissue requiring debridement (Correct answer)
Venous insufficiency ulcers with dependent edema

Correct answer: Management of wounds with necrotic tissue requiring debridement

Whirlpool's agitation aids mechanical debridement of necrotic tissue, making it appropriate for wounds requiring wound bed preparation.

Question 129: A physical therapist auscultates a patient's lungs and hears a high-pitched, musical sound during expiration that is audible without a stethoscope. Which term best describes this adventitious breath sound?

Rhonchi
Wheezing (Correct answer)
Crackles
Stridor

Correct answer: Wheezing

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

Question 130: In the previous month, Peter experienced a couple of briefs and unprovoked episodes of vertigo that lasted under 24 hours. He recently visited his primary care physician due to the development of tinnitus and a feeling of ear fullness. He noticed a change in the quality of his hearing in one ear, which was beginning to alarm him. Which of the following diagnoses for vestibular disorders best fits Peter's symptoms?

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

Correct answer: Meniere's disease

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

Question 131: Which type of medication requires a PT to use the Rating of Perceived Exertion (RPE) scale instead of target heart rate for exercise intensity monitoring?

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

Correct answer: Beta-blockers

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

Question 132: Which intervention is MOST appropriate to prevent pressure injury formation in a patient with complete spinal cord injury at T6?

Performing weight shifts every 15-30 minutes while in the wheelchair (Correct answer)
Repositioning every 4 hours
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 133: When fabricating a low-temperature thermoplastic orthosis, the material becomes too rigid before molding is complete. The MOST appropriate solution is:

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

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

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

Question 134: A patient is in the acute phase of recovery from Guillain-Barré syndrome (GBS) and is currently on a ventilator in the intensive care unit. The patient is medically stable but has profound, symmetrical ascending weakness. Which of the following is the MOST appropriate physical therapy intervention at this stage?

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

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

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

Question 135: A patient presents with foot drop and sensory loss over the dorsum of the foot. Which peripheral nerve is most likely injured?

Common fibular (peroneal) nerve (Correct answer)
Femoral nerve
Sciatic nerve
Tibial nerve

Correct answer: Common fibular (peroneal) nerve

The common fibular nerve innervates the ankle dorsiflexors and provides sensation to the dorsum of the foot, making it the most likely injured nerve.

Question 136: During auscultation, a physical therapist hears a high-pitched, continuous musical sound during expiration. This is best described as:

Crackles
Rhonchi
Stridor
Wheezing (Correct answer)

Correct answer: Wheezing

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

Question 137: A patient refuses to sign the informed consent form but still wants to proceed with treatment. What should the PT do?

Proceed with treatment since the patient verbally agreed
Decline to treat until written consent is obtained and document the situation (Correct answer)
Document the refusal and proceed if the patient demonstrates understanding
Have a witness sign on the patient's behalf

Correct answer: Decline to treat until written consent is obtained and document the situation

Informed consent is a legal and ethical requirement; treatment should not proceed without proper consent, and the situation must be documented.

Question 138: A patient is 6 weeks post-ACL reconstruction using a bone-patellar tendon-bone autograft. Which intervention is MOST appropriate at this stage?

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

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

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

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

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

Question 140: Which manual therapy technique is most appropriate for a patient with a stiff glenohumeral joint and limited external rotation?

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

Correct answer: Posterior glide of the humeral head

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

Question 141: A patient with a complete C6 spinal cord injury would be expected to have functional use of which muscle group?

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

Correct answer: Wrist extensors

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

Question 142: A patient presents with intention tremor, dysmetria, and dysdiadochokinesia. Which brain structure is most likely affected?

Cerebellum (Correct answer)
Primary motor cortex
Basal ganglia
Thalamus

Correct answer: Cerebellum

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

Question 143: Which cranial nerve is tested by assessing the gag reflex?

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

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

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

Question 144: Which Wagner classification grade describes a deep ulcer with abscess or osteomyelitis?

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

Correct answer: Grade 3

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

Question 145: Which mobilization grade is MOST appropriate for a patient with a stiff elbow joint at end-range extension with a firm capsular end-feel and no pain?

Grade I oscillations at the beginning of range
Grade II oscillations within the mid-range
Grade IV sustained stretch at the end of available range (Correct answer)
No mobilization; only active exercises

Correct answer: Grade IV sustained stretch at the end of available range

Grade IV mobilizations are small-amplitude oscillations at the end of available range, appropriate for a stiff joint with a firm end-feel and no pain to improve extensibility of the capsule.

Question 146: A child with cerebral palsy is classified as GMFCS Level III. Which functional description BEST applies to this child?

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

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

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

Question 147: Which test is used to assess the integrity of the cerebellum by having the patient stand with feet together and eyes closed?

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

Correct answer: Romberg test

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

Question 148: A wound swab culture returns positive for Pseudomonas aeruginosa. Which clinical sign is most associated with this organism?

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

Correct answer: Blue-green exudate with a fruity odor

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

Question 149: A physical therapist is developing a plan of care for a patient with Parkinson's disease who experiences frequent freezing of gait (FOG) when walking through doorways. Which of the following interventions has the strongest evidence for immediately improving this specific impairment?

Prolonged static stretching of the hip flexors and calf muscles.
Strengthening exercises for the lower extremities using heavy resistance.
Endurance training on a stationary bicycle for 30 minutes.
Using visual and auditory cues, such as stepping over lines on the floor or walking to a metronome beat. (Correct answer)

Correct answer: Using visual and auditory cues, such as stepping over lines on the floor or walking to a metronome beat.

Evidence strongly supports the use of external cueing strategies to overcome freezing of gait in patients with Parkinson's disease. Visual cues (like lines on the floor) and rhythmic auditory stimulation (like a metronome or music) provide an external rhythm that helps bypass the dysfunctional internal rhythm generation in the basal ganglia, facilitating movement initiation and continuation. While strengthening, stretching, and endurance are important components of a comprehensive plan, they do not directly address the motor-planning deficit that causes freezing episodes as effectively as cueing strategies.

Question 150: Elizabeth visits physical therapy to get her vertigo assessed and addressed. She has experienced sporadic, severe episodes of nausea, imbalance issues, and dizziness. To assist her control her symptoms, her primary care physician gave her a medicine to use whenever she has dizziness. Which of the following drugs is frequently used for dizziness?

Meclizine (Correct answer)
Metformin
Furosemide
Zofran

Correct answer: Meclizine

Meclizine is an antihistamine commonly prescribed to alleviate symptoms of dizziness, vertigo, and nausea, particularly those associated with vestibular disorders. It works by acting on the central nervous system to reduce the excitability of the vestibular system. The other listed drugs are used for different conditions: Furosemide (diuretic), Metformin (diabetes), and Zofran (nausea/vomiting).

Question 151: During wound assessment, a physical therapist notes tunneling at the 3 o'clock position. Using the clock method with 12 o'clock oriented toward the patient's head, where is the tunneling located?

Toward the patient's right side
Toward the patient's feet
Toward the patient's left side (Correct answer)
Toward the patient's head

Correct answer: Toward the patient's left side

Using the clock method with 12 o'clock at the patient's head, the 3 o'clock position corresponds to the patient's left side when the patient is supine.

Question 152: During a manual muscle test, a patient can move a body segment through full range of motion against gravity but cannot tolerate any additional resistance. What grade is assigned?

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

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

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

Correct answer: Upper extremity flexor synergy

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

Question 154: Which ABCDE criterion for melanoma assessment refers to a lesion having two or more distinct colors?

Asymmetry
Border
Color (Correct answer)
Diameter

Correct answer: Color

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

Question 155: A patient demonstrates a steppage gait pattern. Which muscle group is MOST likely weak?

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

Correct answer: Ankle dorsiflexors

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

Question 156: Which type of muscle contraction generates the greatest force output?

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

Correct answer: Eccentric contraction

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

Question 157: During a manual muscle test of the middle trapezius, the patient is positioned in which position?

Sitting with arm at side
Supine with shoulder flexed to 90 degrees
Prone with shoulder abducted to 90 degrees and externally rotated (Correct answer)
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 158: A patient with a diabetic foot ulcer is classified as Wagner Grade 3. What does this indicate?

Gangrene limited to the forefoot
Deep ulcer penetrating to tendon, capsule, or joint
Superficial ulcer without penetration to deeper structures
Deep ulcer with osteomyelitis or joint sepsis (Correct answer)

Correct answer: Deep ulcer with osteomyelitis or joint sepsis

Wagner Grade 3 indicates a deep ulcer complicated by osteomyelitis, abscess formation, or septic arthritis, requiring aggressive medical management.

Question 159: 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?

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

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

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

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

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

Question 161: Neuromuscular electrical stimulation (NMES) produces its strongest therapeutic effect in which patient population?

Myasthenia gravis with neuromuscular junction dysfunction
Upper motor neuron lesion with intact peripheral nerve and some volitional control (Correct answer)
Complete spinal cord injury with no voluntary movement
Peripheral neuropathy with axonal degeneration

Correct answer: Upper motor neuron lesion with intact peripheral nerve and some volitional control

NMES requires an intact lower motor neuron (peripheral nerve) and is most effective when combined with voluntary effort, making it ideal for upper motor neuron lesions.

Question 162: A patient with chronic kidney disease has an elevated serum potassium level (6.2 mEq/L). The PT should be MOST concerned about:

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

Correct answer: Cardiac arrhythmia risk during exercise

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

Question 163: Which type of muscle contraction produces the greatest force output?

Isokinetic concentric
Eccentric (Correct answer)
Concentric
Isometric

Correct answer: Eccentric

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

Question 164: 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?

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

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

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

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

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

Question 166: Which orthopedic special test is used to assess for a SLAP lesion of the shoulder?

Empty can test
Neer impingement test
Active compression (O'Brien's) test (Correct answer)
Hawkins-Kennedy test

Correct answer: Active compression (O'Brien's) test

O'Brien's active compression test is specifically designed to detect SLAP lesions and AC joint pathology through resisted internal and external rotation in flexion.

Question 167: A patient presents with a positive Hawkins-Kennedy test. This finding is most consistent with which condition?

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

Correct answer: Subacromial impingement syndrome

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

Question 168: During gait analysis, a patient demonstrates contralateral pelvic drop during single-leg stance. This indicates weakness of which muscle?

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

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

Collateral ligaments
Patellofemoral joint
Menisci (Correct answer)
Cruciate ligaments

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 170: A patient with chronic obstructive pulmonary disease (COPD) demonstrates a barrel chest deformity. Which physiological change BEST explains this finding?

Hypertrophy of the diaphragm muscle
Chronic air trapping leading to hyperinflation of the lungs (Correct answer)
Increased elastic recoil of lung parenchyma
Decreased anteroposterior diameter of the thorax

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

Barrel chest in COPD results from chronic air trapping that causes persistent hyperinflation, increasing the anteroposterior diameter of the thorax.

Question 171: A patient with a C6 spinal cord injury is being evaluated for wheelchair prescription. Which type of wheelchair is MOST appropriate for long-term community mobility?

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

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

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

Question 172: Which assistive device gait pattern requires the HIGHEST energy expenditure?

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

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 173: During the swing phase of gait, which muscle group is primarily responsible for foot clearance?

Knee flexors only
Hip abductors
Plantar flexors
Ankle dorsiflexors (Correct answer)

Correct answer: Ankle dorsiflexors

Ankle dorsiflexors (primarily tibialis anterior) lift the foot during swing phase to ensure clearance; weakness results in foot drop and compensatory circumduction or hip hiking.

Question 174: Which breathing pattern is characterized by progressively deeper breaths followed by progressively shallower breaths with periods of apnea?

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

Correct answer: Cheyne-Stokes respiration

Cheyne-Stokes respiration features a crescendo-decrescendo pattern of breathing depth with intermittent apneic periods.

Question 175: Which lab value indicates the highest concern for initiating resistive exercise in a patient receiving chemotherapy?

Hemoglobin of 11 g/dL
Platelet count below 50,000/mm³ (Correct answer)
WBC of 6,000/mm³
Serum albumin of 3.5 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 176: 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?

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

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

Antihypertensives (Correct answer)
Proton pump inhibitors
Antibiotics
Statins

Correct answer: Antihypertensives

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

Question 178: During iontophoresis for calcific tendinitis, a physical therapist uses acetic acid (acetate ion, CH₃COO⁻). Under which electrode should the medication be placed?

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

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

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

Question 179: Which of the following sets of clinical findings is MOST consistent with a diagnosis of Relapsing-Remitting Multiple Sclerosis (RRMS)?

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

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

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

Question 180: 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 181: A PT working in an outpatient clinic notices a fire in the supply room. What is the correct initial action according to the RACE protocol?

Alert the fire department, then evacuate patients
Confine the fire by closing doors, then evacuate the building
Rescue patients in immediate danger, then activate the alarm (Correct answer)
Activate the alarm first, then rescue patients in immediate danger

Correct answer: Rescue patients in immediate danger, then activate the alarm

The RACE protocol begins with Rescue (remove patients from immediate danger), followed by Alarm, Confine, and Extinguish.

Question 182: Which of the following is the correct sequence for donning a sterile gown in an isolation room?

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

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 183: A PT discovers that a colleague is billing for services not rendered. What is the MOST appropriate initial action?

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

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

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

Question 184: During manual muscle testing, a patient can move the shoulder through full range of motion against gravity but cannot tolerate any additional resistance. What grade would a physical therapist assign to this muscle?

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

Correct answer: Grade 3 (Fair)

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

Question 185: At what heart rate threshold should a PT terminate exercise in a patient on a beta-blocker, given the Karvonen formula cannot be used reliably?

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

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

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

Question 186: 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)
Reassure the patient that initial discomfort is normal and continue
Apply cold water over the hot pack area and continue
Reduce the number of towel layers and continue treatment

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 187: 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?

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

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 188: A 7-year-old is diagnosed with idiopathic scoliosis and a Cobb angle of 20 degrees. The MOST appropriate initial physical therapy intervention is:

Discharge the patient, as curves under 25 degrees require no treatment
Scoliosis-specific exercises (e.g., Schroth method) combined with postural education (Correct answer)
Immediate referral for surgical spinal fusion given the risk of curve progression
Full-time TLSO bracing worn 23 hours per day

Correct answer: Scoliosis-specific exercises (e.g., Schroth method) combined with postural education

For Cobb angles under 25 degrees, scoliosis-specific exercise programs and postural education are the recommended initial physical therapy management, with bracing indicated at 25-45 degrees.

Question 189: A patient presents with a positive Romberg test. What does this finding indicate?

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

Correct answer: Proprioceptive deficit with visual compensation

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

Question 190: 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 right upper extremity, encourage cane, then right lower extremity, then left 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 left upper extremity, encourage cane, then left lower extremity, then right upper extremity gait sequence.

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

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

Question 191: A patient with a rotator cuff repair is 8 weeks post-op. Which exercise is most appropriate at this stage?

Passive range of motion only
Active-assisted shoulder flexion to 90° (Correct answer)
Plyometric throwing exercises
Full overhead press with resistance

Correct answer: Active-assisted shoulder flexion to 90°

At 8 weeks post rotator cuff repair, active-assisted ROM to 90° is typically appropriate as the tendon has sufficient healing to tolerate gentle active movement.

Question 192: A patient presents with foot drop on the left side. Which peripheral nerve is most likely damaged?

Obturator nerve
Tibial nerve
Common peroneal nerve (Correct answer)
Femoral nerve

Correct answer: Common peroneal nerve

The common peroneal nerve innervates the ankle dorsiflexors and evertors; injury at the fibular head is a common cause of foot drop.

Question 193: A patient is in Stage 3 of Brunnstrom's stages of recovery following a stroke. Which of the following clinical findings is MOST characteristic of this stage?

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

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

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

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

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

Question 195: Current evidence MOST strongly supports which intervention for improving upper extremity function in chronic stroke?

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

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 196: Kevin goes to physical therapy with upper abdominal discomfort as a secondary complaint and midthoracic pain as his primary complaint. The evaluating therapist discovers after more probing that Kevin has occasionally had breathing problems, acid reflux, and difficulties swallowing. In order to rule out a hernia as a potential alternate source of Kevin's problems, her therapist suggests Kevin to her primary care physician for evaluation. Which of the subsequent hernias could be the cause of Kevin's supplementary symptoms?

Femoral hernia
Inguinal hernia
Hiatal hernia (Correct answer)
Umbilical hernia

Correct answer: Hiatal hernia

A hiatal hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity. This condition commonly causes symptoms such as upper abdominal discomfort, midthoracic pain, acid reflux (heartburn), and difficulty swallowing, all of which align with Kevin's complaints. Other types of hernias listed typically present with symptoms in different anatomical regions.

Question 197: Which type of end-feel would a physical therapist expect when assessing knee extension in a patient with a large joint effusion?

Capsular end-feel
Soft end-feel (Correct answer)
Empty end-feel
Hard end-feel

Correct answer: Soft end-feel

A soft or boggy end-feel at knee extension is characteristic of significant joint effusion due to fluid accumulation.

Question 198: On joint mobilization grading (Maitland), a Grade III mobilization is BEST described as:

Small amplitude movement into end-range
Large amplitude oscillation into resistance (Correct answer)
Small amplitude oscillation at the beginning of range
Large amplitude movement up to but not into resistance

Correct answer: Large amplitude oscillation into resistance

Maitland Grade III involves large amplitude oscillations that move into tissue resistance and are used for pain management and increasing mobility.

Question 199: A patient is receiving therapeutic ultrasound over the right bicipital tendon region. The physical therapist notes the patient's skin overlying a recent surgical metallic staple. What is the MOST appropriate action?

Increase the treatment frequency to 3 MHz to limit depth of penetration
Discontinue ultrasound and select an alternative modality (Correct answer)
Continue treatment but reduce intensity by 50%
Switch to pulsed mode to eliminate thermal effects

Correct answer: Discontinue ultrasound and select an alternative modality

Metal implants in the direct treatment field are an absolute contraindication to therapeutic ultrasound because the metal can concentrate acoustic energy, causing localized overheating and tissue damage. The therapist must discontinue ultrasound regardless of mode or frequency and select a different modality.

Question 200: 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?

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

Correct answer: High-voltage pulsed current (HVPC)

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

Question 201: A student PT intern asks to observe a patient's treatment session. What must the PT obtain before allowing the student to observe?

Verbal consent from the student's academic program
The patient's informed consent to allow the student's presence (Correct answer)
Written consent from the supervising physician
Approval from the facility administrator

Correct answer: The patient's informed consent to allow the student's presence

Patients must give informed consent before any additional observers, including students, are permitted in the treatment area.

Question 202: A patient has decreased sensation on the medial forearm and weak elbow flexion after a humeral fracture. Which nerve is most likely injured?

Ulnar nerve
Radial 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 203: Which of the following manual therapy grades (Maitland) is most appropriate for treating pain in an acutely inflamed joint?

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

Correct answer: Grade I

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

Question 204: A PT uses pulsed shortwave diathermy (PSWD) over a patient's lumbar region. Which tissue type is MOST effectively heated by the inductive coil method?

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

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

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

Question 205: A patient recovering from a stroke demonstrates hyperreflexia and increased muscle tone in the right upper extremity. Which descending pathway is most likely damaged?

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

Correct answer: Corticospinal tract

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

Question 206: A patient has hyperreflexia, clonus, and a positive Babinski sign in the lower extremities. These findings indicate pathology at which level of the nervous system?

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

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

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

Question 207: A patient with multiple sclerosis is being assessed with the Berg Balance Scale. Which score indicates a HIGH fall risk?

36–44
Below 36 (Correct answer)
45–54
56/56

Correct answer: Below 36

Berg Balance Scale scores below 36 indicate a near 100% fall risk; scores of 41–56 indicate low fall risk in community-dwelling adults.

Question 208: A physical therapist is performing manual chest physiotherapy on a patient with cystic fibrosis. The MOST important contraindication to percussion and vibration is:

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

Correct answer: Recent rib fracture or osteoporosis

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

Question 209: A physical therapist is treating a patient with chronic unilateral vestibular hypofunction. According to the most recent clinical practice guidelines, which intervention is MOST appropriate to improve gaze stability?

Gaze stabilization exercises (X1 viewing) performed for at least 20 minutes daily. (Correct answer)
Static balance activities on a foam surface with eyes closed.
Voluntary smooth pursuit eye movements without head movement.
Habituation exercises focusing on positions that provoke mild dizziness.

Correct answer: Gaze stabilization exercises (X1 viewing) performed for at least 20 minutes daily.

The updated clinical practice guidelines for unilateral vestibular hypofunction strongly recommend gaze stabilization exercises, such as VOR x1 viewing (keeping eyes focused on a target while turning the head), to promote gaze stability. For chronic conditions, a minimum daily duration of 20 minutes is recommended. The guidelines specifically recommend AGAINST using smooth pursuit or saccadic eye movements in isolation (without head movement) for this purpose. While habituation and balance exercises are important components of vestibular rehabilitation, gaze stabilization exercises specifically target the impairment of gaze stability.

Question 210: Which laboratory value would cause a physical therapist to withhold exercise for a patient undergoing chemotherapy?

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

Correct answer: Platelet count below 20,000/mm3

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

Question 211: Which ECG finding is MOST consistent with left ventricular hypertrophy?

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

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

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

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

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

Question 213: A child is unable to isolate finger movements and displays primitive grasp reflexes at age 18 months. This suggests impairment in which developmental progression?

Cortical differentiation and fine motor control (Correct answer)
Gross motor milestones
Visual tracking
Postural righting reactions

Correct answer: Cortical differentiation and fine motor control

Isolated finger movements and release of primitive reflexes depend on cortical maturation; persistence at 18 months indicates delayed fine motor cortical differentiation.

Question 214: A patient with patellofemoral pain syndrome (PFPS) would most benefit from strengthening which muscle group based on current evidence?

Hamstrings
Hip abductors and external rotators (Correct answer)
Plantar flexors
Quadriceps only

Correct answer: Hip abductors and external rotators

Strengthening hip abductors and external rotators reduces dynamic valgus and patellofemoral joint stress, and has strong evidence for improving outcomes in PFPS.

Question 215: A patient presents with spasticity, hyperreflexia, and a positive Babinski sign in both lower extremities following a stroke. These findings are most consistent with a lesion affecting which neural structure?

Upper motor neurons of the corticospinal tract (Correct answer)
Lower motor neurons in the anterior horn of the spinal cord
Peripheral sensory nerves of the lower extremities
Anterior roots of the lumbar plexus

Correct answer: Upper motor neurons of the corticospinal tract

Upper motor neuron (UMN) lesions interrupt descending inhibitory control, producing the classic triad of spasticity, hyperreflexia, and a positive Babinski sign. Lower motor neuron lesions instead cause flaccidity, hyporeflexia, and muscle atrophy.

Question 216: Which of the following BEST describes 'abandonment' in physical therapy practice?

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
Referring a patient to another specialist

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

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

Correct answer: Cervical radiculopathy

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

Question 218: A therapist applies ice to a patient's ankle for 20 minutes. Which physiological effect occurs FIRST?

Vasodilation
Decreased nerve conduction velocity (Correct answer)
Reduced muscle spasm
Decreased metabolic rate

Correct answer: Decreased nerve conduction velocity

Cold application immediately slows nerve conduction velocity, which is the primary early physiological response.

Question 219: Under the Americans with Disabilities Act (ADA), a PT practice is REQUIRED to:

Hire only staff members with disabilities
Waive copayments for disabled patients
Provide free services to all patients with disabilities
Make reasonable accommodations to ensure accessible services for patients with disabilities (Correct answer)

Correct answer: Make reasonable accommodations to ensure accessible services for patients with disabilities

The ADA requires healthcare providers to make reasonable accommodations to ensure equal access to services for individuals with disabilities.

Question 220: Which special test is most appropriate for assessing the integrity of the anterior cruciate ligament?

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

Correct answer: Lachman test

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

Question 221: A patient presents with weakness of hip abduction and a positive Trendelenburg sign on the right side. Which nerve is most likely injured?

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

Correct answer: Superior gluteal nerve

The superior gluteal nerve innervates the gluteus medius and minimus, which are responsible for hip abduction; injury causes a Trendelenburg gait.

Question 222: According to the APTA's Guide to Physical Therapist Practice, which term describes the predicted optimal improvement a patient can reach in a given timeframe?

Evaluation
Diagnosis
Outcome
Prognosis (Correct answer)

Correct answer: Prognosis

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

Question 223: During nerve conduction velocity testing, which finding is most consistent with demyelinating neuropathy rather than axonal neuropathy?

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

Correct answer: Significantly reduced conduction velocity

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

Question 224: A therapist is applying ultrasound over a bony prominence. Which parameter should be adjusted to reduce periosteal heating?

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

Correct answer: Decrease duty cycle

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

Question 225: A physical therapist is performing a sensory evaluation and finds that a patient has lost light-touch sensation along the medial aspect of the lower leg and the great toe. Which nerve root level is most likely compromised?

L3
S1
L4 (Correct answer)
L5

Correct answer: L4

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

Question 226: According to the APTA Guide to Physical Therapist Practice, which term best describes the process of determining who will benefit from physical therapy?

Diagnosis
Screening (Correct answer)
Evaluation
Prognosis

Correct answer: Screening

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

Question 227: Which of the following is the CORRECT normal range for arterial oxygen partial pressure (PaO2) in a healthy adult breathing room air?

60–70 mmHg
45–55 mmHg
75–100 mmHg (Correct answer)
100–120 mmHg

Correct answer: 75–100 mmHg

Normal PaO2 on room air ranges from 75–100 mmHg; values below 60 mmHg indicate hypoxemia requiring supplemental oxygen.

Question 228: A physical therapist is preparing to administer iontophoresis to treat calcific tendinitis in the shoulder using acetic acid. To deliver the medication effectively, how should the therapist set up the electrodes?

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

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

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

Question 229: When positioning a patient with SCI who has lower extremity flexor spasticity at night, which position BEST counteracts the spastic pattern?

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

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

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

Question 230: 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
Posterior glide with the arm at the side
Inferior glide with the arm in resting position (Correct answer)
Anterior glide with the arm in 90 degrees of abduction

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

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

Correct answer: Sacroiliac joint or hip joint

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

Question 232: A therapist performs joint mobilization at the glenohumeral joint. To increase shoulder abduction, which mobilization direction should be applied to the humeral head?

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

Correct answer: Inferior glide

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

Question 233: The Epley canalith repositioning maneuver is the first-line treatment for which condition?

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

Correct answer: Posterior canal BPPV causing brief positional vertigo

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

Question 234: A patient recovering from a stroke demonstrates the synergy pattern of shoulder abduction, elbow flexion, and forearm supination. According to Brunnstrom's stages, this presentation is most consistent with which stage of recovery?

Stage 5
Stage 3 (Correct answer)
Stage 6
Stage 1

Correct answer: Stage 3

Stage 3 of Brunnstrom's recovery is characterized by voluntary movement only within obligatory synergy patterns.

Question 235: A physical therapist is assessing a 10-month-old child who cannot sit independently. According to normal developmental milestones, this finding is:

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

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

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

Question 236: A physical therapist discovers a billing error where services were coded at a higher level than what was actually provided. What should the therapist do?

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

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

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

Question 237: 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?

Phalen's test
Reverse Phalen's test
Tinel's sign (Correct answer)
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 238: 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
Upper motor neuron
Sensory cortex
Lower motor neuron (Correct answer)

Correct answer: Lower motor neuron

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

Question 239: A patient recovering from a total knee arthroplasty is 6 weeks post-operative with persistent quadriceps inhibition. Which neuromuscular electrical stimulation (NMES) parameter setting is MOST appropriate to facilitate quadriceps re-education?

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

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

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

Question 240: A patient receiving mechanical ventilation has a tidal volume of 800 mL set on the ventilator but only 550 mL is delivered to the patient. The MOST likely cause is:

Increased lung compliance
Auto-PEEP
Decreased respiratory rate
Circuit leak or airway disconnect (Correct answer)

Correct answer: Circuit leak or airway disconnect

A significant discrepancy between set and delivered tidal volume in a ventilated patient most commonly results from a circuit leak or partial airway disconnection.

Question 241: A patient with chronic plantar fasciitis is treated with low-level laser therapy (LLLT). Which mechanism best explains its therapeutic effect?

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

Correct answer: Photobiomodulation promoting cellular ATP production

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

Question 242: When using a goniometer to measure knee flexion in prone, the stationary arm is aligned with:

The fibular head to lateral malleolus
The lateral femur parallel to the femoral shaft (Correct answer)
The tibial shaft
The anterior superior iliac spine

Correct answer: The lateral femur parallel to the femoral shaft

For knee flexion, the stationary arm follows the lateral femoral shaft (toward the greater trochanter), and the moving arm follows the fibular shaft toward the lateral malleolus.

Question 243: A therapist uses PNF rhythmic stabilization at the shoulder for a patient with rotator cuff weakness post-neurological injury. What is the PRIMARY physiological mechanism?

Facilitating co-contraction of agonist and antagonist muscles via alternating isometric resistance (Correct answer)
Inhibiting overactive muscles through reciprocal inhibition
Strengthening only the external rotators through concentric contractions
Stretching the glenohumeral capsule through alternating rotation

Correct answer: Facilitating co-contraction of agonist and antagonist muscles via alternating isometric resistance

Rhythmic stabilization uses alternating isometric resistance to both agonist and antagonist, promoting dynamic joint stability through simultaneous co-contraction.

Question 244: A 45-year-old construction worker presents with lumbar radiculopathy and a positive straight leg raise at 40 degrees. Which treatment approach has the STRONGEST evidence for this presentation?

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

Correct answer: Mechanical traction combined with directional preference exercises

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

Question 245: A physical therapist is working with an 80-year-old patient who has early-stage dementia. The patient's adult child, who holds a durable power of attorney for healthcare, insists the therapist perform a painful stretching procedure that the patient is verbally refusing. What is the therapist's MOST appropriate initial action?

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

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

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

Question 246: A patient with Raynaud's phenomenon is being considered for cryotherapy. What is the PRIMARY contraindication?

Impaired sensation
Cold hypersensitivity / vasospastic disorder (Correct answer)
Active infection
Open wound

Correct answer: Cold hypersensitivity / vasospastic disorder

Raynaud's phenomenon involves pathological vasospasm triggered by cold, making cryotherapy directly contraindicated.

Question 247: Which neurotransmitter is deficient in myasthenia gravis and what is the mechanism of dysfunction?

GABA; loss of inhibitory interneurons
Serotonin; reduced synaptic release
Dopamine; presynaptic depletion
Acetylcholine; autoimmune destruction of nicotinic receptors (Correct answer)

Correct answer: Acetylcholine; autoimmune destruction of nicotinic receptors

Myasthenia gravis is caused by autoimmune antibodies against nicotinic acetylcholine receptors at the neuromuscular junction, reducing functional receptor availability.

Question 248: A physical therapist auscultates a patient's chest and hears a high-pitched, musical wheeze during expiration. Which condition is this finding MOST consistent with?

Pneumonia with consolidation
Asthma or bronchospasm (Correct answer)
Pleural effusion
Pulmonary fibrosis

Correct answer: Asthma or bronchospasm

High-pitched expiratory wheezing (sibilant rhonchi) results from narrowed lower airways during expiration, which is characteristic of bronchospasm in conditions like asthma.

Question 249: Which ASIA Impairment Scale classification describes a patient with motor and sensory function preserved below the neurological level of injury, with more than half of key muscles below the level having a grade less than 3?

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

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

Berg Balance Scale
Peabody Developmental Motor Scales, 2nd Edition (PDMS-2) (Correct answer)
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.

NPTE-PT (National Physical Therapy Exam)

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

250

Questions

300 min

Time Limit

65%

To Pass

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