NPTE Clinical Files | Physical Therapy
by Kyle Rice
NPTE Clinical Files is a podcast from the creator of Dominating the NPTE, hosted by Kyle Rice. NPTE Clinical Files explains a true clinical scenario in the form of a mock NPTE-based question. Each question is followed by a set of answer choices, where Dr. Kyle Rice explains the right answer with a detailed rationale. Each season covers all of the major systems and topics found in physical therapy and likely to be found on an NPTE. NPTE Clinical Files gives the Physical Therapist a weekly opportunity to solve clinical puzzles while learning the latest research related to the topic.
Episodes
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Primitive Reflex Question That Tricks NPTE Students
Koorin evaluates a 10-month-old infant with delayed gross motor development. The examination reveals a symmetrical tonic neck reflex (STNR) that has not integrated. Which of the following activities will the infant MOST likely have difficulty performing? A) Rolling from supine to prone while...
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The NPTE Synergy Pattern Trap: Can You Spot It?
Yisari sustained a left middle cerebral artery stroke three weeks ago, resulting in right-sided hemiparesis with a flexor synergy pattern. Which of the following positions is MOST appropriate for the affected upper extremity while resting in supine? A) Forearm supination B) Shoulder abduction C)...
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Burn Examination Findings
Jabari examines a patient who sustained a thermal burn to the anterior forearm 48 hours ago. The affected area has a mottled red-and-white appearance with minimal surface moisture and scattered ruptured blisters. The skin demonstrates sluggish blanching with applied pressure, and the patient...
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Ankle Special Tests
Jermaine is a 22-year-old collegiate soccer player who injured his ankle when another player landed on his leg while his foot was planted. The ankle was forced into dorsiflexion and external rotation. Three days later, he has pain and tenderness over the anterolateral distal tibiofibular region,...
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Joint Mobilization Technique - Must Know for the NPTE
Yessica has a history of thumb carpometacarpal osteoarthritis and recently wore a functional hand splint for several weeks following a burn to the hand. After the burn has healed, she demonstrates limited thumb CMC adduction. Which joint mobilization technique is MOST appropriate to improve this...
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One Symptom Is NOT Enough: An NPTE Test-Taking Lesson
Olivia reports progressive lower-extremity weakness and decreased exercise tolerance. Examination reveals a resting heart rate of 104 bpm, a fine hand tremor, brisk deep tendon reflexes, and mild proximal muscle weakness. She also reports recent unintentional weight loss despite no change in diet...
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Hand & Digit Deformities
Jason is referred to physical therapy for gradually progressive bilateral hand pain and stiffness. The patient reports that the hands feel stiff for approximately 15 minutes after waking and becomes increasingly painful after prolonged gripping and household activities. Examination reveals firm...
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Cardiac Meds & Mechanisms
Brian presents with chronic heart failure and is referred to physical therapy for aerobic conditioning. The patient has a history of hypertension and has a resting heart rate of 102 bpm. The medical record indicates that the patient takes a medication that decreases cardiac workload by reducing...
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Gait Assessment & Intervention
Priyanshi is a 68-year-old female referred to physical therapy for gradually increasing right forefoot pain and difficulty walking longer distances. During gait assessment, the physical therapist observes decreased push-off on the right during terminal stance and pre-swing. Examination reveals…
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Symptom-Limited Exercise Tolerance Testing
Ashley is preparing to perform a symptom-limited graded exercise test to determine functional exercise capacity and help develop an aerobic exercise prescription. Which of the following patients is the MOST appropriate candidate for this type of testing? A) A patient with stable coronary artery...
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Infection Control - PPE
Zoe is preparing to ambulate a patient hospitalized with hepatitis B. The patient is medically stable and has no open wounds, active bleeding, or uncontrolled drainage. Which of the following precautions is MOST appropriate during gait training? A) Wear gloves and a gown throughout the treatment...
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Wound Assessment & Documentation
Getsemani examines a patient with a Stage 4 pressure injury over the sacrum. The therapist inserts a sterile cotton-tipped applicator beneath the intact wound edge. The applicator advances 2.4 cm toward the patient’s head while remaining immediately beneath the skin. Which of the following is the...
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NMES Parameter Adjustment
Stassi is administering neuromuscular electrical stimulation (NMES) to improve quadriceps strength following knee surgery. The patient reports that the stimulation feels uncomfortable as the current is delivered. Stassi would like to maintain a strong therapeutic muscle contraction while making…
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NPTE EKG Reading & Response
Inez is receiving physical therapy in the acute cardiac unit following an acute coronary event. During treatment, the physical therapist observes a new telemetry change characterized by progressive PR interval lengthening followed by a dropped QRS complex. The patient denies any new symptoms.…
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Retention vs Acquisition: A High-Yield NPTE Motor Learning Question
Anisa is being treated in an inpatient rehabilitation facility following a traumatic brain injury (TBI). The physical therapist has been training the patient to ambulate using a two-point gait pattern with a single-point cane. Anisa consistently performs the gait pattern correctly in a quiet...
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Genu Valgum Examination - Must Know NPTE Concept
Tasnuva is referred to physical therapy for progressively worsening right knee pain. The patient reports symptoms that have gradually increased over the past year and are aggravated by prolonged walking. Observation reveals right coxa vara and significant genu valgum during standing. Which of the...
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Radial Head Displaced Fracture - LEAST LIKELY
Stephanie is evaluating a patient 8 weeks after sustaining a displaced radial head fracture following a fall onto an outstretched hand. The patient reports persistent lateral elbow pain, difficulty actively extending the wrist and fingers, and weakness when gripping objects. Which of the…
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Non-Systems - Appropriate Discharge
Jeff is a 78-year-old patient recovering from a right CVA. The patient requires moderate assistance for transfers and bed mobility. During therapy, frequent vital sign monitoring is necessary due to ongoing cardiac instability. The patient is now able to tolerate approximately 75 minutes of…
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Diabetes Examination
Chimezie is performing an initial examination of a patient with type 2 diabetes mellitus. The patient’s most recent hemoglobin A1C is 6.7%. During inspection of the right foot, the therapist observes a small ulcer on the plantar surface beneath the fifth metatarsal head. The patient reports...
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Congenital Muscular Torticollis
Sando is a 4-month-old infant receiving physical therapy for right congenital muscular torticollis. The physical therapist notes improved cervical alignment, increased tolerance to prone positioning, and improved active midline head control. Which of the following goals would be MOST appropriate…
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Scenario - Recreational Runner Anterior Hip Discomfort
LeMarcus is a 42-year-old recreational runner who reports progressive anterior hip discomfort after increasing mileage over the past 2 months. Examination reveals: * Hip flexion ROM: 125° * Hip extension ROM is limited compared to the uninvolved side * Positive Thomas test * Negative Ely’s test *...
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Deep Tendon Reflex Assessment
Garret is a 30-year-old patient who was hospitalized 3 days ago after being diagnosed with Guillain-Barré syndrome. During examination, the patient is able to perform repeated seated marches without difficulty. However, the therapist notes impaired sensation in a glove-and-stocking distribution…
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Mobilization Grades & Application
Ulises presents with intermittent upper extremity paresthesia reproduced with overhead activity. Examination reveals an elevated first rib on the involved side without reports of soft tissue tenderness. Which of the following mobilization techniques is MOST appropriate? A) Large-amplitude...
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Substance Abuse & Ethics
Brendaisha is a physical therapist who becomes concerned about a colleague who previously completed rehabilitation for substance abuse. Over the past several weeks, the colleague has demonstrated increasing tardiness, reduced attention during patient care, and episodes of excessive drowsiness…
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Non-System Ultrasound Safety
A physical therapist is mentoring a student physical therapist during an outpatient orthopedic clinical rotation. The therapist plans to administer therapeutic ultrasound using the following parameters: * 3 MHz frequency * 20% pulsed duty cycle * 0.5 W/cm² intensity * 6-minute treatment duration...
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Neurologic Gait Evaluation
Harry presents with a right-sided posterolateral disc herniation at L5-S1 and demonstrates weakness associated with the involved nerve root. Which of the following gait deviations is MOST likely? A) Diminished propulsion during terminal stance B) Increased plantarflexion following initial contact...
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Wound Care Dressing Selection - Peripheral Vascular Disease
Jason is a patient with peripheral vascular disease who presents with a lower leg wound containing dry, adherent slough and minimal exudate. The wound bed appears desiccated, and the surrounding skin is fragile but intact. Which of the following interventions is MOST appropriate? A) Transparent...
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ACL & Meniscal Surgical Precautions/Contraindications
Petey is 4 weeks status post ACL reconstruction with a semitendinosus autograft and partial meniscectomy. Which of the following interventions is LEAST appropriate at this time? A) Quad sets held in knee extension B) Mini squats to 45 degrees C) Resisted knee flexion with a 3-lb ankle weight in...
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Skin Condition Differential
Alynne is a woman who reports fatigue, intermittent joint pain, and a recurrent facial rash that becomes worse after spending time in the sun. Examination reveals a rash over the bridge of the nose and cheeks that spares the nasolabial folds. Which of the following conditions is MOST likely? A)...
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Genitourinary Interventions (Incontinence)
Mila reports a sudden, intense urge to urinate followed by leakage before reaching the bathroom. The patient voids frequently throughout the day and wakes multiple times at night to urinate. Pelvic floor strength is 4/5, and there is no leakage with coughing or sneezing. Which of the following...
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Basal Ganglia Dysfunction & Intervention
Mackenzie presents to physical therapy following a stroke affecting the basal ganglia. The patient exhibits bradykinesia and difficulty initiating movements. Which of the following interventions would be MOST effective in addressing these impairments? A) Rhythmic auditory stimulation B)...
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Lower Extremity Swelling Interventions
Bellie presents with persistent bilateral lower extremity swelling that worsens throughout the day. The therapist is selecting an intervention to assist with fluid return. Which of the following interventions would MOST effectively assist with this goal? A) Maintaining the lower extremities in a...
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Mid Thoracic Pain Evaluation
Dr. Rice evaluates a patient with a chief complaint of mid-thoracic pain radiating around the left lateral rib cage. The patient reports symptoms worsen with deep breathing and coughing, but are not reproduced with spinal movement, rib mobilization, or palpation. Neurological screening is...
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Sensitivity & Specificity Principles
Carmen is performing a special test on her patient. The test has a sensitivity of 95% and a specificity of 30%. The patient tests negative. What is the BEST interpretation? A) The condition is unlikely present B) The condition is likely present C) The test confirms the diagnosis D) The test has…
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A Must Know Neurologic Examination Concept
Elena presents with significant muscle atrophy in the lower extremities, fasciculations of the gastrocnemius, and a 1+ Achilles tendon reflex. During gait, the patient demonstrates a "slapping" foot strike. These signs are MOST indicative of: A) A lesion in the corticospinal tract B) An injury to...
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Lumbar HNP Treatment
Yesenia is a 37-year-old patient with lumbar disc herniation who reports pain radiating to the posterior thigh. During treatment, repeated lumbar extension causes leg pain to resolve but increases central low back discomfort. Which intervention is MOST appropriate to continue? A) Discontinue...
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Transfemoral Amputee Gait Deviation
Benito, a patient with a right transfemoral amputation, demonstrates circumduction of the prosthetic limb during the swing phase. Which of the following prosthetic causes is MOST likely contributing to this deviation? A) Insufficient socket flexion B) Socket is excessively abducted C) Knee…
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Pediatric Clinical Decision Making
Victor is a 12-year-old male who presents with a limp and groin pain. The hip rests in external rotation, and hip flexion produces obligatory external rotation. Which of the following should the physical therapist initiate FIRST? A) Begin hip strengthening and gait training B) Stretch hip…
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Cranial Nerve Examination Part 2
Belsnickel is a 63-year-old male who presents with right-sided facial paralysis, inability to abduct the right eye, and an absent corneal blink reflex on the right. Sensation to the face is intact. These findings are MOST consistent with a lesion affecting which of the following cranial nerves?…
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Cranial Nerve Examination Part 1
Juvelyn shows an impaired corneal reflex, loss of facial sensation, and difficulty chewing on the right side. Which of the following is MOST likely impaired? A) Difficulty chewing on the left B) Vertebrobasilar insufficiency (VBI) test on the right C) Jaw jerk test D) Swallowing Use PTH020 to get...
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Pediatric Lower Extremity Evaluation
Hallie presents with bilateral anterior knee pain and an in-toeing gait. Craig’s test reveals 10° of femoral anteversion on both sides. Which of the following special tests is MOST appropriate to further assess the cause of the in-toeing? A) FABER test B) Tibial torsion test C) Q-angle…
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NPTE Medications Side Effects
Lionel has a past medical history of hypertension and has been referred to physical therapy for generalized fatigue and reduced exercise tolerance. During the session, the therapist notes mild bilateral lower extremity edema. Which of the following medications is MOST likely contributing to these...
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NPTE Unfamiliar Terms
Faith is a 65-year-old female recovering from hip replacement surgery and presents with mild calf swelling and tenderness. Based on Virchow’s Triad, which of the following is the LEAST likely contributing factor to her symptoms? A) Endothelial injury B) Stasis of blood flow C) Hypercoagulability…
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Knee Pain Differential & Examination Findings
Skye is a soccer player who reports intermittent knee locking and joint line pain following a twisting injury 2 weeks ago. The McMurray test reproduces pain with a click. Which additional clinical finding would MOST support the suspected diagnosis? A) Positive Pivot shift test B) Negative…
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Lymph Node Dissection
Brittinie presents with difficulty pushing up from a chair, weakness with shoulder extension and adduction, and no significant sensory deficits. She recently underwent axillary lymph node dissection following surgery for breast cancer. Which of the following peripheral nerves is MOST likely...
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Pelvic Health & Intervention
Betty is a 45-year-old female who presents to physical therapy with complaints of pelvic pain, urinary frequency, and urgency without signs of infection. She reports symptoms worsening after prolonged sitting and during high-impact exercises. Which intervention is MOST appropriate to address her...
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Hypertrophic Cardiomyopathy
Josue recommends a prolonged warm-up for a patient with hypertrophic cardiomyopathy before initiating aerobic exercise. Which of the following is the MOST likely rationale for this recommendation? A) To increase left ventricular filling time B) To prevent sudden increases in heart rate C) To...
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ALS: Functional Mobility Management
Bill presents with early-stage amyotrophic lateral sclerosis (ALS) and reports mild lower extremity weakness and occasional tripping when walking on uneven surfaces. Which intervention is MOST appropriate to address his current functional mobility? A) Prescribe a wheelchair for energy…
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Low Back Pain Treatment Considerations
Aiyana is an office worker with chronic low back pain who is referred to physical therapy. During a core stability assessment, the patient demonstrates difficulty maintaining a neutral pelvis while lifting one leg in a hook-lying position. Which muscle is MOST likely underperforming? A) Iliopsoas...
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Nutrition & Hydration in PT
Leilani is an athlete who reports muscle cramps, fasciculations in the legs, and fatigue during prolonged training sessions. Which of the following is the MOST likely cause of her symptoms? A) Steroid abuse B) Inadequate caloric intake C) Hypervolemia D) Hyponatremia DOWNLOAD THIS EPISODE'S...
About this show
NPTE Clinical Files is a podcast from the creator of Dominating the NPTE, hosted by Kyle Rice. NPTE Clinical Files explains a true clinical scenario in the form of a mock NPTE-based question. Each question is followed by a set of answer choices, where Dr. Kyle Rice explains the right answer with a detailed rationale. Each season covers all of the major systems and topics found in physical therapy and likely to be found on an NPTE. NPTE Clinical Files gives the Physical Therapist a weekly opportunity to solve clinical puzzles while learning the latest research related to the topic.
Hosted by
Kyle Rice