NPTE Clinical Files | Physical Therapy

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 MOST appropriate documentation of this finding?A) Tunneling of 2.4 cm at 12 o’clockB) Undermining of 2.4 cm at 12 o’clockC) Maceration extending 2.4 cm at 12 o’clockD) Induration extending 2.4 cm at 12 o’clockText our team the word COACH for a free diagnostic: (727) 732-4573

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 the treatment more comfortable for the patient. Which of the following stimulation parameters should be adjusted?A) AmplitudeB) Pulse rate (frequency)C) Pulse durationD) Ramp down timeText our team the word COACH for a free diagnostic: (727) 732-4573

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. What is the MOST appropriate action by the physical therapist?A) Continue treatment because this is an expected finding following an acute coronary event.B) Continue treatment after increasing supplemental oxygen while monitoring telemetry.C) Hold treatment and notify the physician regarding the new telemetry findings.D) Terminate treatment and activate the emergency response team immediately.Text our team the word COACH for a free diagnostic: (727) 732-4573

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 hallway without verbal cueing. Which of the following is the BEST strategy to improve long-term retention and carryover of this skill?A) Open environment with randomized practiceB) Closed environment with serial practiceC) Open environment with serial practiceD) Closed environment with blocked practiceText our team the word COACH for a free diagnostic: (727) 732-4573

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 following structures is MOST likely contributing to the patient’s symptoms?A) Anterior cruciate ligamentB) Gluteus medius tendonC) Medial meniscusD) Lateral meniscusText our team the word COACH for a free diagnostic: (727) 732-4573

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 following examination findings is LEAST likely?A) 5/5 elbow extension manual muscle testB) Limited forearm supination range of motionC) Diminished finger extension passive range of motionD) Decreased power grip strengthJoin the FREE NPTE Facebook Group: www.nptegroup.comText our team the word COACH for a free diagnostic: (727) 732-4573

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 therapy each day; however, they live alone in a two-story home. Which of the following is the MOST appropriate discharge setting?A) Inpatient rehabilitation facilityB) Skilled nursing facilityC) Home with home health physical therapyD) Long-term acute care hospitalJoin the FREE NPTE Facebook Group: www.nptegroup.comText our team the word COACH for a free diagnostic: (727) 732-4573

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 progressively limiting walking activities because of discomfort in the involved foot. Which of the following examination procedures is MOST important for the therapist to perform?A) Measure the patient’s maximum ambulation distanceB) Inspect the medial ankle for additional ulcerationC) Test protective sensation using a 10-g monofilamentD) Measure capillary blood glucose before continuing the examinationText our team the word COACH for a free diagnostic: (727) 732-4573

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 to include in the patient's plan of care?A) Restore left cervical rotation passive ROMB) Restore right cervical rotation passive ROMC) Restore right cervical side-bending passive ROMD) Restore length of the left sternocleidomastoid muscleJoin the FREE NPTE Facebook Group: www.nptegroup.comText our team the word COACH for a free diagnostic: (727) 732-4573

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* Hip flexor strength: 5/5* Hip extensor strength: 5/5* Negative FABER testWhich of the following activities would MOST likely be limited?A) Riding a stationary bicycleB) Walking with a long stride lengthC) Rising from a low chairD) Descending stairs with the affected leg firstJoin the FREE NPTE Facebook Group: www.nptegroup.com

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 and difficulty with heel- and toe-walking. The therapist decides to assess the hip flexor deep tendon reflex. Which of the following reflex grades is MOST likely?A) 0B) 1+C) 2+D) 4+Join the FREE NPTE Facebook Group: www.nptegroup.com

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 oscillations performed into tissue resistanceB) Small-amplitude oscillations performed into tissue resistanceC) Large-amplitude oscillations performed before tissue resistanceD) Small-amplitude oscillations performed before tissue resistanceText our team the word COACH for a free diagnostic: (727) 732-4573Join the FREE Facebook Group: www.nptegroup.com

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 while completing documentation. No direct evidence of substance use has been observed, and no adverse patient events have occurred. Which of the following actions is MOST appropriate?A) Report the colleague to the state licensing board due to suspected relapseB) Delay intervention unless patient safety is clearly compromisedC) Discuss the observed behaviors privately with the colleague and follow organizational reporting policies if concerns continueD) Continue monitoring the situation until substance use can be objectively verifiedText our team the word COACH for a free diagnostic: (727) 732-4573Join the FREE Facebook Group: www.nptegroup.com

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 durationWhich of the following patients should NOT receive this treatment?A) A 14-year-old basketball player with Osgood-Schlatter disease over an open tibial epiphyseal plateB) A 72-year-old patient status post cemented total knee arthroplasty 8 months agoC) A 68-year-old male with benign prostatic hyperplasia receiving treatment to the lumbar paraspinalsD) A 59-year-old patient with diabetic neuropathy and absent protective sensation over the treatment regionLooking for a quick way to learn important info about Therapeutic Ultrasound?Download my free cheatsheet here: www.nptecheatsheet.com/therapeutic-usJoin the FREE Facebook Group: www.nptegroup.com

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 stanceB) Increased plantarflexion following initial contactC) Contralateral pelvic drop during stanceD) Genu recurvatum during stanceJoin the FREE Facebook Group: www.nptegroup.comAre your scores stuck despite working hard? Take my diagnostic quiz: https://thepthustle.com/blocks

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 filmB) HydrocolloidC) Impregnated gauzeD) Amorphous hydrogelJoin the FREE Facebook Group: www.nptegroup.comGet my Top 10 MSK Cheatsheets for free: www.nptecheatsheets.com

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 extensionB) Mini squats to 45 degreesC) Resisted knee flexion with a 3-lb ankle weight in proneD) Sidelying straight leg raisesJoin the FREE Facebook Group: www.nptegroup.comUse PTH020 to get 20% off the 90-day Truelearn Subscription: www.truelearn.com

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) PsoriasisB) Systemic lupus erythematosusC) EczemaD) RosaceaJoin the FREE Facebook Group: www.nptegroup.com

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 stimulationB) High-resistance strength trainingC) Visual cueing during gait trainingD) Balance exercises using an unstable surfaceJoin the FREE Facebook Group: www.nptegroup.com

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 gravity-dependent positionB) Diaphragmatic breathingC) Sustained isometric contraction of the upper extremitiesD) Passive trunk rotation in supineJoin the FREE Facebook Group: www.nptegroup.com

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 unremarkable. Which of the following structures is MOST likely referring pain to this region?A) Thoracic facet joint dysfunctionB) Intercostal muscle strainC) The pleuraD) The pancreashttp://www.nptecheatsheets.com

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 presentB) The condition is likely presentC) The test confirms the diagnosisD) The test has low false negativesJoin the FREE Facebook Group: www.nptegroup.com

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 tractB) An injury to the cerebellumC) Compression of the posterior columns D) A lesion in the anterior horn cellsJoin the FREE Facebook Group: www.nptegroup.com

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 extension due to increased lumbar painB) Progress lumbar flexion exercises to reduce spinal compressionC) Continue repeated lumbar extension within toleranceD) Introduce hamstring stretching to reduce neural tensionJoin the FREE Facebook Group: www.nptegroup.comDownload my lumbar spine intervention cheatsheet: www.nptecheatsheet.com/lumbar-treat

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 flexionB) Socket is excessively abductedC) Knee friction is too lowD) Foot is set too posteriorlyJoin the FREE Facebook Group: www.nptegroup.com

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 trainingB) Stretch hip internal rotators and adductorsC) Make the patient non–weight bearing and refer urgentlyD) Initiate aquatic therapy for pain-free ROMJoin the FREE Facebook Group: www.nptegroup.com

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?A) Cranial nerve V, VIB) Cranial nerve VIC) Cranial nerve VI, VIID) Cranial nerve II, VIJoin the FREE Facebook Group: www.nptegroup.com

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 leftB) Vertebrobasilar insufficiency (VBI) test on the rightC) Jaw jerk testD) SwallowingUse PTH020 to get 20% off the 90-day Truelearn Subscription: www.truelearn.comDownload my quick cranial nerves cheatsheet: www.nptecheatsheet.com/cranial

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 testB) Tibial torsion testC) Q-angle measurementD) Thomas testJoin the FREE Facebook Group: www.nptegroup.com

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 findings?A) LisinoprilB) FurosemideC) AmlodipineD) MetoprololJoin the FREE Facebook Group: www.nptegroup.com

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 injuryB) Stasis of blood flowC) HypercoagulabilityD) Arterial insufficiencyJoin the FREE Facebook Group: www.nptegroup.comDownload my unfamiliar terms cheatsheet: www.nptecheatsheet.com/unfamiliar-terms

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 Clarke’s testC) Positive Thessaly test at 20° flexionD) Pain with valgus stress testingJoin the FREE Facebook Group: www.nptegroup.com

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 injured?A) Axillary nerveB) Thoracodorsal nerveC) Long thoracic nerveD) Radial nerveJoin the FREE Facebook Group: www.nptegroup.com

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 condition?A) Pelvic floor muscle strengthening with biofeedbackB) Bladder retraining and dietary modificationC) Myofascial release for the pelvic floorD) Core strengthening exercises to improve pelvic stabilityJoin the FREE Facebook Group: www.nptegroup.com

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 timeB) To prevent sudden increases in heart rateC) To increase myocardial oxygen consumptionD) To enhance stroke volume during exerciseDOWNLOAD THIS EPISODE'S CHEATSHEET:www.nptecheatsheet.com/hyper-heart

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 conservationB) Provide ankle-foot orthoses (AFOs) to prevent foot dropC) Initiate high-intensity strength training for lower extremitiesD) Recommend a walker to improve stabilityJoin the FREE Facebook Group: www.nptegroup.com

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) IliopsoasB) Erector SpinaeC) Quadratus lumborumD) Rectus abdominisTEXT OUR TEAM:(727) 732-4573

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 abuseB) Inadequate caloric intakeC) HypervolemiaD) HyponatremiaDOWNLOAD THIS EPISODE'S CHEATSHEET:www.nptecheatsheet.com/electrolyte

Zayden presents with well-defined, raised plaques on the extensor surfaces of his elbows and knees. The lesions are covered with silvery scales, and he reports occasional itching and no systemic symptoms. What is the MOST likely diagnosis?A) Atopic dermatitisB) Psoriasis vulgarisC) Tinea corporisD) Lichen planusJoin the FREE Facebook Group: www.nptegroup.com

Miraide is recovering from a total hip arthroplasty and reports mild calf discomfort on the second day post-surgery. On examination, there is no significant swelling or redness, but the patient has a resting heart rate of 105 bpm. Which of the following interventions is MOST appropriate to reduce the risk of deep vein thrombosis?A) Initiate ambulation with a walkerB) Apply ice packs to the calfC) Administer ankle pumps and quad setsD) Perform a Homan’s test to confirm DVTDOWNLOAD THIS EPISODES CHEATSHEET:www.nptecheatsheet.com/dvt-implications

Orion is a 12-year-old with spastic diplegic cerebral palsy and is evaluated for gait abnormalities. The therapist observes excessive hip flexion, knee flexion, and ankle dorsiflexion throughout the gait cycle. Which of the following gait patterns BEST describes these findings?A) Crouch gaitB) Scissoring gaitC) Ataxic gaitD) Steppage gaitTEXT OUR TEAM:(727) 732-4573

Kai is a 65-year-old male who presents with deep groin pain, morning stiffness lasting 30 minutes, and a positive scour test. Which gait deviation is MOST likely to be observed?A) Uneven cadenceB) Decreased step length on the unaffected limbC) Lateral trunk lean toward the unaffected limbD) Marked hip internal rotation on the affected sideDOWNLOAD THIS EPISODE'S CHEATSHEET:www.nptecheatsheet.com/osteo-arthritis

Harper presents with neck pain and tingling radiating into the right hand. Symptoms worsen with overhead activities and improve with the arm at rest. Examination reveals weakness in elbow flexion, diminished biceps reflex, and reduced sensation over the lateral forearm. Which of the following tests is the MOST effective to assess this condition? A) Spurling’s testB) Cervical distraction testC) Upper limb tension test (ULTT) for the median nerveD) Adson’s testJoin the FREE Facebook Group: www.nptegroup.com

DeShawn is assessing a 12-month-old child during a developmental screening. The child can pull to stand, cruise along furniture, and grasp small objects using a pincer grip, but has not yet started walking independently. Which of the following findings is MOST concerning?A) Inability to walk independentlyB) Absence of babbling or single wordsC) Persistence of the Moro reflexD) Lack of interest in grasping toysTEXT OUR TEAM: (727) 732-4573

Diego is six weeks post-rotator cuff repair and reports stiffness and a pulling sensation near the surgical incision during overhead movement. Examination reveals restricted shoulder range of motion and palpable adhesions. Which technique is MOST appropriate to address the patient’s symptoms?A) EffleurageB) Transverse friction massageC) Myofascial releaseD) Joint mobilizationDOWNLOAD THIS EPISODE'S CHEATSHEET:www.nptecheatsheet.com/soft-tissue

Luca is a 68 year old male with moderate COPD who is referred for physical therapy to improve exercise tolerance. He reports dyspnea with minimal exertion and has a 6-minute walk test distance of 250 meters. His resting oxygen saturation is 92% on room air. Which of the following is the MOST appropriate initial exercise approach?A) Interval training with short work and rest periods at moderate intensityB) Continuous training at 75% of peak work rate to build enduranceC) Resisted walking with a weighted vest to strengthen lower extremitiesD) Breathing retraining combined with unsupported upper extremity exercisesJoin the FREE Facebook Group: www.nptegroup.com

Amara presents with mild to moderate Alzheimer’s disease and has impaired gait and balance. She becomes disoriented in new environments and struggles with multi-step instructions.Which intervention is MOST appropriate for this patient?A) High-intensity balance exercises on uneven surfacesB) Dual-task training to improve cognitive functionC) Structured gait training in a familiar environmentD) Community ambulation to enhance adaptabilityTEXT OUR TEAM: (727) 732-4573

Helga is two days post-total knee arthroplasty (TKA) and reports moderate knee pain and stiffness. Her knee range of motion is 0–45 degrees, and her incision is well-approximated with mild edema. Which intervention is MOST appropriate to prioritize during this session?A) Full weight bearing on the surgical legB) Low-intensity range of motion exercises to increase knee flexionC) Ambulation with a rollator walker for at least 200 feetD) Manual lymphatic drainage to reduce swellingDOWNLOAD THIS EPISODE'S CHEATSHEET:www.nptecheatsheet.com/tka

Freda presents with persistent shoulder pain following rotator cuff repair surgery. The therapist considers using electrical stimulation for pain management. The patient has a history of mild hypertension controlled with medication and reports occasional muscle spasms in the surgical area. Which of the following would MOST likely require avoidance of electrical stimulation?A) Metal anchors used during surgical fixationB) Recent use of anti-hypertensive medicationC) Active muscle spasms near the surgical siteD) Impaired sensation over the affected shoulderJoin the FREE Facebook Group: www.nptegroup.com

Mohammad is documenting outcomes for a patient who has been treated for a venous ulcer. Which of the following improvements is the MOST significant to report? A) The patient reports a decrease in pain from 6/10 to 2/10 B) The patient's walking distance has increased from 100 meters to 300 meters C) The wound size has decreased from 6 cm² to 3 cm² D) The patient's lower leg swelling has reduced by 50%TEXT OUR TEAM:(727) 732-4573