NPTE EXAM 1 QUESTIONS CORRECT UPDATED AND
ANSWERS UPDATED QUESTIONS AND CORRECT
ANSWERS
Question:
1. A physical therapist examines a three-year-old patient diagnosed with a genetic condition which
af-fects collagen synthesis. The pa-tient bruises easily and has a life-long history of pathological
frac-tures. What is the patient's MOST likely diagnosis?
1.Osteomalacia 2.Osteopetrosis 3.Pediatric osteoporosis 4.Osteogenesis imperfecta
Answer:
4.Osteogenesis imperfecta Pathological fractures associated with milder presenta-tions of
osteogenesis imperfecta (OI) may raise suspi-cions of child abuse before a formal diagnosis is made.
More severe forms of OI are typically diagnosed early in the child's life with fractures sustained either
in utero or during birth. Milder presentations of OI (types I and IV) are inherited as autosomal
dominant traits while more severe forms (types II and III) are inherited as autosomal recessive traits.
The condition is characterized by bone fragility that is linked to an abnormality in the synthesis of
type I collagen.
Question:
2. A patient diagnosed with rheuma-toid arthritis is referred to physical therapy. The physical
therapist ob-serves bilateral thumb deformities characterized by metacarpopha-langeal joint flexion
with interpha-langeal hyperextension. Which de-formity is MOST consistent with the described
presentation?
1.Boutonniere 2.Swan neck 3.Mallet finger 4.Dupuytren
Answer:
Boutonniere boutonniere deformity may occur in the fingers or thumb as a result of trauma or
progressive arthritic changes. In patients diagnosed with rheumatoid arthritis, bouton-niere deformity
is the most commonly occurring thumb deformity. 1.In the thumb, chronic synovitis eventually forces
the metacarpophalangeal (MCP) joint into a flexed position. The associated palmar displacement
causes tension on the extensor mechanism of the interphalangeal (IP) joint resulting in
hyperextension. In the fingers, this deformi-ty presents with flexion in the proximal interphalangeal
(PIP) joint and extension of the distal interphalangeal (DIP) joint.
Question:
3. A physical therapist works with a patient recovering from surgery on gait activities on a level
surface. Which value represents the MAX-IMUM amount of knee flexion re-quired to complete the
described activity?
1.0-90 degrees 2.0-60 degrees 3.0-30 degrees 4.0-20 degrees
Answer:
2.0-60 degrees The gait cycle is comprised of a stance phase and swing phase. Each phase has
anticipated motion that is ex-pected throughout the cycle for each joint. Stance phase accounts for 60
percent of the gait cycle and swing phase accounts for 40 percent. Many functional activities (e.g.,
stair climbing) may require more than 60 degrees of knee flexion. A patient requires 0-60 degrees of
knee flexion with gait on a level surface. The greatest amount of knee flexion is required from the
initial swing to midswing.
,Question:
4. A 28-year-old female with low back pain is referred to physical thera-py. The patient indicates that
her pain started the previous week-end after painting a ceiling and currently is localized on the left
side of her low back. The patient states the pain is better when sit-ting in a "slouched" posture and is
worse during periods of pro-longed standing. An examination reveals a positive quadrant test and
positive Kemp's test on the left. Based on the presented in-formation, which structures are MOST
likely involved?
1.Right thoracic facets 2.Left thoracic facets 3.Left lumbar facets 4.Right lumbar facets
Answer:
Left lumbar facets The facet joints are likely to be stressed in positions of spinal extension, especially
when combined with a rotation and/or lateral flexion component (e.g., position used when painting
overhead). Flexion (i.e., slouched posture) will relieve the pain since pressure is taken off of the facet
joints. The quadrant test and Kemp's test are tests which are used to indicate pathology of the facet
joints. During the quadrant test or Kemp's test, the patient ex-tends and laterally flexes or rotates to
the side of pain. This causes maximal narrowing of the intervertebral fora-men and stress on the facet
joint. Since the patient had a positive test when moving to the left, the left lumbar facet joints are
likely the source of the pain.
Question:
5. A patient experiences left low-er extremity sciatica secondary to posterior derangement of the L5
disk. The patient tolerated a prone on elbows position without an in-crease in symptoms, however,
af-ter performing the exercise shown in the video the patient reports in-creased radicular pain in the
left lower extremity. What would be the physical therapist's MOST ap-propriate response?
1.Instruct the patient to assume a prone position 2.Instruct the patient to assume a prone on elbows
position 3.Instruct the patient to assume a standing extension position 4.Discontinue the extension
pro-gression
Answer:
2.Instruct the patient to assume a prone on elbows po-sition Centralized pain is often considered to be
a positive outcome during an extension progression. Patients may experience discomfort during
positioning, however, an increase in radiating symptoms warrants reassessment of the
appropriateness of the intervention. The prone press-up position may have been initiated prematurely.
Returning to the non-exacerbating prone on elbows position should assist the therapist to deter-mine
how to best proceed with the patient's care (e.g., more time accommodating to prone on elbows
position or discontinuing the extension progression).
Question:
6. An individual with declining health due to unhealthy lifestyle choices plans to engage in an
indepen-dent exercise program designed to improve their cardiovascular health. Which form of
self-moni-toring would be the MOST appro-priate for the individual to utilize when exercising?
1.Metabolic equivalents 2.Systolic blood pressure 3.Rate of perceived exertion 4.Respiration rate
Answer:
There are a variety of subjective and objective meth-ods available to monitor exercise intensity. The
most ap-propriate method for a given clinical scenario is influ-enced by a number of variables
including measurement purpose, medical status, patient's abilities, setting, and equipment available.
Patients can utilize a perceived exertion scale, such as Borg's Rating of Perceived Exertion (RPE)
Scale, as a subjective means of self-monitoring during exercise. The RPE quantifies the subject's
overall sense of effort by quantifying the amount of strain or level of exertion the patient is
experiencing during activity.
, Question:
7. After palpating several peripher-al pulse sites a physical thera-pist concludes that a patient has a
strong pulse at the popliteal artery, but a weak pulse at the dor-salis pedis artery. Which medical
finding identified during exercise would be MOST likely based on the patient's current status?
1.Orthopnea 2.Deep vein thrombophlebitis 3.Intermittent claudication 4.Venous thrombosis
Answer:
Intermittent claudication Palpation of peripheral arteries is used to assess perfu-sion of the extremities
in addition to pulse rate. Patients with diabetes or peripheral vascular disease often have diminished
blood flow to the hands and feet and may experience intermittent claudication pain when the
cir-culation is inadequate to meet the metabolic demands of the tissues. A strong popliteal artery
pulse and weak dorsalis pedis artery pulse suggests that blood flow between these sites is diminished,
perhaps from atherosclerosis. This patient could be expected to experience intermittent claudica-tion,
or pain in the calf muscles caused by ischemia during exercise.
Question:
8. A special test confirms the pres-ence of a sensory disturbance af-fecting the fourth and fifth digits
of the hand. What form of testing would MOST likely have been used to generate the positive test?
1.Resisted testing 2.Tapping 3.Joint mobility testing 4.Reflex testing
Answer:
Tapping Testing using Tinel's sign occurs with the patient po-sitioned in sitting with the elbow in
slight flexion. The therapist taps directly over the accessible portion of the ulnar nerve at the elbow. A
positive test is indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand,
and fingers. A positive test may be indicative of ulnar nerve compression or compromise. Tinel's sign
requires the therapist to tap with the index finger between the olecranon process and the medial
epicondyle. A positive test is indicated by a sensory dis-turbance in the ulnar nerve distribution.
Question:
9. A physical therapist examines the lower extremity of a patient with a transtibial amputation.
During the examination the therapist deter-mines the patient has weak (2/5) adductors and normal
(5/5) abduc-tors. Based on the patient's clinical presentation, what position might the lower extremity
tend to favor in standing?
1.Adduction 2.Abduction 3.Adduction and lateral rotation 4.Abduction and medial rotation
Answer:
Abduction Patients status post amputation are especially prone to contracture formation, making
patient education on ap-propriate positioning an integral component of the plan of care. Large
discrepancies in the strength of different muscle groups can lead to abnormal positioning of the limbs
and the development of contractures. Due to the relative strength of the abductors in relation to the
adductors, the lower extremity would tend to assume an abducted position.
Question:
10. A physical therapist examines a patient diagnosed with suspect-ed arterial occlusive disease. The
therapist identifies a number of findings consistent with the di-agnosis including absent femoral
pulse, dependent rubor, and in-termittent claudication in the but-tocks, hamstrings, and calf mus-cles.
What is the MOST likely site of occlusion?
1.Iliac artery 2.Femoral artery 3.Popliteal artery 4.Tibial artery
ANSWERS UPDATED QUESTIONS AND CORRECT
ANSWERS
Question:
1. A physical therapist examines a three-year-old patient diagnosed with a genetic condition which
af-fects collagen synthesis. The pa-tient bruises easily and has a life-long history of pathological
frac-tures. What is the patient's MOST likely diagnosis?
1.Osteomalacia 2.Osteopetrosis 3.Pediatric osteoporosis 4.Osteogenesis imperfecta
Answer:
4.Osteogenesis imperfecta Pathological fractures associated with milder presenta-tions of
osteogenesis imperfecta (OI) may raise suspi-cions of child abuse before a formal diagnosis is made.
More severe forms of OI are typically diagnosed early in the child's life with fractures sustained either
in utero or during birth. Milder presentations of OI (types I and IV) are inherited as autosomal
dominant traits while more severe forms (types II and III) are inherited as autosomal recessive traits.
The condition is characterized by bone fragility that is linked to an abnormality in the synthesis of
type I collagen.
Question:
2. A patient diagnosed with rheuma-toid arthritis is referred to physical therapy. The physical
therapist ob-serves bilateral thumb deformities characterized by metacarpopha-langeal joint flexion
with interpha-langeal hyperextension. Which de-formity is MOST consistent with the described
presentation?
1.Boutonniere 2.Swan neck 3.Mallet finger 4.Dupuytren
Answer:
Boutonniere boutonniere deformity may occur in the fingers or thumb as a result of trauma or
progressive arthritic changes. In patients diagnosed with rheumatoid arthritis, bouton-niere deformity
is the most commonly occurring thumb deformity. 1.In the thumb, chronic synovitis eventually forces
the metacarpophalangeal (MCP) joint into a flexed position. The associated palmar displacement
causes tension on the extensor mechanism of the interphalangeal (IP) joint resulting in
hyperextension. In the fingers, this deformi-ty presents with flexion in the proximal interphalangeal
(PIP) joint and extension of the distal interphalangeal (DIP) joint.
Question:
3. A physical therapist works with a patient recovering from surgery on gait activities on a level
surface. Which value represents the MAX-IMUM amount of knee flexion re-quired to complete the
described activity?
1.0-90 degrees 2.0-60 degrees 3.0-30 degrees 4.0-20 degrees
Answer:
2.0-60 degrees The gait cycle is comprised of a stance phase and swing phase. Each phase has
anticipated motion that is ex-pected throughout the cycle for each joint. Stance phase accounts for 60
percent of the gait cycle and swing phase accounts for 40 percent. Many functional activities (e.g.,
stair climbing) may require more than 60 degrees of knee flexion. A patient requires 0-60 degrees of
knee flexion with gait on a level surface. The greatest amount of knee flexion is required from the
initial swing to midswing.
,Question:
4. A 28-year-old female with low back pain is referred to physical thera-py. The patient indicates that
her pain started the previous week-end after painting a ceiling and currently is localized on the left
side of her low back. The patient states the pain is better when sit-ting in a "slouched" posture and is
worse during periods of pro-longed standing. An examination reveals a positive quadrant test and
positive Kemp's test on the left. Based on the presented in-formation, which structures are MOST
likely involved?
1.Right thoracic facets 2.Left thoracic facets 3.Left lumbar facets 4.Right lumbar facets
Answer:
Left lumbar facets The facet joints are likely to be stressed in positions of spinal extension, especially
when combined with a rotation and/or lateral flexion component (e.g., position used when painting
overhead). Flexion (i.e., slouched posture) will relieve the pain since pressure is taken off of the facet
joints. The quadrant test and Kemp's test are tests which are used to indicate pathology of the facet
joints. During the quadrant test or Kemp's test, the patient ex-tends and laterally flexes or rotates to
the side of pain. This causes maximal narrowing of the intervertebral fora-men and stress on the facet
joint. Since the patient had a positive test when moving to the left, the left lumbar facet joints are
likely the source of the pain.
Question:
5. A patient experiences left low-er extremity sciatica secondary to posterior derangement of the L5
disk. The patient tolerated a prone on elbows position without an in-crease in symptoms, however,
af-ter performing the exercise shown in the video the patient reports in-creased radicular pain in the
left lower extremity. What would be the physical therapist's MOST ap-propriate response?
1.Instruct the patient to assume a prone position 2.Instruct the patient to assume a prone on elbows
position 3.Instruct the patient to assume a standing extension position 4.Discontinue the extension
pro-gression
Answer:
2.Instruct the patient to assume a prone on elbows po-sition Centralized pain is often considered to be
a positive outcome during an extension progression. Patients may experience discomfort during
positioning, however, an increase in radiating symptoms warrants reassessment of the
appropriateness of the intervention. The prone press-up position may have been initiated prematurely.
Returning to the non-exacerbating prone on elbows position should assist the therapist to deter-mine
how to best proceed with the patient's care (e.g., more time accommodating to prone on elbows
position or discontinuing the extension progression).
Question:
6. An individual with declining health due to unhealthy lifestyle choices plans to engage in an
indepen-dent exercise program designed to improve their cardiovascular health. Which form of
self-moni-toring would be the MOST appro-priate for the individual to utilize when exercising?
1.Metabolic equivalents 2.Systolic blood pressure 3.Rate of perceived exertion 4.Respiration rate
Answer:
There are a variety of subjective and objective meth-ods available to monitor exercise intensity. The
most ap-propriate method for a given clinical scenario is influ-enced by a number of variables
including measurement purpose, medical status, patient's abilities, setting, and equipment available.
Patients can utilize a perceived exertion scale, such as Borg's Rating of Perceived Exertion (RPE)
Scale, as a subjective means of self-monitoring during exercise. The RPE quantifies the subject's
overall sense of effort by quantifying the amount of strain or level of exertion the patient is
experiencing during activity.
, Question:
7. After palpating several peripher-al pulse sites a physical thera-pist concludes that a patient has a
strong pulse at the popliteal artery, but a weak pulse at the dor-salis pedis artery. Which medical
finding identified during exercise would be MOST likely based on the patient's current status?
1.Orthopnea 2.Deep vein thrombophlebitis 3.Intermittent claudication 4.Venous thrombosis
Answer:
Intermittent claudication Palpation of peripheral arteries is used to assess perfu-sion of the extremities
in addition to pulse rate. Patients with diabetes or peripheral vascular disease often have diminished
blood flow to the hands and feet and may experience intermittent claudication pain when the
cir-culation is inadequate to meet the metabolic demands of the tissues. A strong popliteal artery
pulse and weak dorsalis pedis artery pulse suggests that blood flow between these sites is diminished,
perhaps from atherosclerosis. This patient could be expected to experience intermittent claudica-tion,
or pain in the calf muscles caused by ischemia during exercise.
Question:
8. A special test confirms the pres-ence of a sensory disturbance af-fecting the fourth and fifth digits
of the hand. What form of testing would MOST likely have been used to generate the positive test?
1.Resisted testing 2.Tapping 3.Joint mobility testing 4.Reflex testing
Answer:
Tapping Testing using Tinel's sign occurs with the patient po-sitioned in sitting with the elbow in
slight flexion. The therapist taps directly over the accessible portion of the ulnar nerve at the elbow. A
positive test is indicated by a tingling sensation in the ulnar nerve distribution of the forearm, hand,
and fingers. A positive test may be indicative of ulnar nerve compression or compromise. Tinel's sign
requires the therapist to tap with the index finger between the olecranon process and the medial
epicondyle. A positive test is indicated by a sensory dis-turbance in the ulnar nerve distribution.
Question:
9. A physical therapist examines the lower extremity of a patient with a transtibial amputation.
During the examination the therapist deter-mines the patient has weak (2/5) adductors and normal
(5/5) abduc-tors. Based on the patient's clinical presentation, what position might the lower extremity
tend to favor in standing?
1.Adduction 2.Abduction 3.Adduction and lateral rotation 4.Abduction and medial rotation
Answer:
Abduction Patients status post amputation are especially prone to contracture formation, making
patient education on ap-propriate positioning an integral component of the plan of care. Large
discrepancies in the strength of different muscle groups can lead to abnormal positioning of the limbs
and the development of contractures. Due to the relative strength of the abductors in relation to the
adductors, the lower extremity would tend to assume an abducted position.
Question:
10. A physical therapist examines a patient diagnosed with suspect-ed arterial occlusive disease. The
therapist identifies a number of findings consistent with the di-agnosis including absent femoral
pulse, dependent rubor, and in-termittent claudication in the but-tocks, hamstrings, and calf mus-cles.
What is the MOST likely site of occlusion?
1.Iliac artery 2.Femoral artery 3.Popliteal artery 4.Tibial artery
