NPTE: PRACTICE EXAM 1 QUESTIONS
CORRECT
A physical therapist examines a three-year-old patient diagnosed with a genetic
condition which affects collagen synthesis. The patient bruises easily and has a lifelong
history of pathological fractures. 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 presentations of osteogenesis imperfecta
(OI) may raise suspicions 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.
A patient diagnosed with rheumatoid arthritis is referred to physical therapy. The
physical therapist observes bilateral thumb deformities characterized by
metacarpophalangeal joint flexion with interphalangeal hyperextension. Which deformity
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,
boutonniere 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 deformity presents with flexion in the proximal interphalangeal (PIP) joint
and extension of the distal interphalangeal (DIP) joint.
A physical therapist works with a patient recovering from surgery on gait activities on a
level surface. Which value represents the MAXIMUM amount of knee flexion required 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 expected 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.
A 28-year-old female with low back pain is referred to physical therapy. The patient
indicates that her pain started the previous weekend after painting a ceiling and
currently is localized on the left side of her low back. The patient states the pain is better
when sitting in a "slouched" posture and is worse during periods of prolonged standing.
An examination reveals a positive quadrant test and positive Kemp's test on the left.
Based on the presented information, 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 extends and laterally flexes or
rotates to the side of pain. This causes maximal narrowing of the intervertebral foramen
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.
A patient experiences left lower extremity sciatica secondary to posterior derangement
of the L5 disk. The patient tolerated a prone on elbows position without an increase in
symptoms, however, after performing the exercise shown in the video the patient
reports increased radicular pain in the left lower extremity. What would be the physical
therapist's MOST appropriate 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 progression - Answer-2.Instruct the patient to assume a
prone on elbows position
,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 determine how to
best proceed with the patient's care (e.g., more time accommodating to prone on
elbows position or discontinuing the extension progression).
An individual with declining health due to unhealthy lifestyle choices plans to engage in
an independent exercise program designed to improve their cardiovascular health.
Which form of self-monitoring would be the MOST appropriate 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 methods
available to monitor exercise intensity. The most appropriate method for a given clinical
scenario is influenced 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.
After palpating several peripheral pulse sites a physical therapist concludes that a
patient has a strong pulse at the popliteal artery, but a weak pulse at the dorsalis 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 perfusion 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 circulation 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 claudication, or pain in the calf muscles caused
by ischemia during exercise.
, A special test confirms the presence of a sensory disturbance affecting 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 positioned 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 disturbance
in the ulnar nerve distribution.
A physical therapist examines the lower extremity of a patient with a transtibial
amputation. During the examination the therapist determines the patient has weak (2/5)
adductors and normal (5/5) abductors. 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 appropriate 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.
A physical therapist examines a patient diagnosed with suspected arterial occlusive
disease. The therapist identifies a number of findings consistent with the diagnosis
including absent femoral pulse, dependent rubor, and intermittent claudication in the
buttocks, hamstrings, and calf muscles. What is the MOST likely site of occlusion?
1.Iliac artery
2.Femoral artery
3.Popliteal artery
4.Tibial artery - Answer-Iliac artery
CORRECT
A physical therapist examines a three-year-old patient diagnosed with a genetic
condition which affects collagen synthesis. The patient bruises easily and has a lifelong
history of pathological fractures. 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 presentations of osteogenesis imperfecta
(OI) may raise suspicions 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.
A patient diagnosed with rheumatoid arthritis is referred to physical therapy. The
physical therapist observes bilateral thumb deformities characterized by
metacarpophalangeal joint flexion with interphalangeal hyperextension. Which deformity
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,
boutonniere 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 deformity presents with flexion in the proximal interphalangeal (PIP) joint
and extension of the distal interphalangeal (DIP) joint.
A physical therapist works with a patient recovering from surgery on gait activities on a
level surface. Which value represents the MAXIMUM amount of knee flexion required 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 expected 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.
A 28-year-old female with low back pain is referred to physical therapy. The patient
indicates that her pain started the previous weekend after painting a ceiling and
currently is localized on the left side of her low back. The patient states the pain is better
when sitting in a "slouched" posture and is worse during periods of prolonged standing.
An examination reveals a positive quadrant test and positive Kemp's test on the left.
Based on the presented information, 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 extends and laterally flexes or
rotates to the side of pain. This causes maximal narrowing of the intervertebral foramen
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.
A patient experiences left lower extremity sciatica secondary to posterior derangement
of the L5 disk. The patient tolerated a prone on elbows position without an increase in
symptoms, however, after performing the exercise shown in the video the patient
reports increased radicular pain in the left lower extremity. What would be the physical
therapist's MOST appropriate 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 progression - Answer-2.Instruct the patient to assume a
prone on elbows position
,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 determine how to
best proceed with the patient's care (e.g., more time accommodating to prone on
elbows position or discontinuing the extension progression).
An individual with declining health due to unhealthy lifestyle choices plans to engage in
an independent exercise program designed to improve their cardiovascular health.
Which form of self-monitoring would be the MOST appropriate 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 methods
available to monitor exercise intensity. The most appropriate method for a given clinical
scenario is influenced 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.
After palpating several peripheral pulse sites a physical therapist concludes that a
patient has a strong pulse at the popliteal artery, but a weak pulse at the dorsalis 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 perfusion 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 circulation 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 claudication, or pain in the calf muscles caused
by ischemia during exercise.
, A special test confirms the presence of a sensory disturbance affecting 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 positioned 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 disturbance
in the ulnar nerve distribution.
A physical therapist examines the lower extremity of a patient with a transtibial
amputation. During the examination the therapist determines the patient has weak (2/5)
adductors and normal (5/5) abductors. 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 appropriate 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.
A physical therapist examines a patient diagnosed with suspected arterial occlusive
disease. The therapist identifies a number of findings consistent with the diagnosis
including absent femoral pulse, dependent rubor, and intermittent claudication in the
buttocks, hamstrings, and calf muscles. What is the MOST likely site of occlusion?
1.Iliac artery
2.Femoral artery
3.Popliteal artery
4.Tibial artery - Answer-Iliac artery
