NPTE Test Practice Questions And Answers (Verified Solution) With Rationale

NPTE Test Practice Questions And Answers (Verified Solution) With Rationale What conditions are the abnormal heart sounds S3 and S4 associated with, respectively? A. S3 = MI or HTN; S4 =CHF B. S3 = Tracheal Stenosis; S4 = Asthma C. S3 = closure of Mitral and Tricuspid Valves; S4 = Closure of Pulmonary Valves D. S3 = CHF; S4 =MI or HTN Feedback Correct Answer - D S3 is heard in early diastole (after S2) and is associated with CHF. S4 is heard in late diastole (before S1) and is associated with an MI or hypertension. A chronic smoker diagnosed with COPD was tested for an arterial blood gas (ABG) analysis. After reviewing the patient's chart, the physical therapist is MOST likely to see which of the following changes in the ABG results? A. Decreased PaCO2, increased PaO2, and decreased pH. B. Decreased PaCO2, decreased PaO2, and increased pH. C. Increased PaCO2, increased PaO2, and increased pH. D. Increased PaCO2, decreased PaO2, and decreased pH Feedback Correct Answer - D COPD causes dilation and destruction of the airspaces and alteration in pulmonary vasculature resulting in mismatch in ventilation in the alveoli and perfusion in the capillary membrane. This results in hypoxemia (decreased oxygen in the arterial blood) in the early stage of COPD and hypercapnea (increased carbon dioxide in the arterial blood) as the disease progresses. A geriatric patient recently developed CHF. The patient has symptoms of nausea, vomiting, and gastrointestinal irritability. The patient also presents with mental confusion and frustration. Based on these symptoms, what clinical condition does the therapist suspect? A. Alzheimer's disease B. Dementia C. Digoxin toxicity D. Age related symptoms Feedback Correct Answer - C Signs of digoxin toxicity in patients with CHF : Nausea, vomiting, headache, dizziness, confusion, abdominal pain, delirium, vision disturbance. With Alzheimer's and dementia, patient will experience significant memory loss. A patient has a history of diabetes, hypertension, and chronic heart failure. The patient's venous filling time is 10 seconds, while Homan's sign and rubor dependency tests are both negative. These findings support which of the following diagnoses? Select one: A. Chronic venous insufficiency B. Intermittent claudication C. Arterial insufficiency D. Lymphedema Feedback Correct Answer - A Venous filling time- The extremity is elevated and then lowered into a dependent position. The time it takes for the veins on top of the foot to refill is recorded. Normal filling time is 15 seconds. Greater than 15 seconds indicates arterial disease whereas less than 15 indicate venous disease. Rubor dependency test is negative indicating no arterial insufficiency. No signs of intermittent claudication and lymphedema are seen. While evaluating a 30-year-old male with shoulder pain, the therapist applies pressure at the end range of shoulder abduction and external rotation. The patient feels a sudden PARALYZING pain and WEAKNESS in his shoulder. This finding is MOST LIKELY an indication of: A. Thoracic outlet syndrome B. Myotome involvement C. Anterior instability D. Cervical spondylosis Feedback Correct Answer - C The therapist is performing anterior apprehension test or crank test. This test is primarily designed to check for traumatic instability problems causing gross or anatomical instability of the shoulder; positive anterior apprehension test indicates anterior instability. A physical therapist is examining a patient with hypomobile talocrural joint and finds that the range of motion of ankle dorsiflexion is limited. Which of the following mobilization techniques can be used to increase ankle dorsiflexion? A. Posterior glide of talus with small amplitude oscillations into tissue resistance at the limit of available joint motion B. Anterior glide of talus with small-amplitude rhythmic oscillations performed at the beginning of the range C. Posterior glide of talus with small-amplitude rhythmic oscillations performed at the beginning of the range D. Anterior glide of talus with small amplitude oscillations into tissue resistance at the limit of available joint motion Feedback Correct Answer - A Posterior glide of talus with small amplitude oscillations into tissue resistance at the limit of available joint motion At the talocrural joint, convex talus moves over with the concave mortise made up of the tibia and fibula. So, according to convex-concave rule, posterior glide of talus can be used to increase ankle dorsiflexion. Grade I, i.e. small-amplitude rhythmic oscillations performed at the beginning of the range is primarily used for treating joints limited by pain or muscle guarding. Grade IV, i.e. small-amplitude rhythmic oscillations performed at the limit of the available motion and stressed into the tissue resistance is used as stretching maneuver to increase range of motion. So, grade 4 and posterior glide of talus will be the most appropriate mobilization techniques for the patient. A therapist is examining a patient's straight leg raise by taking their leg into hip flexion, knee extension and ankle dorsiflexion with inversion. Which nerve is MOST likely being biased in this position? A. Common peroneal nerve B. Tibial nerve C. Sciatic and Tibial nerve D. Sural nerve Feedback Feedback Correct Answer - D Ankle Dorsiflexion with inversion places tension on the sural nerve. Plantar flexion and inversion places tension on the common peroneal nerve. Dorsiflexion and eversion with toe extension places tension on the tibial nerve. A physical therapist is assessing muscle strength of a 20-year-old male who reports having shoulder pain ever since he started lifting weights at the gym as part of his New Year's resolution. The therapist positions the patient in the supine position with 120° of shoulder abduction and moves the shoulder diagonally down and inward towards the patient's opposite hip. Resistance is given above the wrist in an up and outward direction. Which muscle is being tested? A. Pectoralis major clavicular head B. Pectoralis major both heads C. Pectoralis major sternal head D. Pectoralis minor Feedback Correct Answer - C MMT of Pectoralis major sternal head - the motion begins at 120° of shoulder abduction and moves diagonally down and in toward the patient's opposite hip. Resistance is given above the wrist in an up and outward direction. During a gait training session, a PT notices that the patient is beginning to lose balance in the anterior direction. What IMMEDIATE action should the therapist take? A. Pull the patient backwards B. Allow the patient to re-gain their balance C. Bring the patient to one knee D. Push the patient forward Feedback Correct Answer - A As the patient is beginning to lose the balance forward; pulling the patient backwards will help him to regain balance by performing a posterior weight shift. This is easiest to accomplish when assisted by the therapist. While evaluating the gait of a patient with right hemiplegia, the PT notes foot drop during mid-swing of the right leg. The MOST LIKELY cause of this deviation is: A. Inadequate contraction of the ankle dorsiflexors B. Excessive extensor synergy C. Decreased proprioception of foot-ankle muscles D. Excessive flexor synergy Feedback Correct Answer - A Ankle remains plantar flexed during swing and can be associated with dragging of the toes, typically called drop foot. It is caused by weakness or paralysis of foot dorsiflexors. Excessive extensor synergy causes tight plantar flexors. Excessive flexor synergy causes excessive dorsiflexion. Decreased proprioception does not cause foot drop. It causes sensory ataxia causing foot stomping gait. Which of the following is the MOST appropriate long-term goal for a PT to address in a patient with Down syndrome? A. Accelerate the rate of motor skills development B. Strengthen weak muscles C. Minimize the development of compensatory movement patterns D. Focus on rhythmic stabilization exercises Feedback Correct Answer - C In Down Syndrome, it is important to address the development of compensatory movement pattern, as it can further exacerbate hypotonicity. While rhythmic stabilization exercises do support the above, they are not a viable goal, but rather an activity. When examining a patient with a stroke, a physical therapist finds the patient's speech to be slow and hesitant. The patient is limited to one- or two-word responses but appears to fully comprehend sentences. Which of the following is the BEST description of the patient's ability to communicate? A. Global aphasia B. Non-expressive aphasia C. Wernicke's aphasia D. Broca's aphasia Feedback Correct Answer - D Broca's aphasia (nonfluent) is caused due to lesion involving third frontal convolution of the left hemisphere. The flow of speech is slow and hesitant, vocabulary is limited, and syntax is impaired. Speech production is labored or lost completely whereas comprehension is good. In Wernicke's aphasia speech flows smoothly with a variety of grammatical constructions but auditory comprehension is impaired. Global aphasia is severe aphasia with marked dysfunction across all language modalities and with severely limited residual use of all communication modes for oral-aural interactions. An elderly gentleman was admitted to the hospital with a stroke 2 days ago. The physical therapist has assessed the patient's functional strength, sensation, and bed mobility. With the patient seated at the edge of bed, the therapist instructs the patient to touch his nose with his index finger. The patient first flexes the elbow, and then adjusts the position of the wrist and fingers. The patient then further flexes the elbow, and lastly flexes the shoulder to generate contact between the index finger and the nose. What neurological impairment does the patient MOST likely have? A. Dysdiadochokinesia B. Titubation C. Dyssynergia D. Rebound phenomenon Feedback Correct Answer - C Dyssynergia is a manifestation of cerebellar pathology where the movement is performed in a sequence of component parts rather than as a single, smooth activity. A physical therapist is treating a patient status post a cerebrovascular accident. The patient is struggling to successfully clear his airway. Which of the following interventions should the therapist use? A. Coughing B. Incentive spirometer C. Postural drainage D. Huffing Feedback Correct Answer - D Huffing is a safe and effective technique for airway clearance. In huffing, abdominals are pulled up and in, rather than pushed out, causing decreased pressure in the abdominal cavity. Incentive spirometry is used to increase the inspiratory capacity. A patient diagnosed with Ménière's disease presents with vertigo. Which sign and symptom is LEAST consistent with the condition? A. Hearing loss B. Head tilt to one side C. Vertigo lasting 30 minutes D. Tinnitus Feedback Feedback Correct Answer - B Meniere's disease is a recurrent and usually progressive vestibular disease. It is associated with low frequency hearing loss, episodic vertigo. The patient may also complain of a sense of fullness and tinnitus. Head tilt to one side is not seen with Meniere's disease but seen with UVH. A 40-year-old male is a principal at a local high school, and was admitted to the hospital 1 week ago. During this time he had multiple complications including septic shock, decreased kidney function, and ultimately a great toe amputation to his right foot. The patient now presents with a warm, red, and edematous right lower limb. The MOST likely diagnosis is? A. Herpes zoster B. Dermatitis C. Cellulitis D. Impetigo Feedback Correct Answer - C Cellulitis is a painful infection of the soft tissue that is characterized by expanding local erythema, palpable lymph nodes, fever, and chills. Skin is hot, red and edematous. Most cases are caused by cuts, abrasions, insect bites, and local burns. Impetigo is superficial skin infection associated with inflammation, itching and small pus filled vesicles. Dermatitis is itching, inflammation of the skin. Herpes Zoster is pain, tingling over the spinal or cranial nerve dermatome and red papules, vesicle along its course. A female patient comes to the clinic complaining of loss of urine during activities such as sneezing, coughing, or laughing. Upon examination the physical therapist notices weakness in core and pelvic floor musculature. What is the MOST likely condition associated with these symptoms and findings? A. Urge incontinence B. Stress incontinence C. Overflow incontinence D. Flaccid bladder Feedback Correct Answer - B Urinary incontinence is the involuntary leakage of urine. Stress incontinence occurs when the support for the bladder or urethra is weak or damaged, but the bladder itself is normal. With stress incontinence, pressure applied to the bladder from coughing, sneezing, laughing, lifting, exercising, or other physical exertion increases abdominal pressure, and the pelvic floor musculature cannot counteract the urethral/ bladder pressure. Urge incontinence, is the involuntary contraction of the detrusor muscle with a strong desire to void and loss of urine as soon as the urge is felt. Overflow incontinence is over distention of the bladder and the bladder cannot empty completely. Urine leaks or dribbles out so the client does not have any sensation of fullness or emptying. A PT is assessing a patient's lymph nodes 6 months post-chemotherapy treatment. When assessing the lymph nodes, which presentation LEAST likely requires referral to a physician? A. Hard and fixed lymph node B. Rubbery or firm lymph node C. Soft and non-palpable D. Palpable lymph node Feedback Correct Answer - C Lymph nodes up to 1 cm in diameter of soft-to-firm consistency that move freely and easily without tenderness are considered within normal limits. Lymph nodes more than 1 cm in diameter that are firm and rubbery in consistency or tender are considered suspicious. Enlarged lymph nodes associated with infection are more likely to be tender, soft, and movable than slow-growing nodes associated with cancer. A 30-year-old male presents with atrophy of the intrinsic hand musculature, drooping of the eyelids, sunken eyeballs, lack of sweating and pupil constriction. Patient complaints include sudden pleuritic pain and a hoarse voice. What clinical condition is MOST likely related to these findings? A. Thoracic outlet syndrome B. Rib fracture C. Cervical myelopathy D. Pancoast tumor Feedback Correct Answer - D A growing Pancoast tumor can cause compression paravertebral sympathetic nerves leading to Horner's syndrome (drooping eyelid, lack of sweating, pupil constriction), compression of recurrent laryngeal nerve causing hoarseness of voice, compression of brachial plexus causing atrophy and weakness of muscles of arm and hand. TOS, rib fracture and cervical myelopathy will not cause Horner's syndrome. A patient fails to attain established physical therapy goals within the number of visits initially set by the physical therapist. The patient has made substantial progress in therapy, however has plateaued over the last 4 sessions. The most appropriate action for the physical therapist is? A. Request additional visits from the referring physician B. Document a progress note that updates the patient's current status C. Talk to the patient regarding their compliance D. Discharge the patient from physical therapy with a home exercise program Feedback Correct Answer - D With the patient's status plateauing, the therapist can no longer document that the patient's treatment is medically necessary. For this reason, it is best to discharge the patient with a home exercise program. A physical therapy student is planning to collect data on the effects of an electrical stimulation program on scapular dynamics in an asymptomatic population. The student will measure the distance between the spinous process to the inferior scapular angle at 0, 30, 60 and 100 degrees of shoulder abduction at three different time points. One of the MOST important factors for the success of this study is: A. Face validity B. Intra-rater reliability C. Inter-rater reliability D. Predictive validity Feedback Correct Answer - B Consistency of repeated measures performed by one individual is referred intrarater reliability. Here, one student will measure the distance multiple times; hence intra rater reliability is most important. For interrater reliability more than one tester must be present. Face validity is an assumption of validity based on the appearance of an instrument. Predictive validity is the degree to which a test is used to predict future outcome. A 27-year-old girl had a flip phone for the past 4 years and finally upgraded to an iphone 8. She has been on her new phone constantly and is now having difficulty swiping upwards with her thumb. She explains this to her friend who is a PT student. To improve her thumb's range of motion without difficulty, what is the BEST mobilization or glide the PT student should perform? A. Inferior glide B. Superior glide C. Ulnar glide D. Radial glide