NPTE Questions Flashcards
A physical therapist is evaluating a 66 year old female who has a history of severe head trauma following a motor vehicle accident. The patient has difficulty with rapid alternating movements while performing neurologic testing. The BEST term to describe this specific impairment is:
- Ataxia
- Dysmetria
- Dysarthria
- Dysdiadocokinesia
- Ataxia - is a global term comprising inaccuracy and decomposition of movement. Although this encompasses many forms of movement impairments, it is too general to describe difficulty with rapid alternating movement.
- Dysmetria is defined as a decreased ability to judge distance and range.
- Dysarthria is defined as a motor impairment involving the muscles used in speech and breathing.
- This is the correct answer. By definition, dysdiadochokinesia is an impairment specifically involving rapid alternating movements, such as pronating and supinating one’s hands quickly
If a magnetic resonance image (MRI) correctly identifies 95% of patients as positive for anterior cruciate ligament tears, then the MRI is:
- Sensitive
- Specific
- Significant
- Stable
- Sensitive- A test that is sensitive will correctly identify the true positives. With high sensitivity, a test that is negative will likely mean that you can rule OUT the condition because positives are so reliable.
- Specificity is the % of true negatives identified. With high specificity, a test that is positive will rule IN the condition because the negatives are so reliable.
- Statistically significant would mean the result is likely NOT due to chance.
- Stable would mean the result does not fluctuate.
A 20 year old male soccer player presents with a Grade II right lateral ankle sprain upon evaluation. What are the characteristics of a Grade II ankle sprain?
- Partial tear of the lateral ligament complex with mild joint instability, moderate intracapsular swelling and tenderness, and some loss of ROM and joint function
- Complete rupture of the anterior talofibular ligament, calcaneofibular ligament, and capsule with mechanical joint instability; severe intra/extra-capsular swelling, ecchymosis, tenderness and inability to weight-bear.
- Stretch of the lateral ligament complex with no macroscopic tear or joint instability, little swelling or tenderness
- Partial tear of the syndesmosis, creating generalized swelling and tenderness throughout the ankle joint complex; inability to bear weight, severe ecchymosis, and mortise widening.
- This is the correct answer. This describes a Grade II lateral ankle sprain.
- This describes a severe or Grade III lateral ankle sprain.
- This describes a mild or Grade I lateral ankle sprain.
- This describes a “high” ankle sprain, or Syndesmosis sprain.
An 11 year old male presents to the physical therapy clinic with signs of hypertonicity related to cerebral palsy. The boy has significant shortening of the left sternocleidomastoid muscle, creating a severe torticollis to the right. This has led to a pressure ulcer forming on his right ear from contact with the wheelchair headrest. The MOST appropriate course of action is to:
- Begin a course of active-assisted range of motion exercises, focusing on the upper extremities and creating a home program to improve shoulder active range of motion.
- Inform the patient’s family that the child should not be in a wheelchair to prevent the formation of any more pressure ulcers and decrease pain associated with torticollis.
- Inform the primary care provider of the child and request him/her to order an oral prescription of Baclofen because the child has developed a tolerance for the current dosage.
- Begin a course of passive range of motion stretches, focusing on the neck, and instruct the patient’s family on proper positioning and wheelchair adjustments to decrease the likelihood of future ulcers.
- This is a distractor option that does not address torticollis or ear ulceration. While shoulder range of motion exercises may not be harmful or cause problems, it certainly won’t solve this one.
- This will solve the ulceration problem, but when does a physical therapist ever put a patient on bed rest? This is not the MOST appropriate course of action.
- Getting an increase dosage of Baclofen may be part of the solution, but there are several issues with this item. If the patient is affected enough to develop ulceration from positioning, he likely won’t be able to tolerate oral Baclofen (he will have to receive it intrathecally). Also, Baclofen use does not generally create tolerance to the drug requiring higher doses.
- This is the MOST correct answer. It is straightforward in describing a course of action that focuses on treating the hypertonic neck muscles, but also addresses positioning and family/patient education.
A physical therapist evaluating a 66 year old female who has a history of severe head trauma following a motor vehicle accident. The patient has difficulty with rapid alternating movements while performing neurologic testing. The BEST term to describe this specific impairment is:
- Ataxia
- Dysmetria
- Dysarthria
- Dysdiadocokinesia
- Ataxia is a global term comprising inaccuracy and decomposition of movement. Although this encompasses many forms of movement impairments, it is too general to describe difficulty with rapid alternating movement.
- Dysmetria is defined as a decreased ability to judge distance and range.
- Dysarthria is defined as a motor impairment involving the muscles used in speech and breathing.
- Correct answer. By definition, dysdiadochokinesia is an impairment specifically involving rapid alternating movements, such as pronating and supinating one’s hands quickly
A 79 year old female presents to outpatient rehabilitation services 6 weeks following a CVA with right hemiplegia. She complains of right shoulder pain working on functional upper extremity movements and has severe shoulder pain when practicing bed mobility activities such as rolling and scooting. On examination, it is observed that the humeral head is inferiorly displaced. Which of the following would be the MOST appropriate for her condition?
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Functional Electrical Stimulation (FES)
- Short Wave Diathermy (SWD)
- Interferential Current (IFC) Stimulation
- TENS is a powerful modality that will treat pain in many individuals. This woman does complain of pain, but the impairment of an inferiorly displaced humeral head is also mentioned. TENS will have little effect on this displacement.
- FES is the correct answer. Using FES to help elevate her shoulder will treat the displacement and ideally eliminate the source of pain.
- SWD is a pain relief modality that is not used often.
- IFC is another form of TENS, and will not help much with the displaced humeral head.
A 30 year old male presents to outpatient rehabilitation with numbness and tingling on the 4th and 5th fingers of the left hand consistent with nerve entrapment symptoms. Upon further examination, it is noted that the patient has normal sensation on the dorsum of the hand on the ulnar side. Where is the MOST likely source of nerve entrapment?
- Guyon’s Canal
- Carpal Tunnel
- Cubital Tunnel
- 1st Rib
- Guyon’s Canal -The ulnar nerve provides the sensory innervation for the 4th and 5th digits, narrowing the answer to either the Cubital Tunnel or Guyon’s Canal. The ulnar nerve has a dorsal cutaneous branch that innervates the dorsum of the hand. Because dorsal sensation is intact, the nerve must be trapped at Guyon’s Canal.
- The median nerve passes through the Carpal Tunnel and does not innervate the 4th and 5th digits.
- Entrapment at the Cubital tunnel would not typically leave any sensation on the dorsum of the hand on the ulnar side.
- Thoracic Outlet Syndrome would have entrapment at the 1st rib, but sensation loss would occur in a similar manner to entrapment at the Cubital tunnel.
A 45 year old male presents to the burn unit with partial thickness burns over the entire right arm, left arm, front of head, and front of chest. Approximately what percentage of his body is burned?
- 31.5%
- 36%
- 40.5%
- 45%
This question requires knowledge of the rule of nines: entire right arm = 9%, entire left arm = 9%, front of head = 4.5%, front of chest = 18%. Total = 40.5%, correct answer is 3
A patient presents to the inpatient rehabilitation unit who has suffered a vertebro-basilar CVA and has difficulty depressing the eye from an adducted position. Which cranial nerve is the MOST likely cause of this impairment?
- CN I 2
- CN II
- CN III
- CN IV
Cranial nerve testing for ocular movements is performed using the “H” pattern to assess tracking movements. Difficulty adducting and depressing the eye is indicative of Trochlear nerve involvement (CN IV).
A 59 year old male patient is being evaluated for left shoulder pain. The patient reports that his shoulder pain is closely associated with activity, including stress at work. The patient reports that at worst, the pain radiates into his neck, and he feels shortness of breath which subsides with rest. What would the MOST appropriate intervention be?
- Begin passive range of motion exercises within the pain free range of motion.
- Postpone treatment and refer the patient to his physician for further evaluation.
- Apply modalities to the shoulder and instruct the patient on activity modification.
- Begin the patient with rotator cuff exercises within the pain reduced range of motion and instruct patient on activity modification.
- PROM is an excellent treatment for sore shoulders, but the patient is presenting with signs and symptoms consistent with cardiac distress, not musculoskeletal pain.
- This is the most appropriate initial action. The patient is having signs of cardiac distress that would be worsened with activity.
- This is not appropriate considering the above information.
- The pain is not originating from the rotator cuff, thus this would be a poor choice.
A 35 year old patient with a complete T5 spinal cord injury is working on supine to sit transfers on the mat table when he suddenly appears flushed and complains of his heart pounding. Upon examination, his blood pressure is 180/100 and he has a pounding headache. The most appropriate INITIAL course of action is:
- Lay the patient supine and notify the patient’s physician.
- Sit the patient up and notify the patient’s physician.
- Allow the patient to rest longer between sets of activity.
- Initiate core strengthening exercises to maintain intraabdominal pressure.
- This is not correct because putting the patient in supine will exacerbate the autonomic dysreflexia.
- This is the correct answer. By sitting the patient up, you decrease the blood pressure in the head and mitigate the effects of the dysreflexia.
- This is incorrect considering that autonomic dysreflexia is a life-threatening condition
- Also incorrect.
A 21 year old female patient presents with neck pain and stiffness that has gradually worsened over the last two weeks. Upon examination, the patient is noted to have pain with left side bending with left rotation and reports pain on the left at the C5-6 junction. Hypomobility is also noted with right side-gliding of C6. Which of the following techniques will be most appropriate to decrease pain?
- Closing technique for the mid-thoracic spine.
- Closing manipulation in extension for C5-C6
- Gapping manipulation in flexion for C5-C6.
- Flexion/opening manipulation for mid-thoracic spine
- The cervical spine “closes” with side-bending and ipsilateral rotation (i.e. “closed” with left SB and left rot.). Manipulating the thoracic spine for neck pain is a common treatment strategy, however the specific issues noted in the question require more than just a nonspecific t-spine manip.
- This is the correct answer. The hypomobility is noted at C6 with right side-gliding and pain with left SB and rotation.
- This would be the treatment if the pain were on the right with the left SB and rotation. (Difficulty “opening” the right C5-6 facet joint.
- Refer to #1. Not the MOST appropriate manipulation, however this could be used as an adjunct to #2.
A 22 year old female presents to the clinic with a chief complaint of knee pain following a twisting injury while playing soccer 5 days ago. The patient’s knee is swollen significantly and is unable to jump or run. What special test would be the MOST appropriate to diagnose the injury?
- Lachman’s test
- Posterior drawer test
- Active Lachman’s test
- External Rotation Recurvatum Test
- This is the most correct answer. The overwhelming majority of injuries to female soccer players is to the ACL, especially with a running/twisting injury and swelling. In addition, the Lachman’s test is validated well by multiple studies.
- PCL’s are an issue with twisting injuries, but not to the extent that ACL’s are.
- Active Lachman’s test has not had near the validation that the plain-vanilla Lachman’s test has.
- Good test, but not the MOST appropriate.
A geriatric patient with “walking” pneumonia and a history of recent falls is receiving physical therapy for general strengthening. What part of this person’s treatment is affected MOST by his lung condition?
- Decreased stamina/tolerance of activity
- Inability to participate in endurance type activities
- Diminished tidal volumes
- Lower oxygen saturation with moderate activity
- This is the correct answer. Having a “walking” pneumonia and history of falls indicates a decreased tolerance of activity/stamina will likely slow therapy the most.
- This is related to number 1, but the patient’s treatment will focus on easy endurance type activities. The patient will be able to participate some.
- Diminished tidal volume will be a part of the issue, but can be monitored and controlled with coaching
- This is related to number 3, but will not be the MOST affected portion because it will be difficult for this patient to perform much moderate intensity activity
A patient complains of pain in the right hip while she is ambulating. Upon examination, you notice that the patient has a significant drop of the left hip while in midstance on the right leg. The MOST appropriate treatment for this impairment would be:
- Standing hip abduction of the left leg.
- Standing hip abduction of the right leg.
- Standing flexion of the left leg.
- Standing flexion of the right leg.
- This is the most correct answer. The patient is demonstrating a Trendeleburg gait with the weakness on the right hip abductors. The trick (and this is very true in the clinical world) is that while standing on the involved hip and abducting the opposite, you are loading the right hip (closed-chain) more than the left hip (open chain). Thus you are MORE effective at strengthening the right hip abductors by using the closed chain exercise.
- Good, but this open chain activity for the right hip abductors is not as appropriate as a closed-chain activity.
- Not directly related to the impairment.
- Same as (3).
A patient presents to the clinic with signs of lethargy and mild dizziness. The patient’s resting blood pressure is 100/70. Which of the following is MOST likely to cause this decrease in blood pressure?
- Lisinopril
- Prednisone
- Sertraline
- Metformin
- This is the correct answer. Lisinopril is an ACE inhibitor and is used primarily for the treatment of hypertension.
- This is used to treat inflammatory diseases and is typically not associated with decreases in blood pressure.
- Sertraline treats depression and is typically not associated with decreases in blood pressure.
- Metformin controls blood sugar in Type II Diabetes and is not typically associated with decreases in blood pressure.
A patient presents to the clinic with right shoulder pain and complains of difficulty reaching overhead, with pain especially from 60-120 degrees of shoulder flexion. Which special test would be MOST informative for this set of symptoms?
- Neer Test
- Empty Can Test
- Crossover Test
- Push Off Test
- This is the correct answer. The Neer Test is a test for subacromial impingement and is typically associated with the painful arc.
- The Empty Can Test assesses supraspinatus pathology.
- The Crossover Test checks for AC Joint pathology
- The Push Off Test assesses strength and integrity of the subscapularis, one of the rotator cuff muscles.
A patient is in the inpatient rehabilitation unit for a total knee replacement. While reviewing the case, you note that the patient has been diagnosed with an infection of Methicillin-resistant Staphylococcus aureus (MRSA) and is in an isolation room. What is the MOST appropriate action to take to prevent contamination?
- Don gown, mask, gloves, and respirator before entering the room, wash hands after.
- Limit therapy sessions to less than 15 minutes and limit contact during treatment.
- Don gloves when in contact with the patient and wash hands after.
- Wash hands before and after contact with the patient, but do not touch the patient.
- This is the most conservative of precautions that is used for droplet precautions, especially the mask. MRSA requires contact precautions.
- This is not appropriate.
- Hand washing and gloves are the MOST appropriate. If you anticipate extensive contact, donning a gown would also be appropriate for Contact Precautions. http://www.cdc.gov/mrsa/prevent/healthcare/precautions.html
- This is not appropriate.
A 32 year old female presents to the clinic complaining of left shoulder pain. The patient’s symptoms include pain with reaching and limited motion in all planes. The patient’s symptoms have been progressively worsening over the last month. What would be the MOST effective initial treatment?
- Refer the patient to their primary care provider for intracapsular corticosteroid injections.
- Begin gentle progressive stretching exercises with the focus on increased active range of motion.
- Initiate rotator cuff strengthening exercises, focusing on external rotation.
- Instruct the patient on Codman pendulum exercises and apply a moist heat pack
- While corticosteroid injections can be a helpful to achieve short term results, there is little evidence they have long term effects.
- This is the most correct answer. An effective treatment program for adhesive capsulitis should use gentle progressive stretching as the primary treatment.
- This is not appropriate considering the symptoms of adhesive capsulitis.
- This is not appropriate.
While treating a patient for cardiac rehab, a physical therapist relies on the Borg RPE scale. The Borg rating of perceived exertion scale (RPE) is MOST representative of which type of data scale?
- Nominal
- Ordinal
- Cardinal
- Marginal
- Nominal scales are used to indicate categories that are not higher or lower (example: race, gender, etc.)
- Ordinal scales are used to represent data that is comparatively higher or lower that other data. This is the most correct answer.
- Cardinal scales are used when there is an absolute zero and are quantitative. Age and weight are good examples of these.
- Not related.