NPTE Clinical Files | Physical Therapy

Jermaine is a 22-year-old collegiate soccer player who injured his ankle when another player landed on his leg while his foot was planted. The ankle was forced into dorsiflexion and external rotation. Three days later, he has pain and tenderness over the anterolateral distal tibiofibular region, especially during push-off. Which of the following examination procedures would be MOST appropriate to assess the suspected injury?

A) Stabilize the lower leg and translate the talus and calcaneus anteriorly.

B) Stabilize the lower leg and externally rotate the foot with the ankle slightly dorsiflexed.

C) Stabilize the foot and externally rotate the tibia while applying an inversion force to the ankle.

D) Stabilize the lower leg and invert the calcaneus to tilt the talus.

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Yessica has a history of thumb carpometacarpal osteoarthritis and recently wore a functional hand splint for several weeks following a burn to the hand. After the burn has healed, she demonstrates limited thumb CMC adduction. Which joint mobilization technique is MOST appropriate to improve this motion?

A) Dorsal glide of the first metacarpal on the trapezium

B) Volar glide of the first metacarpal on the trapezium

C) Radial glide of the first metacarpal on the trapezoid

D) Ulnar glide of the first metacarpal on the trapezoid

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Olivia reports progressive lower-extremity weakness and decreased exercise tolerance. Examination reveals a resting heart rate of 104 bpm, a fine hand tremor, brisk deep tendon reflexes, and mild proximal muscle weakness. She also reports recent unintentional weight loss despite no change in diet or activity level.

Which of the following conditions is MOST likely responsible for Olivia’s presentation?

A) Graves disease

B) Hashimoto thyroiditis

C) Multiple myeloma

D) Hyperparathyroidism

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Jason is referred to physical therapy for gradually progressive bilateral hand pain and stiffness. The patient reports that the hands feel stiff for approximately 15 minutes after waking and becomes increasingly painful after prolonged gripping and household activities. Examination reveals firm enlargement of several interphalangeal joints and decreased motion of the first carpometacarpal joints bilaterally. There is no significant warmth or swelling of the metacarpophalangeal joints.

Which of the following additional findings would be MOST likely in this patient?

A) Ulnar drift of the digits at the metacarpophalangeal joints

B) Swan-neck deformity involving hyperextension of the PIP joints

C) Heberden nodes involving the distal interphalangeal joints

D) Boutonnière deformity involving flexion of the PIP joints

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Brian presents with chronic heart failure and is referred to physical therapy for aerobic conditioning. The patient has a history of hypertension and has a resting heart rate of 102 bpm. The medical record indicates that the patient takes a medication that decreases cardiac workload by reducing preload through increased renal excretion of sodium and water. Which of the following medications is MOST likely prescribed?

A) Lisinopril

B) Metoprolol

C) Furosemide

D) Nitroglycerin

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Priyanshi is a 68-year-old female referred to physical therapy for gradually increasing right forefoot pain and difficulty walking longer distances. During gait assessment, the physical therapist observes decreased push-off on the right during terminal stance and pre-swing. Examination reveals the following findings:

* Right first metatarsophalangeal joint extension PROM: 40°

* Right ankle dorsiflexion PROM: 10°

* Right ankle plantar flexor strength: 4/5

* Right quadriceps strength: 3+/5

* Right gluteus maximus strength: 3+/5

Which of the following interventions would be MOST appropriate to address the impairment primarily contributing to the observed gait deviation?

A) Progressive resisted strengthening of the right plantar flexors

B) Progressive resisted strengthening of the right gluteus maximus

C) Joint mobilization to improve extension of the right first metatarsophalangeal joint

D) Progressive resisted strengthening of the right quadriceps

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Ashley is preparing to perform a symptom-limited graded exercise test to determine functional exercise capacity and help develop an aerobic exercise prescription. Which of the following patients is the MOST appropriate candidate for this type of testing?

A) A patient with stable coronary artery disease who reports predictable substernal discomfort during prolonged uphill walking

B) A patient with acute pericarditis who reports chest discomfort at rest

C) A patient with suspected acute pulmonary embolism who developed sudden dyspnea earlier in the day

D) A patient with unstable angina who has experienced increasingly frequent chest pain during minimal activity

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Zoe is preparing to ambulate a patient hospitalized with hepatitis B. The patient is medically stable and has no open wounds, active bleeding, or uncontrolled drainage. Which of the following precautions is MOST appropriate during gait training?

A) Wear gloves and a gown throughout the treatment session because the infection can be transmitted through direct contact

B) Wear gloves only when contact with blood or other potentially infectious body fluids is anticipated

C) Wear a surgical mask when treating the patient within 3 feet (0.9 m)

D) Wear an N95 respirator and perform treatment in a negative-pressure room

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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’clock

B) Undermining of 2.4 cm at 12 o’clock

C) Maceration extending 2.4 cm at 12 o’clock

D) Induration extending 2.4 cm at 12 o’clock

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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) Amplitude

B) Pulse rate (frequency)

C) Pulse duration

D) Ramp down time

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