NPTE Clinical Files | Physical Therapy
NPTE Clinical Files is a podcast from the creator of Dominating the NPTE, hosted by Kyle Rice. NPTE Clinical Files explains a true clinical scenario in the form of a mock NPTE-based question. Each question is followed by a set of answer choices, where Dr. Kyle Rice explains the right answer with a detailed rationale. Each season covers all of the major systems and topics found in physical therapy and likely to be found on an NPTE. NPTE Clinical Files gives the Physical Therapist a weekly opportunity to solve clinical puzzles while learning the latest research related to the topic.
Episodes
Ulises presents with intermittent upper extremity paresthesia reproduced with overhead activity. Examination reveals an elevated first rib on the involved side without reports of soft tissue tenderness. Which of the following mobilization techniques is MOST appropriate?
A) Large-amplitude oscillations performed into tissue resistance
B) Small-amplitude oscillations performed into tissue resistance
C) Large-amplitude oscillations perfo...
Brendaisha is a physical therapist who becomes concerned about a colleague who previously completed rehabilitation for substance abuse. Over the past several weeks, the colleague has demonstrated increasing tardiness, reduced attention during patient care, and episodes of excessive drowsiness while completing documentation. No direct evidence of substance use has been observed, and no adverse patient events have occurred. Which of ...
A physical therapist is mentoring a student physical therapist during an outpatient orthopedic clinical rotation. The therapist plans to administer therapeutic ultrasound using the following parameters:
* 3 MHz frequency
* 20% pulsed duty cycle
* 0.5 W/cm² intensity
* 6-minute treatment duration
Which of the following patients should NOT receive this treatment?
A) A 14-year-old basketball player with Osgood-Schlatter disease ...
Harry presents with a right-sided posterolateral disc herniation at L5-S1 and demonstrates weakness associated with the involved nerve root. Which of the following gait deviations is MOST likely?
A) Diminished propulsion during terminal stance
B) Increased plantarflexion following initial contact
C) Contralateral pelvic drop during stance
D) Genu recurvatum during stance
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Jason is a patient with peripheral vascular disease who presents with a lower leg wound containing dry, adherent slough and minimal exudate. The wound bed appears desiccated, and the surrounding skin is fragile but intact. Which of the following interventions is MOST appropriate?
A) Transparent film
B) Hydrocolloid
C) Impregnated gauze
D) Amorphous hydrogel
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Petey is 4 weeks status post ACL reconstruction with a semitendinosus autograft and partial meniscectomy. Which of the following interventions is LEAST appropriate at this time?
A) Quad sets held in knee extension
B) Mini squats to 45 degrees
C) Resisted knee flexion with a 3-lb ankle weight in prone
D) Sidelying straight leg raises
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Alynne is a woman who reports fatigue, intermittent joint pain, and a recurrent facial rash that becomes worse after spending time in the sun. Examination reveals a rash over the bridge of the nose and cheeks that spares the nasolabial folds. Which of the following conditions is MOST likely?
A) Psoriasis
B) Systemic lupus erythematosus
C) Eczema
D) Rosacea
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Mila reports a sudden, intense urge to urinate followed by leakage before reaching the bathroom. The patient voids frequently throughout the day and wakes multiple times at night to urinate. Pelvic floor strength is 4/5, and there is no leakage with coughing or sneezing. Which of the following interventions is MOST appropriate for the treatment of this patient?
A) Pelvic floor strengthening with maximal sustained holds
B) Bladder ret...
Mackenzie presents to physical therapy following a stroke affecting the basal ganglia. The patient exhibits bradykinesia and difficulty initiating movements. Which of the following interventions would be MOST effective in addressing these impairments?
A) Rhythmic auditory stimulation
B) High-resistance strength training
C) Visual cueing during gait training
D) Balance exercises using an unstable surface
Bellie presents with persistent bilateral lower extremity swelling that worsens throughout the day. The therapist is selecting an intervention to assist with fluid return. Which of the following interventions would MOST effectively assist with this goal?
A) Maintaining the lower extremities in a gravity-dependent position
B) Diaphragmatic breathing
C) Sustained isometric contraction of the upper extremities
D) Passive trunk rotation in...
Dr. Rice evaluates a patient with a chief complaint of mid-thoracic pain radiating around the left lateral rib cage. The patient reports symptoms worsen with deep breathing and coughing, but are not reproduced with spinal movement, rib mobilization, or palpation. Neurological screening is unremarkable. Which of the following structures is MOST likely referring pain to this region?
A) Thoracic facet joint dysfunction
B) Intercosta...
Carmen is performing a special test on her patient. The test has a sensitivity of 95% and a specificity of 30%. The patient tests negative. What is the BEST interpretation?
A) The condition is unlikely present
B) The condition is likely present
C) The test confirms the diagnosis
D) The test has low false negatives
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Elena presents with significant muscle atrophy in the lower extremities, fasciculations of the gastrocnemius, and a 1+ Achilles tendon reflex. During gait, the patient demonstrates a "slapping" foot strike. These signs are MOST indicative of:
A) A lesion in the corticospinal tract
B) An injury to the cerebellum
C) Compression of the posterior columns
D) A lesion in the anterior horn cells
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Yesenia is a 37-year-old patient with lumbar disc herniation who reports pain radiating to the posterior thigh. During treatment, repeated lumbar extension causes leg pain to resolve but increases central low back discomfort. Which intervention is MOST appropriate to continue?
A) Discontinue extension due to increased lumbar pain
B) Progress lumbar flexion exercises to reduce spinal compression
C) Continue repeated lumbar extension wi...
Benito, a patient with a right transfemoral amputation, demonstrates circumduction of the prosthetic limb during the swing phase. Which of the following prosthetic causes is MOST likely contributing to this deviation?
A) Insufficient socket flexion
B) Socket is excessively abducted
C) Knee friction is too low
D) Foot is set too posteriorly
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Victor is a 12-year-old male who presents with a limp and groin pain. The hip rests in external rotation, and hip flexion produces obligatory external rotation. Which of the following should the physical therapist initiate FIRST?
A) Begin hip strengthening and gait training
B) Stretch hip internal rotators and adductors
C) Make the patient non–weight bearing and refer urgently
D) Initiate aquatic therapy for pain-free ROM
Belsnickel is a 63-year-old male who presents with right-sided facial paralysis, inability to abduct the right eye, and an absent corneal blink reflex on the right. Sensation to the face is intact. These findings are MOST consistent with a lesion affecting which of the following cranial nerves?
A) Cranial nerve V, VI
B) Cranial nerve VI
C) Cranial nerve VI, VII
D) Cranial nerve II, VI
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Juvelyn shows an impaired corneal reflex, loss of facial sensation, and difficulty chewing on the right side. Which of the following is MOST likely impaired?
A) Difficulty chewing on the left
B) Vertebrobasilar insufficiency (VBI) test on the right
C) Jaw jerk test
D) Swallowing
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Hallie presents with bilateral anterior knee pain and an in-toeing gait. Craig’s test reveals 10° of femoral anteversion on both sides. Which of the following special tests is MOST appropriate to further assess the cause of the in-toeing?
A) FABER test
B) Tibial torsion test
C) Q-angle measurement
D) Thomas test
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Lionel has a past medical history of hypertension and has been referred to physical therapy for generalized fatigue and reduced exercise tolerance. During the session, the therapist notes mild bilateral lower extremity edema. Which of the following medications is MOST likely contributing to these findings?
A) Lisinopril
B) Furosemide
C) Amlodipine
D) Metoprolol
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