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.
Amara presents with mild to moderate Alzheimer’s disease and has impaired gait and balance. She becomes disoriented in new environments and struggles with multi-step instructions.Which intervention is MOST appropriate for this patient?
A) High-intensity balance exercises on uneven surfaces
B) Dual-task training to improve cognitive function
C) Structured gait training in a familiar environment
D) Community ambulation to enhance adaptab...
Helga is two days post-total knee arthroplasty (TKA) and reports moderate knee pain and stiffness. Her knee range of motion is 0–45 degrees, and her incision is well-approximated with mild edema. Which intervention is MOST appropriate to prioritize during this session?
A) Full weight bearing on the surgical leg
B) Low-intensity range of motion exercises to increase knee flexion
C) Ambulation with a rollator walker for at least 200 fee...
Freda presents with persistent shoulder pain following rotator cuff repair surgery. The therapist considers using electrical stimulation for pain management. The patient has a history of mild hypertension controlled with medication and reports occasional muscle spasms in the surgical area. Which of the following would MOST likely require avoidance of electrical stimulation?
A) Metal anchors used during surgical fixation
B) Recent use...
Mohammad is documenting outcomes for a patient who has been treated for a venous ulcer. Which of the following improvements is the MOST significant to report?
A) The patient reports a decrease in pain from 6/10 to 2/10
B) The patient's walking distance has increased from 100 meters to 300 meters
C) The wound size has decreased from 6 cm² to 3 cm²
D) The patient's lower leg swelling has reduced by 50%
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Sweeney recently underwent a hysterectomy and requests to sit after ambulating a few feet. The patient reports dizziness and right lower extremity pain. On examination, her resting heart rate is 102 bpm, and she has significant swelling in her right lower leg. Which of the following should be assessed FIRST:
A) Walking distance before stopping
B) Pulse pressure
C) Deep calf tenderness
D) Dorsal pedal integrity
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Azaria is a 22-year-old swimmer with intermittent right shoulder pain who complains of a slipping sensation during overhead activities. Which of the following tests should be performed FIRST?
A) Apprehension test
B) Speed's test
C) Drop arm test
D) Load and shift test
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John reports dizziness and unsteadiness when walking, especially in busy environments or when turning his head quickly. He denies positional dizziness but struggles to read signs while walking. Examination reveals normal balance in static postures and no spontaneous nystagmus. Which test is MOST appropriate to assess the suspected deficit?
A) Dix-Hallpike maneuver
B) Head thrust test
C) Snellen Chart Reading while walking
D) Romberg te...
Before an evaluation, Arial is reviewing the patient's MRI report that describes sequestration at the L4 – L5 level. The intake form reveals sensory changes along the lateral calf, and dorsum of the foot. Which clinical finding is the most consistent with the medical record?
A) Impaired heel walking
B) Gastrocnemius and soleus atrophy
C) Extensor hallicus longus weakness
D) Saddle paraesthesia
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Samantha is an office worker who presents with pain and numbness in the right hand, particularly at night. On examination, there is decreased sensation along the palmar aspect of the thumb, index, and middle fingers. Which the of the following is the LEAST likely impaired:
A) Abductor pollicus brevis
B) Flexor pollicus longus
C) Opponens pollicus
D) 2nd Lumbrical
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Denise is six days post-abdominal surgery with a midline incision. The incision is well-approximated with slight redness but no drainage or dehiscence. She is concerned about safely participating in physical therapy. Which recommendation is MOST appropriate for this patient?
A) Avoid core exercises until 6 weeks post-op
B) Continue light activities and monitor for redness, swelling, or drainage
C) Apply heat to the incision before exe...
Kelly is referred to physical therapy six days after coronary artery bypass graft (CABG) surgery. She reports mild fatigue but denies chest pain or shortness of breath. Her resting heart rate is 85 bpm, and her blood pressure is 125/80 mmHg. The therapist plans to begin light aerobic exercise as part of her cardiac rehabilitation. Which of the following is the MOST appropriate guideline to follow during this session?
A) Monitor for ...
Ollie reports progressive weakness in his legs and tingling sensations in his hands and feet after a recent upper respiratory infection. On examination, he has moderate dorsiflexor weakness, and mild gait instability. Which of the following is the MOST anticipated finding?
A) Hyperreflexia with distal weakness
B) Loss of tactile sensation
C) Severe gross hip muscle weakness
D) Limb contractures
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Rella presents with a diagnosis of adhesive capsulitis in the freezing phase. She reports persistent, deep shoulder pain at rest and significant discomfort with attempted movement. Passive range of motion reveals capsular end-feel in all directions, particularly with external rotation. Which intervention is MOST appropriate to address the patient’s symptoms at this stage?
A) Low-load prolonged passive stretching with gradual increas...
Bailey presents with a history of osteoarthritis and hypertension and is referred to physical therapy for knee pain management. She reports taking over-the-counter medication daily for pain relief. During the session, she mentions experiencing mild stomach discomfort and occasional dizziness. Her blood pressure is 138/86 mmHg. Which medication is MOST likely contributing to the patient’s symptoms?
A) Acetaminophen
B) Ibuprofen
C) Calc...
Pouria presents with secondary lymphedema following breast cancer treatment. The patient reports heaviness in the arm and mild discomfort but denies significant pain. The affected arm shows a circumference 3 cm greater than the contralateral arm. She has no open wounds or signs of infection. Which compression and therapy strategy is MOST appropriate to manage this patient’s lymphedema?
A) High-stretch bandages to provide consistent ...
Jafar has a history of atrial fibrillation and reports occasional fatigue and palpitations. His resting heart rate is 96 bpm and irregular, and he takes a beta-blocker. During a six-minute walk test, he experiences mild shortness of breath but completes the test without difficulty. Which consideration is MOST important when developing this patient’s exercise program?
A) Monitor for a target heart rate based on age-predicted max hear...
Taylor presents with a TBI and is recently learning to transfer from a wheelchair to a bed independently. The therapist aims to facilitate the learning process while minimizing cognitive load. Which training strategy is MOST effective for this stage of motor learning?
A) Massed practice; intrinsic feedback
B) Distributed practice; concurrent feedback
C) Blocked practice; knowledge of results feedback
D) Random practice; knowledge of pe...
Kyle reports sudden posterior ankle pain after jumping, describing it as feeling “kicked.” Examination reveals mild swelling, a palpable gap above the calcaneus, limited active plantarflexion, and inability to perform a single-leg heel raise. Passive range of motion is full and pain-free. Which finding BEST explains the patient’s inability to perform a single-leg heel raise?
A) Tear of the medial ankle stabilizer leading to decrease...
Martha presents with six weeks of dull, intermittent low back pain. The pain worsens with standing but improves slightly with rest. Examination reveals mild lumbar tenderness and restricted motion. Which line of questioning is MOST important to uncover a potential red flag?
A) “Have you noticed changes in bowel or bladder habits?”
B) “What activities seem to aggravate or relieve your pain?”
C) “Have you experienced an increased heart...
Gertrude presents with right knee osteoarthritis and is being trained to use a cane. She demonstrates unsteady steps when initiating gait and turning, occasionally placing the cane too far ahead of her. She reports feeling unsure about how to use the cane properly in crowded environments. Which intervention is MOST important to improve the patient’s safety and confidence during cane use?
A) Adjust cane height to ensure proper weight...
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