Sample NPTE Questions
Practice Set #1
Setting: Acute Care
Sex: Male
Age: 28
Presenting Problem / Current Problem
• Worsening global deconditioning since recent fall 8 weeks prior.
Past Medical History
• Obesity
• Duchenne’s Muscular Dystrophy (DMD)
Other Information
• Lives in single-story home with mother
• 4 steps to enter, bilateral railings.
• Modified independent household ambulator <250 feet with FWW prior to admission
• Modified independent with stair negotiation using right ascending handrail with step-to pattern.
Physical Therapy Examination(s):
• Bed mobility with moderate assist of one person
• Sit-to-stand transfers with moderate assist of one person
• Gait: Minimal assist for 30 feet with FWW until fatigued
Patient stated goal
• “Return to how I was before”
Question #1
Which of the following is the most appropriate goal for this patient?
A. Patient will be able to ambulate 250 feet with use of FWW on uneven, outdoor surfaces with modified independence in 6 weeks.
B. In 6 weeks, the patient will be able to independently negotiate 4 steps using a step-over pattern with 2 lofstrand crutches.
C. Patient 30-Second Sit to Stand Score will be at least 15 repetitions to reach age normative values in 6 weeks.
D. In 3 weeks, the patient will be able to perform bed mobility independently using log roll technique on flat bed surface.
Correct Answer: D.
All of these are SMART goals – sorry, no free giveaways here! Which of these are both REASONABLE and SALIENT to the patient?
A. Patient will be able to ambulate 250 feet with use of FWW on uneven, outdoor surfaces with modified independence in 6 weeks.
This will not be salient to the patient. The patient is primarily a household ambulator.
B. In 6 weeks, the patient will be able to independently negotiate 4 steps using a step-over pattern with 2 lofstrand crutches.
This will not be salient to the patient.
C. Patient 30-Second Chair Stand Test will be at least 15 repetitions to reach age normative values in 6 weeks.
This test requires the patient to stand without upper extremity assistance. The patient was unable to do this even at baseline.
D. In 3 weeks, the patient will be able to perform bed mobility independently using log roll technique on flat surface. (Correct Answer)
Simply put, this is reasonable and salient.
Question #2
The most appropriate outcome measure for this patient is:
A. 30-Second Chair Stand Test
B. High-Level Mobility Assessment Tool (HiMAT)
C. 10-Meter Walk Test
D. Mini BESTest
Correct Answer: C.
A. 30-Second Chair Stand Test
This test requires the patient to be able to stand without upper extremity assistance. The patient was unable to do these even at baseline.
B. High Level Mobility Assessment Tool (HiMAT)
This test is specific to those with traumatic brain injuries! Additionally, the tested activities are much too high level for this patient.
C. 10 Meter Walk Test (Correct Answer)
This is the most appropriate test as the patient is ambulatory and it allows for the use of an assistive device and therapist assistance.
D. Mini-BESTest
This test does not allow for the use of an assistive device. The patient probably wouldn’t be safe to perform this even at their baseline!
Practice Set #2
Setting: Outpatient
Sex: Female
Age: 42
Presenting Problem / Current Problem
• Left shoulder discomfort beginning 1 month prior with insidious onset
• Gradual increase in global left upper extremity weakness
• Recent doppler imaging results suggest negative findings
Past Medical History
• Hypertension
• S/p left-sided mastectomy x20 months prior
Other Information
• Works as a behavioral therapist
Physical Therapy Examination(s):
• Mid-humeral circumference: left ~1 cm greater than right
• Negative Hyperabduction and ROOS test bilaterally
• Mild pitting edema at left brachium, absent in right
• Glenohumeral joint mobility WNL bilaterally
• Right shoulder AROM WFL in all planes
Question #1
Which of the following is the most likely diagnosis?
A. Deep Vein Thrombosis
B. Lymphedema
C. Adhesive Capsulitis
D. Venous insufficiency
Correct Answer: B.
A. Deep Vein Thrombosis
As suggested in the subjective, a negative doppler rules out a DVT.
B. Lymphedema (Correct Answer)
The patient presents with symptoms of stage 1 lymphedema, which includes mild swelling, mobility deficits, and a sensation of heaviness/discomfort in the arm.
C. Adhesive capsulitis
The only two pertinent pieces of information regarding adhesive capsulitis in this case include joint mobility and AROM/PROM. Objective findings do not suggest abnormal joint mobility nor a capsular pattern.
D. Venous insufficiency
Symptoms suggestive of venous insufficiency relevant to this case include limb swelling and relief with elevation. However, the medical history of s/p mastectomy makes lymphedema the more likely option.
Question #2
Which of the following is the MOST appropriate treatment intervention to directly treat the diagnosis?
A. Long-stretch bandages
B. Manual lymphatic drainage, beginning proximal to distal
C. Standing rows with scapular retractions
D. Glenohumeral joint mobilizations
Correct Answer: B.
A. Long-stretch bandages
Long-stretch bandages are better for musculoskeletal use, while short-stretch bandages are better for lymphedema. “LONG-stretch” means the bandage can stretch out LONGER. With a lax bandage, fluid has the opportunity to build up. A “SHORT-stretch” bandage cannot physically stretch as much, providing resistance to fluid buildup. With lymphedema, the aim is to decrease fluid buildup. Thus, a short-stretch bandage would be appropriate in this case.
B. Manual lymphatic drainage, beginning proximal to distal (Correct Answer)
Lymphatic drainage is an appropriate treatment intervention for lymphedema, which is the most likely diagnosis. You MUST begin centrally/proximally to create an opening for the flow of lymph. Essentially, you need to massage the proximal lymphatic structures to induce relaxation and size expansion, allowing lymph fluid to easily pass through when pushed from distal areas later in the treatment.
C. Standing rows with scapular retraction
This exercise would DIRECTLY address muscular-based pathologies. The diagnosis is not muscular-based in nature.
D. Glenohumeral joint mobilizations
Joint mobility deficits were not evident. Why treat what is not impaired?