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. Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support
Hamza is 3 weeks post-stroke and presents with right-sided hemiparesis. He is able to sit unsupported but struggles to stand and has difficulty walking without assistance. His Brunnstrom stage is III for the right upper extremity and II for the right lower extremity. Which of the following interventions would be most appropriate for this patient to improve his functional mobility and independence?
A) Facilitate weight-bearing on the right lower extremity using assistive devices
B) Move the patient's right lower extremity through PNF patterns
C) Use body-weight-supported treadmill training (BWSTT)
D) Initiate fine motor activities for the right hand to improve hand dexterity
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Milani presents with anterior shoulder pain and reports difficulty with overhead activities. The patient describes intermittent clicking and discomfort with forward reaching. On examination, the therapist observes a positive Speed’s test, normal strength in external rotation, and no pain with passive shoulder elevation. Which of the following is the MOST likely diagnosis?
A. Bankart lesion
B. Subacromial bursitis
C. Biceps tendinopathy
D. Rotator cuff tendinopathy
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Jeremy is performing a neurological evaluation. The therapist notes repeated falls in quiet standing with a suspected forward anticipatory balance impairment. Which of the following tests is MOST likely to reveal this specific impairment?
A) Functional Reach Test
B) Romberg Test
C) Sensory Organization Test
D) Standing in tandem with eyes closed
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A 45-year-old female presents to physical therapy with complaints of persistent fatigue, and unexplained weight loss. Upon examination, the therapist notes tachycardia, low blood pressure episodes, and excessive sweating. Which of the following is the MOST likely diagnosis?
A) Graves Disease
B) Cor Pulmonale
C) Hypoglycemia
D) Adrenocortical hyperplasia
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Lina presents with a history of chronic heart failure, increased dyspnea and fatigue during daily activities. The physical therapist plans to implement an aerobic exercise program. Which of the following exercise protocols is MOST appropriate for this patient?
A) 70-85% of HRmax, 5 times per week, for 45-60 minutes
B) 50-60% of HRR, 3 times per week, for 20-40 minutes
C) 30-40% of HRmax, daily, for 10-15 minutes
D) 80-90% of HRR, 4 times per week, for 60 minutes
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Bronny presents to the hospital with burns to the anterior neck, chest, axillas, and cubital fossa regions. Which of the following positions is the BEST for this patient?
A. Cervical slight extension, arm abduction with elbow extension
B. Neutral cervical spine, shoulder external rotation with wrist extension
C. Cervical slight flexion, arm elevated and elbow extended
D. Cervical extension with arm abduction and elbow flexion
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Cory is a 3 year old child presents with severe hypotonia. The child has difficulty maintaining an upright posture and frequently collapses when attempting to sit or stand. Which of the following interventions would be MOST appropriate?
A. Sitting balance exercises on an unstable surface such as a wobble cushion
B. Passive stretching of the hamstrings to improve flexibility
C. Practicing squats with support to encourage leg strength
D. Rhythmic stabilization exercises in a seated position on a therapy ball
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Everett presents with right groin pain. Which of the following conditions must be ruled out FIRST?
A) Diverticulitis
B) L2 nerve root compression
C) Appendicitis
D) Psoas abscess
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Calen presents to physical therapy with difficulty grasping a glass. Upon examination, the patient has diminished joint mobility at the 2nd MCP and difficulty performing abduction of the digit. Which of the following glides is the MOST effective?
A. Volar glide
B. Dorsal glide
C. Radial glide
D. Medial glide
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During a clinical evaluation, Aiyinde notices that a patient exhibits pronounced anterior pelvic tilt while standing but this posture significantly improves when the patient engages in a squat. This observation is MOST likely due to tightness in which of the following muscles?
A. Iliopsoas
B. Gluteus maximus
C. Rectus abdominis
D. Biceps femoris (long head)
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