Free NPTE-PT Practice Test

Answer: C. Snuffbox tenderness after a fall on an outstretched hand is the classic scaphoid fracture picture, and a normal first film doesn't clear it: StatPearls estimates up to 25% of scaphoid fractures aren't visible on initial radiographs. Standard management is thumb spica immobilization with repeat films in about 1–2 weeks, or MRI. A and D load a possible fracture whose blood supply runs distal to proximal, which is why missed fractures risk nonunion and avascular necrosis. B immobilizes the wrist but not the thumb.

Review next: scaphoid blood supply and why proximal pole fractures heal poorly.

Source: StatPearls, Scaphoid Fracture

Answer: A. The ACA supplies the medial surface of the frontal and parietal lobes, where the leg is represented on the motor homunculus, so the deficit is contralateral and leg-predominant. B is the classic middle cerebral artery pattern (face and arm more than leg). C puts the deficit on the wrong side. D doesn't fit a unilateral cortical infarct.

Review next: MCA vs. ACA vs. PCA syndromes, including aphasia (dominant MCA) and neglect (nondominant hemisphere).

Source: StatPearls, Anterior Cerebral Artery Stroke

Answer: B. 1.4 ÷ 2.6 ≈ 0.54. The GOLD criterion for persistent airflow limitation is a post-bronchodilator FEV1/FVC below 0.70. Restrictive disease (A) typically lowers both FEV1 and FVC with a normal or high ratio. C inverts the ratio. Lung volumes (D) help confirm restriction, but you don't need them to identify obstruction.

Review next: GOLD grades by FEV1 % predicted, and how obstructive and restrictive patterns change exercise prescription.

Source: GOLD Science Committee, pre- and post-bronchodilator spirometry for COPD diagnosis

Answer: D. In Park et al. (2005), the combination of painful arc, drop-arm sign, and infraspinatus (external rotation) weakness gave the best post-test probability for a full-thickness tear: about 91% when all three were positive, falling to about 9% when all three were negative. External rotation weakness and a positive drop-arm sign point to tendon failure, not just bursitis (A). Adhesive capsulitis (B) presents with loss of passive motion, especially external rotation, not weakness with intact passive range. C ignores what clusters are for.

Review next: the Hawkins-Kennedy + painful arc + infraspinatus cluster for impingement, from the same study.

Source: Park HB et al. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87:1446–1455

Answer: A. Medial gaiter location, shallow irregular shape, heavy exudate, hemosiderin staining, edema, and relief with elevation are the venous pattern. Arterial ulcers (B) tend to sit on the toes, heels, or lateral malleolus, look punched out with a pale dry base, and hurt more with elevation. Neuropathic ulcers (C) typically form under weight-bearing plantar surfaces. A pressure injury (D) sits over a bony prominence exposed to sustained pressure. Before starting compression for a venous ulcer, an ankle-brachial index is checked to rule out arterial disease.

Review next: why compression helps venous ulcers and can harm arterial ones.

Source: A Persistent Wound: Differentiating Between Arterial and Venous Ulcers, UCLA

Answer: C. The APTA clinical practice guideline for Parkinson disease (Osborne et al., 2022) gives external cueing a strong recommendation based on high-quality evidence, for reducing freezing of gait and improving gait outcomes. Strengthening (A) and flexibility (D) have roles in a full program but don't target the cueing deficit behind freezing. Looking down and slowing (B) doesn't address the problem and can worsen posture.

Review next: the other strong recommendations in the PD guideline (aerobic exercise, resistance training, balance training, gait training).

Source: Osborne JA et al. Physical Therapist Management of Parkinson Disease: APTA Clinical Practice Guideline. Phys Ther. 2022

Answer: D. Obligatory external rotation with passive hip flexion (the Drehmann sign) plus limited, painful internal rotation in an adolescent points to slipped capital femoral epiphysis. Pain is often referred to the knee, so a normal knee exam is a reason to examine the hip, not to treat the knee. Watchful waiting (B, C) risks slip progression and avascular necrosis, and loading exercise (A) treats the wrong joint. Management is protected weight-bearing and prompt orthopedic referral for fixation.

Review next: SCFE vs. Legg-Calvé-Perthes disease by age, sex, and presentation.

Source: StatPearls, Slipped Capital Femoral Epiphysis

Answer: B. TB spreads by airborne droplet nuclei that stay suspended and travel on air currents. CDC guidance calls for airborne precautions: an airborne infection isolation (negative-pressure) room and a fit-tested N95 or higher-level respirator put on before entry. A surgical mask (A, D) doesn't seal against airborne particles. Contact precautions (C) address organisms spread by touch, such as C. difficile.

Review next: the other classic airborne diseases (measles, varicella, disseminated zoster) and which conditions need droplet or contact precautions.

Source: CDC, TB infection control and respiratory protection

Answer: C. Wainner et al. (2003) found that all four positive (ULTT A, Spurling, distraction, rotation <60° toward the involved side) gave a positive likelihood ratio of about 30, a large shift toward the diagnosis; three of four gave about 6. The rotation cutoff is 60°, not 45° (A). The ULTT is sensitive, so its value lies in a negative result helping rule radiculopathy out (D has it backwards). One caveat worth knowing: the cluster is specific but insensitive, so a patient who doesn't meet all four can still have radiculopathy.

Review next: SnNout and SpPin, and which single cervical tests are best for ruling in versus ruling out.

Source: Wainner RS et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52–62

Answer: A. Weakness of the whole half of the face, forehead included, is a lower motor neuron pattern, as in Bell palsy. The forehead receives upper motor neuron input from both hemispheres, so a cortical lesion (B) typically spares the forehead and weakens the lower face on the opposite side. A right cortical lesion (C) would affect the left face. The trigeminal nerve (D) supplies facial sensation and the muscles of chewing, not facial expression. Forehead-sparing weakness with limb or speech signs is treated as a stroke until proven otherwise.

Review next: eye protection with incomplete closure, and the prognosis of Bell palsy.

Source: Continuum, Bell's Palsy (2017)

Answer: D. Muscle pain, weakness, and tea- or cola-colored urine are the classic presentation of rhabdomyolysis, a rare but serious statin effect that can cause acute kidney injury. Statins are a recognized cause, and the timing after a dose increase fits. This needs medical evaluation (typically a creatine kinase level and kidney function), not exercise modification (A, C) or continued exercise (B), which adds muscle damage.

Review next: other medications that change PT management, such as beta-blockers, anticoagulants, and corticosteroids.

Source: Statin-induced rhabdomyolysis: a comprehensive review of case reports. Physiother Can. 2014

Answer: B. The 2019 JOSPT patellofemoral pain guideline (Willy et al.) recommends exercise therapy combining hip- and knee-targeted exercise to reduce pain and improve function in the short, medium, and long term. Knee-only work (A) is less effective than the combined approach. The guideline advises against knee orthoses and sleeves (C) and against passive modalities and other nonactive treatments on their own (D). Patellar taping can be added early for pain relief, alongside exercise.

Review next: how PFP is diagnosed (pain reproduced by squatting or other loaded knee flexion) and what must be excluded first.

Source: Willy RW et al. Patellofemoral Pain: Clinical Practice Guidelines. J Orthop Sports Phys Ther. 2019;49(9):CPG1–CPG95

Answer: A. A positive head impulse test and oscillopsia indicate unilateral vestibular hypofunction. The 2022 Academy of Neurologic PT guideline (Hall et al.) supports vestibular rehabilitation with gaze stabilization exercises, which use head movement with visual fixation, and suggests doing them at least 3 times a day for acute and subacute cases. The same guideline recommends against eye-movement exercises without head movement (C). Canalith repositioning (B) treats BPPV. Prolonged suppressants and inactivity (D) slow central compensation.

Review next: how to progress gaze stabilization (busier backgrounds, faster head speed, standing and walking).

Source: Hall CD et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: Updated CPG. J Neurol Phys Ther. 2022

Answer: D. The American Heart Association's heart failure self-check plan treats a sudden gain of more than 2–3 lb in 24 hours (or 5 lb in a week), especially with new swelling, as a warning sign of fluid retention that warrants prompt contact with the heart-failure team. Feeling fine (A) doesn't rule out early decompensation. Walking farther (B) doesn't remove fluid and adds cardiac load. Fluid restriction (C) is a medical prescription, not a PT instruction.

Review next: other HF warning signs (orthopnea, new cough, reduced exercise tolerance) and how the therapist should respond to each.

Source: American Heart Association, Self-Check Plan for HF Management

Answer: C. Symmetric involvement of the MCPs, PIPs, and wrists with DIP sparing and prolonged morning stiffness (typically over 30–60 minutes) is the inflammatory pattern of rheumatoid arthritis. Osteoarthritis (A) favors DIPs, PIPs, and the thumb CMC, with brief morning stiffness under about 30 minutes. Gout (B) usually presents as an acute monoarthritis. de Quervain (D) is a single tendon problem at the radial wrist.

Review next: joint protection and exercise during RA flares vs. remission.

Source: MSD Manual Professional Edition, Rheumatoid Arthritis (reviewed May 2026; updated October 2026)

Answer: B. CDT has two phases. The intensive phase reduces volume with manual lymphatic drainage, multilayer short-stretch bandaging, remedial exercise (done in compression so muscle contraction helps move lymph), and skin care. The maintenance phase uses compression garments and self-care. Garments are measured once maximum reduction is reached (A), not at the start. Deep-tissue massage (C) isn't MLD, which uses light skin-stretching pressure. Heat (D) increases filtration and fluid load.

Review next: how Stemmer sign and limb volume or circumference are used to track response.

Source: Complex decongestive therapy: reduction and maintenance phases

Answer: D. Speed = 10 m ÷ 16.1 s ≈ 0.62 m/s. Perry et al. (1995) categories are household under 0.4 m/s, limited community 0.4–0.8 m/s, and unlimited community over 0.8 m/s. A and B are the wrong bands, and C ignores that the 10MWT exists to produce a speed. Updated cutoffs from later research (0.49–0.93 m/s for limited community) would place him in the same category.

Review next: minimal clinically important difference for gait speed, and timing over the middle 10 m to exclude acceleration and deceleration.

Source: Walking speed and community ambulation after stroke (Perry classification)

Answer: B. Left shoulder pain after left upper quadrant trauma is the Kehr sign: blood irritating the diaphragm refers pain through the phrenic nerve (C3–C5) to the shoulder. With tachycardia and lightheadedness, splenic rupture with hemorrhage is the concern, and that's an emergency. A pain-free shoulder exam is the clue the pain isn't musculoskeletal (A, C). Waiting (D) delays care for possible hemorrhagic shock.

Review next: other visceral referral patterns (gallbladder to the right scapula, heart to the left arm and jaw, kidney to the flank).

Source: StatPearls, Splenic Rupture

Answer: A. Squeezing an intact calf passively plantarflexes the foot. No plantarflexion is a positive Thompson (Simmonds-Thompson) test and indicates complete Achilles rupture, typically 2–6 cm above the insertion where blood supply is poorest. Reported sensitivity and specificity are high. Some patients can still weakly plantarflex actively using posterior tibialis and the toe flexors, which is why the squeeze test is more useful than asking him to point his foot. The anterior drawer (C) tests the ATFL.

Review next: risk factors for rupture, including fluoroquinolone and corticosteroid use.

Source: Albertson S, Boysen Osborn M. Thompson Test in Achilles Tendon Rupture. JETem. 2016

Answer: C. Depth of ultrasound penetration is inversely related to frequency. 3 MHz is absorbed in superficial tissue (roughly 1–2 cm) and heats it faster, while 1 MHz reaches deeper structures (roughly 3–5 cm). A reverses the relationship. Intensity (B) affects how much energy is delivered, not the depth. A 20% duty cycle (D) produces minimal heating and doesn't match a thermal goal.

Review next: contraindications to ultrasound (over a pregnant uterus, active malignancy, the eyes, areas of impaired sensation for thermal use).

Source: Draper DO et al. Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound. J Orthop Sports Phys Ther. 1995;22(4):304–307; Draper DO et al. Rate of temperature increase in human muscle during 1 MHz and 3 MHz continuous ultrasound. J Orthop Sports Phys Ther. 1995;22(4):142–150

Answer: D. This is Brown-Séquard syndrome, a hemisection of the cord. The corticospinal tract and dorsal columns carry fibers that haven't crossed yet at this level, so motor function and proprioception are lost on the same side. Spinothalamic fibers cross within one or two segments of entry, so pain and temperature are lost on the opposite side, starting a level or two below the injury. A puts the spinothalamic loss on the wrong side. B and C describe complete or cervical lesions.

Review next: central cord and anterior cord syndromes, and which incomplete syndrome has the best walking prognosis.

Source: StatPearls, Brown-Séquard Syndrome

Answer: A. The Too Fit To Fracture recommendations emphasize resistance and balance training, back-extensor endurance, and "spine-sparing" movement such as hip hinging, while avoiding repeated or loaded spinal flexion, which raises compressive load on the anterior vertebral bodies. B, C, and D are components the recommendations support.

Review next: how the recommendations change after a vertebral compression fracture.

Source: Giangregorio LM et al. Too Fit To Fracture. Osteoporos Int. 2014; and the 2015 Delphi consensus

Answer: A. The international consensus on exercise in type 1 diabetes (Riddell et al., Lancet Diabetes & Endocrinology, 2017) says unexplained glucose above about 270 mg/dL calls for a ketone check, and blood ketones of 1.5 mmol/L or more make exercise contraindicated until the hyperglycemia is managed. With insufficient insulin, exercise can push glucose and ketones higher, toward ketoacidosis, so B and D are unsafe. C treats hypoglycemia, the opposite problem.

Review next: starting glucose targets for exercise, and how to manage a low pre-exercise reading.

Source: Riddell MC et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017

Answer: C. He fits Rancho Los Amigos Level IV, confused-agitated: a heightened state of activity driven by internal confusion, with no short-term recall. Management prioritizes reducing stimulation and keeping caregivers and routines consistent, with simple, familiar activity. A busy environment (A) feeds agitation. Arguing with confused content (B) escalates it. He can't yet learn new complex skills (D).

Review next: how management shifts at Levels V and VI as attention and carryover improve.

Source: StatPearls, Rancho Los Amigos; Alberta Health Services, Behavioural Management of Agitation following Brain Injury

Answer: B. A positive Trendelenburg sign is a drop of the pelvis on the unsupported side during single-leg stance, caused by weakness of the hip abductors (gluteus medius and minimus) on the stance side. Standing on the right with the left pelvis dropping implicates the right abductors. A is the most common mistake: the drop is on the opposite side from the weak muscle. Gluteus maximus weakness (C) produces a backward trunk lurch at initial contact.

Review next: the compensated Trendelenburg gait (trunk lean toward the weak side) and why a cane in the opposite hand helps.

Source: StatPearls, Trendelenburg Sign

Answer: D. Systolic pressure should rise with workload. A drop of more than 10 mm Hg from baseline despite increased workload, with other evidence of ischemia such as chest pressure, is an absolute indication to stop exercise in the AHA exercise standards. A and B keep stressing an ischemic heart. Water (C) doesn't address a cardiac cause.

Review next: the relative indications to stop exercise and the normal BP response to exercise.

Source: Fletcher GF et al. Exercise Standards for Testing and Training: AHA Scientific Statement. Circulation. 2013

Answer: A. HIPAA permits covered entities to disclose protected health information to another provider for treatment without written authorization. HHS also states that the minimum necessary standard does not apply to disclosures to a health care provider for treatment (C). The medium of communication (D) doesn't change permission, though reasonable safeguards still apply. Some state laws and record types (for example, substance use treatment records) add stricter rules.

Review next: when the minimum necessary standard does apply (payment, operations), and patients' right to access their records.

Source: HHS, Uses and Disclosures for Treatment, Payment, and Health Care Operations; HHS, Minimum Necessary Requirement

Answer: C. Sensory symptoms in the median distribution with weakness and wasting of the thenar muscles (abductor pollicis brevis, opponens pollicis) fit carpal tunnel syndrome. Ulnar nerve entrapment (A) affects the little finger, ulnar ring finger, hypothenar muscles, and interossei. A C8 radiculopathy (B) produces neck-related symptoms on the ulnar side of the hand. Radial nerve palsy at the spiral groove (D) causes wrist drop. Thenar atrophy signals more advanced compression.

Review next: the palmar cutaneous branch of the median nerve, which runs over the carpal tunnel and keeps thenar skin sensation intact in CTS.

Source: StatPearls, Thenar Eminence

Answer: B. In the recovery phase, nerves are remyelinating and muscles fatigue easily. Rehabilitation guidance stresses pacing: graded exercise with rest breaks, avoiding overwork and exhausting effort, which can cause prolonged fatigue and set back recovery. A and D overload recovering motor units. Bed rest (C) brings deconditioning, contractures, and VTE risk. Watch respiratory function closely in the acute phase, when weakness can involve the breathing muscles.

Review next: orthoses for foot drop, and fatigue as a long-term residual problem after GBS.

Source: UW Medicine, Guillain-Barré Syndrome and Exercise

Answer: D. Blisters, a moist red base that blanches, and severe pain mark a superficial partial-thickness burn involving the epidermis and papillary dermis, which usually heals in 2–3 weeks with minimal scarring. Superficial burns (B) are red and painful but don't blister, like a sunburn. Deep partial-thickness burns (C) blanch sluggishly or not at all and have reduced pain. Full-thickness burns (A) are leathery, white or charred, and insensate.

Review next: which burns are excluded from total body surface area calculations, and when burn center referral is indicated.

Source: StatPearls, Burn Classification

Answer: A. Fever, flank pain, nausea, urinary symptoms, and costovertebral angle tenderness together suggest acute pyelonephritis, an infection that needs prompt medical treatment with antibiotics. Back pain that no spinal movement changes, plus systemic signs, is a screening red flag. B, C, and D treat a nonmechanical problem as mechanical and delay care.

Review next: how kidney stones differ (colicky pain, often without fever) and other systemic red flags in back pain screening.

Source: StatPearls, Acute Pyelonephritis

Answer: C. Absolute risk reduction = control event rate − experimental event rate = 0.20 − 0.15 = 0.05. NNT = 1 ÷ ARR = 1 ÷ 0.05 = 20, so 20 people need the program to prevent one additional faller. A is 1 ÷ 0.25, which uses the relative risk reduction. B is 1 ÷ 0.15, which uses the treatment group's event rate. D treats the 25% relative risk reduction as the NNT. NNTs are rounded up to whole patients.

Review next: relative vs. absolute risk reduction, and why the same RRR gives very different NNTs at different baseline risks.

Source: Centre for Evidence-Based Medicine, Number Needed to Treat

Answer: D. This is the Finkelstein-type test for de Quervain tenosynovitis, which stretches the APL and EPB where they pass through the first dorsal compartment at the radial styloid. ECRB (A) is involved in lateral epicondylalgia at the elbow. The EPL (C) runs in the third compartment around Lister's tubercle. FCR (B) is a volar tendon. The thumb-in-fist version is technically Eichhoff's maneuver and produces more false positives than Finkelstein's original method.

Review next: thumb spica orthoses and activity modification for de Quervain.

Source: StatPearls, Finkelstein Sign

Answer: B. The contextual interference effect, first shown by Shea and Morgan (1979), is that random practice often looks worse during the session but produces better retention and transfer than blocked practice. Blocked practice (A) gives smoother performance in the session but weaker long-term learning. That gap between performance and learning is exactly what exam items like to test. Blocked practice can still help in the very first stage of learning a new task.

Review next: knowledge of results vs. knowledge of performance, and fading feedback frequency.

Source: Shea JB, Morgan RL. Contextual interference effects on the acquisition, retention, and transfer of a motor skill. J Exp Psychol Hum Learn Mem. 1979;5(2):179–187

Answer: A. "Up with the good, down with the bad": going down, the crutches move first with the injured leg, so the arms and crutches support the injured side, then the stronger leg follows. Going up, the strong leg leads and the crutches and injured leg follow. B and C lead with the strong leg going down, which leaves the injured leg to lower the body. D moves the injured leg without crutch support.

Review next: guarding position on stairs (therapist below the patient) and stair technique with one crutch and a rail.

Source: UPMC, Using crutches on stairs

Answer: C. This is Cozen's test: resisted wrist extension loads the common extensor origin, mainly the ECRB, and reproducing lateral epicondyle pain supports lateral epicondylalgia ("tennis elbow"). Medial epicondylalgia (A) is provoked by resisted wrist flexion and pronation. A fracture (B) follows trauma. Cubital tunnel syndrome (D) involves the ulnar nerve with ulnar-side hand symptoms.

Review next: Mill's test (passive stretch) and Maudsley's test (resisted middle finger extension), and how radial tunnel syndrome can mimic tennis elbow.

Source: Physiotutors, Cozen's Test

Answer: D. Later in pregnancy, lying supine can compress the vena cava, reducing venous return and causing hypotension and lightheadedness. ACOG Committee Opinion 804 supports continuing exercise in uncomplicated pregnancy, with position changes for supine activity. Stopping all exercise (A) gives up well-documented benefits. Longer supine holds (B) worsen the problem. Breath-holding (C) and straining are discouraged.

Review next: ACOG warning signs to stop exercise (vaginal bleeding, regular painful contractions, dizziness, chest pain, calf pain or swelling).

Source: ACOG Committee Opinion No. 804, Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2020

Answer: B. Central nervous system dysfunction with a core temperature above 105°F defines exertional heat stroke. The 2015 NATA position statement calls cold-water immersion the most effective treatment and supports "cool first, transport second," because survival depends on how fast core temperature comes down. Transporting without cooling (A) delays the treatment that matters most. Fluids and shade (C) treat heat exhaustion. Ice packs alone (D) cool far more slowly than immersion.

Review next: why rectal temperature is the only reliable field measure, and how heat exhaustion differs from heat stroke.

Source: NATA, Exertional Heat Illnesses Position Statement executive summary (published in full 2015)

Answer: A. Centralization is the retreat of referred symptoms toward the spine with repeated movements or positions. It identifies a directional preference and is associated with a favorable prognosis. Guidelines support repeated movements that centralize symptoms in acute low back pain with related leg pain, and the 2021 JOSPT guideline lists Mechanical Diagnosis and Therapy as an option for acute LBP. Peripheralization (B) is symptoms moving farther down the leg. C reverses the prognosis. Nothing here suggests a nonmechanical source (D).

Review next: red flags that override a mechanical exam, and treatment-based classification for acute LBP.

Source: George SZ et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021; APTA, Pain Centralization

Answer: D. Leg symptoms that come on with walking and ease with sitting or bending forward, but not with standing still, point to neurogenic claudication. Flexion opens up the spinal canal, which is why leaning on a shopping cart or walking uphill is easier than walking upright. Vascular claudication (A) eases with rest in any position and usually comes with weak pulses or skin changes. Hip osteoarthritis (B) causes groin pain with hip motion and doesn't explain tingling in both legs. An acute disc herniation (C) usually causes one-sided radicular pain, not symptoms set off by walking distance and relieved by sitting.

Review next: how a lower-extremity vascular screen (pulses, skin, ankle-brachial index) separates the two kinds of claudication.

Source: MSD Manual Professional, Lumbar Spinal Stenosis

Answer: B. The American Thoracic Society's six-minute walk test guideline lists the reasons to stop right away: chest pain, intolerable shortness of breath, leg cramps, staggering, heavy sweating (diaphoresis), and a pale or ashen look. A rise in heart rate (A) is the normal response to walking. Patients are allowed to slow down, or stop and rest, during the test (C); the clock keeps running and the distance is recorded. Protocols that use continuous oximetry also stop for SpO2 below 80%, and 93% (D) is well above that.

Review next: the standard 6MWT instructions (course length, scripted encouragement) and how distance walked is interpreted.

Source: ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2002;166:111–117; PhenX Toolkit, Six-Minute Walk Test protocol

Answer: C. The ACG GERD guideline (Katz et al., 2022) suggests avoiding meals within 2–3 hours of bedtime and raising the head of the bed for nighttime symptoms, and recommends weight loss for patients with overweight or obesity. A, B, and D each pair a full stomach or a flat position, which makes reflux easier. The same idea carries into the clinic: for a patient with reflux, schedule supine or head-down exercise away from meals.

Review next: symptoms that need medical review rather than reassurance, such as trouble swallowing, unplanned weight loss, or chest pain with exertion.

Source: ACP Gastroenterology summary of the ACG Clinical Guideline for the Diagnosis and Management of GERD

Answer: A. Equal loss of active and passive motion, worst in external rotation and then abduction and internal rotation, is the frozen shoulder pattern. Diabetes is a known risk factor, and the course (a painful phase moving into a stiff phase) fits its typical stages. A rotator cuff tear (B) limits active motion while passive motion stays close to full. Glenohumeral osteoarthritis (C) would usually show joint changes on radiographs. Bursitis (D) makes movement painful but doesn't block passive motion in several planes.

Review next: the three phases of adhesive capsulitis and how treatment shifts from pain control to stretching as irritability falls.

Source: StatPearls, Adhesive Capsulitis

Answer: B. In the Physical Activity and Lymphedema (PAL) trial (Schmitz et al., 2009), women with breast cancer-related lymphedema who did slowly progressive weight lifting had no more arm swelling than controls, plus fewer lymphedema flare-ups, fewer symptoms, and more strength. A and C apply an outdated blanket restriction and give up those benefits. D drops the slow progression, which is what the trial actually tested: start light, progress gradually, and watch the arm.

Review next: signs of a lymphedema flare (more swelling, heaviness, redness) and when to pause the program and reassess.

Source: Schmitz KH et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–673

Answer: D. His pain is shaped by more than tissue: fear, beliefs about damage, and avoidance are psychological dimensions of pain that affect his prognosis and plan. The 2021 JOSPT low back pain guideline (George et al.) says PTs should deliver pain neuroscience education alongside other treatment, such as exercise, for chronic low back pain, and should favor active treatment over education given on its own (B). Rest and avoidance (A) feed the fear and add deconditioning. More imaging (C) doesn't change management here and can reinforce the idea that something is damaged.

Review next: what fear-avoidance questionnaires measure, and the difference between graded activity and graded exposure.

Source: George SZ et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021

Answer: C. Age-predicted maximum = 220 − 60 = 160 bpm. Heart rate reserve = 160 − 70 = 90 bpm. Target = 70 + (0.60 × 90) = 124 bpm. A is 60% of maximum heart rate, a different and lower method. B is 60% of the reserve without adding resting heart rate back. D takes 60% of the maximum and then adds resting heart rate (96 + 70).

Review next: why age-predicted maximums are only estimates, and why ratings of perceived exertion replace heart-rate targets for patients on beta-blockers.

Source: Karvonen J, Vuorimaa T. Heart rate and exercise intensity during sports activities. Sports Med. 1988;5(5):303–311

Answer: D. APTA's documentation guidelines say charting errors are corrected by drawing a single line through the error and initialing and dating the chart, or, in an electronic record, through a method that shows a change was made without deleting the original. The original entry stays readable, which keeps the record honest and defensible. A, B, and C all hide or destroy the original entry.

Review next: what APTA's guidelines require for authenticating entries (ink, signature, and professional designation).

Source: APTA, Guidelines: Physical Therapy Documentation of Patient/Client Management (BOD G03-05-16-41)

Answer: A. Intention-to-treat analysis includes everyone who was randomized, in their original groups, whatever happened afterward. That keeps the groups comparable, which is the whole point of randomizing, and gives a cautious, real-world estimate of benefit. Per-protocol analysis (B) uses only participants who finished without major protocol deviations, and people who stick with a treatment often differ from those who don't, so it can overstate benefit. As-treated analysis (C) groups people by what they actually received, which breaks randomization rather than protecting it. Blinding (D) is a different safeguard.

Review next: how missing outcome data complicate intention-to-treat, and where it appears on the PEDro scale.

Source: Gupta SK. Intention-to-treat concept: a review. Perspect Clin Res. 2011;2(3):109–112

Answer: C. Pusher syndrome has three features: the body tilts toward the paretic side, the nonparetic limbs push toward that side, and the patient resists passive correction. Karnath and Broetz (2003) tie it to an altered perception of body orientation relative to gravity, while perception of the visual vertical is largely preserved. Cerebellar ataxia (A) causes incoordination without active pushing. A visual field cut (D) doesn't explain active pushing and resistance.

Review next: the Scale for Contraversive Pushing and the typical recovery course (pushing is rarely still present at 6 months).

Source: Karnath HO, Broetz D. Understanding and treating "pusher syndrome." Phys Ther. 2003;83:1119–1125

Answer: B. Because visual vertical is intact, treatment built on Karnath and Broetz's approach uses visual feedback so she can see that she's tilted, then practices active movements to reach and hold upright, such as reaching toward the nonparetic side. Forcing her to midline (A) triggers more resistance. C tilts her farther toward the paretic side. Avoiding sitting (D) delays recovery.

Review next: why transfers toward the paretic side can be easier when pushing is severe.

Source: Karnath HO, Broetz D. Understanding and treating "pusher syndrome." Phys Ther. 2003;83:1119–1125

Answer: D. The 2026 AHA/ASA Guideline for Adult Stroke Rehabilitation and Recovery says overhead pulley exercises should not be used to increase range of motion or reduce shoulder pain in people with stroke who have glenohumeral subluxation, shoulder weakness, or shoulder pain. The same guideline supports shoulder assessment (C) and patient and caregiver education (B), and positioning and support (A) are standard protection for a subluxed shoulder.

Review next: causes of hemiplegic shoulder pain and why arm support matters during transfers.

Source: Richards LG et al. 2026 Guideline for Adult Stroke Rehabilitation and Recovery. Stroke. 2026;57(10):e514–e658

Answer: A. For patients at risk of hypercapnic respiratory failure, such as many with COPD, the British Thoracic Society guideline sets a target saturation of 88–92%, and his physician ordered that range. 90% is on target. Pushing saturation higher (B) risks CO2 retention and goes beyond the order. Breathlessness at an on-target saturation doesn't require stopping (C). Removing ordered oxygen (D) isn't a PT decision.

Review next: why this population has a lower target than the 94–98% used for most acutely ill patients.

Source: O'Driscoll BR et al. BTS Guideline for oxygen use in adults: summary of recommendations. BMJ Open Respir Res. 2017

Answer: C. Pursed-lip breathing creates back-pressure that helps keep airways open during exhalation, slows the respiratory rate, increases tidal volume, and reduces dyspnea, with the strongest evidence in moderate to severe COPD. Rapid shallow breathing (B) worsens air trapping. Breath-holding (A) and forceful exhalation (D) increase work of breathing and can promote airway collapse.

Review next: why diaphragmatic breathing has weaker evidence than pursed-lip breathing in COPD.

Source: Gosselink R. Breathing techniques in patients with COPD. Chron Respir Dis. 2004

Answer: B. A forward-leaning position with the arms supported improves the length-tension relationship of the flattened diaphragm and lets the accessory muscles work more effectively by stabilizing the shoulder girdle. Gosselink's review of breathing techniques in COPD lists forward leaning among the techniques with supporting evidence. Supine (A) and prone (D) positions are usually poorly tolerated by breathless patients, and standing with the arms unsupported (C) loses the accessory-muscle advantage.

Review next: energy conservation and paced breathing during daily activities.

Source: Gosselink R. Breathing techniques in patients with COPD. Chron Respir Dis. 2004

Answer: B. The 2026 APTA total knee arthroplasty guideline says physical therapists should apply NMES to the quadriceps after TKA, beginning early after surgery and using the highest tolerable intensity, to improve quadriceps strength, gait performance, and other performance-based outcomes. Her quadriceps lag and weak voluntary contraction make that recommendation directly relevant. Sensory-level TENS (C) may be used for pain in some patients, but it is not the strengthening intervention asked for here. Ultrasound (A) and moist heat (D) do not address the quadriceps activation deficit.

Review next: why quadriceps weakness after TKA is partly an activation problem, not just muscle size.

Source: Bove AM et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Phys Ther. 2026;106(7):pzag058

Answer: C. The 2026 APTA total knee arthroplasty guideline gives a strong recommendation not to use continuous passive motion (CPM) after a primary, uncomplicated TKA. Evidence still does not show meaningful clinical benefit from routine CPM, while active range of motion, progressive strengthening, gait, and functional training address the outcomes she needs. A, B, and D incorrectly treat CPM as a routine requirement.

Review next: the treatments with the strongest support in the same guideline: preoperative exercise, cryotherapy, and motor function training.

Source: Bove AM et al. Clinical practice guideline for physical therapist management of total knee arthroplasty: revision 2026. Phys Ther. 2026;106(7):pzag058

Answer: D. Increasing redness, drainage from the wound, a fever over 100°F, and pain at rest and with activity are the warning signs of infection after knee replacement that AAOS lists, with the instruction to tell the surgeon immediately. An infection around the implant threatens the joint replacement, so speed matters. A and C treat symptoms and delay care. More aggressive motion (B) doesn't address the cause.

Review next: other early complications to screen for after joint replacement, including deep vein thrombosis and wound separation.

Source: AAOS OrthoInfo, Total Knee Replacement

Answer: A. A 10-g monofilament is one of the standard clinical tests for protective sensation and is used to identify feet at risk for ulceration and amputation. The 2026 American Diabetes Association standards recommend 10-g monofilament testing as part of the neurologic foot examination. For a comprehensive evaluation of loss of protective sensation, the monofilament should be paired with another neurologic assessment such as pinprick, temperature, reflexes, or vibration. Two-point discrimination on the fingertips (B) tests the wrong site and function. The ankle-brachial index (C) assesses arterial perfusion, and the Romberg test (D) is a balance/proprioception test rather than a foot protective-sensation test.

Review next: the other parts of a diabetic foot screen: vibration sense, skin and nail inspection, footwear, and pulses.

Source: American Diabetes Association. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2026

Answer: C. The 2023 IWGDF offloading guideline strongly recommends a nonremovable knee-high offloading device as the first choice for a neuropathic plantar forefoot or midfoot ulcer, using either a total contact cast or a nonremovable knee-high walker depending on local resources. His ulcer shows no infection or poor blood flow that would change that choice. Removable devices (B) are the guideline's second choice; a device he can't take off protects the ulcer with every step. Ordinary shoes (A) don't relieve the pressure under the metatarsal head that keeps the ulcer open, and a heel-offloading shoe (D) unloads the wrong part of the foot.

Review next: how infection or ischemia changes offloading choices, and what to check when a total contact cast is applied.

Source: International Working Group on the Diabetic Foot. Guidelines on offloading foot ulcers in persons with diabetes (2023 update)

Answer: B. A consensus on exercise for people with diabetes at risk of foot ulcers (Gracia-Sánchez et al., 2023) advises that someone with an open ulcer shouldn't put pressure on it or do exercise that loads that area, and that stretching and strengthening be done sitting or lying down. Walking for exercise (A) and jogging (C) add the repeated plantar loading that offloading is meant to remove. Stopping all exercise (D) gives up the benefits for glucose control and fitness when safe options exist.

Review next: how the exercise plan changes once the ulcer has healed and he returns to weight-bearing activity.

Source: Gracia-Sánchez A et al. Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study. Braz J Phys Ther. 2023;27(2):100500