National Physical Therapy Examination (NPTE) Quiz: Emergency Response And Abuse Recognition
20 questions · exam conditions
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Emergency Response And Abuse RecognitionQuestion 1 of 20

A 70-year-old male with a history of a previous DVT is being seen for osteoarthritis of the knee. During the session, he complains of a new, dull ache and tightness in his right calf. The therapist's examination reveals unilateral pitting edema, warmth, and tenderness to palpation in the posterior calf. The calf circumference is 3.5 cm greater than the left side. The patient also has active cancer.

Based on the Wells' Clinical Prediction Rule for DVT, what is the MOST appropriate next step for the physical therapist?

Apply moist heat and perform gentle massage to the calf to alleviate the symptoms before continuing the session.
Initiate ankle pump exercises and compression wrapping to reduce the edema and pain associated with the condition.
Document the findings and advise the patient to monitor the symptoms and call his doctor if they worsen over the next few days.
Withhold further intervention, contact the referring physician immediately to report the high probability of DVT, and recommend urgent medical evaluation.
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National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Emergency Response And Abuse Recognition

Practice Emergency Response And Abuse Recognition in National Physical Therapy Examination (NPTE) with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Emergency Response And Abuse Recognition, giving you a quick way to practice the rules, question types, and explanations that matter most for National Physical Therapy Examination (NPTE).

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A 70-year-old male with a history of a previous DVT is being seen for osteoarthritis of the knee. During the session, he complains of a new, dull ache and tightness in his right calf. The therapist's examination reveals unilateral pitting edema, warmth, and tenderness to palpation in the posterior calf. The calf circumference is 3.5 cm greater than the left side. The patient also has active cancer.

Based on the Wells' Clinical Prediction Rule for DVT, what is the MOST appropriate next step for the physical therapist?

  1. Apply moist heat and perform gentle massage to the calf to alleviate the symptoms before continuing the session.
  2. Initiate ankle pump exercises and compression wrapping to reduce the edema and pain associated with the condition.
  3. Document the findings and advise the patient to monitor the symptoms and call his doctor if they worsen over the next few days.
  4. Withhold further intervention, contact the referring physician immediately to report the high probability of DVT, and recommend urgent medical evaluation. (correct answer)
Explanation: The patient presents with multiple positive criteria for the Wells' rule: active cancer (+1), previous DVT (+1), calf swelling >3cm (+1), unilateral pitting edema (+1), and localized tenderness (+1). This results in a high score, indicating a high probability of DVT. DVT is a medical emergency due to the risk of pulmonary embolism. Physical therapy is contraindicated. The only safe and appropriate action is to stop treatment and ensure the patient receives immediate medical attention. A and B) Heat, massage, and exercise are dangerous as they could dislodge a potential clot. C) Delaying medical evaluation is unsafe given the high probability of DVT.

Question 2

A physical therapist is treating a 68-year-old male with a T4 spinal cord injury for shoulder pain. During a session involving seated therapeutic exercise, the patient reports a sudden, pounding headache. The therapist notes the patient's face is flushed, and there is significant sweating above the level of the lesion. The patient's blood pressure is measured at 180/110 mmHg, a significant increase from his baseline of 100/60 mmHg. His heart rate is 50 bpm.

Which of the following is the MOST appropriate immediate sequence of actions for the physical therapist to take?

  1. Lower the patient to a supine position, elevate his legs, and activate emergency medical services (EMS).
  2. Sit the patient fully upright, loosen any tight clothing or devices, check the urinary catheter for blockage, and monitor vital signs. (correct answer)
  3. Administer a quick-acting carbohydrate, check blood glucose levels, and prepare to activate EMS if symptoms do not resolve.
  4. Continue with gentle upper extremity range of motion to promote circulation and immediately notify the primary care physician.
Explanation: The patient is exhibiting classic signs of autonomic dysreflexia (AD), a medical emergency common in individuals with spinal cord injuries at T6 or above. The correct response is to first sit the patient upright to help lower blood pressure via orthostatic effect. The next step is to identify and remove the noxious stimulus, which is most commonly a kinked urinary catheter or bowel impaction. Loosening clothing is also critical. Activating EMS is a subsequent step if the stimulus cannot be found and removed quickly and blood pressure remains dangerously high. A) Lowering the patient would worsen the hypertension. C) The symptoms are not indicative of hypoglycemia. D) Continuing any activity is contraindicated and dangerous.

Question 3

A 45-year-old female is 4 days post-total knee arthroplasty and is participating in an inpatient physical therapy session. While performing ankle pumps in a seated position, she suddenly reports sharp, localized chest pain that worsens with deep inspiration. She appears anxious and short of breath. Her vital signs are: HR 120 bpm, BP 110/70 mmHg, RR 28 breaths/min, and SpO2 89% on room air.

Which of the following conditions is MOST likely, and what is the therapist's BEST immediate course of action?

  1. Myocardial infarction; administer aspirin if available and activate the facility's rapid response team.
  2. Anxiety attack; encourage diaphragmatic breathing and pause the session until she feels calm.
  3. Pulmonary embolism; discontinue the session, keep the patient in a comfortable position of rest, and activate the facility's rapid response team. (correct answer)
  4. Costochondritis; apply a moist hot pack to the anterior chest wall and instruct the patient in gentle stretching.
Explanation: The patient's recent surgery (a major risk factor for DVT), sudden onset of pleuritic chest pain, dyspnea, tachycardia, tachypnea, and hypoxia are classic signs and symptoms of a pulmonary embolism (PE). This is a life-threatening medical emergency. The most appropriate action is to immediately stop all activity and activate the facility's emergency response system. A) While MI is in the differential, the pleuritic nature of the pain and the strong risk factor for PE make it the leading diagnosis. B) Attributing these signs to anxiety would be a critical error, as it would delay life-saving treatment. D) Costochondritis would not typically present with these acute systemic signs and vital sign changes.

Question 4

A 58-year-old male with type 2 diabetes is exercising on a stationary bicycle during a physical therapy session. He reports feeling dizzy and weak. The therapist observes that he appears pale and diaphoretic. He is coherent but confused about what day it is. He states he took his insulin as usual this morning but skipped breakfast to make his appointment on time.

What is the physical therapist's MOST appropriate immediate action?

  1. Activate EMS immediately, as the patient is showing signs of diabetic ketoacidosis.
  2. Check the patient's blood glucose level; if low, provide 15-20 grams of a fast-acting carbohydrate. (correct answer)
  3. Have the patient lie supine with legs elevated and provide a blanket to treat for shock.
  4. Discontinue exercise, have the patient rest, and provide water, assuming symptoms are due to dehydration.
Explanation: The patient's presentation (dizziness, weakness, pallor, diaphoresis, confusion) combined with the history of taking insulin without eating is highly indicative of hypoglycemia. The first and most critical step is to confirm this by checking his blood glucose. If it is low (typically <70 mg/dL), the immediate treatment is to provide a fast-acting carbohydrate (e.g., juice, glucose tablets). A) These are not the primary signs of diabetic ketoacidosis, which typically involves hyperglycemia, fruity-smelling breath, and Kussmaul respirations. C) While the patient might feel weak, this is not shock, and elevating the legs is not the primary treatment. D) While dehydration can cause some symptoms, the constellation of signs and the patient's history strongly point to hypoglycemia, which must be addressed specifically and immediately.

Question 5

A 72-year-old female patient is receiving physical therapy for balance deficits. During a session, she begins to have a generalized tonic-clonic seizure. She loses consciousness and falls to the floor, where her body stiffens and then begins to rhythmically jerk.

Which of the following describes the MOST appropriate actions for the physical therapist to take during the active seizure?

  1. Insert a bite block or soft object into the patient's mouth to prevent her from biting her tongue and restrain her limbs to prevent injury.
  2. Ease the patient to the floor, clear the immediate area of hard or sharp objects, place a soft item under her head, and time the seizure. (correct answer)
  3. Immediately begin chest compressions and rescue breaths as the patient will likely stop breathing during the tonic phase.
  4. Position the patient in a high-sitting position, administer a sternal rub to try to shorten the seizure duration, and call her emergency contact.
Explanation: The standard of care during a tonic-clonic seizure is to ensure patient safety. This involves preventing injury from the fall and the surrounding environment. Clearing the area, protecting the head, and timing the duration are the key immediate actions. EMS should be called if the seizure lasts more than 5 minutes, if it is the person's first seizure, or if they do not regain consciousness afterward. A) Nothing should ever be placed in the mouth during a seizure, and limbs should not be restrained, as this can cause musculoskeletal injury. C) CPR is not indicated unless the patient does not resume breathing after the seizure has stopped. D) A sitting position increases aspiration risk, and painful stimuli like a sternal rub are ineffective and inappropriate.

Question 6

A physical therapist is treating a 35-year-old female for chronic low back pain. Her husband accompanies her to every session, answers most questions directed at her, and frequently criticizes her performance during exercises, saying things like, "You're not even trying." The therapist notes several faded, yellow-green bruises on the patient's upper arms. When asked about them, the patient and her husband both state she is "clumsy and bruises easily."

What is the physical therapist's BEST course of action in this situation?

  1. Ask the husband to leave the treatment area so the therapist can directly question the patient about domestic violence.
  2. Find an opportunity to speak with the patient alone, express concern for her safety in a non-judgmental way, and provide information on local resources. (correct answer)
  3. Call the police immediately from the clinic to report suspected domestic abuse based on the husband's behavior and the patient's bruises.
  4. Document the husband's behavior and the patient's bruises but take no further action unless the patient discloses abuse directly.
Explanation: The combination of the husband's controlling and belittling behavior, along with bruises with a vague explanation, are indicators of potential intimate partner violence. The therapist's role is not to investigate or accuse but to create a safe space for the patient. The best approach is to find a private moment (e.g., while changing, during a modality treatment) to express concern and empower the patient by providing resources. A) Directly asking the husband to leave could escalate the situation and endanger the patient later. C) Unless there is immediate, life-threatening danger, calling the police may disempower the patient and may not be what she wants; reporting requirements for competent adults vary by state and are different from those for children or vulnerable elders. D) Ignoring these significant red flags is unethical and fails to address the patient's overall well-being and safety.

Question 7

An athlete is undergoing rehabilitation for an ankle sprain in a busy, warm physical therapy clinic. During agility drills, the patient stops and complains of severe cramping, headache, and nausea. The therapist notes the patient's skin is pale and clammy, and their breathing is rapid. The patient is alert and oriented.

Based on the presentation, which condition should the therapist suspect, and what is the MOST appropriate initial management?

  1. Heat stroke; immediately activate EMS and begin rapid cooling measures such as an ice bath.
  2. Heat exhaustion; move the patient to a cool place, provide sips of a sports drink or water, and loosen clothing. (correct answer)
  3. Exercise-associated hyponatremia; restrict fluid intake and activate EMS for medical evaluation.
  4. Rhabdomyolysis; discontinue exercise, apply ice to cramping muscles, and send the patient home with instructions to hydrate.
Explanation: This patient's symptoms (cramping, headache, nausea, pale/clammy skin, rapid breathing) while maintaining a normal mental status are classic for heat exhaustion. The appropriate first aid is to stop activity, move to a cool environment, and begin rehydration. A) Heat stroke is a more severe condition characterized by central nervous system dysfunction (confusion, collapse, seizure) and typically hot, dry skin (though this can vary). It requires immediate EMS activation. C) While possible, heat exhaustion is far more likely, and initial management with controlled fluid intake is appropriate. D) Rhabdomyolysis typically presents with severe muscle pain and dark urine and is not the most likely diagnosis here; sending the patient home would be inappropriate.

Question 8

A patient with low back pain reports a sudden change in symptoms over the weekend. He now describes numbness and tingling in his perineal region, a feeling that his legs are "heavy and weak," and difficulty initiating urination. The physical therapist's objective examination confirms diminished sensation in the S2-S4 dermatomes and bilateral weakness of the ankle plantarflexors and dorsiflexors.

These findings are MOST consistent with which condition, requiring what action?

  1. Cauda equina syndrome; immediately contact the referring physician or instruct the patient to go to the nearest emergency department. (correct answer)
  2. A large lumbar disc herniation; initiate a trial of mechanical traction and instruct the patient in extension-based exercises.
  3. Spinal stenosis; educate the patient on positioning for comfort and begin a flexion-based exercise program.
  4. Piriformis syndrome; perform soft tissue mobilization to the piriformis and instruct the patient in stretching exercises.
Explanation: When you encounter a patient with sudden onset of perineal numbness, bilateral lower extremity weakness, and urinary dysfunction, you're looking at a constellation of symptoms that should immediately raise red flags for cauda equina syndrome. This is a neurosurgical emergency involving compression of multiple nerve roots below the conus medullaris. The key clinical indicators here are the "red flag" symptoms: perineal numbness (saddle anesthesia), bilateral leg weakness affecting multiple muscle groups, and urinary retention. The S2-S4 dermatome involvement confirms compression at the cauda equina level, where these nerve roots control bowel/bladder function and perineal sensation. The bilateral nature and sudden onset distinguish this from typical unilateral radiculopathy. Answer A correctly identifies cauda equina syndrome and the appropriate emergency action. This condition requires immediate surgical decompression within 24-48 hours to prevent permanent neurological damage. Answer B describes treatment for a standard disc herniation, but the bilateral symptoms and saddle anesthesia indicate something far more serious than typical disc pathology. Answer C suggests spinal stenosis management, but stenosis typically presents with neurogenic claudication and gradual onset, not acute saddle anesthesia and urinary retention. Answer D addresses piriformis syndrome, which would never cause perineal numbness or urinary dysfunction, as the piriformis doesn't compress these nerve pathways. Remember this pattern: perineal numbness + bilateral leg symptoms + bowel/bladder dysfunction = cauda equina syndrome = immediate medical emergency. Never attempt conservative treatment when these red flags are present.

Question 9

A physical therapist is treating a 62-year-old female for shoulder pain. Her medical history is significant for diabetes and a previous myocardial infarction (MI) five years ago. During an exercise, she complains of sudden, severe fatigue and shortness of breath. She denies chest pain but reports an aching sensation in her jaw. She appears diaphoretic and pale.

Given the patient's history and current presentation, what is the therapist's MOST appropriate immediate action?

  1. Assume an atypical presentation of an acute MI, cease all activity, and activate EMS. (correct answer)
  2. Check her blood glucose, as her symptoms are likely due to hypoglycemia.
  3. Place a cold pack on her jaw and continue with less strenuous exercises for the shoulder.
  4. Have the patient perform diaphragmatic breathing to manage the shortness of breath, which is likely from overexertion.
Explanation: Emergency recognition is a critical skill in physical therapy, especially when treating patients with cardiovascular risk factors. When you encounter a patient with a history of MI and diabetes presenting with concerning symptoms during exercise, you must immediately consider cardiac complications. This patient's presentation strongly suggests an atypical myocardial infarction. Women and diabetics often experience "silent" or atypical MIs without classic chest pain. The combination of sudden severe fatigue, shortness of breath, jaw pain (referred cardiac pain), diaphoresis, and pallor during physical activity in someone with previous MI history creates a high-probability cardiac emergency scenario. Answer A is correct because recognizing atypical MI presentations and immediately activating emergency medical services is the standard of care. Any delay could be life-threatening. Answer B is wrong because while diabetics can experience hypoglycemia, the constellation of symptoms (especially jaw pain and diaphoresis) points more toward cardiac issues than blood sugar problems. Checking glucose would waste precious time. Answer C is completely inappropriate as it treats the jaw pain as a local musculoskeletal issue while ignoring the systemic emergency signs. Continuing exercise during a potential MI could be fatal. Answer D misinterprets serious cardiac symptoms as simple overexertion. While breathing exercises might help with anxiety-related shortness of breath, this presentation demands immediate medical evaluation, not continued therapy intervention. Remember: When patients with cardiac risk factors develop sudden onset of fatigue, shortness of breath, and diaphoresis during activity, always suspect cardiac emergency first. Women and diabetics frequently present without chest pain, so don't wait for "classic" symptoms.

Question 10

While working with a patient who recently underwent a multi-ligamentous knee reconstruction, the therapist removes the dressing for a wound check. The therapist observes that the incision line is intact, but the entire lower leg distal to the incision is exquisitely tender to light touch, cool, pale, and the therapist is unable to palpate a dorsalis pedis pulse. The patient reports increasing pain that is not relieved by the prescribed analgesics and a pins-and-needles sensation in his foot.

These findings are most indicative of which emergent condition?

  1. Deep vein thrombosis (DVT).
  2. Complex regional pain syndrome (CRPS).
  3. Acute compartment syndrome. (correct answer)
  4. Peripheral nerve injury from the surgery.
Explanation: The "5 P's" (pain out of proportion, pallor, pulselessness, paresthesia, and paralysis/paresis) are the classic signs of acute compartment syndrome, a surgical emergency where increased pressure within a fascial compartment compromises circulation and function. This patient presents with several of these key findings. This requires immediate medical attention to prevent permanent tissue death and disability. A) DVT typically presents with warmth, swelling, and redness, not coolness and pallor. B) CRPS is a consideration post-surgery, but the acute vascular compromise (pallor, pulselessness) points away from it. D) A peripheral nerve injury would explain sensory/motor changes but not the profound vascular signs.

Question 11

A physical therapist is treating a patient in an acute care setting who has a chest tube in place connected to a drainage system. While assisting the patient in moving from the bed to a chair, the chest tube becomes dislodged from the patient's chest.

What is the physical therapist's MOST appropriate and immediate action?

  1. Place a gloved hand over the insertion site, cover the site with an occlusive dressing, and call for immediate medical assistance. (correct answer)
  2. Attempt to reinsert the chest tube into the opening and then call for nursing assistance.
  3. Lower the drainage system below the level of the chest and instruct the patient to perform the Valsalva maneuver.
  4. Immediately place the patient in a Trendelenburg position and monitor vital signs until the nurse arrives.
Explanation: When you encounter chest tube emergencies in acute care, your priority is preventing a pneumothorax from worsening while getting immediate medical help. A dislodged chest tube creates an open pathway between the pleural space and atmosphere, which can lead to tension pneumothorax - a life-threatening condition. The correct immediate response is option A: place a gloved hand over the insertion site, cover with an occlusive dressing, and call for medical assistance. This creates a seal to prevent air from entering the pleural space while maintaining sterility. The occlusive dressing acts as a one-way valve, potentially allowing air to escape but preventing further air entry. Option B is dangerous because physical therapists should never attempt to reinsert medical devices - this requires sterile technique and medical training you don't have. You could cause tissue damage or introduce infection. Option C is problematic because once the tube is dislodged, lowering the drainage system won't help, and the Valsalva maneuver could actually worsen the situation by increasing intrathoracic pressure. Option D (Trendelenburg position) is inappropriate here. This position could compromise respiratory function further and doesn't address the immediate need to seal the insertion site. Study tip: For NPTE questions involving medical emergencies with devices you don't manage (chest tubes, ventilators, central lines), remember your scope of practice. Focus on immediate safety measures (covering/protecting the site, positioning for comfort/safety) and getting appropriate medical help rather than attempting interventions outside your expertise.

Question 12

A physical therapist in a home health setting is treating a frail, 82-year-old female with dementia for generalized deconditioning. The therapist notes the patient has lost 8 pounds since the last visit two weeks ago, has a stage II pressure injury on her sacrum that was not previously documented, and is wearing soiled clothing. The patient's daughter, who is her sole caregiver, states, "Mom has just been refusing to eat and is very stubborn about letting me change her." The daughter appears stressed and avoids eye contact.

What is the physical therapist's MOST appropriate action based on these observations?

  1. Provide the daughter with educational materials on nutrition and pressure injury prevention and schedule a follow-up for the next day.
  2. Document the findings and report the situation to Adult Protective Services as a case of suspected neglect. (correct answer)
  3. Confront the daughter about the signs of neglect and inform her that a report will be filed if conditions do not improve immediately.
  4. Assume care of the pressure injury and directly assist the daughter with cleaning and feeding the patient to ensure proper care.
Explanation: The combination of rapid weight loss, a new pressure injury, and poor hygiene are significant red flags for elder neglect. As a mandated reporter, the physical therapist has a legal and ethical obligation to report a reasonable suspicion of abuse or neglect to the appropriate agency, which is Adult Protective Services (APS). A) Providing education is insufficient and does not address the immediate safety concern or fulfill the reporting requirement. C) Confronting the caregiver can escalate the situation, potentially placing the patient at greater risk, and is not the therapist's primary role. D) While providing care is part of the PT's job, it does not replace the legal duty to report suspected neglect.

Question 13

A patient is brought to the physical therapy department from the emergency department after a closed reduction of a dislocated shoulder. The patient appears extremely anxious, is trembling, and is profusely sweating. They complain of a racing heart. The patient's chart indicates a high blood alcohol level on admission and a long history of heavy alcohol use. The therapy session is scheduled approximately 24 hours after their last reported drink.

The physical therapist should be MOST alert for the development of which potentially life-threatening condition?

  1. Fat embolism from the orthopedic trauma.
  2. Septic arthritis in the reduced shoulder joint.
  3. Alcohol withdrawal delirium (delirium tremens). (correct answer)
  4. A panic attack related to the recent trauma.
Explanation: The patient's symptoms (anxiety, tremors, diaphoresis, tachycardia) occurring 24 hours after cessation of heavy drinking are classic signs of alcohol withdrawal. This can progress to alcohol withdrawal delirium (delirium tremens), a medical emergency characterized by hallucinations, disorientation, hypertension, and seizures. The therapist must recognize this, defer therapy, and immediately report the symptoms to the medical team. A) Fat embolism is more common with long bone fractures. B) Septic arthritis would present with localized signs of infection. D) While the patient may be anxious, the physiological signs in the context of alcohol cessation strongly suggest withdrawal, which is a more dangerous underlying cause.

Question 14

A physical therapist working in a skilled nursing facility is ambulating a 90-year-old resident with a history of atrial fibrillation and severe osteoporosis. The resident, who is on warfarin, sustains a fall despite the therapist providing contact guard assist. There is no visible bleeding, and the resident denies pain, but she seems more confused than her baseline. A neurological screen is unremarkable for focal deficits.

What is the therapist's MOST critical concern and appropriate response?

  1. A possible subdural hematoma; notify the nursing staff immediately, recommend the patient be placed on neurological checks, and file an incident report. (correct answer)
  2. A pathological hip fracture; obtain a wheelchair, return the patient to her room, and request a physician's order for a hip radiograph.
  3. Exacerbation of dementia due to the stress of the fall; reorient the patient, document the change in mental status, and continue with the session.
  4. A vasovagal response from the fall; place the patient in a reclining chair, elevate her legs, and monitor her blood pressure until she feels better.
Explanation: In an elderly patient on anticoagulants (warfarin), any fall, especially one involving a potential head strike, carries a high risk of intracranial bleeding, such as a subdural hematoma. The change in mental status (increased confusion) is a key, and sometimes only, early sign. Even without loss of consciousness or focal deficits, this is a medical emergency. The therapist must immediately alert the nursing staff for urgent medical evaluation. B) While a fracture is possible, the change in mental status makes an intracranial injury the more life-threatening and immediate concern. C) Attributing the confusion to dementia is unsafe and represents a failure to recognize the potential for serious injury. D) There are no signs of a vasovagal response (e.g., bradycardia, pallor).

Question 15

An outpatient physical therapist is screening a new patient who reports left shoulder pain that radiates to the upper back. The pain is unrelated to movement and has been worsening over the past few weeks, often waking him at night. During the subjective history, the patient mentions feeling constantly full, having unexplained weight loss, and noticing dark, tarry stools.

The patient's cluster of symptoms should prompt the physical therapist to consider which of the following as the MOST likely source of the pain?

  1. Cervical radiculopathy originating from the C5-C6 spinal nerves.
  2. Rotator cuff impingement with referred pain to the trapezius.
  3. Visceral referral from a gastrointestinal pathology, such as a peptic ulcer. (correct answer)
  4. Thoracic outlet syndrome with compression of the brachial plexus.
Explanation: While the patient presents with shoulder pain, the accompanying systemic signs (unexplained weight loss), GI symptoms (early satiety), and evidence of GI bleeding (melena/tarry stools) are major red flags. Pain from a bleeding peptic ulcer or other GI pathology can refer to the left shoulder (Kehr's sign if it's the spleen) or upper back. The pain being unrelated to movement is another key indicator of a non-musculoskeletal origin. The therapist must recognize this as a sign of a serious medical condition requiring immediate referral. A, B, and D are musculoskeletal diagnoses that would not explain the systemic and GI symptoms.

Question 16

During an outpatient orthopedic evaluation of a 5-year-old child for elbow pain, the physical therapist observes a well-demarcated spiral fracture of the humerus on the radiograph report. The mother reports the child sustained the injury by falling off a 1-foot-high step stool two days ago. The child is withdrawn and avoids eye contact with both the therapist and the mother. The therapist also notes several older, yellowish bruises on the child's back.

Which of the following is the MOST appropriate interpretation and action for the physical therapist?

  1. Conclude that the injury mechanism is consistent with the mother's report and proceed with the standard plan of care for a pediatric fracture.
  2. Privately ask the child how the injury occurred, and if the story differs from the mother's, then file a report with child protective services.
  3. Recognize that the injury pattern and clinical presentation are highly suspicious for non-accidental trauma and file a report with child protective services. (correct answer)
  4. Inform the mother that the fracture pattern is unusual for the reported fall and recommend a follow-up consultation with an orthopedic specialist.
Explanation: A spiral fracture of a long bone like the humerus in a young child is often caused by a twisting force, which is inconsistent with a simple fall from a low height. This, combined with the child's withdrawn behavior and older bruises, is a significant red flag for non-accidental trauma (child abuse). As a mandated reporter, the therapist must report this suspicion to the appropriate child protective services agency. A) The injury mechanism is not consistent with the report. B) The decision to report should be based on the objective evidence and suspicion, not on a child's potentially coerced or fearful testimony. The report should be made regardless of what the child says. D) While a specialist may be involved, it does not absolve the therapist of the immediate legal responsibility to report suspected abuse.

Question 17

A physical therapist applies a hot pack to the low back of a 60-year-old female with chronic mechanical low back pain. A few minutes later, the patient reports feeling short of breath and itchy all over her body. The therapist removes the hot pack and observes diffuse urticaria (hives) on the patient's trunk and notes audible wheezing.

What is the MOST likely event occurring, and what is the therapist's PRIORITY action?

  1. A simple heat rash; document the sensitivity and use a different modality in the future.
  2. An anxiety response to the heat; use relaxation techniques to calm the patient.
  3. A severe burn from the hot pack; immediately apply cold compresses and sterile dressings.
  4. Anaphylaxis; activate emergency medical services and ask if the patient has an epinephrine auto-injector. (correct answer)
Explanation: The patient is exhibiting a systemic allergic reaction (anaphylaxis), characterized by symptoms in at least two body systems: integumentary (itching, hives) and respiratory (shortness of breath, wheezing). This is a life-threatening emergency that can be triggered by various factors, including, rarely, heat or other physical stimuli. The priority is to activate EMS and assist with an epinephrine auto-injector if available. A) A simple heat rash would be localized and not involve systemic or respiratory symptoms. B) Wheezing and diffuse hives are not characteristic of an anxiety attack. C) There is no indication of a burn; the symptoms are systemic.

Question 18

A physical therapist is conducting a cervical spine examination on a 50-year-old patient for neck pain. During end-range rotation testing to the right, the patient suddenly reports dizziness, nausea, and shows distinct nystagmus. The patient also says, "The room looks like it's tilting, and I see two of you."

What is the therapist's MOST critical immediate response?

  1. Maintain the patient's neck in the rotated position to assess if the symptoms resolve with sustained holding.
  2. Immediately and carefully return the patient's head to a neutral position, lay the patient down, and call for emergency medical assistance. (correct answer)
  3. Perform the Dix-Hallpike test to differentiate between vertebral artery insufficiency and benign paroxysmal positional vertigo.
  4. Document the positive test for cervical arterial dysfunction and proceed with gentle mobilization in the opposite direction.
Explanation: The onset of the "5 D's And 3 N's" (dizziness, diplopia, dysarthria, dysphagia, drop attacks, and ataxia, nystagmus, nausea, numbness) during cervical movement is a red flag for vertebral artery insufficiency (VAI) or cervical arterial dysfunction. This is a potential medical emergency indicating compromised blood flow to the brain. The test must be stopped immediately, the neck returned to a safe, neutral position, and the patient stabilized (lying down is safest) while activating EMS. A) Sustaining the position is dangerous and could prolong or worsen the ischemia. C) Performing another provocative test like the Dix-Hallpike is contraindicated and unsafe. D) Any further mobilization is absolutely contraindicated.

Question 19

A 66-year-old male with a history of hypertension and hyperlipidemia is in an outpatient PT clinic for rotator cuff tendinopathy. While performing active range of motion exercises, he stops and complains of a sudden, intense headache that he describes as "the worst headache of my life." He then becomes increasingly lethargic and complains of a stiff neck.

These signs and symptoms are MOST indicative of which medical emergency?

  1. Cervicogenic headache exacerbated by exercise.
  2. Subarachnoid hemorrhage. (correct answer)
  3. Ischemic stroke in the middle cerebral artery.
  4. Acute hypertensive crisis.
Explanation: The classic presentation of a subarachnoid hemorrhage (SAH) is a sudden, severe "thunderclap" headache. The subsequent development of lethargy and nuchal rigidity (stiff neck) due to meningeal irritation further supports this diagnosis. This is a life-threatening emergency requiring immediate medical attention. A) A cervicogenic headache would typically be of slower onset and related to neck movement, not a sudden thunderclap headache. C) An ischemic stroke typically presents with focal neurological deficits (e.g., hemiparesis, aphasia) rather than this specific headache profile. D) While a hypertensive crisis can cause a headache, the combination with nuchal rigidity and the specific "worst headache" description strongly points to SAH.

Question 20

A physical therapist is working with an 18-month-old child with developmental delay. During the session, the therapist notices the child has a bulging fontanelle, is unusually irritable, seems lethargic, and has a new onset of strabismus. The child's medical history is significant for hydrocephalus treated with a ventriculoperitoneal (VP) shunt.

These clinical signs are MOST concerning for which medical emergency?

  1. A typical childhood febrile seizure.
  2. An adverse reaction to a recent vaccination.
  3. Acute viral meningitis.
  4. Ventriculoperitoneal (VP) shunt malfunction. (correct answer)
Explanation: The classic signs of increased intracranial pressure in an infant include a bulging fontanelle, irritability, lethargy, vomiting, and cranial nerve palsies (like strabismus). In a child with a known VP shunt, this presentation is highly indicative of shunt malfunction or failure, which is a neurosurgical emergency. The therapist must recognize these signs and ensure the child receives immediate medical evaluation. A) There is no mention of fever. B) While possible, the specific signs point strongly to increased ICP. C) Viral meningitis can present similarly, but given the history of a VP shunt, malfunction is the most probable and critical diagnosis to consider first.