National Physical Therapy Examination (NPTE) Quiz: Interpreting Examination Findings
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Interpreting Examination FindingsQuestion 1 of 19

A 22-year-old female presents with anterior knee pain. Observation of her running gait reveals excessive hip adduction and contralateral pelvic drop at midstance. A single-leg squat demonstrates dynamic knee valgus. Manual muscle testing reveals 4-/5 strength for the hip abductors and 4/5 for the hip external rotators. Craig's test for femoral anteversion is measured at 16 degrees bilaterally. The patient has a Q-angle of 14 degrees in standing.

Which interpretation BEST synthesizes these findings to explain the patient's knee pain?

The primary issue is a structural abnormality, specifically excessive femoral anteversion, which dictates the faulty movement pattern.
Weakness of the vastus medialis obliquus is causing poor patellar tracking, leading to compensatory hip muscle activation.
The patient exhibits poor neuromuscular control of the hip, leading to dynamic valgus and subsequent patellofemoral joint stress.
An increased Q-angle is the most significant factor, creating a lateral vector on the patella during quadriceps contraction.
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National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Interpreting Examination Findings

Practice Interpreting Examination Findings 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 Interpreting Examination Findings, 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 22-year-old female presents with anterior knee pain. Observation of her running gait reveals excessive hip adduction and contralateral pelvic drop at midstance. A single-leg squat demonstrates dynamic knee valgus. Manual muscle testing reveals 4-/5 strength for the hip abductors and 4/5 for the hip external rotators. Craig's test for femoral anteversion is measured at 16 degrees bilaterally. The patient has a Q-angle of 14 degrees in standing.

Which interpretation BEST synthesizes these findings to explain the patient's knee pain?

  1. The primary issue is a structural abnormality, specifically excessive femoral anteversion, which dictates the faulty movement pattern.
  2. Weakness of the vastus medialis obliquus is causing poor patellar tracking, leading to compensatory hip muscle activation.
  3. The patient exhibits poor neuromuscular control of the hip, leading to dynamic valgus and subsequent patellofemoral joint stress. (correct answer)
  4. An increased Q-angle is the most significant factor, creating a lateral vector on the patella during quadriceps contraction.
Explanation: The key finding is the dynamic valgus observed during functional activities, linked to weakness in the hip abductors and external rotators. This points to a problem of poor neuromuscular control at the hip. While the femoral anteversion and Q-angle are within normal limits (anteversion 8-15 deg, Q-angle <20 deg for females), the functional weakness is evident. This poor proximal control allows excessive femoral internal rotation and adduction, which increases the dynamic Q-angle and places stress on the patellofemoral joint, causing pain. This interpretation prioritizes the functional deficit over the normal static measurements.

Question 2

A 40-year-old patient reports low back pain with radiation into the left posterior calf. The straight leg raise (SLR) test on the left is positive at 35 degrees, reproducing the calf symptoms. Adding ankle dorsiflexion at this angle intensifies the symptoms. However, manual muscle testing for all lower extremity myotomes is 5/5, sensation is intact to light touch, and all deep tendon reflexes are 2+ and symmetrical.

These findings are best interpreted as evidence of:

  1. acute inflammation of the sciatic nerve or its roots without significant axonal damage. (correct answer)
  2. a large, extruded disc herniation causing significant L5 nerve root compression.
  3. a severe grade 3 hamstring strain mimicking sciatica.
  4. central canal stenosis with neurogenic claudication.
Explanation: When evaluating nerve-related symptoms, you need to distinguish between nerve irritation and actual nerve damage by analyzing the complete clinical picture, not just individual test results. The key finding here is the discrepancy between positive neural tension signs and normal neurological function. The positive straight leg raise at 35° with calf pain reproduction, especially when intensified by ankle dorsiflexion (Lasègue's sign), clearly indicates sciatic nerve irritation. However, the patient maintains normal strength (5/5), intact sensation, and normal reflexes (2+) - all signs that the nerve's ability to conduct signals remains unimpaired. Answer A is correct because this pattern - positive tension signs with preserved neurological function - is classic for acute nerve inflammation without axonal damage. The nerve is irritated and hypersensitive to mechanical stress, but not structurally compromised. Answer B is wrong because significant L5 nerve root compression from a large disc herniation would produce neurological deficits like weakness in ankle dorsiflexion, altered sensation in the L5 dermatome, or diminished reflexes. Answer C is incorrect because hamstring strains don't produce the specific neural tension signs seen here. A hamstring injury wouldn't intensify with ankle dorsiflexion, which specifically loads the sciatic nerve. Answer D is wrong because central canal stenosis typically presents with bilateral symptoms, neurogenic claudication (pain with walking/standing, relief with sitting), and often affects multiple nerve levels simultaneously. Remember: positive neural tension tests with normal strength and reflexes suggest nerve irritation rather than compression with structural damage.

Question 3

A 45-year-old patient reports a 3-month history of insidious onset right shoulder pain and weakness. Examination reveals significant weakness with the lift-off test. Resisted wrist extension is 4/5, and sensation is diminished over the dorsum of the thumb. Passive glenohumeral range of motion is full but painful at end-range internal rotation. The patient has a negative Neer and Hawkins-Kennedy test. Neck extension and right rotation/side-bending do not reproduce the shoulder or arm symptoms.

Based on these examination findings, which of the following interpretations is MOST accurate?

  1. The patient's symptoms are primarily caused by a C6 radiculopathy leading to secondary subscapularis inhibition.
  2. The findings are most consistent with an isolated, full-thickness tear of the subscapularis tendon with radiating pain.
  3. The primary pathology is an upper trunk brachial plexopathy affecting the upper subscapular and radial nerves.
  4. The combination of findings indicates subscapularis tendinopathy with a concurrent, unrelated C6 nerve root irritation. (correct answer)
Explanation: The weakness with the lift-off test points to subscapularis pathology. The 4/5 wrist extension and sensory changes in the thumb distribution are classic for C6 nerve root involvement. However, the negative cervical spine screening tests (Spurling's maneuver) make a currently compressive radiculopathy less likely. The negative impingement signs make a rotator cuff tear due to subacromial impingement less likely. Therefore, the most precise interpretation is that two separate pathologies coexist: a primary shoulder issue (subscapularis tendinopathy) and a separate, mild C6 nerve root irritation that is not currently being compressed by cervical movements.

Question 4

A 68-year-old patient with a history of congestive heart failure is admitted to the hospital. During auscultation, the physical therapist notes bilateral late-inspiratory crackles in the lower lung bases that do not clear with coughing. The therapist also observes jugular vein distention at 45 degrees of head-of-bed elevation and measures a paradoxical pulse of 15 mmHg. The patient's breathing is shallow with a respiratory rate of 22 breaths/minute.

Which interpretation BEST explains the combination of these clinical findings?

  1. The findings suggest an acute bacterial pneumonia, with consolidation causing the crackles and systemic infection causing tachycardia.
  2. The patient is experiencing an exacerbation of left-sided heart failure leading to pulmonary edema and increased right ventricular afterload. (correct answer)
  3. These signs are indicative of a large pulmonary embolism, causing pulmonary hypertension and subsequent right heart strain.
  4. The patient likely has chronic bronchitis with excessive mucus production and secondary cor pulmonale.
Explanation: The combination of findings is classic for an exacerbation of left-sided heart failure. The late-inspiratory crackles that do not clear with coughing are indicative of fluid in the alveoli (pulmonary edema). Jugular vein distention reflects increased central venous pressure, a sign of fluid overload and right heart strain secondary to left-sided failure. A paradoxical pulse greater than 10 mmHg indicates significant pressure shifts within the thorax, often seen in cardiac tamponade but also in severe heart failure or obstructive lung disease. The entire picture points to decompensated left-sided heart failure.

Question 5

A 62-year-old male with type 2 diabetes presents with a non-healing wound on the plantar surface of his right first metatarsal head. The wound bed is pale with minimal granulation tissue. The periwound skin is dry and cool to the touch. Examination reveals an absent dorsalis pedis pulse, a capillary refill time of 5 seconds, and loss of protective sensation to a 10g monofilament test over the entire plantar surface of the foot.

The examination findings are MOST consistent with an interpretation of:

  1. a primarily venous stasis ulcer with secondary sensory deficits due to chronic edema.
  2. an ulcer resulting from a combination of peripheral arterial insufficiency and sensory neuropathy. (correct answer)
  3. a Charcot foot deformity leading to abnormal pressure distribution and skin breakdown.
  4. a purely neuropathic ulcer caused by repetitive mechanical stress in an insensate area.
Explanation: This clinical picture has clear signs of both arterial insufficiency and sensory neuropathy. The absent pulse, slow capillary refill, cool skin, and pale wound bed point to significant peripheral arterial disease (PAD). The loss of protective sensation indicates severe sensory neuropathy. While a neuropathic ulcer is caused by repetitive stress on an insensate foot, the signs of ischemia indicate that poor blood supply is also a major contributing factor to its development and failure to heal. Therefore, interpreting it as a combination of both pathologies is the most complete and accurate assessment.

Question 6

A patient is undergoing vestibular testing for complaints of vertigo. When the therapist moves the patient into the right Dix-Hallpike position, the patient complains of intense vertigo. The therapist observes nystagmus that begins after a 3-second latency, is primarily upbeating with a right torsional component, and subsides completely after 25 seconds. When the patient is returned to sitting, a brief reversal of the nystagmus is observed.

These specific examination findings are MOST accurately interpreted as:

  1. canalithiasis of the right posterior semicircular canal. (correct answer)
  2. a central nervous system lesion affecting the vestibular nuclei.
  3. cupulolithiasis of the right anterior semicircular canal.
  4. canalithiasis of the right horizontal semicircular canal.
Explanation: The classic presentation for posterior canal BPPV is upbeating and torsional nystagmus toward the involved side (right). The presence of latency (3 seconds), limited duration (25 seconds, a sign of fatigue), and reversal upon sitting are all hallmark signs of canalithiasis (free-floating debris) as opposed to cupulolithiasis (debris stuck to the cupula), which would have a more persistent nystagmus. Central lesions typically cause nystagmus that is not positional, does not fatigue, and is often purely vertical or pendular. Anterior canal BPPV would cause downbeating nystagmus, and horizontal canal BPPV would cause geotropic or ageotropic horizontal nystagmus.

Question 7

A 50-year-old patient reports the onset of constant, dull mid-thoracic back pain and right scapular pain over the past week. The pain is not altered by changes in position or movement. The patient notes the pain seems to intensify 1-2 hours after eating, particularly after a high-fat meal. The physical therapist's examination reveals no tenderness to palpation of the thoracic spine or paraspinals, and full, pain-free spinal range of motion. There is, however, mild tenderness to deep palpation over the right upper abdominal quadrant near the costal margin.

Based on this clinical presentation, the therapist should interpret the patient's symptoms as MOST likely originating from the:

  1. thoracic visceral pleura.
  2. gallbladder. (correct answer)
  3. head of the pancreas.
  4. thoracic vertebral disc.
Explanation: The combination of mid-thoracic/scapular pain (a known visceral referral pattern), its constant and non-mechanical nature, exacerbation by fatty foods, and tenderness in the right upper quadrant is a classic presentation for gallbladder pathology (cholecystitis). Pancreatic pain typically refers to the upper abdomen and straight through to the mid-back. Pleural pain would be associated with breathing. A disc lesion would have a mechanical pattern of symptoms, which is absent here.

Question 8

A patient with a T8 complete spinal cord injury (ASIA A) suddenly complains of a pounding headache during a therapy session focused on upright sitting in their wheelchair. The therapist notes the patient is sweating profusely on their forehead and their face is flushed. A blood pressure check reveals a value of 190/115 mmHg, a significant increase from their baseline of 100/60 mmHg.

The physical therapist should interpret this constellation of signs and symptoms as:

  1. orthostatic hypotension due to prolonged sitting.
  2. a vasovagal response triggered by visceral stimulation.
  3. autonomic dysreflexia triggered by a noxious stimulus. (correct answer)
  4. the onset of post-traumatic syringomyelia.
Explanation: This is a classic presentation of autonomic dysreflexia, a medical emergency common in individuals with SCI at or above T6. It is caused by a noxious stimulus below the level of the lesion (e.g., kinked catheter, tight clothing, pressure sore) that triggers a massive, imbalanced sympathetic nervous system response, leading to vasoconstriction below the lesion level and a rapid, dangerous rise in blood pressure. The headache, flushing, and sweating above the lesion level are secondary effects. Orthostatic hypotension is a drop in BP. A vasovagal response causes bradycardia and hypotension. Syringomyelia is a chronic condition causing progressive neurological decline.

Question 9

A 58-year-old female is evaluated 3 years after a right mastectomy with axillary lymph node dissection. She presents with progressive swelling in her right arm. Girth measurements reveal a 4 cm difference at the mid-forearm compared to the left. The skin on the dorsum of her right hand is thickened, and the therapist is unable to pinch and lift a fold of skin at the base of the second finger (positive Stemmer's sign). The edema is non-pitting.

Based on the International Society of Lymphology staging, these findings are BEST interpreted as:

  1. Stage 0 lymphedema (latent or subclinical).
  2. Stage 1 lymphedema (reversible).
  3. Stage 2 lymphedema (spontaneously irreversible). (correct answer)
  4. Stage 3 lymphedema (lymphostatic elephantiasis).
Explanation: Stage 2 lymphedema is characterized by swelling that no longer resolves with elevation (spontaneously irreversible), a positive Stemmer's sign, and the beginning of fibrotic changes in the tissue, which makes the edema non-pitting or poorly pitting. Stage 1 is characterized by pitting edema that resolves with elevation. Stage 3 involves significant fibrotic and sclerotic skin changes, papillomas, and further hardening of the limb, which is more advanced than what is described. Stage 0 is a subclinical state with no visible swelling.

Question 10

A patient with a history of recurrent ankle sprains complains of the ankle "giving way." The physical therapist performs an anterior drawer test, which reveals excessive anterior translation of the talus with a soft end-feel. The talar tilt test into inversion is also positive. However, strength testing of the ankle evertors is 5/5. Joint position sense testing, where the patient is asked to replicate a passively positioned ankle angle, shows a 10-degree error on the involved side compared to a 2-degree error on the uninvolved side.

The MOST complete interpretation of these findings is:

  1. acute tear of the anterior talofibular ligament with significant muscle guarding.
  2. a high ankle sprain involving the syndesmosis, causing talar hypermobility.
  3. isolated peroneal muscle weakness leading to a functional loss of dynamic stability.
  4. mechanical ligamentous instability combined with a functional proprioceptive deficit. (correct answer)
Explanation: When evaluating ankle instability, you need to distinguish between mechanical instability (structural ligament damage) and functional instability (proprioceptive deficits). Both can coexist and contribute to the sensation of the ankle "giving way." The findings clearly indicate both components are present. The positive anterior drawer test with soft end-feel and positive talar tilt test demonstrate mechanical instability from chronic ligament damage, likely involving the anterior talofibular and calcaneofibular ligaments. The significant proprioceptive deficit (10-degree error versus 2-degree normal) shows functional instability - the patient's ability to sense joint position is compromised, contributing to recurrent sprains. Choice A is incorrect because this describes an acute injury, but the soft end-feel and recurrent history suggest chronic ligamentous laxity, not acute tearing with muscle guarding. Choice B misidentifies the location - syndesmotic injuries affect the distal tibiofibular joint and typically result from external rotation mechanisms, not the inversion pattern suggested by the positive talar tilt. Choice C focuses only on dynamic stability from muscle weakness, but the strength testing shows normal 5/5 evertor strength, and this doesn't explain the positive ligamentous tests. Choice D correctly identifies that both mechanical (ligamentous) and functional (proprioceptive) deficits are present, explaining the complete clinical picture of recurrent instability. Remember: chronic ankle instability typically involves both structural ligament damage AND proprioceptive deficits. Don't assume it's purely mechanical or purely functional - look for evidence of both components in the examination findings.

Question 11

A patient in the intensive care unit recovering from abdominal surgery is receiving mechanical ventilation in assist-control (A/C) mode. The therapist observes that the patient's respiratory rate is 28 breaths/minute, well above the ventilator's set rate of 12. The patient is visibly using their sternocleidomastoid and scalene muscles with each inspiration. Arterial blood gas results show: PaO2 85 mmHg, PaCO2 30 mmHg, pH 7.50.

Which of the following BEST interprets this clinical picture?

  1. The patient is adequately supported by the ventilator and is ready to begin the weaning process.
  2. The ventilator settings are causing over-assistance, leading to a suppression of the patient's own respiratory drive.
  3. The patient has developed a metabolic acidosis, which is stimulating the respiratory drive.
  4. The patient is experiencing significant respiratory distress and muscle fatigue despite ventilator support. (correct answer)
Explanation: When evaluating patients on mechanical ventilation, you need to integrate multiple clinical signs to determine their respiratory status and ventilator tolerance. This question tests your ability to recognize respiratory distress despite mechanical support. The correct answer is D because multiple indicators point to significant respiratory distress. The patient's respiratory rate of 28 is more than double the ventilator's set rate of 12, indicating they're triggering additional breaths beyond what the machine provides. The visible use of accessory muscles (sternocleidomastoid and scalenes) is a classic sign of increased work of breathing and respiratory distress. The blood gas results show respiratory alkalosis (pH 7.50, PaCO2 30), confirming hyperventilation due to distress rather than adequate ventilation. Answer A is incorrect because a patient ready for weaning wouldn't exhibit accessory muscle use or tachypnea - these are signs of inadequate support, not readiness for independence. Answer B misinterprets the situation entirely; over-assistance would suppress respiratory drive and decrease breathing rate, not increase it to 28. Answer C incorrectly identifies the acid-base disorder - the pH of 7.50 indicates alkalosis, not acidosis, and metabolic acidosis would show low bicarbonate levels, which aren't provided here. Remember that in ventilator management questions, always look for the constellation of signs: respiratory rate relative to ventilator settings, accessory muscle use, and blood gas interpretation. Tachypnea plus accessory muscle use typically signals respiratory distress, regardless of mechanical support.

Question 12

A patient is 2 weeks post-right cerebral vascular accident. During an attempt to stand up from a chair, the therapist observes the patient actively pushing with their non-paretic left arm and leg, causing their body to tilt strongly toward the paretic right side. The patient resists any attempt by the therapist to correct their alignment to a vertical position, indicating a distorted perception of midline.

This observed motor behavior is BEST interpreted as:

  1. severe weakness of the right trunk musculature causing a passive fall to the right.
  2. unilateral spatial neglect, causing the patient to be unaware of their right side.
  3. lateropulsion, or 'pusher syndrome,' secondary to a posterolateral thalamus lesion. (correct answer)
  4. a compensatory strategy to unweight the paretic right lower extremity during the transfer.
Explanation: The key finding is the active pushing with the non-paretic side toward the paretic side. This distinguishes the condition from simply falling due to weakness. This phenomenon, known as lateropulsion or 'pusher syndrome,' is caused by a mismatch between the visual vertical and the perceived postural vertical, often associated with lesions of the posterolateral thalamus. While weakness and neglect may coexist, the defining characteristic described is the active pushing.

Question 13

An 80-year-old resident of a long-term care facility is noted to have a discolored area over her coccyx. The area is 4 cm in diameter, has a deep purple hue, and the overlying skin is intact. Upon palpation, the area feels firmer and warmer than the adjacent tissue. The patient's chart indicates a serum albumin level of 2.6 g/dL (normal: 3.5-5.5 g/dL). The area does not blanch with pressure.

The MOST accurate interpretation of these findings is:

  1. a suspected deep tissue injury with compromised tissue tolerance due to malnutrition. (correct answer)
  2. a Stage 1 pressure injury with evidence of hyperemia.
  3. a Stage 3 pressure injury with undermining that has not yet opened to the surface.
  4. a hematoma resulting from a recent fall, unrelated to pressure.
Explanation: When evaluating suspicious skin discoloration in at-risk patients, you need to systematically assess the appearance, depth, and underlying tissue condition to properly classify pressure injuries. The key clinical findings here point to deep tissue injury: the deep purple discoloration with intact skin, increased firmness and warmth, and non-blanching response all indicate damaged tissue beneath the surface. The low albumin level (2.6 g/dL, well below the normal 3.5-5.5 g/dL) confirms malnutrition, which significantly impairs tissue tolerance and healing capacity. This makes option A correct - it accurately identifies both the injury type and the contributing nutritional factor. Option B is wrong because Stage 1 pressure injuries present as red (not deep purple) areas that typically blanch with pressure. The deep purple color and non-blanching response indicate more severe tissue damage than Stage 1. Option C incorrectly identifies this as Stage 3, but Stage 3 injuries involve full-thickness skin loss with visible subcutaneous tissue. Here, the skin remains intact, ruling out Stage 3 classification. Option D suggests trauma-related hematoma, but the location over a bony prominence (coccyx), the patient's immobility risk factors, and the characteristic non-blanching purple appearance are classic for pressure-related deep tissue injury, not traumatic bleeding. Study tip: For pressure injury questions, always note skin integrity first (intact vs. open), then color and blanching response. Deep purple + intact skin + non-blanching = suspected deep tissue injury. Don't forget to consider contributing factors like nutrition status, as these affect both development and healing.

Question 14

A patient presents with right-hand weakness and sensory changes following a fall onto an outstretched hand 2 weeks ago. Examination reveals 2/5 strength of the finger abductors and adductors, atrophy of the hypothenar eminence, and sensory loss over the palmar aspect of the fifth digit and medial half of the fourth digit. Froment's sign is positive. Sensation over the dorsal ulnar aspect of the hand is intact. Tinel's sign is negative at the cubital tunnel but positive at the wrist, just proximal to the pisiform bone.

What is the MOST accurate interpretation of the location of this patient's nerve lesion?

  1. Compression of the ulnar nerve at the cubital tunnel, affecting all motor and sensory branches distally.
  2. A C8-T1 nerve root lesion from a traction injury, resulting in myotomal and dermatomal deficits.
  3. Compression of the deep motor branch of the ulnar nerve within the hand, sparing all sensation.
  4. Compression of the ulnar nerve within Guyon's canal, distal to the takeoff of the dorsal cutaneous branch. (correct answer)
Explanation: The motor deficits (interossei, hypothenar muscles) and sensory loss (ulnar one and a half digits) clearly indicate an ulnar nerve lesion. The key to localization is the sparing of sensation on the dorsal ulnar aspect of the hand. The dorsal cutaneous branch of the ulnar nerve arises in the forearm and would be affected by a cubital tunnel lesion but spared by a lesion at Guyon's canal (wrist). The positive Tinel's at the wrist further localizes the lesion to this area.

Question 15

A 72-year-old patient with idiopathic Parkinson's disease is being examined. During passive range of motion of the elbow, the therapist feels increased resistance throughout the entire range, which is intermittently broken up by a series of brief relaxations. This phenomenon is present regardless of how fast the therapist moves the limb. The patient's score on the pull test is a 2, indicating he takes 3 steps backward before recovering his balance.

The therapist should interpret the type of hypertonicity and the balance finding as:

  1. velocity-dependent spasticity and impaired somatosensory input.
  2. cogwheel rigidity and a deficit in postural reflexes. (correct answer)
  3. paratonia (gegenhalten) and cerebellar ataxia.
  4. dystonia and vestibular hypofunction.
Explanation: The description of increased resistance throughout the range of motion, independent of velocity, with superimposed tremor-like catches, is the definition of cogwheel rigidity, a hallmark sign of Parkinson's disease due to basal ganglia dysfunction. The pull test specifically assesses postural reflexes, and the inability to recover balance quickly indicates a significant impairment in these reflexes, another classic feature of the disease. Spasticity is velocity-dependent. Paratonia is an inability to relax during passive movement. Dystonia involves sustained contractions.

Question 16

A 28-year-old runner presents with right anterior hip pain, described with a C-sign. During observation of a single-leg squat, the therapist notes a pelvic drop on the left side (positive Trendelenburg sign) and increased femoral adduction and internal rotation on the right. The flexion, adduction, internal rotation (FADIR) test is positive for sharp anterior pain. Hip abductor strength is 4/5, but the patient reports pain during testing.

Which of the following statements BEST interprets the relationship between these findings?

  1. Weakness of the gluteus medius is the primary driver of the dynamic valgus, causing secondary impingement symptoms.
  2. Underlying femoroacetabular impingement (FAI) is causing pain-related inhibition of the hip abductor muscles. (correct answer)
  3. A superior gluteal nerve palsy is responsible for the Trendelenburg sign and subsequent anterior hip pain.
  4. Excessive femoral anteversion is the structural cause for both the FADIR sign and the observed movement dysfunction.
Explanation: While gluteus medius weakness is present (4/5 strength, positive Trendelenburg), the C-sign and positive FADIR test are highly suggestive of an intra-articular pathology like femoroacetabular impingement (FAI) with or without a labral tear. In this context, the most likely interpretation is that the underlying FAI is causing pain, which then leads to reflex inhibition and apparent weakness of the surrounding musculature, including the hip abductors. This creates a cycle where the underlying pathology drives the functional deficit.

Question 17

A 65-year-old patient is evaluated following a sudden onset of facial weakness. When asked to raise their eyebrows, they are able to wrinkle their forehead symmetrically. However, when asked to smile, the left corner of their mouth does not move and the nasolabial fold is flattened on the left side. They also have difficulty closing their left eye completely.

This specific pattern of facial muscle weakness is MOST consistent with a lesion affecting the:

  1. right motor cortex or its descending corticobulbar tracts (upper motor neuron). (correct answer)
  2. left facial nerve nucleus or its peripheral branches (lower motor neuron).
  3. left trigeminal nerve, affecting motor supply to the muscles of facial expression.
  4. right cerebellum, leading to facial muscle incoordination and hypotonia.
Explanation: When you encounter facial weakness patterns, the key is distinguishing between upper motor neuron (UMN) and lower motor neuron (LMN) lesions based on forehead involvement. This patient shows preserved forehead wrinkling but weakness in the lower face (smile, eye closure). This classic pattern indicates an upper motor neuron lesion. Here's why: the forehead muscles receive bilateral cortical innervation, meaning both brain hemispheres control forehead movement. When one side of the motor cortex is damaged, the forehead can still function because the intact hemisphere compensates. However, lower facial muscles receive primarily contralateral (opposite-side) cortical control, so a right cortical lesion causes left lower facial weakness. Answer A correctly identifies a right motor cortex or corticobulbar tract lesion, explaining the left-sided lower facial weakness with forehead sparing. Answer B describes a lower motor neuron lesion (like Bell's palsy), which would cause complete facial paralysis including the forehead on the affected side. Answer C incorrectly identifies the trigeminal nerve, which primarily provides sensory innervation to the face and motor supply to muscles of mastication, not facial expression. Answer D suggests cerebellar involvement, but cerebellar lesions cause coordination problems and hypotonia rather than the clear weakness pattern described. For the NPTE, remember this critical distinction: forehead sparing = UMN lesion (stroke), complete facial paralysis = LMN lesion (Bell's palsy). This pattern recognition will help you quickly identify stroke-related facial weakness versus peripheral facial nerve disorders.

Question 18

A patient presents with pain and paresthesia along the lateral forearm and thumb. Examination reveals 4/5 strength in the biceps brachii and brachialis muscles. Sensation to light touch is diminished over the lateral forearm. The brachioradialis deep tendon reflex is 1+. The Phalen's test and Tinel's sign at the wrist are negative. Cervical range of motion, including Spurling's test, is full and does not reproduce any of the patient's symptoms.

The MOST precise interpretation of these findings is an isolated lesion of the:

  1. C6 spinal nerve root.
  2. upper trunk of the brachial plexus.
  3. musculocutaneous nerve. (correct answer)
  4. median nerve at the carpal tunnel.
Explanation: The findings point specifically to the musculocutaneous nerve. This nerve innervates the biceps brachii and brachialis (elbow flexors) and provides sensation to the lateral forearm via its terminal branch, the lateral antebrachial cutaneous nerve. While a C6 radiculopathy can present with similar weakness and sensory changes (and would explain the diminished brachioradialis reflex), the complete absence of symptom reproduction with cervical testing makes a peripheral nerve entrapment more likely. An upper trunk lesion would also involve shoulder muscles. A median nerve lesion would affect different muscles and a different sensory distribution.

Question 19

A patient complains of right jaw pain and clicking. During the examination of the temporomandibular joint (TMJ), the therapist observes an audible click at 25 mm of opening and a second, quieter click just before the teeth make contact during closing. The patient's maximum active opening is 50 mm. Lateral deviation to the left is 5 mm, while lateral deviation to the right is 12 mm. There is pain with palpation of the right TMJ.

Which interpretation BEST explains this combination of findings?

  1. Myofascial pain syndrome involving the left lateral pterygoid muscle.
  2. Anterior disc displacement without reduction of the right TMJ.
  3. Anterior disc displacement with reduction of the right TMJ. (correct answer)
  4. Degenerative joint disease of the left TMJ with crepitus.
Explanation: The reciprocal click (one on opening, one on closing) is the hallmark sign of an anterior disc displacement with reduction. The opening click occurs as the condyle moves forward and relocates onto the displaced disc. The closing click occurs as the condyle slips off the disc posteriorly. The limited lateral deviation to the contralateral side (left) is also a key sign of a right TMJ intracapsular problem, as the right condyle is unable to translate forward effectively to allow the jaw to swing to the left. A displacement without reduction would result in a significantly limited opening range.