National Physical Therapy Examination (NPTE) Quiz: Multisystem Prognosis Evaluation
20 questions · exam conditions
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Multisystem Prognosis EvaluationQuestion 1 of 20

Healed bilateral dysvascular amputee with diabetes: what best predicts prosthetic ambulation?

Cardiopulmonary reserve
Residual limb shape quality
Severity of phantom pain
Socket suspension design
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National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Multisystem Prognosis Evaluation

Practice Multisystem Prognosis Evaluation 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 Multisystem Prognosis Evaluation, 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

Healed bilateral dysvascular amputee with diabetes: what best predicts prosthetic ambulation?

  1. Cardiopulmonary reserve (correct answer)
  2. Residual limb shape quality
  3. Severity of phantom pain
  4. Socket suspension design
Explanation: Bilateral dysvascular amputation dramatically raises the energy cost of walking, so your cardiopulmonary reserve is the strongest predictor of prosthetic ambulation. Residual limb shape affects socket fit and comfort but not whether you can sustain walking. Phantom pain and suspension design influence quality of use, not the fundamental ability to ambulate.

Question 2

Stroke, diabetes, CKD, prior MI: which best captures multisystem prognosis?

  1. Total number of comorbidities
  2. HbA1c and creatinine values
  3. Acute stroke severity score
  4. Weighted comorbidity burden (correct answer)
Explanation: Multisystem prognosis depends on how each comorbid condition contributes and interacts, so a weighted comorbidity burden like the Charlson index captures risk better than a simple count. The most tempting wrong answer is the total number of comorbidities because it treats every condition equally and ignores severity. Single lab values or stroke severity focus on only one system.

Question 3

PAD with diabetic neuropathy and toe ulcer: which finding predicts poorest healing?

  1. ABI 0.8 with HbA1c 8.2%
  2. ABI 0.60 with HbA1c 8.0%
  3. ABI 0.45 with HbA1c 9.2% (correct answer)
  4. Sensory loss with ABI 0.90
Explanation: Severe arterial insufficiency is the strongest predictor of failed ulcer healing, and an ABI of 0.45 indicates critical limb ischemia. Add HbA1c 9.2%, reflecting poor glycemic control, and healing is most compromised. The tempting ABI 0.60 with HbA1c 8.0% also shows PAD, but its perfusion is less severely impaired and glucose control is better.

Question 4

Ventilated COPD with AKI and shock: which factor most strongly predicts liberation?

  1. Extrapulmonary organ recovery (correct answer)
  2. Initial ventilator mechanics
  3. Sedation holiday response
  4. Elective tracheostomy timing
Explanation: In a ventilated COPD patient with shock and AKI, liberation hinges on resolving extrapulmonary organ failure, because weaning requires hemodynamic stability and metabolic/renal clearance, not just lung mechanics. The tempting answer is sedation holiday response, but that only tests whether sedation is masking readiness; it cannot overcome unresolved shock or acute kidney injury.

Question 5

An 80-year-old male is admitted to the hospital with community-acquired pneumonia. His history is significant for Parkinson's disease (Hoehn & Yahr Stage 4), severe dysphagia requiring a percutaneous endoscopic gastrostomy (PEG) tube for all nutrition, and a large, unstageable pressure injury on his sacrum. In determining the patient's prognosis for recovery and discharge potential, which factor is the single MOST critical negative indicator?

  1. Impaired airway clearance due to truncal rigidity and a weak cough associated with advanced Parkinson's.
  2. A persistent systemic inflammatory state and catabolism from the unstageable pressure injury.
  3. An inability to participate in functional mobility due to the severity of his Parkinson's symptoms.
  4. A high probability of recurrent aspiration events secondary to severe oropharyngeal dysphagia. (correct answer)
Explanation: The correct answer is D. While all listed factors are negative indicators, the severe dysphagia represents the most critical and immediate threat to recovery and long-term survival. The presence of a PEG tube for all nutrition implies that he cannot safely manage his own secretions. This puts him at an extremely high risk for aspirating oral secretions, which is a common cause of pneumonia in this population. This underlying, unresolvable issue means that even if he recovers from the current pneumonia, he is highly likely to have recurrent episodes. This cycle of aspiration and pneumonia is the most significant factor leading to a poor prognosis. A, B, and C contribute to his overall frailty and complicate recovery, but the direct and recurring assault on his pulmonary system from aspiration (D) is the most critical determinant of his outcome.

Question 6

Which system's involvement most negatively influences prognosis in a post-surgical patient with rising creatinine, low urine output, and generalized weakness?

  1. Renal involvement affecting fluid balance, medication clearance, and fatigue (correct answer)
  2. Endocrine involvement from mild thyroid variation
  3. Dermatologic involvement from surgical dressing irritation
  4. Ophthalmologic involvement from needing bifocals
Explanation: This question tests NPTE skills in evaluating prognosis with multisystem involvement, integrating patient history and clinical data. Prognosis evaluation requires understanding how multiple systems interact and affect overall health outcomes, integrating clinical findings and patient goals. In the vignette, the patient presents post-surgically with rising creatinine, low urine output, and weakness, indicating renal dominance. Choice A is correct because it considers the dominant systems impacting prognosis, as evidenced by fluid and fatigue effects. Choice B is incorrect because it misinterprets thyroid as key, a common error when not prioritizing renal involvement. Encourage students to integrate clinical reasoning across systems, prioritize based on symptom severity, and consider patient-specific factors in prognosis. Practice with diverse case scenarios to develop a comprehensive evaluation approach.

Question 7

What additional test is essential to refine prognosis in heart failure with COPD when the patient reports severe fatigue but vitals appear stable at rest?

  1. Borg rating of perceived exertion and symptom-limited activity trial during walking (correct answer)
  2. Sleep study to diagnose narcolepsy as the primary cause
  3. Urine culture to evaluate asymptomatic bacteriuria
  4. Knee MRI to explain shortness of breath with stairs
Explanation: This question tests NPTE skills in evaluating prognosis with multisystem involvement, integrating patient history and clinical data. Prognosis evaluation requires understanding how multiple systems interact and affect overall health outcomes, integrating clinical findings and patient goals. In the vignette, the patient presents with heart failure, COPD, severe fatigue, and stable resting vitals, indicating exertion assessment need. Choice A is correct because it considers the dominant systems impacting prognosis, as evidenced by Borg rating and symptom-limited trials during walking. Choice B is incorrect because it misinterprets fatigue as narcolepsy, a common error when not evaluating exertional responses. Encourage students to integrate clinical reasoning across systems, prioritize based on symptom severity, and consider patient-specific factors in prognosis. Practice with diverse case scenarios to develop a comprehensive evaluation approach.

Question 8

A 35-year-old female in her first trimester of pregnancy is referred for physical therapy for severe sacroiliac joint pain. Her medical history is remarkable for Ehlers-Danlos syndrome, hypermobility type (hEDS), and postural orthostatic tachycardia syndrome (POTS). When discussing her prognosis for managing pain and function throughout her pregnancy, the therapist should emphasize that the greatest challenge will be:

  1. Orthostatic intolerance and fatigue from POTS limiting her ability to perform therapeutic exercises.
  2. Progressive, profound ligamentous laxity and joint instability due to the synergistic effect of hEDS and relaxin. (correct answer)
  3. Contraindications to the use of physical agents and certain manual therapies during pregnancy.
  4. Increased biomechanical stress on the lumbar spine and pelvis due to anterior weight shift as the pregnancy advances.
Explanation: The correct answer is B. The patient's underlying condition is systemic hypermobility due to hEDS. During pregnancy, the hormone relaxin is released, which causes further, systemic ligamentous laxity to prepare the pelvis for childbirth. In a patient with hEDS, this effect is greatly amplified, leading to profound and often debilitating joint instability, particularly in the weight-bearing joints of the pelvis and spine. This is the core pathophysiological driver of her pain and functional decline, and it represents the greatest challenge to manage. A and D are consequences and contributing factors, but the fundamental problem is the extreme instability. C represents treatment limitations, not the underlying prognostic factor related to her condition.

Question 9

A 22-year-old college student with a new diagnosis of a T6 ASIA A spinal cord injury is preparing for discharge from inpatient rehabilitation. He has a history of Crohn's disease, currently in remission, and a recently diagnosed generalized anxiety disorder. When determining the prognosis for his successful reintegration into his campus environment, which factor presents the MOST significant challenge?

  1. Managing bowel and bladder care routines within a non-medical dormitory setting.
  2. The potential for a Crohn's disease flare-up precipitated by the stress of his injury and new lifestyle.
  3. The patient's ability to manage fear and avoidance behaviors related to his anxiety disorder. (correct answer)
  4. Navigating physical accessibility barriers and varied terrain across the university campus.
Explanation: The correct answer is C. Successful community reintegration is as much a psychosocial process as it is a physical one. While the other factors are significant practical challenges, a generalized anxiety disorder can be the most insidious barrier to progress. It can manifest as a fear of leaving a safe environment (the dorm), social anxiety, fear of medical emergencies (e.g., autonomic dysreflexia), and avoidance of new or challenging situations. This can prevent the patient from practicing and using the very skills learned in rehab, leading to social isolation and a failure to reintegrate. A and D are practical skills and challenges that can be overcome with training and adaptive strategies. B is a valid medical concern, but the anxiety is a more direct and immediate barrier to the behaviors required for reintegration.

Question 10

A 48-year-old male with a 15-year history of relapsing-remitting multiple sclerosis (MS) is seen for progressive gait dysfunction. He also has a history of psoriasis with active psoriatic arthritis affecting his hands and feet, and he reports symptoms of depression. He has stalled in his progress with traditional strengthening and balance exercises. The patient's prognosis for improved ambulation is MOST likely limited by the interaction between:

  1. MS-related spasticity and painful foot joints from psoriatic arthritis. (correct answer)
  2. Central fatigue from MS and motivational deficits from depression.
  3. Impaired motor control from MS and reduced hand function from arthritis for using an assistive device.
  4. Uhthoff's phenomenon during exercise and systemic inflammation from psoriatic arthritis.
Explanation: The correct answer is A. This option presents a direct and debilitating mechanical interaction. MS-related spasticity (e.g., equinovarus posturing) creates abnormal forces and positioning of the foot. When combined with painful, inflamed joints in the feet from psoriatic arthritis, ambulation becomes exceedingly difficult and painful. This combination creates a vicious cycle where spasticity worsens joint pain, and joint pain prevents effective stretching or gait training to manage spasticity. This direct conflict in the primary functional area (the feet) is the most significant limiter. B is a very strong distractor, as fatigue and depression are huge factors in MS. However, the mechanical impossibility of weight-bearing on a spastic, painful foot (A) is a more direct and often insurmountable barrier to ambulation itself. C and D are also relevant but less fundamentally limiting than the issue described in A.

Question 11

A 66-year-old male is referred for outpatient physical therapy after a coronary artery bypass graft (CABG) surgery 6 weeks ago. He is progressing well with aerobic conditioning but complains of persistent, sharp midsternal pain with upper extremity movements. His medical history includes rheumatoid arthritis (RA) managed with methotrexate, and osteoporosis. A chest x-ray shows good sternal healing. Which factor is the most likely cause of his persistent pain and will most significantly impact his prognosis for returning to activities like lifting and golf?

  1. Non-union or instability of the sternal osteotomy, despite the negative x-ray findings.
  2. Referred pain from pericarditis, a common post-CABG complication.
  3. Inflammation of the costochondral and sternoclavicular joints due to his underlying rheumatoid arthritis. (correct answer)
  4. Over-adherence to sternal precautions, leading to excessive soft tissue stiffness and guarding.
Explanation: The correct answer is C. Given the patient's history of RA, the most likely etiology for his sharp, movement-related sternal pain, in the context of a healing sternotomy, is an inflammatory flare-up of the joints in that specific area (costosternal, sternoclavicular). The surgical trauma can trigger a localized RA flare. This is a difficult diagnostic problem that often mimics sternal instability. This will significantly complicate his recovery and delay his return to higher-level activities because the pain is driven by a systemic inflammatory process, not just mechanical healing. A is less likely given the clear x-ray. B typically presents with more constant, pleuritic pain, often relieved by position. D could be a factor, but is less likely to cause sharp pain and is secondary to the primary pain generator.

Question 12

A 79-year-old female is evaluated for home physical therapy following a hospitalization for a urinary tract infection and subsequent delirium. Her standing diagnosis is multifactorial gait instability. Her history includes macular degeneration with severe central vision loss, cervical spondylosis with myelopathy, and anxiety. Which of her chronic conditions presents the MOST fundamental and least remediable obstacle to improving her balance and reducing her fall risk?

  1. Anxiety and fear of falling, leading to a guarded and inefficient gait pattern.
  2. Decreased neck range of motion and pain from cervical spondylosis.
  3. Impaired proprioceptive feedback from the lower extremities due to cervical myelopathy. (correct answer)
  4. Severe central vision loss from macular degeneration.
Explanation: The correct answer is C. Balance is maintained through the integration of three sensory systems: visual, vestibular, and somatosensory (proprioception). This patient has severe compromise in two of the three. Her vision (D) is severely impaired. The cervical myelopathy (compression of the spinal cord in the neck) damages the dorsal columns, which carry proprioceptive information from the legs to the brain. This loss of proprioception (C) is a devastating and often irreversible deficit. Attempting to improve balance with two out of three primary sensory systems severely compromised is extremely difficult. The loss of proprioception is the most fundamental obstacle because it removes the body's primary source of information about joint position and movement. A and B are treatable to some extent, but the neurological deficits from vision loss and myelopathy are largely permanent.

Question 13

A 50-year-old male with end-stage renal disease (ESRD) on hemodialysis three times per week is undergoing rehabilitation following a transtibial amputation due to diabetic foot complications. He also has a history of ischemic cardiomyopathy with an ejection fraction of 25%. His primary goal is to walk with a prosthesis. The prognosis for achieving consistent, functional prosthetic use is poorest due to:

  1. Fluctuating fluid volume and limb size between dialysis sessions, complicating prosthetic fit.
  2. Poor wound healing potential of the residual limb due to diabetes and ESRD.
  3. Severe cardiovascular limitations and low physiological reserve for the increased energy cost of ambulation. (correct answer)
  4. High risk of skin breakdown on the contralateral foot from increased weight-bearing.
Explanation: The correct answer is C. While all options are serious concerns, the patient's severe ischemic cardiomyopathy (EF 25%) provides the most profound barrier to functional prosthetic use. Ambulation with a transtibial prosthesis increases the energy expenditure of walking by 20-40% compared to able-bodied gait. A patient with such severe cardiac compromise lacks the physiological reserve to meet this increased metabolic demand. His activity will be severely limited by dyspnea, fatigue, and potential for angina or arrhythmias, making consistent, functional ambulation (beyond very short, in-home distances) an unrealistic goal. A, B, and D are very significant challenges in this population, but a person cannot walk if their heart cannot support the activity.

Question 14

A 30-year-old male with a C6 ASIA B spinal cord injury wants to maximize his potential for neurological recovery. He is considering adjunctive therapies. His medical history is complicated by hemophilia A and a seizure disorder that is well-controlled with medication. Based on his multisystem involvement, which potential adjunctive therapy would carry the GREATEST risk, therefore negatively impacting his overall prognosis if pursued?

  1. Functional electrical stimulation (FES) cycling to maintain muscle mass and improve circulation.
  2. High-intensity locomotor training on a body-weight support treadmill system.
  3. Aggressive, passive range of motion and stretching to prevent contractures.
  4. Acupuncture or dry needling to address neuropathic pain and spasticity. (correct answer)
Explanation: The correct answer is D. Hemophilia A is a severe bleeding disorder. Invasive procedures like acupuncture or dry needling, which involve piercing the skin and underlying tissues with needles, carry a significant risk of causing deep muscle hematomas or uncontrolled bleeding in a patient with hemophilia. Such a complication could be limb- or life-threatening and would be a major setback to his rehabilitation. This makes the risk-benefit ratio extremely unfavorable. A, B, and C are standard and appropriate interventions for SCI rehabilitation; while they must be monitored for safety (e.g., skin breakdown, autonomic dysreflexia), they do not carry the specific, high-risk contraindication that needling does in the context of hemophilia.

Question 15

A 69-year-old male with idiopathic pulmonary fibrosis (IPF) is referred to pulmonary rehabilitation. His comorbidities include obesity (BMI 33 kg/m²), obstructive sleep apnea (OSA) treated with CPAP, and type 2 diabetes. The patient's prognosis for improved exercise tolerance and quality of life is MOST severely limited by:

  1. The progressive and irreversible nature of the lung scarring in IPF. (correct answer)
  2. Hypoventilation and increased work of breathing due to his obesity.
  3. The risk of exercise-induced hypoglycemia related to his diabetes.
  4. Nocturnal hypoxemia resulting from poorly controlled OSA.
Explanation: The correct answer is A. This question requires identifying the condition with the most immutable and severe prognosis. Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal lung disease characterized by irreversible scarring of lung tissue. While pulmonary rehab can improve functional capacity and quality of life, it cannot halt or reverse the underlying disease process. The patient's functional ceiling is ultimately determined by the relentless progression of their IPF. B, C, and D are all significant comorbidities that must be managed to optimize his participation in rehab, but they are treatable conditions. The underlying IPF, however, dictates a fundamentally poor long-term prognosis for respiratory function, which is the primary determinant of exercise tolerance.

Question 16

A 77-year-old male is evaluated in a skilled nursing facility for failure to thrive. He has a history of alcohol-related cirrhosis (Child-Pugh Class C), dementia, and chronic malnutrition with sarcopenia. He is currently bed-bound. The team is establishing a plan of care. What is the MOST significant barrier to making any meaningful functional progress, such as achieving sitting at the edge of the bed?

  1. Safety risks and impaired motor learning due to dementia.
  2. Orthostatic hypotension and fatigue related to hepatic insufficiency.
  3. The presence of ascites, which alters his center of mass and increases the work of breathing.
  4. Lack of physiological reserve and muscle mass due to sarcopenia and end-stage liver disease. (correct answer)
Explanation: The correct answer is D. End-stage liver disease (Child-Pugh C) combined with chronic malnutrition leads to severe sarcopenia and a profound state of cachexia. The patient fundamentally lacks the metabolic and muscular building blocks necessary for even basic functional tasks. He has no physiological reserve to tolerate the stress of activity or to build new muscle. While A, B, and C are all major challenges, they are secondary to the core problem: the patient's body is in a state of terminal catabolism and lacks the basic physical capacity to generate movement or respond to therapeutic intervention. This makes the prognosis for any functional gain extremely poor.

Question 17

A 45-year-old female is referred to physical therapy for chronic fatigue and widespread pain, recently diagnosed as fibromyalgia. She also has a history of Polycystic Ovarian Syndrome (PCOS), Hashimoto's thyroiditis (currently euthyroid on levothyroxine), and a vitamin D deficiency. When formulating a prognosis for her ability to engage in a graded exercise program, the therapist should recognize that which comorbidity, if unaddressed, is most likely to synergistically worsen her fibromyalgia symptoms?

  1. Insulin resistance associated with Polycystic Ovarian Syndrome. (correct answer)
  2. Autoimmune processes related to Hashimoto's thyroiditis.
  3. The persistent vitamin D deficiency.
  4. Hormonal fluctuations characteristic of PCOS.
Explanation: The correct answer is A. There is growing evidence linking insulin resistance, a key feature of PCOS, to central sensitization and inflammation, which are the proposed mechanisms underlying fibromyalgia. Uncontrolled insulin resistance can exacerbate pain and fatigue, making it much harder for the patient to tolerate or benefit from exercise. Therefore, addressing this metabolic component is critical to the prognosis. B is less likely to be a factor if her thyroid levels are stable ('euthyroid'). C, vitamin D deficiency, is associated with myalgia, but the systemic inflammatory and metabolic effects of insulin resistance (A) are thought to have a more profound, synergistic effect on the core pathophysiology of fibromyalgia. D is a factor but less directly linked to the pain processing mechanisms than insulin resistance.

Question 18

An 82-year-old female with a history of a vertebral compression fracture is being treated for lumbar spinal stenosis. She also has advanced chronic glaucoma, Paget's disease of bone affecting her pelvis and femurs, and is a long-term survivor of breast cancer treated with an aromatase inhibitor. Her primary complaint is leg pain with walking that limits her to half a block. Which comorbidity is the MOST likely primary contributor to her current symptoms and carries the worst prognosis for improvement with conservative care?

  1. Neurogenic claudication from the lumbar spinal stenosis.
  2. Pathological changes and potential microfractures in the femur from Paget's disease. (correct answer)
  3. Increased fall risk and altered gait mechanics due to poor peripheral vision from glaucoma.
  4. Accelerated bone loss and arthralgias, which are known side effects of aromatase inhibitors.
Explanation: The correct answer is B. While neurogenic claudication (A) is the classic symptom of spinal stenosis, Paget's disease affecting the weight-bearing bones of the pelvis and femurs can also cause severe pain with walking due to bone deformity, mechanical stress, and microfractures. This pain can mimic claudication. The prognosis is worse because the pain is from a primary bone pathology that is not amenable to the typical PT interventions for stenosis (e.g., flexion-based exercises, unloading). The underlying bone structure is compromised. A is the obvious answer but ignores the other powerful pain generator. C affects her safety but not the pain itself. D contributes to her overall osteoporosis but is less likely to cause the specific, severe claudication-like symptoms than active Paget's disease.

Question 19

A 60-year-old male with a 20-year history of ankylosing spondylitis presents with new-onset shortness of breath during exertion. He has also been diagnosed with atrial fibrillation and is on a beta-blocker. His pulmonary function tests show a restrictive pattern. What is the MOST likely underlying cause of his dyspnea, which will govern his prognosis for improving activity tolerance?

  1. Exercise intolerance and blunted heart rate response from his beta-blocker medication.
  2. Decreased cardiac output and exertional intolerance due to atrial fibrillation.
  3. Reduced chest wall excursion and vital capacity due to costovertebral joint fusion from ankylosing spondylitis. (correct answer)
  4. General deconditioning from a sedentary lifestyle due to chronic pain and stiffness.
Explanation: The correct answer is C. A hallmark of advanced ankylosing spondylitis is the fusion of the spine and costovertebral joints. This severely restricts the ability of the rib cage to expand during inhalation, leading to an extrinsic restrictive lung disease. This mechanical limitation is a direct, progressive, and largely irreversible consequence of his primary disease and is the most fundamental limiter of his ventilatory capacity and thus his exercise tolerance. A and B are contributing cardiac factors, and D is a consequence, but the structural inability of his chest to move (C) is the primary driver of his restrictive pulmonary pattern and his dyspnea.

Question 20

A 62-year-old male with Stage III right upper extremity lymphedema secondary to melanoma treatment (axillary lymph node dissection and radiation) is referred for complete decongestive therapy (CDT). His comorbidities include morbid obesity (BMI = 42 kg/m²), chronic kidney disease (CKD) Stage 4, and medically managed coronary artery disease. Which factors create the GREATEST physiological barrier to a successful long-term prognosis for lymphedema reduction?

  1. Increased risk of cellulitis due to the combination of obesity and compromised lymphatic drainage.
  2. Poor tolerance for compression bandaging due to skin fragility and potential for skin breakdown.
  3. Impaired systemic fluid processing from CKD combined with increased lymphatic load from obesity. (correct answer)
  4. Cardiovascular strain from fluid shifts during manual lymphatic drainage and compression.
Explanation: The correct answer is C. The prognosis for sustained lymphedema reduction is poorest due to the synergistic negative effects of CKD and morbid obesity. CDT works by mobilizing excess interstitial fluid from the limb back into the systemic circulation. However, Stage 4 CKD means the kidneys have a severely limited capacity to filter and excrete this excess fluid. Concurrently, morbid obesity significantly increases the overall lymphatic and interstitial fluid load. This creates a closed-loop problem: fluid removed from the arm cannot be effectively cleared by the body and will rapidly re-accumulate, leading to a poor long-term prognosis for volume control. A is a risk, but not the primary barrier to volume reduction. B is a treatment challenge, but not a fundamental physiological barrier. D is a precaution that requires monitoring but does not inherently doom the long-term outcome like the fluid overload issue does.