National Physical Therapy Examination (NPTE) Quiz: Prognosis Assessment
20 questions · exam conditions
0:00
Prognosis AssessmentQuestion 1 of 20

A 70-year-old female with a BMI of 35 kg/m² undergoes a total knee arthroplasty (TKA). Pre-operatively, she had severe pain, a score of 35 on the Knee injury and Osteoarthritis Outcome Score (KOOS), and significant quadriceps weakness. She also has a history of depression, which is managed with medication.

Which pre-operative factor is MOST associated with a poorer functional outcome and less satisfaction following TKA?

High body mass index (BMI)
History of managed depression
Low pre-operative KOOS score
Severe pre-operative pain levels
← Back to quizzes

National Physical Therapy Examination (NPTE) Quiz

National Physical Therapy Examination (NPTE) Quiz: Prognosis Assessment

Practice Prognosis Assessment 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 Prognosis Assessment, 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 female with a BMI of 35 kg/m² undergoes a total knee arthroplasty (TKA). Pre-operatively, she had severe pain, a score of 35 on the Knee injury and Osteoarthritis Outcome Score (KOOS), and significant quadriceps weakness. She also has a history of depression, which is managed with medication.

Which pre-operative factor is MOST associated with a poorer functional outcome and less satisfaction following TKA?

  1. High body mass index (BMI)
  2. History of managed depression (correct answer)
  3. Low pre-operative KOOS score
  4. Severe pre-operative pain levels
Explanation: While high BMI and poor pre-operative function (low KOOS score) are negative prognostic factors, the presence of depression is one of the strongest predictors of poor outcomes after TKA. Patients with depression, even if managed, tend to report higher post-operative pain, lower functional scores, and significantly less satisfaction with the surgical outcome compared to non-depressed patients.

Question 2

A 17-year-old rugby player sustained a first-time traumatic anterior shoulder dislocation, which was reduced in the emergency department. An MRI reveals a Bankart lesion but no significant glenoid bone loss. The athlete is being treated non-operatively.

What is the MOST significant factor for determining this patient's prognosis regarding the risk of recurrent instability?

  1. The mechanism of injury being a contact sport
  2. The patient's age of 17 years (correct answer)
  3. The presence of a Bankart lesion on MRI
  4. The choice of non-operative management
Explanation: For first-time traumatic anterior shoulder dislocations, patient age is the single most important predictor of recurrence. Patients under the age of 20 have a recurrence rate as high as 80-90% with non-operative treatment. This risk decreases significantly with increasing age. While the other factors are relevant, age is the dominant prognostic variable for recurrence.

Question 3

A patient with idiopathic pulmonary fibrosis (IPF) is undergoing a 6-minute walk test as part of a physical therapy evaluation. The patient's resting oxygen saturation (SpO₂) is 96% on room air. After 3 minutes of walking, the SpO₂ drops to 86% and the patient becomes severely dyspneic, forcing them to stop.

This exercise-induced desaturation is a strong prognostic indicator of which of the following outcomes?

  1. Increased mortality (correct answer)
  2. Improved response to corticosteroids
  3. Likelihood of developing pulmonary hypertension
  4. Progression to an obstructive ventilatory defect
Explanation: In patients with IPF, exercise-induced desaturation to ≤88% during a 6-minute walk test is a powerful and independent predictor of increased mortality. It reflects the severity of the underlying gas exchange abnormality and is more predictive of survival than resting pulmonary function tests alone. The other options are not directly or as strongly predicted by this specific finding.

Question 4

A physical therapist is evaluating a 72-year-old patient one week following an ischemic stroke affecting the middle cerebral artery. The patient presents with dense right hemiplegia, global aphasia, and persistent urinary incontinence. The patient's NIH Stroke Scale (NIHSS) score on admission was 22. The family is asking about the likelihood of the patient returning home.

Which of the patient's clinical findings is MOST indicative of a poor prognosis for achieving functional independence?

  1. Age of 72 years
  2. Ischemic nature of the stroke
  3. Initial NIHSS score of 22
  4. Persistent urinary incontinence (correct answer)
Explanation: While advanced age and a high initial NIHSS score are negative prognostic indicators, the presence of persistent urinary incontinence one week post-stroke is one of the strongest predictors of poor long-term functional outcome, increased mortality, and the need for institutionalization. It often reflects extensive neurological damage affecting autonomic control and sacral cord pathways.

Question 5

A 68-year-old male with severe Chronic Obstructive Pulmonary Disease (COPD) is referred for pulmonary rehabilitation. His clinical data includes: FEV1 of 35% predicted, a 6-minute walk test (6MWT) distance of 250 meters, a modified Medical Research Council (mMRC) dyspnea scale score of 4, and a Body Mass Index (BMI) of 19 kg/m².

When considering the patient's prognosis for 4-year mortality using the BODE index, which factor contributes the MOST points to his risk score?

  1. FEV1 of 35% predicted
  2. 6MWT distance of 250 meters
  3. mMRC dyspnea scale score of 4 (correct answer)
  4. BMI of 19 kg/m²
Explanation: The BODE index calculates risk based on BMI, Obstruction (FEV1), Dyspnea (mMRC), and Exercise capacity (6MWT). An mMRC score of 4 ('too breathless to leave the house or breathless when dressing') contributes the maximum 3 points. An FEV1 of 35-49% predicted contributes 2 points. A 6MWT distance of 250-349m contributes 1 point. A BMI <21 contributes 1 point. Therefore, the severe dyspnea is the highest-scoring component, indicating the poorest prognosis among the given factors.

Question 6

A 65-year-old patient underwent arthroscopic repair of a full-thickness rotator cuff tear. Pre-operative MRI revealed a large, retracted tear of the supraspinatus and infraspinatus tendons with Goutallier grade 3 fatty infiltration of the muscle bellies.

Which pre-operative finding is MOST associated with a poor prognosis for tendon healing and long-term functional outcome?

  1. Patient age of 65 years
  2. Large, retracted nature of the tear
  3. Goutallier grade 3 fatty infiltration (correct answer)
  4. Arthroscopic method of repair
Explanation: Goutallier grade 3 fatty infiltration signifies moderate to severe muscle atrophy and replacement with fat, which is largely irreversible. This severely compromises the muscle-tendon unit's ability to generate tension and has been shown to be a strong negative predictor of tendon healing, clinical outcomes, and a higher rate of re-tear after surgical repair, more so than tear size or age alone.

Question 7

A patient with New York Heart Association (NYHA) Class III heart failure is discharged from the hospital after an exacerbation. The patient's left ventricular ejection fraction is 30%. During a home health visit, the physical therapist notes the patient is not consistently taking their prescribed diuretic and has gained 4 pounds (1.8 kg) in the last two days.

Which factor presents the HIGHEST immediate risk for hospital readmission and indicates a poor short-term prognosis?

  1. NYHA Class III classification
  2. Ejection fraction of 30%
  3. Recent weight gain of 4 pounds (correct answer)
  4. History of a recent exacerbation
Explanation: A rapid weight gain of more than 2-3 pounds in 24 hours or 5 pounds in a week is a critical sign of fluid retention and impending decompensation in heart failure. This, combined with medication non-adherence, indicates a very high immediate risk of rehospitalization. While the other factors indicate a poor overall prognosis, the acute weight gain is the most urgent sign of instability.

Question 8

A 45-year-old construction worker presents with a 4-week history of mechanical low back pain without red flags. During the subjective examination, the patient states, "I'm sure I've slipped a disc. I'm afraid to bend over because I'll make it worse. I don't think I'll ever be able to go back to my job." The patient's score on the Fear-Avoidance Beliefs Questionnaire (FABQ) is significantly elevated.

Which factor is the MOST important predictor of this patient's transition to chronic disability?

  1. Duration of symptoms for 4 weeks
  2. High score on the FABQ (correct answer)
  3. Occupation as a construction worker
  4. Belief of having a 'slipped disc'
Explanation: Psychosocial factors are stronger predictors of long-term disability from low back pain than physical or anatomical findings. A high score on the Fear-Avoidance Beliefs Questionnaire (FABQ) indicates that fear and avoidance of activity are major drivers of the patient's behavior. This is a very strong prognostic indicator for developing chronic pain and long-term work disability, often outweighing the physical demands of a job or the duration of acute symptoms.

Question 9

A 68-year-old patient with type 2 diabetes and peripheral vascular disease is being considered for a transtibial amputation. The patient has a non-healing ulcer on the right foot. Examination reveals an absent dorsalis pedis pulse on the contralateral (left) limb and an ankle-brachial index (ABI) of 0.6 on that side. The patient lives alone and has good cognitive function.

Which factor is the MOST critical negative predictor for this patient's successful ambulation with a prosthesis?

  1. Age of 68 years
  2. Diagnosis of type 2 diabetes
  3. Living alone and lacking social support
  4. Poor vascular status of the contralateral limb (correct answer)
Explanation: The vascular health of the contralateral (sound) limb is a critical prognostic factor for prosthetic ambulation. An ABI of 0.6 indicates moderate arterial disease in the remaining limb, which will be subjected to increased stress during prosthetic use. This significantly increases the risk of future ulceration, claudication, and potential amputation of the second limb, making successful long-term ambulation much less likely.

Question 10

A physical therapist is treating a 55-year-old patient with Parkinson's disease, Hoehn and Yahr stage 3. The patient has significant postural instability and a history of two falls in the past month. The patient's primary complaint is 'freezing' when walking through doorways.

Which factor in the patient's history is the single BEST predictor of future falls?

  1. Hoehn and Yahr stage 3 classification
  2. Presence of freezing of gait
  3. History of two falls in the past month (correct answer)
  4. Presence of postural instability
Explanation: Across many populations, including Parkinson's disease, the single strongest predictor of a future fall is a history of a recent fall. While postural instability, freezing of gait, and H&Y stage are all significant risk factors, a history of falling itself has the highest predictive value for subsequent falls.

Question 11

A 48-year-old patient with Stage IV lung cancer with bone metastases is referred to physical therapy for generalized weakness. The patient reports severe fatigue and a pain level of 7/10. The patient's Karnofsky Performance Status (KPS) scale score is 40. The goal is to improve quality of life.

Based on this information, what is the MOST realistic prognosis regarding the patient's functional status?

  1. The patient is likely to return to independent community mobility with an assistive device.
  2. The patient's status indicates a need for hospice care and palliative interventions. (correct answer)
  3. The patient is a good candidate for a moderate-intensity aerobic and resistance training program.
  4. The patient's functional decline can be reversed with skilled physical therapy.
Explanation: A Karnofsky Performance Status (KPS) score of 40 is defined as 'disabled; requires special care and assistance.' It signifies a poor prognosis with limited life expectancy. Patients at this level are typically not candidates for restorative or moderate-intensity exercise. The prognosis is not for functional improvement but for decline. Therefore, the most appropriate plan of care would involve palliative interventions focused on comfort, safety, and symptom management, consistent with hospice philosophy.

Question 12

A 19-year-old collegiate soccer player is 6 months post-anterior cruciate ligament (ACL) reconstruction using a patellar tendon autograft. The patient has no pain, full range of motion, and demonstrates 95% symmetry on the Limb Symmetry Index (LSI) for quadriceps and hamstring strength. However, the patient scores low on the ACL-Return to Sport after Injury (ACL-RSI) scale, reporting significant fear of re-injury.

Based on this presentation, what is the MOST significant factor limiting this patient's prognosis for a successful return to competitive sport?

  1. Time from surgery of only 6 months
  2. Use of a patellar tendon autograft
  3. Low psychological readiness score (correct answer)
  4. Residual 5% quadriceps strength deficit
Explanation: The patient has met or exceeded most physical criteria for return to sport (strength, ROM). The most significant barrier described is the low psychological readiness, as indicated by the ACL-RSI score. Fear of re-injury and low kinesiophobia scores are strong independent predictors of failure to return to the previous level of sport, even in physically ready athletes.

Question 13

A 30-year-old individual is evaluated in an inpatient rehabilitation facility following a severe traumatic brain injury (TBI). The patient's Glasgow Coma Scale (GCS) score was 6 upon admission to the emergency department. The patient is now emerging from a coma but remains disoriented and unable to form new memories of daily events. This state has persisted for 20 days.

The duration of the patient's post-traumatic amnesia (PTA) is MOST consistent with a prognosis of:

  1. Good recovery with minor long-term deficits.
  2. Moderate disability with potential for independent living. (correct answer)
  3. Severe disability requiring lifelong dependency.
  4. Vegetative state with no meaningful recovery.
Explanation: The duration of post-traumatic amnesia (PTA) is a strong predictor of TBI outcome. A PTA duration of 14-28 days is generally associated with a moderate disability. This implies the person will likely achieve independence in self-care and activities of daily living but may have persistent cognitive, physical, or behavioral deficits that prevent a return to their previous level of work or social life. It is less severe than would be predicted for severe disability (PTA > 4 weeks) but worse than a good recovery (PTA < 2 weeks).

Question 14

A 60-year-old male is evaluated 3 months after a coronary artery bypass graft (CABG) surgery. His post-operative course was complicated by a sternal wound infection requiring a prolonged hospital stay. His current left ventricular ejection fraction is 40%. He works as an accountant and expresses significant anxiety about returning to his job.

Which factor is MOST predictive of this patient's inability to successfully return to work?

  1. Anxiety and other psychosocial factors (correct answer)
  2. History of a post-operative sternal wound infection
  3. Left ventricular ejection fraction of 40%
  4. The sedentary nature of his accounting job
Explanation: After cardiac surgery, psychosocial factors such as anxiety, depression, and lack of self-efficacy are often more powerful predictors of failure to return to work than clinical variables like ejection fraction or post-operative complications, especially for sedentary jobs. The patient's expressed anxiety is the most significant barrier identified, suggesting that fear and psychological distress are primary drivers of his inability to resume work.

Question 15

A 22-year-old male presents with a 5-year history of ankylosing spondylitis (AS). His primary complaints are morning stiffness and low back pain. Radiographs show early sacroiliitis. He reports that his father also had AS but developed severe hip arthritis requiring bilateral total hip arthroplasties in his 40s.

Which feature of this patient's overall clinical picture suggests a prognosis for a more severe and disabling disease course?

  1. Male gender
  2. Early sacroiliitis on radiograph
  3. Positive family history of AS
  4. Family history of early hip involvement (correct answer)
Explanation: In ankylosing spondylitis, early and significant hip joint involvement is one of the strongest predictors of a poor prognosis, leading to greater functional disability and a higher likelihood of requiring joint replacement surgery. While male gender and a positive family history are risk factors for developing AS, the specific pattern of joint involvement (especially the hips) is more indicative of the disease's future severity.

Question 16

A physical therapist is treating an 80-year-old patient with dementia who developed a stage 3 pressure injury over the sacrum during a recent hospital stay for pneumonia. The patient is now in a skilled nursing facility. The wound bed is 100% granulation tissue, but the patient has a serum albumin level of 2.8 g/dL and requires maximal assistance for bed mobility.

Which factor is the MOST significant barrier to wound healing and indicates a poor prognosis for this patient?

  1. Presence of dementia
  2. Stage 3 depth of the injury
  3. Low serum albumin level (correct answer)
  4. Location of the injury over the sacrum
Explanation: A serum albumin level below 3.5 g/dL indicates malnutrition, which significantly impairs all phases of wound healing by limiting the availability of proteins necessary for cellular repair and collagen synthesis. While dementia, injury stage, and location are all relevant factors, poor nutritional status is a primary systemic barrier that will prevent healing even with optimal local wound care.

Question 17

A physical therapist is evaluating a patient with newly diagnosed Guillain-Barré syndrome (GBS) in the acute care setting. The patient presents with rapidly ascending, symmetrical weakness and is now having difficulty managing oral secretions and reports a change in voice quality.

Which clinical finding is MOST indicative of a poor short-term prognosis and the potential need for mechanical ventilation?

  1. Symmetrical pattern of weakness
  2. Reports of distal paresthesias
  3. Absence of deep tendon reflexes
  4. Difficulty managing oral secretions (correct answer)
Explanation: In GBS, difficulty managing oral secretions and changes in voice quality (dysphonia/dysarthria) are signs of bulbar muscle involvement (cranial nerves IX, X, XII). This involvement is a strong predictor of impending respiratory failure and the need for mechanical ventilation. While the other options are classic signs of GBS, bulbar weakness indicates the disease is affecting the muscles critical for airway protection and breathing.

Question 18

A 66-year-old female presents with a chronic venous insufficiency ulcer on the medial malleolus. The wound is 4 cm x 5 cm with moderate exudate and a granular base. Her ankle-brachial index (ABI) is measured at 0.95. The patient is receiving wound care and compression therapy.

Which factor is the MOST favorable prognostic indicator for wound healing in this patient?

  1. The patient's ABI of 0.95 (correct answer)
  2. The moderate amount of wound exudate
  3. The granular appearance of the wound base
  4. The location on the medial malleolus
Explanation: An ABI of 0.9-1.3 is considered normal, indicating adequate arterial blood flow to the lower extremity. The presence of normal arterial circulation is a critical and highly favorable prognostic factor for healing a venous ulcer, as it ensures that oxygen and nutrients can reach the tissue. While a granular base is good, it can be present in a non-healing wound if arterial supply is compromised. Adequate arterial inflow is a prerequisite for healing.

Question 19

A 25-year-old patient sustained a traumatic spinal cord injury from a diving accident. A neurological examination reveals motor function present at C6 but absent below, with preservation of light touch and pin prick sensation in the sacral segments (S4-S5) but no voluntary anal contraction.

Based on these examination findings consistent with an ASIA Impairment Scale (AIS) B classification at the C6 neurological level, what is the correct interpretation for the patient's prognosis for motor recovery?

  1. The injury is complete, and no motor recovery is expected below the C6 level.
  2. The presence of sacral sparing indicates an incomplete injury with potential for motor recovery. (correct answer)
  3. AIS B injuries have the worst prognosis for motor recovery of all incomplete classifications.
  4. The C6 level indicates the patient will likely recover wrist extension but not elbow extension.
Explanation: An AIS B classification indicates an incomplete injury with sensory function preserved below the neurological level, including in the sacral segments S4-S5. Even without motor sacral sparing, the preservation of sensation indicates spinal cord continuity and potential for some neurological recovery. Incomplete injuries (AIS B, C, D) have significantly better prognoses than complete injuries (AIS A) for functional recovery.

Question 20

An 85-year-old female who lives alone sustained an intertrochanteric hip fracture and underwent an open reduction internal fixation. Prior to the fall, she used a single-point cane for community ambulation. She has a history of mild cognitive impairment and hypertension. She is evaluated by a physical therapist on post-operative day 2.

What is the single STRONGEST predictor of this patient's ability to return to her prior level of function?

  1. Pre-fracture ambulatory status (correct answer)
  2. Surgical fixation with ORIF
  3. Absence of post-operative delirium
  4. Well-controlled hypertension
Explanation: For older adults with hip fractures, the single most powerful predictor of post-operative functional level is the pre-fracture functional level. Patients who were independently ambulatory, even with an assistive device, have a significantly better prognosis for regaining function than those who were wheelchair-bound or required assistance for transfers. While other factors like cognitive status are important, pre-fracture mobility is the most robust prognostic indicator.