National Physical Therapy Examination (NPTE) Quiz: Test And Measure Selection

A 68-year-old male is referred to outpatient physical therapy with a primary complaint of right-sided, anterolateral hip pain that has been present for 4 months. The pain is worse with prolonged walking and when rising from a chair. He has a history of coronary artery disease and is managed with a beta-blocker. Examination reveals pain with passive hip flexion, adduction, and internal rotation. He also demonstrates a positive Trendelenburg sign on the right. The physical therapist suspects gluteus medius tendinopathy co-existing with early-stage hip osteoarthritis.

Given the combined suspicion of intra-articular and extra-articular pathology, which of the following special tests would be MOST appropriate to differentiate the primary source of nociception?

A 22-year-old collegiate swimmer reports a 3-month history of deep, anterior shoulder pain during the pull-through phase of the freestyle stroke. She denies any instability events. Examination reveals a painful arc between 80-120 degrees of active elevation, positive Neer and Hawkins-Kennedy tests, and significant scapular dyskinesis. The physical therapist suspects subacromial pain syndrome with secondary rotator cuff tendinopathy. The treatment plan will focus heavily on scapular muscle retraining.

To BEST quantify the scapular dyskinesis and establish a baseline for tracking progress, which of the following assessments should be performed?

A 66-year-old female is evaluated in the intensive care unit (ICU) after being weaned from mechanical ventilation for 24 hours following an exacerbation of chronic obstructive pulmonary disease (COPD). The primary goal is to assess her readiness for mobilization. She is alert, oriented, and hemodynamically stable. She is receiving supplemental oxygen at 3 L/min via nasal cannula. The therapist needs to objectively measure respiratory muscle strength.

Which is the MOST appropriate and feasible method to assess this patient's respiratory muscle strength at the bedside?

A 28-year-old female presents to direct access physical therapy with a 1-week history of right calf pain and swelling that began after a long flight. She denies any specific trauma. She is an avid runner and has been training for a marathon. Examination reveals calf swelling (3.5 cm greater circumference than the left), pitting edema, and tenderness to palpation over the posterior calf. The skin is warm and slightly erythematous.

Given the patient's presentation, which of the following is the MOST critical initial test/measure for the physical therapist to perform?

A 52-year-old woman is seen in physical therapy for primary lymphedema of the left lower extremity. Her thigh circumference is 8% larger than the right, and the tissue has a firm, fibrotic feel with a positive Stemmer's sign at the base of the second toe. She is currently in the intensive phase of complete decongestive therapy (CDT). The therapist needs to objectively monitor the changes in tissue composition in response to treatment.

In addition to circumferential measurements, which measurement technique would provide the MOST objective data regarding tissue texture changes in this patient?

A 72-year-old male is undergoing cardiac rehabilitation phase II following a myocardial infarction 6 weeks ago. He has a history of type 2 diabetes and complains of occasional numbness and tingling in his feet. During a warm-up on the treadmill, he reports a sudden onset of cramping and aching in his calf, which is relieved within 2 minutes of stopping. His skin appears pale and shiny, with diminished hair growth on his lower legs.

To screen for the most likely cause of this patient's exertional leg pain, which of the following tests should the physical therapist perform?

A 55-year-old female presents with a chief complaint of urinary urgency and frequency, along with occasional urge incontinence. She denies any symptoms of stress incontinence. She works as a high school teacher and finds she has to leave her classroom frequently to use the restroom. She reports no pain, but the symptoms are significantly impacting her quality of life. The physical therapist decides to assess her pelvic floor muscle function as part of the examination.

Which test is MOST appropriate to assess the endurance capacity of her pelvic floor muscles related to her symptoms of urgency?

A 40-year-old male presents with right-sided face pain, described as a sharp, electrical shock, lasting for several seconds. The episodes are triggered by chewing, brushing his teeth, and a light breeze on his face. He denies any hearing loss or dizziness. The neurological screen reveals intact cranial nerves II-XII, except for hyperalgesia in the V2 and V3 distributions on the right. The therapist suspects trigeminal neuralgia but must rule out musculoskeletal causes of facial pain.

Which examination procedure would be MOST useful to help differentiate between trigeminal neuralgia and temporomandibular dysfunction (TMD)?

A 70-year-old female with a diagnosis of severe emphysema is participating in a pulmonary rehabilitation program. She demonstrates a hyperinflated chest, pursed-lip breathing, and significant dyspnea with minimal exertion (Modified Borg score of 5/10 after walking 50 feet). The therapist wants to measure her functional exercise capacity to establish a baseline and set goals for the program.

Given her significant dyspnea with minimal activity, which exercise test is the MOST appropriate and safest to administer?

A 65-year-old female presents with bilateral, symmetric hand pain and stiffness, worse in the morning and lasting for over an hour. She reports swelling in her metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. She has a family history of rheumatoid arthritis (RA). The physical therapist observes ulnar drift of the fingers and fusiform swelling of the PIP joints. The therapist needs to select a patient-reported outcome measure to quantify functional status and track disease progression.

Which of the following outcome measures is MOST specific and appropriate for this patient's condition?

A 75-year-old male with congestive heart failure (ejection fraction 35%) is referred to home health physical therapy for generalized weakness and decreased functional mobility. During the initial evaluation, the therapist assesses the patient's resting vital signs: HR 88 bpm, BP 110/70 mmHg, RR 20 breaths/min, SpO2 94% on room air. The therapist notes 2+ bilateral pitting edema in the ankles. The patient then ambulates 50 feet with a rolling walker and sits down, reporting fatigue.

Which of the following clinical signs, if observed immediately after the activity, would be the STRONGEST indicator that the exercise intensity was excessive and warrants modification of the treatment plan?

A 62-year-old male is admitted to an inpatient rehabilitation facility after a right middle cerebral artery stroke 2 weeks ago. He has left hemiparesis, most pronounced in the upper extremity, and moderate expressive aphasia. He is able to follow 2-step commands. The physical therapist needs to select an outcome measure to assess his overall functional mobility and predict discharge destination.

Which of the following outcome measures is MOST appropriate for this patient at this stage of recovery?

A 45-year-old female presents with a 2-week history of intense, spinning vertigo triggered by looking up and rolling over in bed to the left. The episodes last less than a minute. She denies hearing loss, tinnitus, or aural fullness. The physical therapist suspects benign paroxysmal positional vertigo (BPPV) of the left posterior semicircular canal. Her past medical history is significant for severe cervical spondylosis with documented foraminal stenosis at C5-C6.

Considering the patient's cervical spine condition, which is the MOST appropriate assessment to confirm the suspected diagnosis?

A 58-year-old male is evaluated for a suspected full-thickness supraspinatus tear. He reports a specific incident 1 week ago where he felt a pop while lifting a heavy box. He is unable to actively abduct his arm past 30 degrees. Passive range of motion is full but painful at end-range. The physical therapist wants to use a cluster of tests to maximize diagnostic accuracy.

Which combination of three clinical tests, when all positive, provides the highest positive likelihood ratio for diagnosing a full-thickness rotator cuff tear?

A 35-year-old male construction worker is being treated for chronic low back pain with radiating symptoms into the left posterior thigh, consistent with lumbar radiculopathy. He has completed 6 weeks of physical therapy, and while his pain has decreased, he reports persistent functional limitations and fears returning to his physically demanding job. The therapist wants to use a patient-reported outcome measure to specifically quantify his disability related to his back condition.

Which outcome measure is the MOST appropriate to administer to this patient to assess condition-specific disability?

A 15-year-old female gymnast is evaluated for right medial elbow pain. The pain is localized over the medial epicondyle and is exacerbated during tumbling and vaulting activities. There is tenderness to palpation over the medial epicondyle and pain with resisted wrist flexion. The therapist suspects medial epicondyle apophysitis ("Little League Elbow"). The therapist is concerned about potential ulnar collateral ligament (UCL) instability, which can co-exist with this condition.

Which special test is the MOST appropriate to assess the integrity of the ulnar collateral ligament in this patient?

A 59-year-old male with a 10-year history of idiopathic Parkinson's disease is referred for an assessment of fall risk. He reports two falls in the past month, both occurring while turning in the kitchen. He uses a straight cane for community ambulation. His medication (carbidopa-levodopa) is reported to be optimized. The therapist observes shuffling gait, festination, and difficulty with multi-directional movements.

Which functional outcome measure would provide the MOST comprehensive assessment of the specific balance deficits contributing to his falls?