NPTEFF April posts Q&A

Q.1 Is there any way to memorize prosthetic gait: early and late knee
flexion and excessive knee flexion, insufficient knee flexion?
Ans:
Early and Excessive are caused due to hard heel cushion and high heels.
Delayed and inadequate are caused due to soft heel cushion and low
heels.
Early and late happens in late stance whereas excessive and inadequate
seen in early stance.

Q.2 In case of constrain induced mov therapy for stroke what is ideal
duration to kept less affected arm in mitt?
Ans:
It consists of a 2-week constraint-induced movement (CI) therapy
intervention program with training of the more affected UE up to 6
Hr/day and use of the mitt on the less affected hand for up to 90% of
waking hours.

Q.3 In case of posterior surface of arm burn what should be positioning?

 NPTEFF April posts Q&A
Ans:
Motions to be stress are extension and supination and splint in extension

Q.4 How to differentiate between dyssynergia and dyspraxia?

Ans:
Asynergia is inability to coordinate complex movements.
Dyssynergia is difficulty in performing smooth and single activity, so
they perform it in a component like if you ask them to touch their face,
they first flex elbow then wrist and fingers etc.
Dyspraxia is partial loss of ability to perform a task. Dyspraxia is
defined as “a breakdown of praxis [action]” and “the inability to utilize
voluntary motor abilities effectively in all aspects of life from play to
structured skilled tasks”

Q.5 If patient is fully recovered and still want to continue therapy then
what should be best action by PT? Discharge with HEP or accept out of
pocket payment?
Ans:
If patient has recovered, then no need for PT. Can do HEP and self-
management

Q.6 What is the difference between Lofstrand crutches and platform

crutches?
Ans:
Platform crutches have a forearm attachment so you can offload the
wrist from weight bearing.

Q.7 While strengthening Gluteus Medius in a side lying position, which

side to lie on? Affected or non-affected side?
Ans:
whichever side glutes you want to strength, that side will be up in anti-
gravity plane
“Muscle should face the ceiling”
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Q.8 What is appropriate treatment strategy for patient with Broca’s

aphasia and verbal apraxia or in case of dysarthria?
Ans: Broca's use yes or no questions. you don’t want them to speak too
long sentences. Verbal apraxia would be similar too. For dysarthria
pointing, drawing, or writing can be helpful. Speak one word at a time.
For Wernicke’s use gestures

Q.9 How to differentiate between tension type headache and

cervicogenic headache?

Q.10 What changes occur in terms of HR, BP, and glucose uptake, with
thyroid and adrenal gland disorders?
Ans: With HYPO thyroid - glucose uptake decreases so hyperglycemia,
increased BP, and decreased HR
Opposite for HYPERthyroid
With Adrenal insufficiency (Addison’s) - decreased glucose (so
increased uptake) increased HR and decreased BP
Opposite for Cushing’s
 NPTEFF April posts Q&A

Q.11 A patient that uses parallel bars at the clinic for gait training, what
kind of firm surface for upper extremity support can this patient use for
gait training at home?
Ans: If the patient uses parallel bars in clinic. He can be progressed to
gait training with Crutches/ walker and then he can use them at home.

Q.12 What is peritonitis?

Ans: Inflammation of the membrane lining the abdominal wall and
covering the abdominal organs.

Q.13 What are the exercise termination criteria within phase 1 or 2

cardiac rehab?
Ans: Termination of exercise:
Absolute:
Drop in SBP >10mmHg
Moderate to severe angina
Increasing CNS symptoms (ataxia, dizziness, syncope) Syncope is loss
of consciousness d/t insufficient blood flow to the brain.
Poor perfusion
Subject desire to stop
Technical difficulties in monitoring the ECG or BP
Sustained Ventricular Tachycardia
ST elevation > 1.0 MM
Relative:
ST or QRS changes (excessive ST depression)
Arrhythmias (Multifocal PVC, triplets, SVT, heart block,
bradyarrhythmia)
Fatigue, SOB, wheezing, leg cramps and claudication
Bundle branch block
Chest pain
Hypertensive response
ETT is done is phase 2 of cardiac rehab so if you see any of this
symptom you terminate the exercise test.
 NPTEFF April posts Q&A
Q.14 What is the relationship of heart rate with autonomic dysreflexia
and orthostatic hypotension.
Ans: HR increases with Orthostatic hypotension and decreases with
autonomic dysreflexia.

Q.15 Is diaphragmatic breathing contraindicated for emphysema

patients?
Ans: Yes

Q.16 What will be end feel in case of muscle spasm and capsular
tightness in TMJ?
Ans: Muscle spasm end feel will be springy and capsular tightness will
be firm capsular end feel

Q.17What will happen to right and left iliopsoas in case of right

scoliosis?
Ans: Iliopsoas tight on left side (concave side) and may become weak on
convex side (right side)

Q.18 What is the difference between light touch, crude touch, and two-
point discrimination? What would you use for each?
Proprioception and kinesthesia?
Ans: Light touch is same as fine touch e.g.: a feather
Crude touch is a touch that is nondiscriminatory and cannot be localized.
The two-point discrimination test is used to assess if the patient can
identify two close points on a small area of skin, and how fine the ability
to discriminate this are. It is a cortical sensation. Calipers are used to test
it
Proprioception and Kinesthesia are deep sensations
Proprioception - joint position sense (checking position if joint is up or
down)
Kinesthesia - joint movement sense (checking if patient can move the
joint in relation to the other joint)

Q.19 What is active and Passive insufficiency?

 NPTEFF April posts Q&A
Ans: When the muscle cannot cause adequate tension at all joints, it is
called active insufficiency. Remember it is with AROM
Whereas passive insufficiency is when the opposing muscle becomes
stretched to a point at which the muscle can no longer lengthen or cause
movement. Think of it like stretching.
https://youtu.be/U7XiyBrJ9sQ.

Q.20 Level for Spastic bladder-→Above T12

Q.21 Is there any difference if the lesion occurs at optic nerve, optic
tract, and optic chiasma?
Ans:

To summarize: optic nerve will cause blindness on that side. Optic

chiasm lesion will cause bitemporal hemianopsia. And optic tract is
homonyms hemianopsia.

Q22.What is gold standard for body composition analysis?

 NPTEFF April posts Q&A
Ans: Hydro densitometry or underwater weighing, considered for many
years the gold standard for measuring body fat, is based upon the
Archimedes principle whereby the volume of a mass is equal to the
volume of liquid displaced by that solid

Q.23 Will Valsalva first reduce BP and HR but eventually lead to an

increase in both?
Ans: Phases of Valsalva maneuver are as follows:

Q.24 What is the movement test/ provocation position posterior labral

tear in hip?
Ans: Anterior Labral tears are more common in hip and a FADDIR
movement can test it.
Posterior Labral tear can be tested by EXABER movement.

Q.25 What is sensory distribution of nerves?

Ans:
 NPTEFF April posts Q&A

Q26. In case of salicylate toxicity what will be present first? Metabolic

acidosis or respiratory alkalosis and what is it same as Aspirin toxicity?
Ans: For salicylate toxicity: Nausea, vomiting, diaphoresis, and tinnitus
are the earliest signs and symptoms of salicylate toxicity. Other early
symptoms and signs are vertigo, hyperventilation, tachycardia, and
hyperactivity.
Yes, Aspirin is a salicylate that is used as an analgesic agent for mild to
moderate pain. So, the over consumption of Aspirin can cause salicylate
toxicity
Hyperventilation causes respiratory alkalosis.

Q.27 Which movements will cause facet pain vs intervertebral foramen

pain?
Ans: Facet usually worsens with ext.
With foraminal pain if it causes stenosis then again worsens with ext.
Improves with flexion. This can have radiating symptoms too.

Q.28 How to measure the height for the armrest in a wheelchair?

 NPTEFF April posts Q&A
Ans: Measure from the seat of the chair to the olecranon process with
the user's elbow
9 inches above the chair seat
flexed to 90 degrees, and then add approximately 1 inch (Note: This
measurement will be affected if a seat cushion is to be used; the
person should be measured while seated on the cushion, or the thickness
of the cushion must be considered by adding that value to the actual
measurement)

Q.29 Does the NPTE follow the exception to the convex concave rule
when it comes to shoulder joint mobilizations for IR and ER? If a
question, ask what mobilization to perform to improve shoulder ER
should we put anterior or posterior?
Ans: To improve ER — anterior glide.
If it mentions Adhesive capsulitis, then NPTE does follow the exception
rule of posterior glide to improve ER

Q.30 What’s the difference between non-outlet and outlet impingement

of the shoulder?
Ans: The subacromial impingement syndrome has both primary and
secondary forms. Primary impingement is due to structural changes that
mechanically narrow the subacromial space (1); these include bony
narrowing on the cranial side (outlet impingement), bony malposition
after a fracture of the greater tubercle, or an increase in the volume of
the subacromial soft tissues – due, e.g., to subacromial bursitis or
calcific tendinitis – on the caudal side (non-outlet impingement).
Secondary impingement results from a functional disturbance of
centering of the humeral head, such as muscular imbalance, leading to
an abnormal displacement of the center of rotation in elevation and
thereby to soft tissue entrapment
 NPTEFF April posts Q&A
Q.31 Summary sheet with examples for reliable data, ratio, ordinal and
interval data
Ans:

Q32. Benediction hand is a result of Ulnar or Median nerve palsy?

Ans: Hand of benediction/ Bishop’s hand is a Ulnar nerve lesion. You
see MCP extension and IP flexion of the last two digits. It is due to
absence of action of 4th and 5th lumbricals supplied by the ulnar nerve.
Hand of Benediction can also be a median nerve injury issue, but that is
only when you see the Hand of benediction while attempting to make a
fist. When you try to make a fist and the first three digits do not flex- it
is a median nerve lesion
Summary: If you see a bishop’s band/ hand of benediction while
attempting to make a fist —-> Median nerve lesion
If you see it while you are opening a fist, or stationary deformity —->
Ulnar nerve lesion.

Q.33 Does Raynaud’s disease is contraindicated for iontophoresis and

what to consider for any peripheral arterial disease?
Ans: All vascular diseases are a contraindication for Electrical stim /
iontophoresis

Q.34 What nerve innervates the specific muscles of the thumb for each
motion?
Ans: Abductor pollicis - Radial
Flexor pollicis - median
 NPTEFF April posts Q&A
Adductor pollicis - ulnar

Q.35 What happen to subcostal angle in COPD?

Ans: widening of the subcostal angle due to lung hyperinflation

Q36. Any tables or charts for brachial plexus pathologies?

Ans: https://youtu.be/RLJ8aUw468M

Q.37 List of the ligaments in the knee and ankle and what are their
mechanisms of injury
Ans:
ACL- hyperextension
PCL- hyperflexion
MCL - valgus stress
LCL- Varus stress
Ankle
Lateral ankle sprain - PF and inversion mainly ATFL, CFL in inversion,
PTFL in DF and eversion
High ankle sprain - Tibiofibular sprain- DF and eversion

Q.38 DD for TMJ

Ans: Summary
Hypomobility—>> Less opening and deviation to same side
Disc displacement with reduction— >> Only Clicking, no problem with
mouth opening or deviation
Synovitis- Only pain and limited mouth opening, no deviation
Capsulitis- limited mouth opening and same side deviation

Q.39 What is the direction of the movement to open Right lumbar

foramen what should be direction of rotation
Ans: Oppo side bending and same side rotation

Q.40 exercise prescription for MS, obesity, dyslipidemia , DM

 NPTEFF April posts Q&A
https://docs.google.com/.../1-B0k0smvfKBrDnqGKtXP.../edit..

Q.41 3rd Degree AV block-→Stop and call EMS

Q.42 What are the exercise guidelines for diastasis recti based on size?
Ans: if it is >2cm - is significant and bracing/ stabilizing is priority
3cm - 4cm- Bracing with head tilts, then progress to head lift with ppt
combined with bracing
>4cm - bracing and breathing exercises no head lifts and ppt
If it is less than 2, no bracing needed just head lifts and ppt

Q.43 With Genu valgum is always tibial media rotation and genu varus
always tibial external rotation, right?
Ans: Genu valgum is IR of tibia, with pediatrics, with activities like
squatting and most of the times but it can also present as ER of tibia with
patellofemoral pain syndrome, females with increased Q angle.
Genu Varum is bowlegs so presents as IR of tibia

Q.44 **Predicted question on Cardiopulmonary section:

Cardio:
- Auscultation, Heart sounds, DPP (Rate pressure product)
- BP new values
- Changes in Vitals with Aquatic therapy, Altitude, Age, Exercise,
Pregnancy.
- Effect of beta blockers
- HR vs RPE (tricks to remember)
- Important tests: 6MWT, Bruce Protocol and Ergometry.
- ECG
- Criteria to terminate exercise.
- RT vs LT Heart failure.
- Cardiac Rehabilitation
- Exercise prescription and ACSM guidelines.
Pulmonary:
- Lung Volumes
 NPTEFF April posts Q&A
- Breath sounds, normal and abnormal
- COPD GOLD scale
- ABG
- Postural drainage
- Pulmonary DD
- Breathing exercises and Interventions

Q.45 What is the 1st CMC rolling and gliding mechanism?

Ans: Final Frontier Rule of Thumb: This is How We ROLL!
When we think of the rolling of the 1st digit, your 1st digit is giving you
the answers.
1) As we go into 1st digit FLX: The 1st digit is pointing to the ulnar side
of your arm. It’s telling you that it’s an ulnar roll. 2) As we go into 1st
digit EXT: The 1st digit is pointing to the radial side of your arm. It’s
telling you that it’s a radial roll. If you have trouble remembering which
is 1 digit EXT, think back to that anatomical snuff box and we have to
1st digit EXT to get that to be prominent
3) As we go into 1st digit ABD: The 1st digit is creating a “V” (1st &
2nd digit). It’s telling you that it’s rolling volar.
4) As we go into 1st digit ADD: The 1st digit is coming into your hand
(so you can slap this upcoming NPTE exam). It’s telling you that it’s
rolling dorsal.
5) 1st digit FLX/EXT is concave on convex, so roll/slide(glide) are
SAME 6) 1st digit ABD/ADD is convex on concave, so roll/slide(glide)
is OPPOSITE

Q.46 When to go for spinous process and when to go for transverse

process while giving PA glides?
Bilateral problem- always pick Spinous Process. If that is not in option,
you can also pick bilateral Transverse processes. (Not Unilateral)
 NPTEFF April posts Q&A
In the review, there was no correct option that said SP of T5., so you
picked b/l TP of T5
If the problem is Unilateral, right, or left opening/ closing restriction
then you can pick U/L TP

Q.47 What are the important things to know about cancer?

Ans: Important points to know about Cancer
Cancer:
Early warning signs (CAUTION)
C- Change in bowel or bladder
A- A sore that does not heal
U- Unusual bleeding/discharge
T- Thickening or lump in breast or elsewhere
I- Indigestion or dysphagia
O- Obvious change in a wart
N- Nagging cough or hoarseness lasting >4weeks
TNM – T = tumor, N = Lymph Node involved, M = Metastasis
Stage 0 – in situ
Stage 1 – T <2cm localized
Stage 2 – T, advances, with or without N involvement 2-5 cm
Stage 3 – T, localized and more advanced, with N involvement (Specific
type of cancer)
Stage 4 – Metastasis

Q.48 What are the important things about Hemophilia?

Ans: Hemophilia
Hemophilia is a bleeding disorder characterized by a deficiency in
clotting factors which are proteins responsible for stopping bleeding
after an injury. Hemophilia can be classified into two types: Hemophilia
A characterized by a deficiency in clotting factor VIII and Hemophilia B
characterized by a deficiency in clotting factor IX.
The main symptom of hemophilia is excessive bleeding or prolonged
bleeding after an injury, surgery, or around the time of a dental
procedure.
 NPTEFF April posts Q&A
Physical therapy- strengthening exercises to improve joint stability,
range of motion exercises to maintain flexibility, low-impact aerobic
exercises to promote cardiovascular health
Patients with hemophilia should take certain precautions to prevent
bleeding events, including avoiding activities that may increase the risk
of injury, wearing appropriate protective gear when engaging in sports
or other physical activities, maintaining good oral hygiene, and avoiding
the use of certain over-the-counter medications

Q.49 What is the difference between resting hand and intrinsic plus
position?
Ans: The only difference in resting hand and intrinsic plus position is the
IP position. The IP have slight flexion in resting hand and are
completely in extension for intrinsic plus to prevent contracture.

Q.50 If a patient experiences a right hemisphere stroke and experiences

contralateral homonymous hemianopsia, does this mean they will be
able to SEE to the RIGHT or are their left optic tract affected and they
will be able to see to the left?
Ans: With Right CVA -CL (left) HH - occurs so they won't be able to
see left temporal side and right nasal. Right optic nerve gets affected.

Q.51 What happen to hip flexors and abdominals in swayback posture?

Ans: back posture has anteriorly shifted pelvic, but the tilt is posterior
Weak hip flexors, tight hip extensors, tight upper Abs, and weak lower
abdominals

Q.52 Wallenberg syndrome and its signs and symptoms--

Ans: Cn 5,9,10,11 would be affected on same side of lesion
And pain and temp on oppo side

Q.53 Which kind of bladder will be seen in prostate hyperplasia?

Ans: Overflow

Q.54 Prosthetic gait variations depending on heels

 NPTEFF April posts Q&A
Ans: A too hard heel —->> excessive DF—->> leading to excessive
knee flexion
Soft heel —->> excessive PF—->> knee hyper extension
If a knee is extended — you want to DF the foot, so knee can go in
flexion

Early and Excessive are caused due to hard heel cushion and high heels
Delayed and inadequate are caused due to soft heel cushion and low
heels
Early and late happens in late stance whereas excessive and inadequate
seen in early stance.

Q.55 Which nerve root should be affected with disc herniation?

Ans: Here’s an example if we consider thoracic or lumbar L4-L5:
When it’s disc herniation (any direction), the exiting nerve root doesn’t
compress. It compresses the transversing nerve root. (The below one --
L5)
With stenosis/ Foramen compression - it will compress the above one
(the exiting one --L4)
For cervical: the nerve affected will be the one below. Example C6-C7,
C7 will be affected for stenosis and herniation.

Q.56 Difference between hold relax, Contract relax, and Hold relax
active contraction
Ans: Hold relax - Isometric contraction at end range and then stretch
into new range
Contract relax - isotonic contraction of muscle and stretch into new
range
Hold relax AC —- same as Hold relax, just that now you will actively
move into the new range (instead of passively stretching into new range)

Q.57 Is fine touch sensation carried by DCML or by ALST Tract?

Ans: Fine and light touch -DCML
 NPTEFF April posts Q&A

Q.58 Can someone explain why a posterior glide be more beneficial to

improve shoulder external rotation for someone with adhesive
capsulitis?
Ans: It shows more improvement

Q.59 For improving festinating gait in Parkinson's disease, what we can

improvise as a treatment plan?
Ans: A toe wedge as that will help with shifting weight backwards and
prevent anteropulsion.

Q.60 What modalities are absolute contraindications for patients with

cardiac pacemakers
Ans: Any electrical modality like E stim, TENS, HVPC, Iontophoresis
as the current will interfere with the pacemaker
US is contraindicated over and around the pacemaker site, but it is ok to
give it in a distal area.

Q.61 Intensity in resistance training post MI and CABG in terms of Lbs.

Ans: Use light weights/ bands :1-5 lbs
For CABG - after 8 weeks
MI- after 5 weeks

Q 62 In case of DM what is preferred exercise time early morning or

afternoon and what intensity is preferable moderate or vigorous?
Ans: Moderate intensity exercises preferred in the morning.

Q. 63 What is the difference between isotonic and concentric exercises?

Ans: Isotonic exercises refer to exercises that involve the movement of a
joint through a range of motion while resisting a constant amount of
resistance. In other words, the force required by the muscle to move the
weight stays the same throughout the exercise. Examples of isotonic
exercises include bicep curls, squats, push-ups, and lunges.
 NPTEFF April posts Q&A
Concentric exercises refer to exercises that involve shortening the
muscle fibers while generating tension or force. This is the phase of
movement where the muscle actively contracts, and the resistance
remains constant. Examples of concentric exercises include lifting a
weight during a bicep curl or pushing up during a push-up.

Q.64 Apgar score value with reference.

Ans: A score of 8 to 10 is considered typical for term newborns, and the
infant does not require
resuscitation.
Reference is Pediatric physical therapy textbook by Jen S. Tecklin

Q. 65 When EMG signal increase?

Ans:
EMG signals can increase during both force production and muscle
fatigue, but for different reasons. During force production, an increase in
EMG signal reflects recruitment of more motor units to generate greater
force output, whereas during fatigue the EMG signal may increase
initially but later decline as fatigue progresses through the muscle.

Q.66 Which of the Incomplete SCI syndromes have the best and worst
prognosis for Ambulation?
Best- Central cord
Worst-Brown sequard

Q. 67 How to interpret polyphasic waves? Those are considered normal

or abnormal?
Polyphasic potentials are generally considered abnormal, and are elicited
on voluntary contraction, not at rest.
They are motor unit potentials with five or more phases.
They are typical of myopathies, peripheral nerve involvement, and nerve
root compression.
Polyphasic potentials may also be seen during degeneration and after
regeneration of a peripheral nerve. As some muscle fibers become
 NPTEFF April posts Q&A
reinnervated, they will generate action potentials with voluntary
contraction.

Q.68 During wearing off phase of levodopa medicine in Parkinson

patient what we have to do?
Ans: Treat them at their best medicine time but also ask them to see their
physician so that the problem is fixed

Q.69 Obstructive vs Restrictive respiratory disease

Q.70 Diabetic Ulcer Staging→ Wagner classification

Q.71 UMM vs LMN signs and diseases/conditions mnemonic→

Ans: For UMN conditions, you can use the mnemonic "BASIC":
- *B*abinski sign
- *S*pasticity
- *C*lonus
UMN conditions -
For LMN conditions, you can use the mnemonic "WOLF":
 NPTEFF April posts Q&A
- *W*asting
- *O*f ischaemia
- *L*ow reflexes
- *F*asciculations

Q.72 From which SCI level patient will be independent for intermittent
catheter use?
Ans: C6 as they have tenodesis grip starting at this level

Q.73 PNF!
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Q.74 What is forefoot rocker? And when does it occur?

Think of forefoot rocker helping you assist in Push off phase ( plantar
flexors) so Terminal stance

Q.75 In contact precaution we should wear PPE upon room entry, or it

should be wear before room entry?
Ans: Gloves and gown: upon entering the room
Remove before leaving the room

Q.76 What is the correct sequence of removing Personal Protective

Equipment using Standard precautions?
Ans: Gloves, goggles, gown, mask. CDC guidelines.

Q.77 What’s the best study design for conclusive cause and effect
analysis
Ans: Randomized control trial
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Q.78 best exercise for acute lumbar disc posterior derangement?

Ans: Lumbar extension like prone on elbows/ hand

Q.79 What is the maximum number of sessions for Ultrasound→14

Q.80 C5 Myotome is shoulder abduction or elbow flexion?

Ans: For Myotome C5—shoulder abduction
C5 Nerve root/ SCI key muscles--- Elbow flexion