October 10, 2015
Preparation Tips, Q & A with Iyke
Copyright © 2015 PT Final Exam

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BSc Physiotherapy (2000), MSc
Physiotherapy (2012), University of Lagos.
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Married with 3 kids.
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Heard about PTFE in November 2014.
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Passed the NPTE on my second attempt
(Feb, 2015).
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Sports enthusiast, avid basketball fan.
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Iyke@ptfinalexam.com

• Don’t break your routine – sleep times, meals, rest times, etc.
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Be confident and relaxed – if you can, take a break from studying a day before the exams and try not to cram on exam day.
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Eat something for breakfast / lunch – it’s a 5hr exam and you cannot survive on adrenaline alone.
(remember, don’t break your routine).
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Arrive early.

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Dress comfortably and appropriately.
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Clear your head – forget about previous exams, past questions, previous failures, number of attempts or personal challenges etc.
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Be mindful of the exam sections and plan your breaks in advance
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Mine for useful information but do not add information. Ignore distractors.

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Try to use up as much of the allocated time as possible (do not rush your answers).
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Do not panic if you are stumped or in a dilemma. Do not spend more time than is necessary on any particular question. Mark difficult questions and come back to them later when you have answered the other questions in the section.
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Always observe the test centre rules and regulations and do not even attempt to cheat.

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* (All questions are original and do not violate NPTE/FSBPT privacy terms).
Mrs Jones, a 65 year old cardiac patient, is on medication for an unrelated gastrointestinal discomfort. She religiously adheres to the prescribed dosage for a period of 4 weeks and a day. However, an adverse reaction is suspected when she inexplicably suffers a fit of violent convulsions following a momentary bout of disorientation. Serum electrolyte and arterial blood gas tests are ordered by the physician which are then reviewed together with other members of her health team. It is observed from the results that her blood PH is now 7.55
compared to 7.35 from 4weeks ago.
Mrs Jones is likely suffering from which acid-base disorder?
a) Metabolic acidosis b) Respiratory acidosis c) Metabolic alkalosis d) Respiratory alkalosis
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PH=-log (H+). It is a figure expressing the acidity or alkalinity of a solution on a logarithmic scale on which 7 is neutral. lower values are more acidic and higher values more alkaline. Blood PH is tightly regulated (7.35
-7.45).
As the numerical value of blood PH increases, alkalinity is indicated. However, increase in the value of hydrogen ion concentration indicates acidity.

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Respiratory acidosis or respiratory alkalosis results from abnormalities of the respiratory system. Metabolic acidosis or metabolic alkalosis results from all causes other than abnormal respiratory functions.
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Metabolic alkalosis occurs when ↑ bicarbonate accumulation or an abnormal loss of acids. PH > 7.45
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Continuous vomiting, ingesting antacids, diuretic therapy etc.
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Hyperexcitability of the nervous system (especially of PNS) leading to spasms and tetanic contractions, diarrhea, confusion, muscle cramping, convulsions, paresthesias etc.
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HCO3- > 26 mEq/L and PH > 7.40
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Metabolic acidosis occurs when there is accumulation of acids or bicarbonate loss. PH < 7.35
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Renal failure, starvation, diabetic/alcoholic ketoacidosis, poisoning etc.
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CNS depression leading to disorientation, compensatory hyperventilation, headache, weakness etc. may induce coma or lead to death if left untreated.
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HCO3- < 26 mEq/L and PH < 7.40
Metabolic
and respiratory acidosis and alkalosis https://www.youtube.com/watch?v=M7VTtGnZs2w

A middle-aged, male patient walks into your consulting room with a referral note and some printouts which represent the results of some diagnostic and imaging tests carried out earlier that week. As you both review his laboratory results, he is particularly concerned about a particular report which indicates,
‘…blood gas values with normal bicarbonate levels, decreased hydrogen ion [H+] concentration and depressed PaCO2 levels …’.
It is likely that the patient is suffering from which acid-base disorder?
a) Compensated metabolic acidosis b) Respiratory acidosis c) Metabolic alkalosis d) Respiratory alkalosis
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A 50 year old corporate executive has been referred for physical therapy to manage radiating pain secondary to spinal spondylosis worsened by prolonged sitting and neck flexion. During the digital examination of both the cervical and the lumbar spine, a familiar shooting pain was elicited when the
PT palpated the nerve roots between C5,C6 and L2,L3 vertebrae. The nerve roots identified are; a) C5, L2 b) C6, L3 c) C5, L3 d) C6, L2
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In general, nerve roots are named after the vertebra above them e.g. the nerve root that exits between the
L2 and L3 is L2. The cervical nerves are different.
Although there are only 7 cervical vertebrae, there are
8 cervical nerves, the first of which exits above the first cervical vertebra. So in the cervical spine, the nerves are labeled after the vertebrae below them e.g. if C5 -
C6 vertebrae are highlighted, then the nerve root that passes between them is C6.
In order to be clear, it's usually best to specify nerve roots by referencing both vertebrae.
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For more on spinal nerve roots and spinal architecture; http://neurology.about.com/od/Peripheral/a/Spinal-Nerve-Roots.htm

A middle-aged, endomorphic male is referred for physical therapy to manage low back pain with radiating symptoms. The patient is a smoker and works as a check-out teller in a large supermarket. The PT elects to carry out some additional tests in the PT gym which is about 100ft from the consulting room.
On arrival, and before any test is carried out, the patient reports pain in the right calf area which he describes further as, ‘cramping and appears to be radiating upwards towards my thighs and buttocks’. Which of the following conditions best represents the patient’s symptoms?
a) Radicular pain associated with sciatic nerve irritation.
b) Radiating pain as a result of disc herniation.
c) Claudication pain secondary to PAD/PVD d) Pain as a result of delayed onset muscular soreness (DOMS)
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A simple tip for telling the two conditions apart is that Individuals with vascular claudication have pain that starts in the feet or calves that radiates up toward their back and buttock. Whereas, spinal stenosis causes pain that starts in the back and buttock and radiates down toward the feet.
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Vascular claudication vs spinal http://www.healthcommunities.com/back-pain/vascularclaudication-versus-spinal-stenosis_jhmwp.shtml
stenosis.
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Differential diagnosis for physical therapists. CC Goodman and EK
Snyder. 2013, 5 th edition. Chapter 3, Pain types and Viscerogenic pain patterns, pgs 125,127.

A patient is status 2 weeks post CVA with right sided deficits. Prior to his therapy session, the PT asks how he is feeling. His response is effortless, longwinded and out of place. Furthermore, in the same response, he articulately describes his days in the army as both ‘fantabulistic’ and ‘nestlic’. He is apparently unperturbed by the fact that he is not being understood. The patient above presents with which type of neurologic deficit?
a) Global aphasia b) Broca’s aphasia c) Wernicke’s aphasia d) Conduction aphasia
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Temporal lobe, Wernicke’s area or regions of parietal lobe.
Frontal lobe (anterior speech center) of the dominant hemisphere.
Functional word output and speech production.
Poor word output.
Prosody is acceptable. Empty speech / jargon.
Speech lacks substance. Use of paraphasias and neologisms.
Dysprosodic speech
(impairment in the rhythm and inflection of speech)
Poor articulation and increased effort for speech.
Wernicke’s aphasia and conduction aphasia.
Broca’s aphasia and global aphasia.

won
lost

An amateur tennis player is referred for physical therapy to manage pain on the lateral aspect of her right wrist which makes it difficult for her to hold on to her racquet. Her physician’s referral note suggests a possible abductor pollicis longus involvement. Which special test or unique sign will best guide the PT to arrive at a preliminary diagnosis?
a) Phalen’s test b) Froment’s sign c) Finkelstein’s test d) Bunnel-Littler’s test
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FINKELSTEIN’S TEST
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De Quervain’s tenosynovitis is common with activities that rely on repetitive hand or wrist movement. Activities such as gardening, golf, racket sports or lifting a baby — can make it worse.
FROMENT’S SIGN
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Ulnar nerve compromise or paralysis
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Pain over the abductor pollicus longus and extensor pollicis brevis tendons.
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Patient makes a fist with the thumb tucked inside the fingers. PT ulnarly deviates the wrist.
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Adductor pollicis muscle paralysis.
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PT attempts to pull out a piece of paper held between the thumb and index finger. Patient flexes distal phalanx of the thumb.

Following a positive outcome with physical therapy to manage knee osteoarthritis suffered by her sister, a 50 year old woman elects to seek physical therapy intervention to help with her arthritis as well. During her screening, she indicates that she is concerned that the deformity of the small joints of her hands prevent her from painting. The PT observes bilateral MCP extension, PIP flexion and DIP hyperextension. This patient’s presentation describes; a) Ulnar drift b) boutonniere’s deformity c) Swan neck deformity d) Claw hand
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Boutonnière deformity (BD) can manifest itself acutely after trauma, but most BDs are found as the result of progressive arthritis. The proximal interphalangeal (PIP) joint of the finger is flexed, and the distal interphalangeal (DIP) joint is hyperextended (see the image below).
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Swan neck deformity is a deformity of the digits that consists of hyperextension of the PIP joints and compensatory flexion of the distal interphalangeal DIP joints. It is classically associated with Rheumatoid Arthritis.

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Pierre-Auguste Renoir (1841 – 1919) was a French artist who was a leading painter in the development of the
Impressionist style.
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Renoir first battled with rheumatism in the mid-1890s and the disease plagued him for the rest of his life disfiguring his hands leaving his fingers permanently curled.
PORTRÄT VON JEAN UND GENEVIÈVE
CAILLEBOTTE (1895)

53 seconds into an Olympic gold medal Taekwondo match, one of the combatants is knocked out cold following a precisely delivered round-house kick to the head. The medical team is only allowed unto the mat after an 8 second count by the referee. The unconscious protagonist is rigidly supine with the trunk and lower limbs in extension and both upper limbs held in flexion. This presentation describes; a) A deep coma according to the Glasgow coma scale b) Decerebrate rigidity c) Cog-wheel rigidity d) Decorticate rigidity
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Decorticate posturing, also called flexor response or mummy pose, is indicative of a corticospinal lesion at the level of the diencephalon. It usually means damage to the thalamus, the midbrain and the cerebral hemispheres which essentially controls thought, speech and memory. Recovery is possible but is often limited to staring and twitching.
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Decerebrate posturing is also called extensor posturing or decerebrate rigidity. It indicates a corticospinal lesion at the level of the brainstem that results in extension of the trunk and all extremities.
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Decerebrate posturing is considered a worse prognosis than decorticate posturing because of the brain stem damage. The brain stem regulates vital functions such as breathing and blood pressure etc. In addition, decerebrate posturing often manifests after the patient has been in a decorticate posture for a while.
http://head-nurse.blogspot.com/2010/10/abnormal-posturing-made-overly-simple.html

A 19 year old college athlete has been referred for physical therapy following injuries sustained in a ghastly fall after a failed dunk attempt. The PT in charge of the plan of care elects to test the cranial nerves as part of a comprehensive neurological screening. As part of the test, the PT asks the athlete to follow a pen with his eyes as the PT traces a line downwards and medially in the athlete’s visual field. A lesion to the inferior rectus muscle of the eyeball is suspected as the athlete is unable to follow this movement with both eyes.
Which cranial nerve is affected in this test?
a) Cranial nerve II b) Cranial nerve III c) Cranial nerve IV d) Cranial nerve VI
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Each extraocular muscle is innervated by a specific cranial nerve (CN):
•superior oblique (SO)—cranial nerve IV (Trochlear)
•inferior oblique (IO)—cranial nerve III (Oculomotor)
•superior rectus (SR)—cranial nerve III (Oculomotor)
•inferior rectus (IR)—cranial nerve III (Oculomotor)
•medial rectus (MR)—cranial nerve III (Oculomotor)
•lateral rectus (LR)—cranial nerve VI (Abducens)
The following can be used to remember the cranial nerve innervations of the six extraocular muscles: LR
6
(SO
4
)
3 i.e. the lateral rectus (LR) is innervated by CN 6, the superior oblique (SO) is innervated by CN 4, and the four remaining muscles (MR,
SR, IR, and IO) are innervated by C.N. 3.
http://www.tedmontgomery.com/the_eye/eom.html
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A PT is about to perform bedside therapy to a 61 year old male in the intensive care unit of a large hospital? The patient’s medical notes describes in detail the precautions suggested in order not to dislodge a soft flexible catheter that had been inserted through a vein into the patient’s pulmonary artery with the aid of fluoroscopy. The device described above is?
a) A Swan – Ganz catheter b) An arterial line c) A Hickman’s line d) A Central venous pressure catheter
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In medicine pulmonary artery catheterization (PAC) is the insertion of a catheter into a pulmonary artery. Its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs.
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A PT is carrying out a research to study the effects of plyometric training techniques on vertical leap among amateur volleyball players. At the conclusion of the study, the researcher subjects his data to statistical analysis and erroneously concludes that a significant relationship exists between the independent and dependent variables. This is an example of?
a) An alpha error b) A beta error c) A standard error of measurement (SE) d) A type II error
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An alpha error (or a type 1 error, or a false positive finding) occurs when a researcher rejects the null hypothesis (Ho) in favour of an alternate hypothesis (Ha) concluding that a significant difference exists or that a relationship exists between variables when in fact, none exists. Furthermore, if the level of significance is set at
0.01 for example, then there is a 1% chance of an alpha error occurring .
A beta error and a type II error mean the same thing and effectively cancel each other out as the correct option. It is also known as a false negative finding. It is when the researcher fails to reject (a statistical term meaning 'to accept') the Ho concluding that there is no significant difference between variables when in fact, there is one.
The standard error (SE) is the standard deviation of a sampling distribution of a statistic The term may also be used to refer to an estimate of that standard deviation, derived from a particular sample used to compute the estimate.

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The one you give after you see that ‘PASS’ against your name!
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BEST WISHES IN YOUR
EXAMS! From all of us at
PTFE .

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