Free NPTE-PTA Exam Flashcards

Initial examinations, evaluations, diagnosis, prognosis, and the plan of care are PT-only responsibilities. A PTA who is asked to 'evaluate' a new patient must redirect the task to the supervising PT, regardless of experience.

A PTA may modify interventions within the PT's established plan of care (e.g., progress reps, adjust resistance) but may not add new interventions, change goals, or alter the plan itself. Changes outside the plan require PT contact and a revised POC.

Most jurisdictions require general supervision in outpatient settings (PT available by telecommunication) and direct or on-site supervision for SNFs, home health, or students. Medicare Part B outpatient services require direct PT supervision of PTAs in private practice settings.

Stop treatment and contact the PT when patient status changes significantly, a new symptom appears outside the POC, the patient fails to progress, vital signs fall outside parameters, or an intervention requires re-evaluation. Document the contact and the PT's response.

Grade 3 = full ROM against gravity, no added resistance. Grade 3+ tolerates minimal resistance through full range. Functionally, grade 3 is the threshold for anti-gravity use of a limb; below 3 patients usually need substitution patterns or assistive devices.

The fulcrum is centered over the joint's axis of motion, the stationary arm aligns with the proximal segment's bony landmark, and the moving arm aligns with the distal segment. Misplaced fulcrum is the leading source of inter-rater goniometric error.

Shoulder flexion is approximately 0-180 degrees and abduction 0-180 degrees. Full abduction requires upward scapular rotation; if the scapula is fixed, motion is limited to roughly 120 degrees of glenohumeral contribution.

Glenohumeral capsular pattern is lateral rotation most limited, then abduction, then medial rotation. Recognizing this pattern points to capsular involvement (e.g., adhesive capsulitis) rather than isolated muscular restriction.

Avoid hip flexion past 90 degrees, adduction past midline, and internal rotation past neutral for the first 6-12 weeks. Teach patients not to cross legs, not to bend forward in a chair, and to use an elevated toilet seat and abduction pillow.

Avoid combined hip extension, adduction, and external rotation. Bridging and prone lying are typically restricted early. Precautions are usually less restrictive than posterior approach and may be lifted sooner per surgeon protocol.

Restoring active knee extension to zero is the top early priority because extension lag impairs gait stance phase. Prone hangs, terminal knee extension exercises, and patellar mobilizations are emphasized; avoid pillows behind the knee at rest.

Avoid open-chain knee extension in the 30-0 degree range early after reconstruction because it loads the graft. Closed-chain quadriceps work, weight-bearing as tolerated per protocol, and protected ROM in a brace are standard early.

When repeated lumbar extension shifts pain from the leg toward the lumbar spine, the symptom is centralizing—a favorable sign consistent with the McKenzie directional preference. Increasing peripheralization indicates the movement is contraindicated.

Resisted shoulder elevation in the scapular plane with the thumb pointed down (Jobe's test) loads the supraspinatus. Weakness or pain suggests supraspinatus tendinopathy or tear and should be documented and reported to the PT.

Resisted wrist extension with the elbow extended reproduces pain over the lateral epicondyle (extensor carpi radialis brevis origin). Treatment emphasizes eccentric wrist extensor loading and activity modification, not just stretching.

Grades I-II are small-amplitude oscillations used for pain modulation; grades III-IV are larger-amplitude into resistance for stiffness; grade V is a high-velocity thrust (manipulation) and is outside PTA scope. PTAs typically apply grades I-IV within the POC.

When a concave joint surface moves on a fixed convex surface, glide and roll occur in the same direction. When a convex surface moves on a fixed concave surface, glide is opposite the roll. Used to choose mobilization direction for restricted motion.

Stage 1 is flaccidity, stages 2-3 develop spasticity and stereotyped flexor/extensor synergies, stages 4-5 break out of synergy, stage 6 shows near-normal coordination. UE flexor synergy includes scapular retraction, shoulder abduction/ER, elbow flexion, forearm supination.

Grades muscle tone from 0 (no increase) to 4 (rigid in flexion/extension). 1+ adds 'catch followed by minimal resistance through less than half the range.' A PTA documents grade and reports new or worsening tone to the PT; medications are not within PTA scope.

External cues bypass impaired basal ganglia timing: visual lines on the floor, a metronome or counting aloud, and rhythmic auditory stimulation reduce freezing and improve stride length. Internal generation of movement is the impaired system.

Uhthoff phenomenon causes transient neurologic worsening with elevated core temperature. Exercise in a cool environment, use cooling vests, schedule sessions earlier in the day, and avoid hot whirlpools or sustained heat modalities.

C6 preserves wrist extensors, enabling tenodesis grasp—passive finger flexion with active wrist extension. Patients can typically self-feed with adaptive equipment, transfer with a sliding board, and propel a manual wheelchair with rim projections.

Medical emergency in SCI at T6 or above: sudden severe hypertension, pounding headache, sweating above the lesion, bradycardia. Stop treatment, sit the patient upright, loosen restrictive clothing, check for noxious stimulus (catheter kink, full bladder), call for help immediately.

Patient stands with feet together, arms at sides, eyes open then closed. Increased sway or loss of balance only with eyes closed suggests dorsal column (proprioceptive) deficit. Loss with eyes open suggests cerebellar or vestibular involvement.

14-item scale scored 0-56. Community-dwelling older adults scoring below 45 are at increased fall risk; below ~40 indicates high risk and supports use of an assistive device. PTAs administer per the POC and report scores to the PT.

Diagonal 1 flexion: shoulder flexion, adduction, external rotation with elbow flexion, forearm supination, wrist and finger flexion to the radial side—'hand to opposite ear.' Used for reaching across midline and self-feeding tasks.

Subjective exertion rating, 6-20 (or 0-10 modified). Ratings of 12-14 correspond roughly to moderate-intensity aerobic work. Useful when heart rate is unreliable (beta-blockers, atrial fibrillation, transplant patients).

Stop exercise for chest pain, drop in SBP >10 mmHg with increasing workload, SBP >180 or DBP >110 mmHg, new dysrhythmia, SpO2 <90%, severe dyspnea, dizziness, pallor, or claudication. Reassure, monitor recovery, and notify the PT.

Target HR = [(HRmax - HRrest) x intensity %] + HRrest. Preferred over straight percentage of HRmax because it accounts for resting fitness. Use the patient's measured HRmax when available; estimate (220 - age) only when measured value is not.

Typically 6-8 weeks: no lifting >10 lb, no pushing/pulling with the arms (including pushing up from a chair), no shoulder flexion or abduction >90 degrees against resistance, no driving. Teach 'cough pillow' splinting and log-roll transfers.

Inhale through the nose, exhale slowly through pursed lips for roughly twice the inspiratory time. Creates back-pressure that splints airways open, reduces air trapping, slows respiratory rate, and improves SpO2 during exertion.

Patient prone, head of bed 18-20 inches below horizontal (Trendelenburg ~30 degrees), pillow under hips. Percuss over the lower ribs. Avoid Trendelenburg with increased ICP, recent eye surgery, hiatal hernia, severe CHF, or uncontrolled hypertension.

Continuous 100% duty cycle is thermal—used for deep tissue heating, joint contractures, chronic conditions. Pulsed 20-50% duty cycle is non-thermal—used for acute inflammation and wound healing. 3 MHz penetrates 1-2 cm; 1 MHz penetrates 3-5 cm.

Do not apply over: malignancy, active epiphyseal plates, pregnant uterus or low back/abdomen in pregnancy, pacemakers, eyes, testes, deep vein thrombosis, areas of impaired sensation or circulation, acute infection, and over the carotid sinus or anterior neck.

TENS uses sensory-level current (no visible contraction) for pain modulation—conventional TENS is high-frequency, short pulse width. NMES uses motor-level current to produce muscle contraction for re-education or strengthening, typically 35-80 Hz, longer pulse widths, with a duty cycle including rest.

Patient progresses through cold, burning, aching, then numbness over roughly 10-15 minutes. Treatment endpoint is numbness or 15-20 minutes, whichever comes first. Avoid in Raynaud disease, cold urticaria, cryoglobulinemia, and over regenerating peripheral nerves.

Typical force is 7-10% of body weight for soft tissue stretch and 10-20% for disc/foraminal unloading, with neck flexed roughly 20-30 degrees to open lower cervical foramina. Contraindicated with rheumatoid arthritis (atlantoaxial instability), Down syndrome, and vertebral artery insufficiency.

Crutch tip 2 inches lateral and 6 inches anterior to the foot; axillary pad 2-3 finger-widths (~2 inches) below the axilla; handgrip set with elbow flexed 20-30 degrees. Weight bears through the hands, not the axillae, to avoid radial nerve compression ('crutch palsy').

Advance the walker first, then the weaker (involved) leg into the walker, then the stronger leg past the involved leg. Patient should not step into the walker—keep the walker slightly ahead. All four points contact the floor before weight transfer.

Cane is held in the hand OPPOSITE the involved (weaker) leg. This narrows the base of support deviation, reduces hip abductor demand on the affected side, and approximates a normal reciprocal gait pattern. Advance cane with the involved leg.

Seat width = widest hip measurement + 2 inches. Seat depth = posterior buttock to popliteal fossa minus 2 inches. Seat height allows 2 inches clearance between the popliteal fossa and the front edge. Improper fit increases pressure injury and postural risk.

Excessive lateral trunk lean over the prosthetic side in stance often reflects weak hip abductors (gluteus medius), a short prosthesis, or an abducted socket. Address with abductor strengthening and communicate suspected component issues to the PT.

A solid or posterior-leaf-spring AFO substitutes for weak dorsiflexors (e.g., post-stroke, peroneal nerve palsy) by holding the foot in neutral during swing. Check skin daily over malleoli and dorsum; an AFO that causes redness lasting >20 minutes is poorly fit.

Stage 3: full-thickness loss with visible subcutaneous fat; no exposed bone, tendon, or muscle. Stage 4: full-thickness loss exposing bone, tendon, or muscle, often with undermining or tunneling. Both require offloading; PTAs report worsening staging promptly.

ABI = highest ankle SBP / highest brachial SBP. 1.0-1.4 normal; 0.91-0.99 borderline; 0.71-0.90 mild PAD; 0.41-0.70 moderate; <0.40 severe. Compression therapy is contraindicated when ABI is below 0.7-0.8; share findings with the PT before applying compression.

Use a gait belt, count cadence aloud ('1-2-3 stand'), block the patient's knees, keep the patient's head over the feet, pivot in small steps. If the patient begins to fall, ease them to the floor by widening your stance and protecting the head—do not catch.

Control the descent using the gait belt: widen your base, step behind the patient, guide them down your thigh or onto the floor. After the fall, assess for injury, take vitals, notify the PT and nursing, and document the event objectively in the chart (not in an incident report).

Generally hold or modify treatment for resting HR <50 or >100 bpm, SBP >180 or <90 mmHg, DBP >110 mmHg, SpO2 <90%, blood glucose <70 or >300 mg/dL, or temperature >100.4 F. Verify against the established POC parameters and notify the PT.

S: subjective patient report. O: objective measurements and interventions performed. A: assessment of response within the POC (PTA writes within plan, not new diagnoses). P: plan for the next visit and communication to the PT. Sign with credential 'PTA.'

Overload: to gain strength, tissue must be loaded beyond habitual demand (via load, volume, or frequency). Specificity: adaptations match the type of training stimulus (concentric vs eccentric, speed, range, position). Both principles guide PTA progression within the POC.