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ABPTS WMS practice questions

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Question 1Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding best supports a diagnosis of stress urinary incontinence rather than urge urinary incontinence?

  1. Leakage is accompanied by incomplete bladder emptying
  2. Leakage is preceded by a strong sudden need to empty the bladder
  3. Leakage occurs with coughing or sneezing and stops with pelvic floor contraction Correct answer.
  4. Leakage occurs only at night during sleep

Explanation

Stress urinary incontinence is defined by involuntary loss of urine with increased intra-abdominal pressure such as coughing, sneezing, or exertion, and it typically resolves with a voluntary pelvic floor contraction. Urgency-predominant symptoms point instead toward urge incontinence.

Question 2Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient reports urine loss during exercise and is asked to perform a voluntary pelvic floor muscle contraction. Which instruction best cues a correct contraction?

  1. Squeeze and lift the muscles as if stopping urine and gas Correct answer.
  2. Take a deep breath and push the abdomen outward
  3. Tighten the buttocks and thighs together
  4. Bear down as if having a bowel movement

Explanation

A correct pelvic floor contraction is a squeeze and inward lift, often described as interrupting urine flow or holding back gas. Valsalva bearing down recruits abdominal pressure rather than elevating the pelvic floor.

Question 3Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which measurement is most appropriate for quantifying pelvic floor muscle strength during a digital vaginal examination?

  1. Goniometric range of hip internal rotation
  2. Pad weight gain over 24 hours
  3. Transabdominal ultrasound bladder volume
  4. Modified Oxford scale grading Correct answer.

Explanation

The modified Oxford scale grades the intensity of a voluntary pelvic floor contraction on a 0 to 5 ordinal scale during digital examination. The other measures assess different constructs such as joint motion, bladder volume, or leakage quantity.

Question 4Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which description is characteristic of a grade 2 anterior vaginal wall prolapse on physical examination?

  1. The anterior wall descends to the hymen but not beyond it Correct answer.
  2. The anterior wall descends to within 1 cm of the hymen
  3. The anterior wall remains well above the hymen with straining
  4. The anterior wall descends more than 1 cm beyond the hymen

Explanation

In the pelvic organ prolapse quantification system, stage 2 corresponds to the leading edge reaching the hymen and descending no more than 1 cm beyond it. Descent to the hymen is the defining landmark for stage 2.

Question 5Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A postpartum patient has a third-degree perineal tear. Which structure is involved in addition to the perineal body?

  1. Anal sphincter complex Correct answer.
  2. Obturator internus
  3. Sacrospinous ligament
  4. Urethral sphincter

Explanation

Third-degree tears extend through the perineal body and into the anal sphincter complex, while fourth-degree tears additionally involve the anal mucosa. The urethral sphincter, obturator internus, and sacrospinous ligament are not part of this classification.

Question 6Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding on history most strongly suggests diastasis recti abdominis in a postpartum patient?

  1. Sharp unilateral groin pain with hip extension
  2. A midline bulge or ridge with abdominal loading Correct answer.
  3. Pain with cervical rotation
  4. Nocturnal cramping in the calves

Explanation

Diastasis recti abdominis presents as a midline separation of the rectus abdominis with a visible or palpable ridge during head lift or other abdominal loading. Provocation with trunk flexion or loading is the typical clinical sign.

Question 7Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which assessment best screens for pelvic girdle pain related to pregnancy?

  1. Straight leg raise test
  2. Posterior pelvic pain provocation test Correct answer.
  3. FABER test of the hip
  4. Slump test

Explanation

The posterior pelvic pain provocation test loads the sacroiliac joint and is a validated screen for pregnancy-related pelvic girdle pain. It reproduces familiar pain with a posterior shear force through the thigh.

Question 8Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient in the third trimester reports supine dizziness and nausea during a mat exercise session. Which physiologic mechanism best explains this?

  1. Pelvic floor muscle fatigue
  2. Physiologic anemia of pregnancy
  3. Increased thoracic kyphosis
  4. Aortocaval compression by the gravid uterus Correct answer.

Explanation

In the supine position the gravid uterus can compress the inferior vena cava and aorta, reducing venous return and cardiac output and producing dizziness or nausea. This is relieved by left side-lying positioning.

Question 9Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which exercise modification is most appropriate for a patient at 30 weeks gestation who develops supine intolerance during exercise?

  1. Increase the duration of supine positioning
  2. Elevate the head of the table 30 degrees or use side-lying Correct answer.
  3. Perform the exercise in the prone position
  4. Continue supine exercise with ankles crossed

Explanation

Avoiding the fully supine position after the first trimester reduces aortocaval compression; semi-reclined or side-lying positions maintain venous return. Prone positioning is also impractical and poorly tolerated in late pregnancy.

Question 10Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding is most consistent with vulvodynia on examination?

  1. Painless genital ulceration
  2. Unilateral labial swelling with erythema
  3. Purulent vaginal discharge
  4. Localized provoked pain at the vulvar vestibule with cotton-swab testing Correct answer.

Explanation

Provoked vestibulodynia is identified by pain elicited with light cotton-swab pressure at the vestibule in the absence of identifiable infection or dermatosis. Swelling, discharge, and ulceration suggest infectious or dermatologic causes instead.

Question 11Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which outcome measure is most appropriate for tracking symptom severity and impact in a patient with chronic pelvic pain?

  1. Six-minute walk test distance
  2. Grip dynamometry
  3. Numeric pain rating scale with a validated pelvic pain questionnaire Correct answer.
  4. Timed up and go

Explanation

Chronic pelvic pain is best tracked with a pain intensity measure combined with a validated condition-specific questionnaire that captures functional and psychosocial impact. Performance tests and grip strength do not capture pelvic pain burden.

Question 12Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient reports deep dyspareunia and cyclic pelvic pain. Which diagnosis should be considered prominently in the differential?

  1. Diastasis recti abdominis
  2. Pubic symphysis dysfunction
  3. Stress urinary incontinence
  4. Endometriosis Correct answer.

Explanation

Cyclic pelvic pain with deep dyspareunia is a classic presentation of endometriosis, which requires medical referral for confirmation. The other conditions present with leakage, midline abdominal separation, or anterior pelvic pain respectively.

Question 13Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which referral is most urgent for a patient presenting with new pelvic pain and unexplained vaginal bleeding after menopause?

  1. Continue physical therapy and reassess in six weeks
  2. Immediate medical referral for evaluation of postmenopausal bleeding Correct answer.
  3. Recommend a course of NSAIDs and return to activity
  4. Initiate a pelvic floor strengthening program

Explanation

Postmenopausal bleeding is a red flag requiring prompt medical evaluation to exclude endometrial pathology. Physical therapy should not delay medical workup for this presentation.

Question 14Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which statement best describes the role of a pessary in the management of pelvic organ prolapse?

  1. It strengthens the levator ani directly
  2. It permanently repairs fascial defects
  3. It eliminates the need for pelvic floor muscle training
  4. It provides mechanical support to reduce prolapse symptoms Correct answer.

Explanation

A pessary is a removable device that supports the vaginal walls and uterus to reduce prolapse symptoms and may be combined with pelvic floor training. It does not repair tissue or strengthen muscle.

Question 15Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which bladder diary finding is most useful in distinguishing polyuria from frequency related to small voided volumes?

  1. Peak flow measurement
  2. Total 24-hour voided volume and number of voids Correct answer.
  3. Single post-void residual volume
  4. One-time urinalysis

Explanation

A bladder diary recording 24-hour volume and voiding frequency distinguishes high total output (polyuria) from frequent small voids typical of storage dysfunction. Post-void residual and urinalysis assess different questions.

Question 16Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which pelvic floor muscle training parameter is most consistent with evidence-based strengthening for stress urinary incontinence?

  1. Contractions performed only during episodes of leakage
  2. Progressive near-maximal contractions with endurance and quick-flick components Correct answer.
  3. Isometric holds performed once weekly
  4. A single daily maximal contraction held for two seconds

Explanation

Effective programs use progressive near-maximal contractions with both endurance holds and quick contractions, performed regularly over at least several weeks. Low-dose or reactive-only training is insufficient for strength gains.

Question 17Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding suggests that a patient is using a Valsalva strategy rather than a pelvic floor contraction during training?

  1. Downward bulging of the perineum with breath holding Correct answer.
  2. Gentle rise of the pelvic floor with inhalation
  3. Inward lift of the perineum with visible relaxation of the abdomen
  4. Sustained lift maintained during exhalation

Explanation

Bearing down with a held breath produces caudal movement of the pelvic floor and increased intra-abdominal pressure. A genuine contraction produces a cranial lift, ideally coordinated with breathing.

Question 18Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient with urge incontinence is learning bladder training. Which instruction best reflects the principle of graduated voiding intervals?

  1. Delay voiding by gradually increasing intervals while using urge suppression skills Correct answer.
  2. Restrict all fluids after noon
  3. Void only when the bladder is completely full
  4. Void every 30 minutes regardless of urge

Explanation

Bladder training uses urge suppression techniques and progressively lengthens the interval between voids to restore normal capacity and control. Fixed very short intervals or fluid restriction are not the core strategy.

Question 19Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which structure is most commonly implicated in the development of a rectocele?

  1. Round ligament
  2. Rectovaginal septum Correct answer.
  3. Obturator membrane
  4. Urethrovesical junction

Explanation

A rectocele results from weakness of the rectovaginal septum, allowing the anterior rectal wall to bulge into the posterior vaginal wall. The other structures are not part of posterior compartment support.

Question 20Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient reports leakage of stool and gas that she cannot control. Which term best describes this presentation?

  1. Rectal prolapse
  2. Fecal impaction
  3. Constipation
  4. Anal incontinence Correct answer.

Explanation

Anal incontinence is the involuntary loss of flatus, liquid, or solid stool, often related to sphincter or pelvic floor dysfunction. Impaction, constipation, and prolapse describe different bowel disorders.

Question 21Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which examination component is most important before prescribing pelvic floor muscle training for a patient with anal incontinence and a history of obstetric sphincter tear?

  1. Lumbar spine range of motion
  2. Digital assessment of anal sphincter tone and voluntary contraction Correct answer.
  3. Hip abductor strength testing
  4. Single-leg balance testing

Explanation

Assessing anal sphincter resting tone and voluntary squeeze identifies sphincter integrity and guides whether training alone is appropriate or referral is needed. The other tests do not evaluate the continence mechanism.

Question 22Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A patient with chronic pelvic pain demonstrates heightened sensitivity to light touch at the vulva and reports fear of intercourse. Which management approach is most appropriate initially?

  1. Pain education, graded exposure, and down-training of pelvic floor overactivity Correct answer.
  2. Immediate high-intensity pelvic floor strengthening
  3. Activity avoidance until pain resolves
  4. Repeated speculum examinations to desensitize

Explanation

Chronic pelvic pain with vulvar allodynia and fear-avoidance responds to multimodal care emphasizing pain neuroscience education, graded exposure, and relaxation or down-training. Aggressive strengthening or avoidance can worsen symptoms.

Question 23Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which factor most increases the likelihood that pelvic floor muscle training will succeed for stress urinary incontinence?

  1. Active untreated urinary tract infection
  2. Ability to perform a voluntary pelvic floor contraction with cranial lift Correct answer.
  3. Severe cognitive impairment without caregiver support
  4. Presence of a fixed stage 4 prolapse

Explanation

The ability to perform a correct voluntary contraction with inward lift is the key prerequisite for effective training. Untreated infection, advanced fixed prolapse, and inability to participate reduce the likelihood of success.

Question 24Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A runner reports urine leakage only at high-impact loading and has a strong voluntary pelvic floor contraction. Which intervention is most appropriate to add to her program?

  1. Coordination training integrating the pelvic floor contraction with running and impact tasks Correct answer.
  2. Prolonged bed rest
  3. Immediate surgical referral
  4. Fluid restriction during all exercise

Explanation

When strength is adequate but leakage occurs under specific high-demand loads, the priority is task-specific coordination and anticipatory contraction during impact. Rest, surgery, and fluid restriction are not first-line for this presentation.

Question 25Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding on a bladder diary most strongly suggests nocturia of nocturnal polyuria origin?

  1. Frequent small daytime voids with normal nighttime volume
  2. Post-void residual of 200 mL
  3. Leakage only with coughing
  4. Large nocturnal voided volume relative to total 24-hour volume Correct answer.

Explanation

Nocturnal polyuria is characterized by an excessive proportion of the 24-hour urine output produced at night. Frequent small daytime voids or activity-related leakage reflect different storage or stress patterns.

Question 26Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 28-year-old woman at 32 weeks gestation reports a 3-week history of sharp, shooting pain in the right buttock that radiates into the posterior thigh. She has no bowel or bladder changes and no saddle anesthesia. Which diagnosis is most likely?

  1. Pudendal neuralgia
  2. Pelvic girdle pain Correct answer.
  3. Sacroiliac joint dysfunction
  4. Lumbar disc herniation

Explanation

Pelvic girdle pain commonly presents in pregnancy with pain in the buttock radiating into the posterior thigh, without neurologic deficits. The absence of bowel/bladder changes and saddle anesthesia makes cauda equina unlikely, and pudendal neuralgia typically presents with perineal pain.

Question 27Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding on physical examination is most specific for pelvic organ prolapse?

  1. A visible bulge at the vaginal introitus Correct answer.
  2. Positive cough stress test
  3. Levator ani avulsion on palpation
  4. Presence of a cystocele on Valsalva

Explanation

A visible bulge at the vaginal introitus is a hallmark sign of pelvic organ prolapse and is often the presenting complaint. While cystocele is a type of prolapse, its presence alone on Valsalva without symptoms or visible bulge is less specific; cough stress test indicates stress urinary incontinence, and levator avulsion is a risk factor, not a specific sign of prolapse.

Question 28Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 45-year-old woman reports chronic pelvic pain for 6 months. She has dysmenorrhea, deep dyspareunia, and dyschezia. On examination, you note a fixed, retroverted uterus and nodularity in the posterior cul-de-sac. Which diagnosis is most likely?

  1. Chronic pelvic inflammatory disease
  2. Interstitial cystitis
  3. Irritable bowel syndrome
  4. Endometriosis Correct answer.

Explanation

The combination of dysmenorrhea, deep dyspareunia, dyschezia, and physical findings of a fixed retroverted uterus and cul-de-sac nodularity is highly suggestive of endometriosis. Interstitial cystitis typically presents with urinary urgency and frequency, pelvic inflammatory disease often has signs of infection, and irritable bowel syndrome lacks the gynecologic findings.

Question 29Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which outcome measure is most appropriate for assessing health-related quality of life in a woman with pelvic organ prolapse?

  1. Pelvic Floor Distress Inventory (PFDI-20)
  2. Patient Health Questionnaire-9 (PHQ-9)
  3. Pelvic Floor Impact Questionnaire (PFIQ-7) Correct answer.
  4. Visual analog scale for pain

Explanation

The PFIQ-7 is a condition-specific quality-of-life measure for women with pelvic floor disorders, including prolapse. The PFDI-20 assesses symptoms and distress, the VAS measures pain intensity, and the PHQ-9 screens for depression.

Question 30Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 60-year-old woman with urge urinary incontinence is starting a bladder training program. She currently voids every hour. What is the most appropriate initial goal?

  1. Void every 2 hours regardless of urge
  2. Restrict fluid intake to 1 liter per day
  3. Void every 30 minutes to prevent leakage
  4. Increase the interval between voids gradually, starting with 15-30 minute increments Correct answer.

Explanation

Bladder training uses gradual increases in voiding intervals to restore normal bladder capacity and control. Starting with small increments (15–30 minutes) and progressing as tolerated is evidence-based. Voiding more frequently or restricting fluids excessively is not recommended.

Question 31Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which muscle is most directly responsible for maintaining continence during a sudden increase in intra-abdominal pressure (e.g., coughing)?

  1. External anal sphincter
  2. Bulbospongiosus
  3. Puborectalis
  4. Levator ani Correct answer.

Explanation

The levator ani, particularly the pubococcygeus and puborectalis, contracts reflexively during increases in intra-abdominal pressure to support the pelvic organs and maintain continence. The bulbospongiosus and external anal sphincter have more specific roles in sexual function and fecal continence, respectively.

Question 32Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 35-year-old woman reports leakage of small amounts of urine during activities such as running and jumping. She has no urgency or frequency. Which type of urinary incontinence is most likely?

  1. Mixed urinary incontinence
  2. Urge urinary incontinence
  3. Overflow incontinence
  4. Stress urinary incontinence Correct answer.

Explanation

Stress urinary incontinence is characterized by leakage with increased intra-abdominal pressure (e.g., coughing, sneezing, exercise) without urgency. Urge incontinence involves a sudden strong desire to void, mixed incontinence has both components, and overflow incontinence is associated with incomplete bladder emptying.

Question 33Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 50-year-old woman with chronic pelvic pain reports pain with intercourse and involuntary tightening of the pelvic floor. On examination, she has increased tone and tenderness of the pelvic floor muscles. Which intervention is most appropriate initially?

  1. Kegel exercises to strengthen the pelvic floor
  2. Down-training with relaxation techniques and manual therapy Correct answer.
  3. Electrical stimulation to increase muscle strength
  4. Biofeedback to improve muscle contraction

Explanation

In patients with pelvic floor hypertonicity and pain, down-training techniques such as relaxation exercises, manual therapy, and biofeedback for relaxation are indicated. Strengthening exercises like Kegels or electrical stimulation to increase strength may exacerbate symptoms.

Question 34Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which factor is most important to assess before initiating a pelvic floor muscle training program for a woman with pelvic organ prolapse?

  1. History of hysterectomy
  2. Ability to perform a correct pelvic floor muscle contraction Correct answer.
  3. Presence of a cystocele
  4. Body mass index

Explanation

The ability to correctly contract the pelvic floor muscles is essential for effective training; without proper technique, exercises may be ineffective or harmful. While other factors influence management, they do not directly determine the ability to perform the training.

Question 35Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 42-year-old woman reports fecal urgency and occasional leakage of loose stool. She has a history of obstetric anal sphincter injury. Which assessment is most important to include in the physical examination?

  1. Digital rectal examination to assess anal sphincter tone and integrity Correct answer.
  2. Anorectal manometry
  3. Pelvic floor muscle strength grading
  4. Endoanal ultrasound

Explanation

Digital rectal examination is a simple, essential component of the physical therapy examination to assess anal sphincter tone and integrity, especially with a history of obstetric injury. Manometry and ultrasound are specialized tests that may be performed by other providers but are not the first-line physical therapy assessment.

Question 36Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which statement best describes the prognostic significance of a strong pelvic floor muscle contraction in a woman with stress urinary incontinence?

  1. It is unrelated to the outcome of conservative treatment
  2. It is associated with a better response to pelvic floor muscle training Correct answer.
  3. It indicates that surgery is the only effective option
  4. It suggests that the incontinence is due to intrinsic sphincter deficiency

Explanation

A strong voluntary pelvic floor muscle contraction is a positive prognostic factor for success with pelvic floor muscle training. It does not preclude conservative management; rather, it supports it.

Question 37Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 55-year-old woman presents with a 6-month history of increased urinary frequency and nocturia. She denies pain or urgency. Her bladder diary shows frequent small-volume voids throughout the day and night. Which is the most likely diagnosis?

  1. Nocturnal polyuria
  2. Bladder pain syndrome
  3. Urinary tract infection
  4. Overactive bladder Correct answer.

Explanation

Overactive bladder is characterized by urinary urgency, frequency, and nocturia, often with small voided volumes. The absence of pain and the frequent small-volume voids are typical. Nocturnal polyuria would show a large proportion of nighttime urine output, and UTI typically presents with dysuria and acute onset.

Question 38Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which finding on a bladder diary most strongly suggests nocturia due to nocturnal polyuria?

  1. Small voided volumes during the day
  2. Increased total daily urine output
  3. More than one-third of daily urine output occurring at night Correct answer.
  4. Voiding more than twice per night

Explanation

Nocturnal polyuria is defined as an increased proportion of urine output at night, typically greater than one-third of the 24-hour total. Voiding more than twice per night may be due to other causes, and small daytime volumes suggest frequency, not nocturnal polyuria.

Question 39Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

A 30-year-old woman is 6 weeks postpartum after a vaginal delivery. She reports urinary leakage when she coughs or sneezes. She is breastfeeding. Which is the most appropriate first-line management?

  1. Surgical consultation
  2. Electrical stimulation
  3. Vaginal pessary
  4. Pelvic floor muscle training Correct answer.

Explanation

Pelvic floor muscle training is the first-line conservative management for postpartum stress urinary incontinence. It is safe during breastfeeding and effective. Electrical stimulation, pessary, and surgery are considered when conservative measures fail.

Question 40Women's Health Physical Therapy Examination, Evaluation, Diagnosis, and Prognosis

Which statement best describes the role of pelvic floor muscle training in the management of pelvic organ prolapse?

  1. It is curative for all stages of prolapse
  2. It is only effective after surgical repair
  3. It should be avoided because it may worsen prolapse
  4. It can reduce prolapse symptoms and prevent worsening Correct answer.

Explanation

Pelvic floor muscle training is an effective conservative intervention for pelvic organ prolapse; it can improve symptoms and may prevent progression. It is not curative for all stages, and it is not harmful when performed correctly.

Question 41Women's Health Physical Therapy Intervention and Management

A patient in the second trimester of pregnancy reports urinary urgency and frequency with coughing and sneezing. Which intervention is the most appropriate first-line pelvic floor muscle training approach?

  1. Recommending breath-holding during all lifting tasks to stabilize the trunk
  2. Teaching a coordinated pelvic floor contraction before and during the increase in intra-abdominal pressure Correct answer.
  3. Prescribing rapid, forceful contractions performed only in standing
  4. Instructing a sustained maximal contraction held for 30 seconds several times daily

Explanation

The pelvic floor must contract in anticipation of and during rises in intra-abdominal pressure to prevent leakage, a strategy known as the knack or anticipatory co-contraction. This timing-based training is the appropriate first-line behavioral approach for stress leakage.

Question 42Women's Health Physical Therapy Intervention and Management

Which finding best indicates that a patient has correctly identified a pelvic floor muscle contraction during instruction?

  1. Contraction of the abdominal muscles with breath holding
  2. An inward and upward lift of the perineum with relaxation after the contraction Correct answer.
  3. Visible contraction of the gluteus maximus with hip extension
  4. A strong bearing-down effort that pushes the perineum outward

Explanation

A correct pelvic floor contraction produces a cephalad, inward lift of the perineum followed by a full relaxation. Bearing down or recruiting hip extensors indicates substitution rather than the target contraction.

Question 43Women's Health Physical Therapy Intervention and Management

A postpartum patient is being taught perineal wound care after a second-degree laceration. Which self-care instruction is most appropriate?

  1. Avoid all sitting for the first two weeks after delivery
  2. Apply continuous heat to the perineum for the first 48 hours
  3. Vigorously scrub the suture line with soap and water twice daily
  4. Perform perineal hygiene with front-to-back cleansing and keep the area dry Correct answer.

Explanation

Front-to-back cleansing limits fecal contamination of the healing suture line, and keeping the area dry reduces maceration and infection risk. Gentle hygiene is preferred over vigorous scrubbing or prolonged heat.

Question 44Women's Health Physical Therapy Intervention and Management

Which exercise is most appropriate for a patient with diastasis recti abdominis in the early postpartum period?

  1. Vigorous twisting trunk rotations against resistance
  2. Full sit-ups with feet anchored
  3. Double leg lowering from 90 degrees of hip flexion
  4. Transverse abdominis activation with pelvic floor co-contraction in a supported position Correct answer.

Explanation

Early intervention emphasizes deep abdominal activation with pelvic floor co-contraction to support the linea alba without increasing doming. Exercises that generate high intra-abdominal pressure or trunk shear are deferred.

Question 45Women's Health Physical Therapy Intervention and Management

A patient reports urine leakage during running. Which training parameter should be progressed first when designing a pelvic floor program?

  1. Adding load by using heavier ankle weights during running
  2. Increasing the duration and number of sustained contractions before adding impact Correct answer.
  3. Reducing the rest interval between contractions to zero
  4. Eliminating all functional activity until symptoms resolve

Explanation

Strength and endurance of the pelvic floor are built by progressive sustained contractions with adequate rest before impact activities are reintroduced. Impact loading should follow demonstrated capacity, not precede it.

Question 46Women's Health Physical Therapy Intervention and Management

Which condition requires referral before initiating an intensive pelvic floor strengthening program because strengthening may be contraindicated until it is addressed?

  1. Stress incontinence during coughing
  2. Postpartum weakness without pain
  3. Pelvic pain with significant levator hypertonicity Correct answer.
  4. Overactive bladder managed with bladder training

Explanation

When the pelvic floor is already hypertonic and painful, strengthening can exacerbate symptoms; downtraining and coordinated relaxation are prioritized. Strength training is appropriate once tone and pain are managed.

Question 47Women's Health Physical Therapy Intervention and Management

A patient with chronic constipation is being trained in defecation mechanics. Which instruction is most consistent with effective pelvic floor coordination?

  1. Perform a strong Valsalva maneuver while bearing down
  2. Strain with a held breath until complete evacuation occurs
  3. Relax the pelvic floor and use diaphragmatic breathing to support evacuation Correct answer.
  4. Clench the anal sphincter throughout the bowel movement

Explanation

Normal defecation requires relaxation of the pelvic floor and anal sphincter coordinated with diaphragmatic breathing and gentle abdominal support. Straining against a closed pelvic floor is counterproductive.

Question 48Women's Health Physical Therapy Intervention and Management

Which intervention best addresses urgency in a patient with overactive bladder as part of a behavioral program?

  1. Timed voiding at fixed short intervals with gradual interval lengthening Correct answer.
  2. Immediate voiding at the first sensation of urgency
  3. Fluid restriction to less than 500 mL per day
  4. Pelvic floor relaxation training alone

Explanation

Bladder training uses scheduled voids with progressive lengthening of intervals to restore normal capacity and reduce urgency. This is combined with pelvic floor strategies and appropriate fluid intake.

Question 49Women's Health Physical Therapy Intervention and Management

During pregnancy, which exercise modification is recommended as the uterus enlarges to reduce the risk of supine hypotension?

  1. Increasing supine exercise time to improve tolerance
  2. Performing all exercise in the Trendelenburg position
  3. Avoiding prolonged supine positions and using side-lying or inclined positions Correct answer.
  4. Continuing supine exercise with the head elevated 10 degrees

Explanation

After the first trimester, the gravid uterus can compress the vena cava in supine, reducing venous return and cardiac output. Side-lying or inclined positioning avoids this compression during exercise.

Question 50Women's Health Physical Therapy Intervention and Management

A patient is 6 weeks postpartum after cesarean birth and wants to return to running. Which criterion is most important to establish before beginning a graded running program?

  1. Achievement of full hip range of motion bilaterally
  2. Completion of a fixed 12-week waiting period regardless of symptoms
  3. Clearance based only on the absence of abdominal incision pain
  4. Adequate pelvic floor strength and load tolerance without pain, leakage, or doming Correct answer.

Explanation

Return to running after childbirth is guided by functional capacity, including pelvic floor strength, load tolerance, and absence of leakage, pain, or abdominal doming. Time alone is not a sufficient criterion.