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NZ Physio Registration study materials
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NZ Physio Registration practice questions

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Question 1Professional, ethical and legal practice

Under the Health and Disability Commissioner Act 1994, which Right of the Code of Health and Disability Services Consumers' Rights entitles a patient to an explanation of the options available and the expected costs before a physiotherapy procedure begins?

  1. Right 4, the right to services of an appropriate standard
  2. Right 6, the right to be fully informed Correct answer.
  3. Right 10, the right to complain
  4. Right 7, the right to make an informed choice and give informed consent

Explanation

Right 6 of the Code is the right to be fully informed, and it obliges the provider to give information about options, risks, and expected costs so the consumer can make a meaningful decision. Right 4 sets the standard of care itself, while Right 7 governs the giving of consent rather than the disclosure that precedes it.

Question 2Professional, ethical and legal practice

A physiotherapist wishes to publish a case study about a patient's unusual shoulder presentation in a professional newsletter. Which action best satisfies the Privacy Act 2020 and the Health Information Privacy Code?

  1. Publish because case studies are exempt from privacy rules when de-identified
  2. Ask a colleague to confirm the patient is unlikely to be recognised
  3. Obtain the patient's informed consent to the specific disclosure before publishing Correct answer.
  4. Publish after removing the patient's name and address only

Explanation

Health information may only be disclosed for a purpose other than that for which it was collected with the individual's authorisation or where another exception applies. Consent should be specific to the proposed publication and obtained before disclosure. De-identification reduces but does not eliminate privacy obligations, and a colleague's opinion is not a substitute for consent.

Question 3Professional, ethical and legal practice

A physiotherapist suspects that a colleague is practising while impaired by alcohol. Under the Health Practitioners Competence Assurance Act 2003, what is the most appropriate first step?

  1. Report the concern to the Physiotherapy Board through its notification process Correct answer.
  2. Discuss it only at the next team meeting without naming anyone
  3. Confront the colleague publicly so other staff witness the concern
  4. Wait until a patient is harmed before acting

Explanation

The HPCA Act establishes the Board as the responsible authority for protecting the public, and it accepts notifications about practitioners who may be unable to practise safely. A concern about impairment should be reported promptly to the Board so risk can be assessed. Public confrontation and delay both expose patients to avoidable harm.

Question 4Professional, ethical and legal practice

Which document published by the Physiotherapy Board of New Zealand sets the expected conduct for registered physiotherapists, including respectful communication and managing conflicts of interest?

  1. The Privacy Act 2020
  2. The Physiotherapy Board's Code of Conduct Correct answer.
  3. The Health Practitioners Competence Assurance Act 2003
  4. The Code of Health and Disability Services Consumers' Rights

Explanation

The Board's Code of Conduct articulates the professional and ethical standards expected of physiotherapists in New Zealand, including integrity, respect, and managing conflicts of interest. The Code of Rights protects consumers, the HPCA Act is the governing statute, and the Privacy Act governs information handling.

Question 5Professional, ethical and legal practice

A patient with capacity declines a recommended strengthening programme and asks to stop therapy. What is the correct professional response?

  1. Respect the decision, document the discussion, and offer alternatives or discharge Correct answer.
  2. Ask a family member to sign consent on the patient's behalf
  3. Record the patient as non-compliant and cease all contact
  4. Continue the programme because the referral requires it

Explanation

Right 7 of the Code confirms that a competent consumer may refuse services, and the physiotherapist must respect that choice. Good practice is to ensure the patient is informed, document the discussion, and discuss alternatives or appropriate discharge. Overriding a competent refusal would breach the Code.

Question 6Professional, ethical and legal practice

A physiotherapist is asked to provide treatment that they consider clinically inappropriate and outside their scope of competence. What is the most appropriate action under the HPCA Act framework?

  1. Decline and refer the patient to a practitioner with the relevant competence Correct answer.
  2. Delegate the treatment to a junior colleague
  3. Perform the treatment and document the concern afterwards
  4. Perform the treatment only if the patient signs a waiver

Explanation

Practitioners must work within their scope of practice and competence, and referring on protects the patient. Performing treatment outside competence, even with a waiver, does not remove the risk. Delegation to someone less competent compounds the problem.

Question 7Professional, ethical and legal practice

When must a physiotherapist obtain informed consent for a treatment such as dry needling?

  1. Only if the patient asks specific questions about the procedure
  2. Before the procedure, after explaining the nature, risks, benefits, and alternatives Correct answer.
  3. Only when the procedure is performed by a student
  4. After the first session, once the patient has experienced it

Explanation

Informed consent must be obtained before the intervention, following a discussion of the nature and purpose, risks and benefits, and reasonable alternatives, as required by Right 6 and Right 7. Consent obtained after the fact is not valid consent. The obligation applies regardless of who performs the procedure.

Question 8Professional, ethical and legal practice

A patient's employer requests a physiotherapist's report containing detailed clinical findings. Which approach best reflects the Health Information Privacy Code?

  1. Refuse all requests from employers as a matter of policy
  2. Disclose only what is necessary for the purpose, ideally with the patient's authorisation Correct answer.
  3. Send the report to a colleague at the employer for informal review
  4. Send the full clinical record because the employer is paying for treatment

Explanation

The Health Information Privacy Code limits disclosure to the purpose for which information was collected or a directly related purpose, and disclosure should be limited to what is necessary. Seeking the patient's authorisation is the safest route. Sending the full record or routing it informally exceeds what is required.

Question 9Professional, ethical and legal practice

A physiotherapist has a close personal relationship with a patient currently under their care. What is the most appropriate professional course of action?

  1. Transfer the patient's care to another physiotherapist and manage the conflict transparently Correct answer.
  2. Ask the patient to sign a statement accepting the risk
  3. Continue treatment but avoid documenting the relationship
  4. Continue treatment because the relationship predates the referral

Explanation

A personal relationship with a current patient creates a conflict of interest and impairs the objectivity and power balance of the therapeutic relationship. The appropriate response is to transfer care and manage the conflict openly. Documentation or patient waivers do not remove the underlying conflict.

Question 10Professional, ethical and legal practice

Under the HPCA Act 2003, which body is responsible for setting the scope of practice and ensuring physiotherapists are competent to practise in New Zealand?

  1. The Physiotherapy Board of New Zealand Correct answer.
  2. The Ministry of Health
  3. Accident Compensation Corporation
  4. The Health and Disability Commissioner

Explanation

The HPCA Act gives each responsible authority, in this case the Physiotherapy Board, the role of defining scopes of practice and maintaining competence requirements. The Ministry of Health sets policy, the Commissioner handles complaints under the Code, and ACC funds treatment.

Question 11Professional, ethical and legal practice

A physiotherapist is asked by a court to release a patient's clinical notes in litigation. What is the most appropriate response?

  1. Release the notes as required by law and inform the patient where practicable Correct answer.
  2. Refuse because the notes are confidential
  3. Release only a summary prepared by the physiotherapist
  4. Ask the patient to collect the notes and deliver them to the court

Explanation

Privacy law permits disclosure where it is required by law, such as a court order or subpoena. The practitioner should comply and, where practicable, inform the patient. Refusing a lawful requirement, substituting a summary, or shifting the burden to the patient is inappropriate.

Question 12Professional, ethical and legal practice

Which statement best describes the concept of cultural safety as it applies to physiotherapy practice in New Zealand?

  1. Requiring patients to disclose their ethnicity before treatment
  2. Learning basic greetings in te reo Māori for reception staff
  3. Assigning Māori patients to Māori clinicians whenever possible
  4. The practitioner examining their own biases and power in the clinical relationship to ensure the patient feels safe Correct answer.

Explanation

Cultural safety, as articulated in New Zealand health frameworks, requires practitioners to reflect on their own culture, biases, and the power imbalance in the clinical encounter so the patient experiences care as safe. It is not limited to language phrases, compulsory disclosure, or matching by ethnicity.

Question 13Professional, ethical and legal practice

A physiotherapist posts a photo on social media showing a patient's unusual gait from behind, without identifying features. Why might this still breach professional obligations?

  1. Because photographs of gait are never clinically useful
  2. Because the patient may be identifiable and consent for public disclosure was not obtained Correct answer.
  3. Because social media use is prohibited for registered physiotherapists
  4. Because only the Board may publish clinical images

Explanation

Even without a name, clinical images can identify a person, and public disclosure requires the patient's informed consent for that specific purpose. There is no blanket prohibition on social media, but professional and privacy standards apply. The clinical usefulness of the image is irrelevant to the disclosure question.

Question 14Professional, ethical and legal practice

A physiotherapist receives a referral for a patient whose treatment would exceed the physiotherapist's current competence in a specialised technique. Which principle from the HPCA Act and professional standards applies most directly?

  1. Practitioners must always refer to a medical practitioner
  2. Practitioners must accept every referral received
  3. Practitioners must practise within their scope of practice and maintain competence Correct answer.
  4. Practitioners may practise outside their scope if supervised informally

Explanation

The HPCA Act requires practitioners to practise within their defined scope and to maintain the competence needed for the services they provide. Accepting work beyond competence, or relying on informal supervision, does not satisfy this. Referral to an appropriate practitioner is the correct course.

Question 15Professional, ethical and legal practice

During a home visit, a physiotherapist notices signs suggesting an older patient may be experiencing elder abuse. What is the most appropriate action?

  1. Confront the family member suspected of abuse immediately
  2. Follow safeguarding processes, document concerns, and report to the appropriate agency Correct answer.
  3. Discuss the concerns with neighbours to gather more information
  4. Ignore the signs because the physiotherapist's role is musculoskeletal only

Explanation

Health practitioners have a professional and ethical duty to act on reasonable concerns about abuse or neglect, following safeguarding processes and documenting findings. Reporting to the appropriate agency protects the patient. Confrontation and discussing the matter with neighbours risk harm and breach confidentiality.

Question 16Professional, ethical and legal practice

A physiotherapist is a sole director of a clinic and also treats its patients. Which arrangement best manages the conflict between commercial interest and clinical duty?

  1. Disclose any financial interest in products recommended and base advice on clinical need Correct answer.
  2. Recommend the clinic's paid products because the physiotherapist owns the business
  3. Avoid telling patients about ownership to prevent confusion
  4. Offer commissions to staff who sell the most products

Explanation

A financial interest in products or services creates a conflict of interest that must be disclosed so patients can weigh the advice. Recommendations should be driven by clinical need, not revenue. Concealment and sales commissions intensify the conflict rather than manage it.

Question 17Professional, ethical and legal practice

A patient asks to see their physiotherapy clinical records. What is the correct response under the Health Information Privacy Code?

  1. Provide access in accordance with the Code, with limited exceptions such as risk of harm Correct answer.
  2. Charge an unlimited fee to discourage the request
  3. Refuse because clinical notes belong to the practitioner
  4. Provide access only if the referrer agrees

Explanation

The Health Information Privacy Code gives individuals a right of access to their own health information, subject to limited exceptions such as where disclosure would pose a serious threat to safety. Blanket refusal, third-party veto, and punitive fees are inconsistent with that right.

Question 18Professional, ethical and legal practice

Which of the following best describes the physiotherapist's obligation when obtaining consent from a patient with limited English proficiency?

  1. Use a qualified interpreter and confirm the patient understands the information Correct answer.
  2. Defer treatment indefinitely until the patient learns English
  3. Proceed once a family member offers to interpret
  4. Rely on written material in English and ask the patient to sign

Explanation

Valid informed consent requires that the patient actually understands the information, so a qualified interpreter should be used where language is a barrier. Relying on family members or English-only written material risks invalid consent. Indefinite deferral is unnecessary where interpretation is available.

Question 19Professional, ethical and legal practice

A physiotherapist is asked to supervise a student who will perform an assessment on a patient. Which statement best reflects the professional and legal position?

  1. The patient should be told the student's role and the supervising physiotherapist retains responsibility Correct answer.
  2. The student's involvement need not be disclosed if the patient is unlikely to notice
  3. Responsibility shifts entirely to the student once consent is given
  4. The student may obtain consent and treat independently without disclosure

Explanation

Patients are entitled to know who is providing their care and the student's role, and the supervising physiotherapist remains accountable for the service. Failing to disclose the student's involvement undermines informed consent. Responsibility does not transfer to the student.

Question 20Professional, ethical and legal practice

A physiotherapist discovers that a colleague has altered a patient's clinical notes to support an ACC claim. What is the most appropriate action?

  1. Discuss it with the patient and let them decide whether to report
  2. Keep quiet because the colleague is senior
  3. Alter the notes back without telling anyone
  4. Report the concern through appropriate channels, such as the employer and the Board Correct answer.

Explanation

Falsifying clinical records is a serious professional and legal breach that undermines trust and may constitute fraud. The appropriate response is to report through the employer's processes and to the Board as required. Silently correcting the notes or deferring to seniority conceals the misconduct.

Question 21Communication and cultural safety, including Te Tiriti o Waitangi obligations

Under Te Tiriti o Waitangi, which article guarantees Māori the same rights and privileges as British subjects, a guarantee now reflected in equitable access to physiotherapy services?

  1. Article the Third Correct answer.
  2. Article the Second
  3. Article the First
  4. The preamble

Explanation

Article the Third (te tuatoru) confers on Māori the same rights and privileges as British subjects, which in health policy underpins the expectation of equitable access and outcomes. Article the First addresses kāwanatanga (governance), and Article the Second addresses tino rangatiratanga over taonga. The preamble sets the context but grants no substantive right.

Question 22Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist working in a hospital outpatient clinic wants to apply the principle of partnership under Te Tiriti. Which action best demonstrates this?

  1. Ensuring all staff complete a one-off cultural awareness module
  2. Displaying a mihi whakatau poster in the waiting room
  3. Recording ethnicity data on the clinic's referral form
  4. Involving kaumātua and local Māori health providers when designing the clinic's referral pathway Correct answer.

Explanation

Partnership requires Māori to be involved as decision-makers in shaping services, not merely as recipients or symbols. Co-designing referral pathways with kaumātua and Māori providers shares power and reflects a genuine Treaty partnership. Posters, single training sessions and ethnicity fields are supporting measures but do not themselves transfer influence over service design.

Question 23Communication and cultural safety, including Te Tiriti o Waitangi obligations

In the Treaty principles framework used across the New Zealand health sector, which pair correctly names the three principles commonly cited alongside partnership?

  1. Professionalism and proficiency
  2. Prevention and rehabilitation
  3. Privacy and consent
  4. Participation and protection Correct answer.

Explanation

The widely used framework derived from the Royal Commission on Social Policy describes partnership, participation and protection. These three guide Crown and health-sector obligations to Māori. The other pairs belong to clinical, ethical or privacy domains and are not Treaty principles.

Question 24Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist greets a Māori patient with a mihi that includes their own pepeha. What is the primary purpose of this practice in a clinical setting?

  1. To demonstrate fluency in te reo Māori
  2. To satisfy a mandatory documentation requirement
  3. To establish who the clinician is and where they come from, building a relational connection Correct answer.
  4. To transfer decision-making authority to the patient's whānau

Explanation

A pepeha situates the speaker through whakapapa connections to people, land and water, creating relational context before the clinical encounter. It signals openness and reciprocity rather than testing language ability. It is not a documentation requirement and does not by itself shift decision-making authority.

Question 25Communication and cultural safety, including Te Tiriti o Waitangi obligations

A patient with limited English brings an adult daughter to interpret during a physiotherapy assessment. Which approach best reflects culturally safe communication?

  1. Defer the assessment until the patient learns sufficient English
  2. Use a trained interpreter and offer the daughter a supporting role with the patient's agreement Correct answer.
  3. Rely on the daughter because she knows the family best
  4. Speak only to the daughter and let her relay instructions

Explanation

Trained interpreters reduce clinical risk from errors, omissions and altered meaning, while family members may filter or soften information. The patient's autonomy and consent should determine who is present and in what role. Deferring care indefinitely is inequitable and unnecessary when interpreter services exist.

Question 26Communication and cultural safety, including Te Tiriti o Waitangi obligations

What does the concept of cultural safety, as developed in Aotearoa New Zealand nursing and midwifery education, require of the clinician?

  1. Adopting the cultural practices of the patient's community
  2. Memorising the customs of every ethnic group they may encounter
  3. Ensuring all staff share a single cultural viewpoint
  4. Critical self-reflection on their own culture and power, with the patient determining whether care feels safe Correct answer.

Explanation

Cultural safety shifts the focus from the practitioner's knowledge of others to the practitioner's own attitudes, biases and use of power. Safety is defined by the person receiving care, not by the clinician's self-assessment. It is not about becoming competent in every culture or adopting another's practices.

Question 27Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist wants to embed the Treaty principle of protection in their musculoskeletal service. Which action is most consistent with this principle?

  1. Actively identifying and removing barriers that cause poorer access and outcomes for Māori Correct answer.
  2. Offering a karakia before every appointment
  3. Ensuring the clinic's signage is bilingual
  4. Referring all Māori patients to a separate Māori service

Explanation

Protection obliges the Crown and its agents to safeguard Māori interests and wellbeing, which in practice means addressing inequities in access and outcomes. Bilingual signage is supportive but not sufficient. Automatic referral elsewhere can fragment continuity and is not what protection requires.

Question 28Communication and cultural safety, including Te Tiriti o Waitangi obligations

During a home visit, a patient indicates that decisions about their rehabilitation will be made together with their whānau. How should the physiotherapist respond?

  1. Document that the patient lacks capacity to decide
  2. Respect whānau involvement in decision-making while confirming the patient's own consent and preferences Correct answer.
  3. Insist the patient decide alone to protect confidentiality
  4. Ask the whānau to wait outside for all discussions

Explanation

Collectivist decision-making is a legitimate cultural preference, and clinicians should accommodate it while still confirming the patient's individual wishes and consent. Insisting on solo decision-making imposes a dominant cultural norm. Whānau involvement does not imply a lack of capacity.

Question 29Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist is preparing patient education material about falls prevention for a community with high Māori enrolment. What best reflects a commitment to equity and cultural relevance?

  1. Translating the existing English pamphlet word for word into te reo Māori
  2. Distributing the standard pamphlet earlier to Māori households
  3. Co-designing the resource with local Māori community members and testing it for readability and cultural fit Correct answer.
  4. Adding a Māori design motif to the cover of the standard pamphlet

Explanation

Equity-focused health communication involves the intended audience in designing content and checking that images, language and examples resonate. Literal translation may preserve inappropriate concepts and reading levels. Superficial design changes do not address relevance or comprehension.

Question 30Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist suspects a patient is not disclosing pain because of mistrust rooted in past experiences of healthcare. Which communication approach is most appropriate?

  1. Acknowledge the mistrust openly, explain what will happen and why, and offer choices about the assessment Correct answer.
  2. Ask a colleague to take over without discussing the concern
  3. Record a suspicion of non-compliance in the notes
  4. Proceed quickly to complete the assessment before the patient loses confidence

Explanation

Transparency about purpose and process, plus genuine choice, builds trust and addresses power imbalances that can suppress disclosure. Rushing the assessment reinforces mistrust. Handing over without explanation and labelling behaviour as non-compliance both avoid the relational issue.

Question 31Communication and cultural safety, including Te Tiriti o Waitangi obligations

Which statement best describes the practical meaning of kāwanatanga in a district health board or health agency setting?

  1. A ceremonial role held by kaumātua in governance meetings
  2. The Crown's right and obligation to govern, exercised so that it protects Māori health interests Correct answer.
  3. The right of Māori to manage all health services independently
  4. The absolute authority of clinicians over treatment decisions

Explanation

Kāwanatanga is the Crown's authority to govern, balanced by the duty to protect Māori interests and honour tino rangatiratanga. It is not clinical authority over patients or a ceremonial role. Tino rangatiratanga, not kāwanatanga, concerns Māori authority over their own affairs.

Question 32Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist uses a standardised outcome measure that has not been validated for the ethnic groups in their community. What is the most culturally safe response?

  1. Assume the measure is universally applicable because it is standardised
  2. Interpret results cautiously, consider the measure's limitations and use additional patient-reported information Correct answer.
  3. Adjust the scores using an assumed ethnic correction factor
  4. Stop using all outcome measures in that community

Explanation

Standardisation does not guarantee cross-cultural validity, so clinicians should recognise measurement limitations and triangulate with other information. Assuming universality can produce misleading conclusions. Invented correction factors lack an evidence base, and abandoning measurement entirely reduces accountability.

Question 33Communication and cultural safety, including Te Tiriti o Waitangi obligations

A kaumātua offers to open a physiotherapy group session with a karakia. How should the physiotherapist respond?

  1. Accept the offer, confirm with the group that this is welcome and allow those who prefer to opt out Correct answer.
  2. Decline because religious practice has no place in a health setting
  3. Replace the karakia with a moment of silence to avoid discomfort
  4. Accept but require all attendees to participate

Explanation

Accepting a karakia respects the cultural context while protecting individual choice, since participation should be voluntary. Refusing outright disregards the offer and local custom. Mandating participation or substituting a different ritual overrides the kaumātua's role and the group's preferences.

Question 34Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist is told a patient's whakapapa links them to a particular marae, and the clinician wants to build rapport. Which response is most appropriate?

  1. Listen respectfully and let the patient decide how much personal and cultural information to share Correct answer.
  2. Ask detailed questions about the patient's genealogy to demonstrate interest
  3. Assume the patient holds traditional health beliefs because of their whakapapa
  4. State the clinician's own knowledge of the local iwi to establish credibility

Explanation

Whakapapa is personal information and the patient controls its disclosure; the clinician's role is to listen and follow the patient's lead. Detailed questioning can feel intrusive and distracts from the clinical purpose. Assuming beliefs from ancestry is a form of stereotyping.

Question 35Communication and cultural safety, including Te Tiriti o Waitangi obligations

Which action best illustrates the Treaty principle of participation at an organisational level in a physiotherapy service?

  1. Providing a cultural competency course for new staff only
  2. Ensuring Māori are represented and heard in service planning, monitoring and evaluation Correct answer.
  3. Translating the clinic's consent form into te reo Māori
  4. Holding a whakatau once a year for staff

Explanation

Participation means Māori have genuine opportunities to contribute to decisions and monitoring, not just receive information. Training, translation and one-off events support capability but do not create ongoing involvement in governance and evaluation. The principle is about sharing influence over the service.

Question 36Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist receives a referral for a Māori patient with long-standing knee pain and notices the referral says the patient has been 'non-compliant' with previous care. What is the most appropriate first step?

  1. Reinforce the importance of compliance and set firm attendance rules
  2. Refer the patient back to the general practitioner for a behaviour plan
  3. Record the non-compliance and limit further appointments
  4. Explore with the patient what got in the way of previous care, including access, cost, transport and trust Correct answer.

Explanation

Apparent non-attendance often reflects structural barriers such as cost, transport, work commitments or mistrust rather than unwillingness. Exploring these factors is an equity-focused response and preserves the therapeutic relationship. Reinforcing compliance language and limiting access can compound inequity.

Question 37Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist's clinic collects ethnicity data but never analyses it against access or outcome indicators. Why is this a problem for meeting Te Tiriti obligations?

  1. The data are only useful for funding applications
  2. Ethnicity data should never be collected in a clinical setting
  3. Collection alone satisfies the Crown's obligation to monitor health outcomes
  4. Without analysis the data cannot reveal inequities or support the accountability needed for protection and participation Correct answer.

Explanation

Monitoring only delivers accountability when data are analysed and used to identify and address disparities. Collection without use cannot inform service change or demonstrate protection of Māori health interests. Ethnicity data are legitimately collected for equity monitoring, not solely for funding.

Question 38Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist is designing a discharge plan for a Māori patient whose whānau will provide most of the home support. Which approach best reflects culturally safe, Treaty-consistent practice?

  1. Write the plan for the patient alone to avoid burdening the whānau
  2. Arrange rest-home placement because whānau care is unreliable
  3. Agree the plan with the patient and whānau, acknowledging their roles and resourcing them with information and support Correct answer.
  4. Assume the whānau will manage without additional information

Explanation

Whānau often play a central caring role, and culturally safe discharge planning recognises and supports that role through shared decision-making and adequate information. Excluding whānau or withholding information undermines the plan. Assuming whānau care is unreliable reflects a deficit view and disrespects the patient's wishes.

Question 39Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist reflects that their department's waiting list rules disadvantage patients who cannot take time off work for weekday appointments. Which analysis best connects this to Te Tiriti obligations?

  1. The issue is an operational matter unrelated to the Treaty
  2. The rules create indirect inequity, so the service should review scheduling and offer alternatives such as evening or outreach clinics Correct answer.
  3. The rules are neutral because they apply to everyone equally
  4. The department should ask Māori patients to rearrange their work hours

Explanation

Formally neutral rules can produce substantively inequitable outcomes, and the protection principle requires services to identify and mitigate such barriers. Equality of rule application does not guarantee equity of access. Asking patients to absorb the burden or dismissing the issue as operational avoids the obligation to act.

Question 40Communication and cultural safety, including Te Tiriti o Waitangi obligations

A physiotherapist is asked to obtain informed consent for a procedure from a patient who prefers to discuss the decision with whānau first. What is the most appropriate action?

  1. Provide the information, allow time for discussion with whānau and confirm the patient's decision later Correct answer.
  2. Decline to treat the patient until they decide without consulting others
  3. Obtain consent immediately to avoid delaying treatment
  4. Ask the whānau to sign the consent form instead of the patient

Explanation

Informed consent requires adequate information and voluntary choice, and patients may legitimately take time to consult whānau. Allowing this space respects autonomy and cultural process. Pressuring immediate consent or transferring the signature to whānau undermines valid consent.

Question 41Patient assessment and clinical reasoning

A 45-year-old presents with sudden onset of severe low back pain after lifting a heavy box, with no red flags on screening. Which finding on physical examination most strongly supports a diagnosis of an acute lumbar disc herniation with radiculopathy?

  1. Pain reproduced by lumbar extension in standing
  2. Localised tenderness over the L4 spinous process
  3. Bilateral symmetrical reduction in lumbar flexion
  4. Positive straight leg raise on the affected side between 30 and 70 degrees Correct answer.

Explanation

A positive straight leg raise in the 30 to 70 degree range indicates tension on the lower lumbar nerve roots and is a recognised clinical sign of L5 or S1 radiculopathy from disc herniation. Local tenderness and restricted range of motion are non-specific findings common to many mechanical low back presentations.

Question 42Patient assessment and clinical reasoning

During assessment of a patient with suspected cervical radiculopathy, which clinical feature best distinguishes radicular pain from referred somatic neck pain?

  1. Pain that is eased by resting in supine
  2. Pain that is reproduced by active neck rotation
  3. Pain that is associated with palpable muscle spasm
  4. Pain accompanied by paraesthesia in a dermatomal distribution Correct answer.

Explanation

Radicular pain follows a dermatomal pattern and is frequently accompanied by paraesthesia or sensory change within that dermatome. Somatic referred pain tends to be more diffuse and does not respect dermatomal boundaries.

Question 43Patient assessment and clinical reasoning

A patient with a suspected rotator cuff tear is being assessed. Which test is most appropriate for identifying an infraspinatus or supraspinatus tendon tear specifically?

  1. Speed's test
  2. External rotation lag sign Correct answer.
  3. Yergason's test
  4. Lift-off (Gerber) test

Explanation

The external rotation lag sign assesses the integrity of the infraspinatus and supraspinatus tendons by detecting the patient's inability to maintain an externally rotated position. The lift-off test assesses subscapularis, while Speed's and Yergason's tests assess biceps pathology.

Question 44Patient assessment and clinical reasoning

A 62-year-old with knee osteoarthritis reports morning stiffness lasting 20 minutes. Which clinical feature most strongly suggests an inflammatory rather than mechanical arthropathy?

  1. Pain that is worse at the end of the day
  2. Crepitus on passive knee extension
  3. Stiffness that improves with activity
  4. Stiffness lasting more than 60 minutes Correct answer.

Explanation

Prolonged morning stiffness lasting more than 60 minutes is characteristic of inflammatory arthropathies such as rheumatoid arthritis, whereas mechanical osteoarthritis typically produces stiffness lasting under 30 minutes. Crepitus and end-of-day pain are features of mechanical joint disease.

Question 45Patient assessment and clinical reasoning

During assessment of a patient with an acute ankle sprain, which finding would most strongly warrant further imaging rather than proceeding with standard conservative management?

  1. Inability to bear weight for four steps immediately after injury and at assessment Correct answer.
  2. Tenderness on palpation of the anterior talofibular ligament
  3. Swelling over the lateral malleolus
  4. Mild bruising around the lateral ankle

Explanation

Inability to bear weight for four steps after injury and at assessment, together with bony tenderness, is a key component of the Ottawa ankle rules used to decide whether radiography is needed to exclude fracture. Lateral swelling, ligament tenderness and bruising are expected soft tissue findings.

Question 46Patient assessment and clinical reasoning

A patient presents with a 6-week history of progressive weakness in both hands and neck pain. Which red flag feature most strongly suggests the need for urgent medical referral?

  1. Pain that is relieved by rest
  2. Unilateral neck pain reproduced by rotation
  3. Progressive bilateral upper limb weakness with gait disturbance Correct answer.
  4. A history of a minor neck strain two months ago

Explanation

Progressive bilateral upper limb weakness with gait disturbance raises concern for cervical myelopathy or cord compression and requires urgent medical assessment. Unilateral mechanical neck pain and a history of minor strain do not carry the same urgency.

Question 47Patient assessment and clinical reasoning

When assessing a patient with suspected carpal tunnel syndrome, which combination of findings most strongly supports the diagnosis?

  1. Pain reproduced by resisted wrist extension with a positive Cozen's test
  2. Nocturnal numbness in a median nerve distribution with a positive Phalen's test Correct answer.
  3. Weakness of the little finger abduction with a positive Tinel's sign at the elbow
  4. Pain over the ulnar aspect of the wrist with a positive Froment's sign

Explanation

Carpal tunnel syndrome produces nocturnal numbness in the median nerve distribution, and Phalen's test increases carpal tunnel pressure to reproduce symptoms. Ulnar nerve findings or lateral epicondylitis signs point to different diagnoses.

Question 48Patient assessment and clinical reasoning

A patient with a suspected complete rupture of the Achilles tendon is being assessed. Which finding is most consistent with this diagnosis?

  1. Pain on resisted plantarflexion with an intact tendon contour
  2. Swelling over the lateral malleolus with a positive anterior drawer
  3. Reduced ankle dorsiflexion with a firm tendon on palpation
  4. A palpable gap in the tendon with a positive Simmonds-Thompson test Correct answer.

Explanation

A complete Achilles rupture typically produces a palpable gap in the tendon and a positive Simmonds-Thompson test, where squeezing the calf does not produce plantarflexion. The other findings describe tendinopathy or lateral ankle ligament injury.

Question 49Patient assessment and clinical reasoning

A 70-year-old patient reports a sudden onset of severe headache and neck stiffness two days after a minor fall. What is the most appropriate physiotherapy action?

  1. Withhold treatment and refer urgently for medical assessment Correct answer.
  2. Apply cervical traction to relieve muscle spasm
  3. Begin gentle cervical mobilisation and reassess in one week
  4. Provide a soft collar and home exercises

Explanation

Sudden severe headache with neck stiffness after trauma raises concern for serious pathology such as haemorrhage or fracture and requires urgent medical assessment before any physiotherapy. Proceeding with manual therapy or traction could be unsafe.

Question 50Patient assessment and clinical reasoning

Which assessment finding is most useful for identifying a lateral ankle ligament sprain rather than a syndesmotic injury?

  1. Pain on the squeeze test at mid-calf
  2. Pain on external rotation of the foot with a positive external rotation stress test
  3. Pain on palpation of the anterior inferior tibiofibular ligament
  4. Tenderness localised over the anterior talofibular ligament with a positive anterior drawer Correct answer.

Explanation

Tenderness over the anterior talofibular ligament with a positive anterior drawer indicates a lateral ligament sprain. Syndesmotic injury is suggested by pain over the anterior inferior tibiofibular ligament, a positive squeeze test, or a positive external rotation stress test.