National Physical Therapy Examination (NPTE) Practice Exam

During segmental breathing exercises for a patient with pleural effusion, where should the therapist apply manual counterpressure to expand the posterior basal segments?

1. Lower lateral costal area

2. Posterior lower ribs

3. Anterior midchest

4. Anterior lower ribs

The correct answer is: Posterior lower ribs

Applying manual counterpressure to the posterior lower ribs during segmental breathing exercises focuses on promoting expansion in the posterior basal segments of the lungs, which is particularly important for patients with conditions like pleural effusion. The posterior basal segments are located in the lower part of the lungs, towards the back, and the application of pressure here facilitates better lung expansion during inhalation. By targeting the posterior lower ribs, the therapist can help improve thoracic mobility and encourage deep breathing in those areas, which can be restricted due to fluid accumulation. This technique aids in improving ventilation and may assist with the clearance of secretions. In this context, the other options do not effectively target the posterior basal segments. The lower lateral costal area might indirectly influence the expanding areas of the lungs, but it's not specific enough to address the posterior segments directly. The anterior midchest and anterior lower ribs primarily engage the anterior aspects of respiratory mechanics and do not adequately stimulate the desired posterior lungs segments for optimal therapeutic outcomes in patients with pleural effusion.