20 free NPTE-PT practice questions

Correct answer: C · Orthostatic hypotension, since systolic pressure fell at least 20 mm Hg

The 2011 consensus definition (Freeman et al.) defines orthostatic hypotension as a sustained fall of at least 20 mm Hg systolic or at least 10 mm Hg diastolic within 3 minutes of standing. Systolic pressure fell 132 − 106 = 26 mm Hg, so the systolic criterion is met, and his lightheadedness fits. Either criterion is enough, so a diastolic fall of only 8 mm Hg does not make the response normal. A heart-rate rise of 12/min is not postural tachycardia syndrome, which the same statement defines in adults as a sustained rise of at least 30/min without orthostatic hypotension. Waiting 10 minutes adds nothing, because the criteria were met within 3. The safe next step is to return him to sitting or lying down, recheck, and report the finding.

Look for this next time: Orthostatic hypotension is a sustained drop of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing.

Correct answer: A · Airflow obstruction, because the FEV1/FVC ratio is about 0.48

Start with the ratio: FEV1/FVC = 1.4 ÷ 2.9 ≈ 0.48. The GOLD 2026 report confirms persistent airflow obstruction, the defining spirometric feature of COPD, when the post-bronchodilator FEV1/FVC is below 0.70, so this is an obstructive pattern; the low FEV1 then reflects how severe it is. A low FEV1 alone does not show restriction: restriction lowers FVC and total lung capacity, usually with a normal or high ratio, and lung volumes are needed to confirm it. A normal FVC does not make the test normal when the ratio is low. A mixed pattern would need reduced lung volumes as well, and an FVC of 85% of predicted is within the normal range.

Look for this next time: Check FEV1/FVC first: a post-bronchodilator ratio below 0.70 confirms airflow obstruction, as in COPD.

Correct answer: D · Perceived exertion of about 12 to 14 on the 6–20 Borg scale

Beta-blockers such as metoprolol blunt the heart-rate response to exercise, so targets from an age-predicted maximum (220 − 61 = 159/min, so 70% to 85% is about 111 to 135/min) may be out of reach or unsafe to chase. Without an exercise test on her current medication, cardiac rehabilitation sets intensity by perceived exertion, which stays useful with beta-blockade; the 2019 AACVPR/AHA/ACC statement on home-based cardiac rehabilitation targets 12 to 14 ("somewhat hard" to "hard") on the 6–20 scale, progressed by response and symptoms. A fixed 120 to 140/min zone ignores her medication and her low resting rate. Pushing the pace until heart rate plateaus is not a safe way to find intensity and could provoke ischemia.

Look for this next time: With a beta-blocker and no exercise test on current medication, set aerobic intensity by perceived exertion, not age-predicted heart rate.

Correct answer: B · Refer her for ankle radiographs before treatment, under the Ottawa Ankle Rules

The Ottawa Ankle Rules call for ankle radiographs when there is pain in the malleolar zone plus any one of: bone tenderness along the posterior edge or tip of the distal 6 cm of the lateral or medial malleolus, or inability to bear weight for four steps both right after the injury and at evaluation. Her posterior lateral malleolar tenderness meets the rule on its own, even though she walked in, so a fracture must be ruled out before treatment. Being able to take four steps does not cancel a positive tenderness finding. An anterior drawer test assesses ligament laxity, not fracture, and stressing a possible fracture is unsafe. The midfoot (foot) rule needs tenderness at the navicular or the base of the fifth metatarsal, which she does not have.

Look for this next time: Under the Ottawa Ankle Rules, tenderness at the posterior edge or tip of a malleolus warrants ankle radiographs, even if the patient can walk.

Correct answer: C · Right gluteus medius

When the left foot leaves the ground, the right limb is in stance. The hip abductors of the stance limb, chiefly the gluteus medius, hold the pelvis level against body weight acting on the unsupported side. When they are weak, the pelvis drops toward the swing side, so a left pelvic drop during right stance points to a weak right gluteus medius: an uncompensated Trendelenburg gait. A weak left gluteus medius would cause a right pelvic drop during left stance. Gluteus maximus weakness typically produces a backward trunk lean early in stance, and iliopsoas weakness affects hip flexion and limb advancement, not frontal-plane control of the pelvis.

Look for this next time: In a Trendelenburg gait, the pelvis drops on the swing side because the stance-limb gluteus medius is weak.

Correct answer: D · Stop weight-bearing activity and refer him urgently for hip imaging

Knee or thigh pain with a normal knee examination, a limp, limited hip internal rotation, and obligatory external rotation as the hip flexes, in an overweight child of about 10 to 16 years, points to slipped capital femoral epiphysis (SCFE). Hip disorders often refer pain to the knee, which is why the hip must be examined. SCFE needs prompt orthopedic referral with hip radiographs, and the child should avoid weight-bearing activity in the meantime, because further slipping can worsen the deformity and raise the risk of avascular necrosis. Strengthening for patellofemoral pain treats the wrong joint. Stretching with a 2-week recheck, or continued activity while watching for night pain, delays care for a condition that is usually treated surgically.

Look for this next time: Knee pain with limited hip internal rotation in an adolescent can signal SCFE: limit weight bearing and refer urgently.

Correct answer: A · Progressive exercise that targets both the hip and the knee musculature

The 2019 patellofemoral pain guideline from the APTA Academy of Orthopaedic Physical Therapy (Willy et al., JOSPT) gives its strongest (grade A) recommendations to exercise that targets the hip and the knee, to reduce pain and improve function. Ultrasound and interferential current followed by rest swap that loading for passive treatment, and rest delays it. Patellar mobilization used by itself, with no exercise, leaves out the core treatment, and vastus medialis EMG biofeedback cannot stand in for a progressive hip and knee program. Taping or foot orthoses can be short-term additions to exercise, not substitutes for it.

Look for this next time: For patellofemoral pain, make progressive hip- and knee-targeted exercise the core of care; passive treatments do not replace it.

Correct answer: B · Inferiorly, opposite to the direction the arm moves

The convex humeral head moves on the concave glenoid, so by the convex–concave rule it rolls in the direction the arm moves and glides in the opposite direction. As the arm abducts, the head rolls superiorly and must glide inferiorly; a restricted inferior glide limits abduction and lets the head ride up under the acromion. An inferior (caudal) glide, progressed toward the end of the available abduction range, therefore targets the limitation. A superior glide would drive the head toward the acromion. An anterior glide addresses a different direction of capsular restriction and is not the primary glide for abduction. Medial compression approximates the joint surfaces rather than stretching the capsule.

Look for this next time: When a convex surface moves on a concave one, glide opposite the movement: an inferior humeral glide improves abduction.

Correct answer: D · A canalith repositioning maneuver (Epley) for the right posterior canal

Vertigo provoked by rolling, with a short latency and upbeating torsional nystagmus that fades in under a minute on the right Dix-Hallpike test, identifies right posterior canal BPPV. The 2017 AAO–HNS clinical practice guideline on BPPV says clinicians should treat posterior canal BPPV, or refer for treatment, with a canalith repositioning procedure such as the Epley maneuver, and should not routinely treat it with vestibular suppressant medications. Brandt-Daroff exercises are a less effective option and not the first choice when repositioning is available. A barbecue roll treats horizontal canal BPPV, which is tested with the supine roll test and produces horizontal nystagmus. Gaze stabilization addresses vestibular hypofunction, not displaced otoconia.

Look for this next time: Upbeating torsional nystagmus on the Dix-Hallpike test means posterior canal BPPV; treat with canalith repositioning on that side.

Correct answer: C · AIS B, because sacral sensation is spared without motor sparing

Under the International Standards for Neurological Classification of Spinal Cord Injury (2019 revision), an injury is incomplete when any sensory or motor function is preserved in the lowest sacral segments, S4–S5, including deep anal pressure. With sacral sensory sparing but no voluntary anal contraction and no motor function more than three levels below the motor level on either side, the grade is AIS B, sensory incomplete. AIS A requires no sacral sensory or motor function at all, so an absent anal contraction alone is not enough. AIS C requires motor function below the level, either voluntary anal contraction or motor sparing more than three levels below the motor level. AIS D needs at least half of the key muscles below the neurological level at grade 3 or higher. The level of injury does not set the grade.

Look for this next time: Sacral sensory sparing without motor sparing more than three levels below the motor level is AIS B, a sensory incomplete injury.

Correct answer: A · Left anterior cerebral artery

The anterior cerebral artery supplies the medial frontal and parietal cortex, where the leg and foot are represented, along with frontal areas involved in bladder control and initiative. A left ACA occlusion therefore causes right-sided weakness and sensory loss that are greater in the leg than in the arm, often with urinary incontinence and abulia (slowed, reduced responses). A left middle cerebral artery stroke typically affects the face and arm more than the leg and, on the dominant side, causes aphasia, which he does not have. A right ACA stroke would affect the left leg. A posterior cerebral artery stroke mainly causes visual field loss, such as a contralateral homonymous hemianopia, rather than leg-predominant weakness.

Look for this next time: Contralateral leg-greater-than-arm weakness with incontinence or abulia points to an anterior cerebral artery stroke.

Correct answer: B · Moderate- to high-intensity walking practice on a treadmill and overground

The 2020 Academy of Neurologic Physical Therapy clinical practice guideline on locomotor function after chronic stroke, incomplete spinal cord injury, and brain injury (Hornby et al.) makes a strong recommendation for moderate- to high-intensity walking training to improve walking speed and distance in people more than 6 months after injury. The training is task specific, so the patient practices walking itself. It found lower-intensity walking and impairment-based training to have equivocal or limited efficacy, and its strong evidence says sitting and standing balance training without virtual reality should not be performed for these goals. Arm ergometry may build general fitness but gives none of the stepping practice his goal requires. He walks independently and responds normally to exercise, so he fits the guideline's population.

Look for this next time: For walking speed and distance after chronic stroke, prioritize task-specific walking practice at moderate to high intensity.

Correct answer: C · External cueing, such as floor lines or a metronome beat, during walking

The 2022 APTA clinical practice guideline for Parkinson disease (Osborne et al.) makes a strong recommendation that physical therapists implement external cueing to reduce motor disease severity and freezing of gait. Visual cues such as tape lines at doorways, and auditory cues such as a metronome or a music beat, give each step a target and a rhythm when internal timing fails. Rushing through a doorway shortens steps further and tends to provoke freezing. Resistance training is recommended for other goals, such as strength and motor severity, but training one muscle group does not target the freezing triggers. No assistive device reliably prevents freezing, so any device needs individual assessment and training.

Look for this next time: For freezing of gait in Parkinson disease, use external visual or auditory cues; rushing tends to provoke freezing.

Correct answer: D · Stage 3 pressure injury

The NPIAP staging system (2016) defines Stage 3 as full-thickness skin loss in which adipose tissue is visible and granulation tissue and epibole (rolled edges) are often present; slough or eschar may be visible, and undermining and tunneling may occur, but fascia, muscle, tendon, ligament, cartilage, and bone are not exposed. Stage 2 is partial-thickness loss with exposed dermis, and fat is not visible. A wound is unstageable only when slough or eschar obscures the extent of tissue loss; here the base can be seen. A deep tissue pressure injury is a persistent, non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin, not an open wound with granulation tissue.

Look for this next time: Visible fat without exposed fascia, muscle, tendon, or bone is a Stage 3 pressure injury when slough does not hide the base.

Correct answer: A · Have him take about 15 g of fast-acting glucose, then recheck in 15 minutes

A glucose below 70 mg/dL with symptoms is hypoglycemia. The ADA Standards of Care in Diabetes—2026 name glucose as the preferred treatment for a conscious person (about 15 g for most people; any glucose-containing carbohydrate can be used), a recheck 15 minutes later with repeat treatment if he is still low, and more food after recovery to prevent another low. Exercise waits until then. A warm-up now would drive glucose lower, because working muscle takes up glucose. Fat slows absorption, so cheese or nuts correct hypoglycemia too slowly. Resting for 30 minutes without treatment leaves the low untreated and lets it worsen.

Look for this next time: For conscious hypoglycemia below 70 mg/dL, give about 15 g of glucose, recheck in 15 minutes, and delay exercise.

Correct answer: B · ISL Stage II

The ISL 2023 consensus document describes Stage I as an early accumulation of protein-rich fluid that subsides with limb elevation; pitting may occur. In Stage II, limb elevation alone rarely reduces the swelling and pitting is manifest; later in Stage II, the limb may stop pitting as excess fat and fibrosis develop. Stage III is lymphostatic elephantiasis, in which pitting can be absent and trophic skin changes such as acanthosis, thickening, and warty overgrowths appear. Stage 0 is a latent or subclinical state in which lymph transport is impaired but swelling is not yet evident. Her swelling persists despite elevation and still pits, without trophic changes, so it fits Stage II.

Look for this next time: In ISL Stage II lymphedema, elevation alone rarely reduces swelling and pitting is manifest; trophic skin changes signal Stage III.

Correct answer: D · Stop the session and refer her for prompt medical evaluation

ACOG Committee Opinion No. 804 (2020, reaffirmed 2023) and ACOG's patient guidance list calf pain or swelling among the warning signs that should stop exercise during pregnancy, along with vaginal bleeding, regular painful contractions, amniotic fluid leakage, shortness of breath before exertion, dizziness, headache, chest pain, and muscle weakness affecting balance. Pregnancy raises the risk of venous thromboembolism, so new one-sided calf pain and swelling need prompt medical evaluation for deep vein thrombosis. Heat and massage over a possible clot are unsafe. Lowering the intensity, or only avoiding left-leg resistance work, keeps her exercising with an unexplained warning sign and delays the diagnosis. New chest pain or sudden breathlessness would make this an emergency.

Look for this next time: During pregnancy, new calf pain or swelling is a warning sign: stop exercise and arrange prompt medical evaluation for possible DVT.

Correct answer: C · Hold the cane in the left hand and move it forward with the right leg

A cane held on the side opposite the painful hip, and moved forward together with that limb, shares the load during right stance. Its long lever arm reduces the hip abductor force needed to keep the pelvis level, which lowers compression in the painful joint. Holding it in the right hand gives the right hip abductors little help. Moving the cane with the left leg breaks the reciprocal pattern, so the cane is off the ground when the painful limb bears weight. The handle should be at about the wrist crease or greater trochanter, giving roughly 20° to 30° of elbow flexion, not at waist height with a straight elbow. The 2019 ACR/Arthritis Foundation osteoarthritis guideline strongly recommends a cane when hip osteoarthritis affects walking, stability, or pain enough to need a device.

Look for this next time: For a painful hip, hold the cane in the opposite hand, move it with the painful leg, and set the handle at wrist-crease height.

Correct answer: A · Drug under the negative electrode (cathode), treatment time 10 minutes

Iontophoresis drives ions into the tissue by like-charge repulsion, so the drug goes under the electrode with the same polarity. Dexamethasone sodium phosphate is negatively charged, so it belongs under the negative electrode (cathode). The dose in mA·min is current × time, so time = dose ÷ current: 40 mA·min ÷ 4.0 mA = 10 minutes. Under the positive electrode, the drug would be attracted to the electrode rather than repelled into the tissue. A time of 160 minutes comes from multiplying 40 by 4.0 instead of dividing, and 36 minutes from subtracting 4.0 from 40. The skin under both electrodes should be checked before and after treatment, because high current density can burn it.

Look for this next time: In iontophoresis, place the drug under the like-charged electrode; treatment time is dose (mA·min) divided by current (mA).

Correct answer: B · Keep it below bladder level and off the floor, with the tubing free of kinks

The CDC/HICPAC 2009 guideline for preventing catheter-associated urinary tract infections says to keep the collecting bag below the level of the bladder at all times, not to rest it on the floor, and to keep the catheter and collecting tube free of kinks, so urine drains by gravity without backflow. Securing the bag low on the walker frame, or carrying it below bladder level, meets those goals. Hanging it above hip level lets urine flow back toward the bladder. Clamping the tubing obstructs drainage and is not part of routine catheter care. Disconnecting the bag breaks the closed drainage system, which the same guideline says to maintain, and raises the risk of infection.

Look for this next time: Keep a urinary drainage bag below bladder level, off the floor, and unkinked, and never break the closed system for mobility.