50 Free NPTE Flashcards (2026)

Shoulder

What is the capsular pattern of the glenohumeral joint?

External rotation is most limited, then abduction, then internal rotation. A global loss of range of motion in this order points to adhesive capsulitis rather than a rotator cuff problem.

Shoulder special tests

The empty can (Jobe) test is positive. Which muscle is implicated, and what is the test position?

Supraspinatus. The arm is elevated to 90 degrees in the scapular plane with the thumb pointed down (internal rotation); pain or weakness against resisted elevation is positive.

Knee special tests

A positive Lachman test indicates injury to which structure, and at what knee angle is it performed?

Anterior cruciate ligament. The knee is held in 20 to 30 degrees of flexion while the tibia is drawn forward; it is the most sensitive clinical test for an ACL tear.

Hip

What motions are most limited in the capsular pattern of the hip?

Internal rotation, flexion and abduction, with internal rotation usually the greatest loss. This pattern is typical of hip osteoarthritis, the most common reason for total hip arthroplasty.

Ankle

Under the Ottawa ankle rules, what findings call for an ankle X-ray?

Pain in the malleolar zone plus either bone tenderness at the posterior edge or tip of the lateral or medial malleolus (distal 6 cm), or inability to bear weight for four steps both right after the injury and at the exam.

Arthrokinematics

State the convex-concave rule for joint mobilization.

When a convex surface moves on a concave surface, roll and glide occur in opposite directions. When a concave surface moves on a convex surface, roll and glide occur in the same direction.

Pediatric orthopedics

An overweight 13-year-old reports insidious hip and knee pain with a limp and limited hip internal rotation. What is the likely diagnosis and the correct action?

Slipped capital femoral epiphysis. It is a medical emergency for the growth plate: make the patient non-weight-bearing and refer immediately for imaging and orthopedic management.

Arthritis

How does morning stiffness differ between osteoarthritis and rheumatoid arthritis?

Osteoarthritis stiffness usually resolves within 30 minutes of moving. Rheumatoid stiffness lasts more than an hour and comes with symmetric small-joint swelling and systemic signs such as fatigue.

Hip special tests

In the Thomas test, the tested thigh rises off the table. If the knee also extends as the thigh is lowered, what is tight?

A rising thigh indicates hip flexor tightness (iliopsoas) that limits hip extension range of motion. If the knee drifts into extension when the hip is brought down, the rectus femoris is tight because it crosses both joints.

Ligament sprains

What distinguishes a grade III lateral ankle sprain from a grade II?

Grade III is a complete ligament tear with marked laxity on the anterior drawer and talar tilt tests, often with an empty end-feel. Grade II is a partial tear with some laxity but a firm end point.

Lumbar spine

Which exercise direction is favored for a patient with symptomatic spondylolisthesis, and which is avoided?

Flexion-biased exercise and trunk stabilization. Repeated or loaded lumbar extension is avoided because it increases shear at the slipped segment.

Joint positions

What are the loose-packed and close-packed positions of the glenohumeral joint?

Loose-packed: about 55 degrees of abduction and 30 degrees of horizontal adduction, used for mobilization. Close-packed: full abduction with external rotation, where the capsule is tightest.

Wrist and hand

After a fall on an outstretched hand, tenderness in the anatomical snuffbox suggests what, and why is it a concern?

A scaphoid fracture. The proximal pole has a poor blood supply, so a missed fracture risks avascular necrosis and nonunion; refer for imaging even if initial X-rays are negative.

Spinal cord syndromes

Describe the deficits in Brown-Sequard syndrome.

Ipsilateral loss of motor function, proprioception and vibration below the lesion; contralateral loss of pain and temperature beginning one to two levels below the lesion.

Spinal cord syndromes

What is preserved in anterior cord syndrome, and what is lost?

Preserved: proprioception, vibration and light touch (dorsal columns). Lost: motor function and pain and temperature sensation below the lesion, usually from flexion injury or anterior spinal artery damage.

Tone

Define a Modified Ashworth Scale score of 1+.

A slight increase in tone shown by a catch followed by minimal resistance through the remainder, less than half, of the range of motion.

Stroke recovery

What characterizes Brunnstrom stage 3 of motor recovery after stroke?

Spasticity is at its peak and voluntary movement is possible only within the limb synergy patterns. Movement outside synergy begins in stage 4.

Stroke

A patient with left hemiparesis actively pushes toward the weak side and resists correction. What is this, and what is the first treatment strategy?

Pusher syndrome, most common after right hemisphere stroke. Treat with visual vertical cues, such as aligning to a doorframe or mirror, in an upright environment so the patient can see and correct the tilt.

Parkinson disease

Why do external cues help gait in Parkinson disease, and which cue fits which problem?

External cues bypass the impaired basal ganglia circuits that generate internal movement timing. Rhythmic auditory cues (metronome) improve cadence and step length; visual floor lines help overcome freezing at thresholds.

Vestibular

What makes a Dix-Hallpike test positive for posterior canal BPPV, and what is the treatment?

Upbeating torsional nystagmus with vertigo that starts after a few seconds of latency, lasts under a minute and fatigues on repetition. Treat with the Epley canalith repositioning maneuver.

Brain injury

What are the three components and maximum scores of the Glasgow Coma Scale, and what total marks a severe injury?

Eye opening 4, verbal response 5, motor response 6, for a maximum of 15. A total of 8 or less is classified as severe brain injury.

Aphasia

Contrast Wernicke aphasia with Broca aphasia.

Wernicke (receptive): fluent speech that carries little meaning with poor comprehension; the patient is often unaware. Broca (expressive): effortful, nonfluent speech with comprehension largely intact; the patient is frustrated.

Cranial nerves

How do you tell a facial nerve (Bell) palsy from facial weakness caused by a cortical stroke?

Bell palsy is a lower motor neuron (LMN) lesion of CN VII, so the whole side of the face is weak, forehead included. A cortical stroke is an upper motor neuron (UMN) lesion and spares the forehead because it has bilateral cortical input.

Spinal cord injury

A patient with a T4 complete injury suddenly has a pounding headache, flushing above the chest and a blood pressure of 190/100. What is happening and what do you do first?

Autonomic dysreflexia, a medical emergency in injuries at T6 and above. Sit the patient upright, loosen clothing, find and remove the noxious stimulus (a blocked catheter is the most common), monitor blood pressure and call for medical help.

Exercise prescription

Why is heart rate an unreliable intensity guide for a patient taking a beta-blocker after a myocardial infarction, and what should you use instead?

Beta-blockers blunt the heart rate response to exercise, so a target heart rate underestimates effort. Use rating of perceived exertion, about 11 to 13 on the 6 to 20 Borg scale, or a dyspnea scale.

Cardiac surgery

List the standard sternal precautions after coronary artery bypass surgery.

For roughly six to eight weeks: no pushing, pulling or lifting more than 5 to 10 pounds, no reaching both arms overhead or behind the back, log roll to get out of bed, and hold a pillow to the chest when coughing.

Exercise testing

Name absolute indications to stop an exercise test.

A drop in systolic pressure of 10 mmHg or more with increasing workload plus other signs of ischemia, moderate to severe angina, neurologic symptoms such as ataxia or near-syncope, signs of poor perfusion, sustained ventricular tachycardia, or the patient asks to stop.

Pulmonary techniques

How does pursed-lip breathing help a patient with COPD?

Exhaling slowly through pursed lips creates back pressure that keeps small airways open longer, reducing air trapping and dyspnea. Cue a two-count inhale through the nose and a four-count exhale.

Energy cost

What is 1 MET, and roughly how many METs does climbing a flight of stairs require?

1 MET is resting oxygen consumption, about 3.5 mL of oxygen per kg per minute. Climbing a flight of stairs is roughly 4 METs, which is a common functional benchmark in early cardiac rehab after a myocardial infarction.

Exercise prescription

Write the Karvonen formula for target heart rate.

Target HR = (HRmax minus resting HR) times the desired intensity, plus resting HR. HRmax is estimated as 220 minus age. Using heart rate reserve accounts for the individual resting rate.

Airway clearance

Describe the postural drainage position for the posterior basal segments of the lower lobes.

Prone with the head down about 30 degrees (foot of the bed raised roughly 18 inches) and a pillow under the hips, so gravity drains the segment toward the main bronchus.

Pressure injuries

How is a stage 3 pressure injury distinguished from stage 4?

Stage 3 is full-thickness skin loss with subcutaneous fat visible; slough may be present but bone, tendon and muscle are not exposed. Stage 4 exposes bone, tendon or muscle.

Wound etiology

Contrast the typical presentation of an arterial ulcer with a venous ulcer.

Arterial: lateral malleolus or toes, punched-out with a pale base, very painful, diminished pulses, ABI below 0.9. Venous: medial malleolus, shallow with irregular edges, heavy exudate, hemosiderin staining, less painful.

Burns

Using the rule of nines, what percentage of body surface area does each region represent in an adult?

Head 9 percent, each arm 9, each leg 18, anterior trunk 18, posterior trunk 18, perineum 1.

Diabetes

A patient reports shakiness, sweating and confusion during a session. What blood glucose defines hypoglycemia, and what is the immediate response?

Below 70 mg/dL. Stop activity, give 15 grams of fast-acting carbohydrate (juice or glucose tablets), recheck in 15 minutes and repeat if still low; do not resume exercise until glucose is back above 100.

Diabetes

When should exercise be held because blood glucose is too high?

Do not exercise if glucose is above 250 mg/dL with ketones present, and use caution above 300 mg/dL even without ketones. Exercise in those states can worsen hyperglycemia.

Lymphedema

What are the stages of lymphedema, and what is the order of complete decongestive therapy?

Stage 0 latent, stage 1 pitting edema that reduces with elevation, stage 2 non-pitting fibrotic edema not reversed by elevation, stage 3 elephantiasis with skin changes. CDT: manual lymph drainage, compression bandaging, exercise and skin care.

Referred pain

A patient reports right shoulder and scapular pain with no mechanical pattern, worse after fatty meals. Which organ should you suspect?

The gallbladder. Gallbladder disease refers pain to the right shoulder and inferior angle of the scapula; visceral pain that does not change with movement or position warrants medical referral.

Referred pain

Where does kidney pain typically refer, and what quick test raises suspicion?

To the costovertebral angle and flank, often radiating to the groin. Pain reproduced by a fist percussion over the costovertebral angle (Murphy percussion) suggests kidney involvement and calls for referral.

Red flags

Name the red flags that make low back pain a surgical emergency for cauda equina syndrome.

Saddle anesthesia, new bladder or bowel dysfunction (retention or incontinence), bilateral leg weakness or sciatica, and loss of anal sphincter tone. Refer to the emergency department immediately.

Infection control

What precautions apply to a patient with Clostridioides difficile, and why is alcohol hand gel not enough?

Contact precautions with gown and gloves, and hand washing with soap and water. Alcohol-based hand rub does not kill C. difficile spores.

Fall risk

What Berg Balance Scale and Timed Up and Go results indicate elevated fall risk in older adults?

A Berg score below 45 out of 56 indicates increased fall risk. A Timed Up and Go of 13.5 seconds or longer is the common cutoff for community-dwelling older adults.

Assistive devices

How is a cane fitted, and in which hand is it held?

Handle at the level of the greater trochanter or wrist crease, giving about 20 to 30 degrees of elbow flexion. It is held in the hand opposite the involved leg and advances with that leg, so the cane shares the load during that leg's stance phase of the gait cycle.

Prosthetics

For a patient with a transtibial amputation, what defines a Medicare K3 functional level, and what prosthetic foot does it justify?

A community ambulator with variable cadence who can traverse most environmental barriers. K3 justifies energy-storing or dynamic-response feet; K2 limited community ambulators are typically fit with a SACH or single-axis foot.

Wheelchair fitting

Give the standard wheelchair seat width and seat depth measurements.

Seat width: widest hip or thigh measurement plus about 2 inches. Seat depth: distance from the posterior buttock to the popliteal fold minus about 2 inches, so the front edge does not press behind the knee.

Ultrasound

When do you choose 1 MHz versus 3 MHz therapeutic ultrasound?

1 MHz penetrates deeper, up to about 5 cm, for structures such as the hip. 3 MHz is absorbed in the first 1 to 2 cm for superficial tissue and heats roughly three times faster, so treatment time is shorter.

Electrical stimulation

List contraindications to electrical stimulation.

Over or near a cardiac pacemaker or implanted stimulator, over the carotid sinus, over the abdomen or low back during pregnancy, over an active deep vein thrombosis, over malignancy, and over areas with impaired sensation as a strong precaution.

Cryotherapy

What is the expected sequence of sensations during an ice application, and name two contraindications.

Cold, burning, aching, then numbness, usually over 10 to 20 minutes. Contraindications include Raynaud phenomenon, cold urticaria, cryoglobulinemia and regenerating peripheral nerves.

Informed consent

What must a patient be told for consent to physical therapy treatment to be informed?

The nature of the proposed treatment, its expected benefits and material risks, reasonable alternatives including no treatment, and the right to refuse or withdraw at any time, all in language the patient understands.

Diagnostic accuracy

Explain SnNout and SpPin.

SnNout: a highly sensitive test with a negative result rules the condition out, because it rarely misses true cases. SpPin: a highly specific test with a positive result rules the condition in, because it rarely flags people who do not have it.