NPTE Neuromuscular Practice Questions

10 Free NPTE Neuromuscular Practice Questions (2026)

10 NPTE-style neuromuscular and nervous systems practice questions covering the second largest content area on the exam — 39 to 48 items per the official FSBPT blueprint. Stroke, spinal cord injury, Parkinson’s, MS, vestibular disorders, and peripheral neuropathy. Written and reviewed by a licensed Doctor of Physical Therapy.

Why neuromuscular matters

Neuromuscular and nervous systems is the second most heavily weighted content area on the NPTE with 39 to 48 scored items per the FSBPT blueprint — roughly 22 to 27 percent of the exam. It is also the area that surprises students most on exam day, particularly on pharmacology impacts, motor control principles, and differential diagnosis between similar neurological conditions.

0 of 10 answered
Stroke — Outcome Measures
Question 1 of 10
A 68-year-old male presents to an outpatient physical therapy clinic three weeks following a right middle cerebral artery (MCA) stroke. The patient exhibits left hemiparesis, with greater involvement of the upper extremity compared to the lower extremity. During the initial evaluation, which of the following tests would be MOST appropriate to quantify upper extremity motor impairment?
Differential Diagnosis
Question 2 of 10
A 68-year-old male presents to physical therapy with a recent onset of progressive, symmetrical ascending weakness and distal sensory loss. He reports having a mild respiratory infection two weeks prior to the onset of these symptoms. Examination reveals absent deep tendon reflexes in the lower extremities and diminished reflexes in the upper extremities. He has difficulty breathing when lying supine. Which of the following is the MOST likely diagnosis?
Spinal Cord Injury
Question 3 of 10
A 25-year-old male sustained a complete T4 spinal cord injury (ASIA A) three weeks ago. He has been medically cleared for aggressive rehabilitation and demonstrates good sitting balance. The patient’s goal is to maximize independence with functional mobility. Which of the following interventions is MOST appropriate to initiate FIRST?
Peripheral Neuropathy
Question 4 of 10
A 68-year-old male with a 10-year history of type 2 diabetes mellitus is referred to physical therapy due to progressive distal lower extremity weakness and sensory loss. He reports difficulty with balance and frequent falls. During the initial examination, which of the following sensory tests is MOST important to assess first?
Vestibular Disorders
Question 5 of 10
A 62-year-old male reports dizziness, blurred vision, and imbalance, particularly when turning his head quickly. He denies hearing loss or tinnitus. Examination reveals a positive Head Thrust Test to the right, and horizontal nystagmus that beats to the left. The patient also demonstrates a 3-line decrease on the Dynamic Visual Acuity test. Based on these findings, which of the following is the MOST likely diagnosis?
Parkinson’s Disease
Question 6 of 10
A 72-year-old male with Parkinson’s disease (H&Y Stage 2) reports increasing difficulty with freezing of gait (FOG) when navigating doorways in his home. He expresses frustration and fear of falling. Which of the following interventions is MOST appropriate to address his primary complaint?
Multiple Sclerosis
Question 7 of 10
A 45-year-old female with a recent diagnosis of multiple sclerosis (MS) is referred to physical therapy. During the initial evaluation, the patient reports experiencing fatigue that significantly impacts her daily activities. She describes the fatigue as both physical and mental, and notes that it worsens throughout the day, especially with physical exertion. Which of the following outcome measures is MOST appropriate for quantifying the impact of fatigue on this patient’s physical, cognitive, and psychosocial functioning?
Cerebellar Dysfunction
Question 8 of 10
A 68-year-old male presents to physical therapy with complaints of increasing difficulty with balance and coordination over the past 6 months. He reports a history of hypertension and hyperlipidemia, managed with medication. During the examination, the therapist observes dysmetria, intention tremor during finger-to-nose testing, and impaired rapid alternating movements. Gait analysis reveals a wide base of support and inconsistent step length. Sensation and strength are intact. Which of the following is the MOST likely diagnosis?
Stroke Rehabilitation
Question 9 of 10
A 68-year-old male presents to outpatient physical therapy three weeks following a right middle cerebral artery (MCA) stroke resulting in left hemiparesis. Examination reveals moderate motor impairment in the left upper extremity (Fugl-Meyer UE score of 22/66) and mild impairment in the left lower extremity. The patient exhibits good cognitive function and motivation. The MOST appropriate intervention to improve upper extremity function is:
Gait Analysis — Stroke
Question 10 of 10
A 68-year-old male presents to outpatient physical therapy following a stroke affecting the right middle cerebral artery. The patient exhibits left hemiparesis, and the therapist observes significant trunk lean to the left during ambulation. Which of the following is the MOST appropriate initial action for the physical therapist to perform during the examination?
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Neuromuscular is 22–27% of the NPTE — strong preparation is essential
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About This Content Area

NPTE Neuromuscular Practice Questions Breakdown

Neuromuscular and nervous systems is the second most heavily weighted content area on the NPTE-PT with 39 to 48 scored items per the official FSBPT blueprint. This section covers central nervous system, peripheral nervous system, and autonomic nervous system conditions — testing your ability to evaluate, diagnose, and treat neurological impairments across the lifespan.

What the neuromuscular section covers
→Stroke and traumatic brain injury
→Spinal cord injury rehabilitation
→Parkinson’s disease and movement disorders
→Multiple sclerosis and other demyelinating diseases
→Vestibular disorders and BPPV
→Peripheral neuropathies and nerve injuries
→Motor control and motor learning principles
→Pharmacology impacts on PT management

The neuromuscular section is where students are most frequently caught off guard on exam day. Unlike musculoskeletal content, which students generally feel confident about, neuro questions often require integration across multiple systems — recognizing when a patient presentation reflects a cerebellar lesion versus vestibular dysfunction versus cortical involvement, or knowing when pharmacological effects are altering the expected clinical picture.

The pattern to recognize

NPTE neuro questions frequently test your ability to select the MOST appropriate intervention from options that are all clinically valid in different contexts. A SCI patient may benefit from standing programs, FES cycling, body-weight supported treadmill training, and wheelchair training — but the question is asking which intervention should come first or matches the specific goal. Read for the nuance, not just the content.

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