1
Maryland Physical Therapist (PT) Licensing Exam
2026/2027: The Complete NPTE-Style Q&A with Well-
Elaborated Answers & Rationales | 100% Verified
Solutions | Instant PDF Download
Exam Overview
The Maryland Board of Physical Therapy Examiners requires candidates to pass the NPTE (administered
by the Federation of State Boards of Physical Therapy, FSBPT) and a Maryland jurisprudence
exam covering state laws and regulations. The NPTE is a 5-hour, 250-question computer-adaptive test.
This practice exam is designed to mirror the difficulty, content, and reasoning style of the actual test.
NPTE-Style Practice Questions
Domain 1: Physical Therapy Examination (Questions 1–50)
1. A 72-year-old male presents with a 6-month history of progressive difficulty climbing stairs and rising
from a chair. He reports no pain. Manual muscle testing reveals symmetric proximal muscle weakness
(3/5) in the hip flexors and extensors. Distal strength is 5/5. Sensation is intact. Deep tendon reflexes are
absent. What is the most likely diagnosis?
A) Guillain-Barré syndrome
B) Polymyositis
C) Lumbar radiculopathy
D) Parkinson’s disease
Correct Answer : B
Rationale: Polymyositis is an inflammatory myopathy that typically presents with symmetric proximal
muscle weakness, no sensory loss, and often diminished or absent reflexes. Guillain-Barré usually
presents with ascending, distal weakness and areflexia. Lumbar radiculopathy would be asymmetric and
may involve pain. Parkinson’s disease presents with rigidity, bradykinesia, and tremor.
2. During the heel-rise test for a patient with suspected Achilles tendinopathy, which finding is most
consistent with a partial rupture of the Achilles tendon?
A) Pain with palpation of the tendon 2 cm above the calcaneus
B) Inability to perform more than 10 single-leg heel rises
,2
C) Pain relieved by ankle dorsiflexion
D) Swelling over the posterior ankle that resolves with rest
Correct Answer : B
Rationale: A partial rupture significantly reduces the ability to perform repetitive heel rises (≤10) due to
weakness. Pain is common in tendinopathy, but a reduced heel-rise count is a stronger sign of
mechanical insufficiency. Swelling and pain are less specific.
3. A 48-year-old female with breast cancer, metastatic to the lumbar spine, reports acute onset of
severe back pain radiating to the anterior thighs. Her lower extremity strength is 4/5 bilaterally,
sensation is diminished in the L3-L4 distribution, and she has urinary incontinence. What is
the priority action?
A) Prescribe a lumbosacral corset and instruct in body mechanics
B) Immediate referral for MRI of the spine
C) Begin a gentle stretching and strengthening program
D) Administer oral corticosteroids
Correct Answer : B
Rationale: The combination of metastatic disease, acute pain, radicular symptoms, and new urinary
incontinence suggests cauda equina syndrome, a neurosurgical emergency. Rapid MRI is required to
identify cord or root compression. Delaying imaging could lead to permanent paralysis or loss of
bowel/bladder function.
4. Which of the following outcome measures is most appropriate to assess balance in a patient with
mild-to-moderate Parkinson’s disease?
A) Berg Balance Scale (BBS)
B) Mini-BESTest
C) Timed Up and Go (TUG)
D) Functional Reach Test
Correct Answer : B
Rationale: The Mini-BESTest was developed specifically to evaluate dynamic balance and fall risk in
patients with Parkinson’s disease. While the BBS and TUG are also used, the Mini-BESTest has better
responsiveness to the balance deficits common in Parkinson’s.
5. A 35-year-old runner reports medial tibial pain that worsens with activity and improves with rest.
Palpation reveals tenderness along the posteromedial border of the tibia. There is no swelling or
erythema. Radiographs are normal. What is the most likely diagnosis?
,3
A) Tibial stress fracture
B) Medial tibial stress syndrome (MTSS)
C) Chronic exertional compartment syndrome
D) Popliteal artery entrapment syndrome
Correct Answer : B
Rationale: MTSS (shin splints) presents with diffuse tenderness along the posteromedial tibia without a
focal point of pain. A stress fracture would have a more focal, point-tender area and may eventually
show radiographic changes. Compartment syndrome is associated with pain with passive stretch and
often neurologic symptoms.
6. A patient 3 days post-total knee arthroplasty (TKA) has a knee flexion range of motion (ROM) of 55
degrees. What is the most appropriate initial intervention?
A) Static progressive splinting at 90 degrees of flexion
B) Gentle active-assistive and passive ROM within pain tolerance
C) Aggressive passive stretching to 110 degrees
D) Continuous passive motion (CPM) for 8 hours daily
Correct Answer : B
Rationale: Early ROM exercises are critical after TKA. The goal is to regain motion without causing
excessive inflammation or wound dehiscence. Aggressive stretching or prolonged CPM may delay
healing. A gradual, pain-limited approach is recommended.
7. Which of the following special tests is most specific for the diagnosis of anterior cruciate ligament
(ACL) rupture?
A) Anterior drawer test
B) Lachman test
C) Pivot shift test
D) Valgus stress test
Correct Answer : B
Rationale: The Lachman test is both highly sensitive and specific for ACL tears, especially when
performed at 20-30 degrees of knee flexion. The pivot shift test is very specific but less sensitive,
especially in the acute setting.
8. A 25-year-old volleyball player has recurrent anterior shoulder instability. A positive apprehension
and relocation test suggests:
A) Rotator cuff tear
B) Anterior glenohumeral instability
, 4
C) Acromioclavicular joint separation
D) Superior labral tear (SLAP lesion)
Correct Answer : B
Rationale: The apprehension test (passive abduction and external rotation) recreates the sensation of
impending anterior dislocation, confirming anterior instability. The relocation test (posterior pressure)
relieves the apprehension.
9. A 60-year-old male with right-sided weakness after a stroke is learning to use a quad cane. When
instructing the patient, the cane should be held in:
A) The right hand
B) The left hand
C) Either hand
D) The hand opposite the weaker leg
Correct Answer : D
Rationale: The cane is held in the hand opposite the weaker leg to reduce the load on the weak side and
improve balance. For a right-sided weakness, the cane is held in the left hand.
10. A patient with acute low back pain has a negative straight leg raise test, no neurologic deficits, and
no red flags. What is the most appropriate recommendation?
A) Bed rest for 2 days
B) Continue normal activities with modifications
C) Lumbar traction
D) Surgical consultation
Correct Answer : B
Rationale: Current guidelines advise against bed rest. Patients should remain active as tolerated. Only
5-10% of acute low back pain becomes chronic; early activity improves outcomes.
11. A 42-year-old female with fibromyalgia reports widespread pain, fatigue, and poor sleep. The most
effective initial intervention is:
A) High-intensity resistance training
B) Low-impact aerobic exercise (walking, swimming) and education
C) Spinal manipulative therapy
D) Trigger point injections
Correct Answer : B
Maryland Physical Therapist (PT) Licensing Exam
2026/2027: The Complete NPTE-Style Q&A with Well-
Elaborated Answers & Rationales | 100% Verified
Solutions | Instant PDF Download
Exam Overview
The Maryland Board of Physical Therapy Examiners requires candidates to pass the NPTE (administered
by the Federation of State Boards of Physical Therapy, FSBPT) and a Maryland jurisprudence
exam covering state laws and regulations. The NPTE is a 5-hour, 250-question computer-adaptive test.
This practice exam is designed to mirror the difficulty, content, and reasoning style of the actual test.
NPTE-Style Practice Questions
Domain 1: Physical Therapy Examination (Questions 1–50)
1. A 72-year-old male presents with a 6-month history of progressive difficulty climbing stairs and rising
from a chair. He reports no pain. Manual muscle testing reveals symmetric proximal muscle weakness
(3/5) in the hip flexors and extensors. Distal strength is 5/5. Sensation is intact. Deep tendon reflexes are
absent. What is the most likely diagnosis?
A) Guillain-Barré syndrome
B) Polymyositis
C) Lumbar radiculopathy
D) Parkinson’s disease
Correct Answer : B
Rationale: Polymyositis is an inflammatory myopathy that typically presents with symmetric proximal
muscle weakness, no sensory loss, and often diminished or absent reflexes. Guillain-Barré usually
presents with ascending, distal weakness and areflexia. Lumbar radiculopathy would be asymmetric and
may involve pain. Parkinson’s disease presents with rigidity, bradykinesia, and tremor.
2. During the heel-rise test for a patient with suspected Achilles tendinopathy, which finding is most
consistent with a partial rupture of the Achilles tendon?
A) Pain with palpation of the tendon 2 cm above the calcaneus
B) Inability to perform more than 10 single-leg heel rises
,2
C) Pain relieved by ankle dorsiflexion
D) Swelling over the posterior ankle that resolves with rest
Correct Answer : B
Rationale: A partial rupture significantly reduces the ability to perform repetitive heel rises (≤10) due to
weakness. Pain is common in tendinopathy, but a reduced heel-rise count is a stronger sign of
mechanical insufficiency. Swelling and pain are less specific.
3. A 48-year-old female with breast cancer, metastatic to the lumbar spine, reports acute onset of
severe back pain radiating to the anterior thighs. Her lower extremity strength is 4/5 bilaterally,
sensation is diminished in the L3-L4 distribution, and she has urinary incontinence. What is
the priority action?
A) Prescribe a lumbosacral corset and instruct in body mechanics
B) Immediate referral for MRI of the spine
C) Begin a gentle stretching and strengthening program
D) Administer oral corticosteroids
Correct Answer : B
Rationale: The combination of metastatic disease, acute pain, radicular symptoms, and new urinary
incontinence suggests cauda equina syndrome, a neurosurgical emergency. Rapid MRI is required to
identify cord or root compression. Delaying imaging could lead to permanent paralysis or loss of
bowel/bladder function.
4. Which of the following outcome measures is most appropriate to assess balance in a patient with
mild-to-moderate Parkinson’s disease?
A) Berg Balance Scale (BBS)
B) Mini-BESTest
C) Timed Up and Go (TUG)
D) Functional Reach Test
Correct Answer : B
Rationale: The Mini-BESTest was developed specifically to evaluate dynamic balance and fall risk in
patients with Parkinson’s disease. While the BBS and TUG are also used, the Mini-BESTest has better
responsiveness to the balance deficits common in Parkinson’s.
5. A 35-year-old runner reports medial tibial pain that worsens with activity and improves with rest.
Palpation reveals tenderness along the posteromedial border of the tibia. There is no swelling or
erythema. Radiographs are normal. What is the most likely diagnosis?
,3
A) Tibial stress fracture
B) Medial tibial stress syndrome (MTSS)
C) Chronic exertional compartment syndrome
D) Popliteal artery entrapment syndrome
Correct Answer : B
Rationale: MTSS (shin splints) presents with diffuse tenderness along the posteromedial tibia without a
focal point of pain. A stress fracture would have a more focal, point-tender area and may eventually
show radiographic changes. Compartment syndrome is associated with pain with passive stretch and
often neurologic symptoms.
6. A patient 3 days post-total knee arthroplasty (TKA) has a knee flexion range of motion (ROM) of 55
degrees. What is the most appropriate initial intervention?
A) Static progressive splinting at 90 degrees of flexion
B) Gentle active-assistive and passive ROM within pain tolerance
C) Aggressive passive stretching to 110 degrees
D) Continuous passive motion (CPM) for 8 hours daily
Correct Answer : B
Rationale: Early ROM exercises are critical after TKA. The goal is to regain motion without causing
excessive inflammation or wound dehiscence. Aggressive stretching or prolonged CPM may delay
healing. A gradual, pain-limited approach is recommended.
7. Which of the following special tests is most specific for the diagnosis of anterior cruciate ligament
(ACL) rupture?
A) Anterior drawer test
B) Lachman test
C) Pivot shift test
D) Valgus stress test
Correct Answer : B
Rationale: The Lachman test is both highly sensitive and specific for ACL tears, especially when
performed at 20-30 degrees of knee flexion. The pivot shift test is very specific but less sensitive,
especially in the acute setting.
8. A 25-year-old volleyball player has recurrent anterior shoulder instability. A positive apprehension
and relocation test suggests:
A) Rotator cuff tear
B) Anterior glenohumeral instability
, 4
C) Acromioclavicular joint separation
D) Superior labral tear (SLAP lesion)
Correct Answer : B
Rationale: The apprehension test (passive abduction and external rotation) recreates the sensation of
impending anterior dislocation, confirming anterior instability. The relocation test (posterior pressure)
relieves the apprehension.
9. A 60-year-old male with right-sided weakness after a stroke is learning to use a quad cane. When
instructing the patient, the cane should be held in:
A) The right hand
B) The left hand
C) Either hand
D) The hand opposite the weaker leg
Correct Answer : D
Rationale: The cane is held in the hand opposite the weaker leg to reduce the load on the weak side and
improve balance. For a right-sided weakness, the cane is held in the left hand.
10. A patient with acute low back pain has a negative straight leg raise test, no neurologic deficits, and
no red flags. What is the most appropriate recommendation?
A) Bed rest for 2 days
B) Continue normal activities with modifications
C) Lumbar traction
D) Surgical consultation
Correct Answer : B
Rationale: Current guidelines advise against bed rest. Patients should remain active as tolerated. Only
5-10% of acute low back pain becomes chronic; early activity improves outcomes.
11. A 42-year-old female with fibromyalgia reports widespread pain, fatigue, and poor sleep. The most
effective initial intervention is:
A) High-intensity resistance training
B) Low-impact aerobic exercise (walking, swimming) and education
C) Spinal manipulative therapy
D) Trigger point injections
Correct Answer : B
