NPTE Exam Prep 2026 Updated Practice Questions,
Comprehensive Physical Therapist Licensing
Examination Review, Detailed Explanations, Verified
Answers, Complete Success Workbook
Domain 1: Musculoskeletal System (44–54 items)
1. A 45-year-old male presents with right shoulder pain and limited
abduction. Passive range of motion is full but painful at end range. Which of
the following is the MOST likely diagnosis?
A) Adhesive capsulitis
B) Subacromial impingement syndrome
C) Rotator cuff tear
D) Acromioclavicular joint arthritis
Rationale: Subacromial impingement syndrome presents with painful abduction,
often with a painful arc between 60° and 120°. Passive range of motion is typically
full but painful at end range. Adhesive capsulitis would present with significant
restriction in both active and passive range of motion, particularly external
rotation. A full-thickness rotator cuff tear would present with weakness and
possible loss of active motion.
2. A patient who has Legg-Calvé-Perthes disease is MOST likely to have
which joint affected?
A) Knee joint
B) Ankle joint
C) Hip joint
D) Talonavicular joint
Rationale: Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the
femoral head in children, primarily affecting the hip joint. It commonly presents
between ages 4 and 10 with hip pain, limp, and limited abduction and internal
rotation.
,3. A physical therapist is evaluating a patient with suspected anterior cruciate
ligament (ACL) injury. Which special test has the HIGHEST sensitivity for
detecting an ACL tear?
A) McMurray test
B) Lachman test
C) Pivot shift test
D) Valgus stress test
Rationale: The Lachman test is considered the most sensitive clinical test for ACL
integrity, with sensitivity reported as high as 85–95%. The pivot shift test is highly
specific but less sensitive. The McMurray test assesses meniscal pathology, and the
valgus stress test assesses the medial collateral ligament.
4. A patient is 6 weeks status post total knee arthroplasty (TKA). Which of the
following interventions is MOST appropriate at this stage?
A) Progressive strengthening of the quadriceps and hamstrings
B) Aggressive passive range of motion beyond 120°
C) High-impact plyometric training
D) Deep squatting exercises
Rationale: At 6 weeks post-TKA, the focus is on progressive strengthening and
functional mobility. Aggressive passive range of motion, high-impact plyometrics,
and deep squatting are contraindicated due to implant protection and tissue healing
constraints.
5. A patient presents with foot drop. Which nerve is MOST likely involved?
A) Tibial nerve
B) Deep peroneal (fibular) nerve
C) Sural nerve
D) Saphenous nerve
Rationale: Foot drop is caused by weakness of the dorsiflexors, primarily the
tibialis anterior, which is innervated by the deep peroneal nerve (L4–L5). The
tibial nerve innervates the plantarflexors, the sural nerve is sensory, and the
saphenous nerve is sensory.
,6. A patient with a positive Trendelenburg sign has weakness of which
muscle?
A) Quadriceps
B) Hamstrings
C) Gluteus medius
D) Iliopsoas
Rationale: A positive Trendelenburg sign indicates weakness of the hip abductors,
primarily the gluteus medius. When the patient stands on the affected leg, the
pelvis drops on the contralateral side due to inability to stabilize the pelvis.
7. Which of the following is a contraindication for joint mobilization?
A) Joint hypomobility
B) Joint hypermobility
C) Muscle tightness
D) Painful movement
Rationale: Joint hypermobility is a contraindication for joint mobilization because
further mobilization could exacerbate instability. Joint hypomobility, muscle
tightness, and painful movement (when appropriate for the technique) are
indications for mobilization.
8. A patient is 2 weeks status post anterior cruciate ligament (ACL)
reconstruction with a patellar tendon autograft. Which of the following is the
MOST appropriate intervention?
A) Controlled range of motion and quadriceps activation
B) Full unrestricted return to sport
C) Deep squatting with weights
D) Aggressive hamstring stretching
Rationale: Early ACL reconstruction rehabilitation focuses on protecting the graft,
controlling swelling, restoring range of motion, and activating the quadriceps. Full
return to sport, deep squatting, and aggressive hamstring stretching are
inappropriate at 2 weeks.
, 9. Which of the following special tests is used to assess for a meniscal tear?
A) McMurray test
B) Lachman test
C) Neer test
D) Phalen test
Rationale: The McMurray test is used to assess for meniscal tears by applying
rotational stress to the knee. The Lachman test assesses ACL integrity, the Neer
test assesses for subacromial impingement, and the Phalen test assesses for carpal
tunnel syndrome.
10. A patient with a distal radius fracture is 4 weeks status post open
reduction internal fixation (ORIF). Which of the following is the MOST
appropriate intervention?
A) Active-assisted range of motion of the wrist and fingers
B) Aggressive passive range of motion
C) Heavy resistance strengthening
D) Immobilization in a cast
Rationale: After ORIF, early controlled motion is encouraged to prevent stiffness.
Active-assisted range of motion is appropriate at 4 weeks, while aggressive passive
range of motion and heavy resistance are contraindicated due to fracture healing.
11. Which of the following is a common gait deviation seen in a patient with a
fused ankle?
A) Absent heel strike
B) Excessive knee flexion at midstance
C) Steppage gait
D) Trendelenburg gait
Rationale: An ankle fusion eliminates ankle dorsiflexion and plantarflexion,
resulting in an absent heel strike and a flat-foot or toe-strike pattern. Steppage gait
is associated with foot drop, and Trendelenburg gait is associated with hip abductor
weakness.
Comprehensive Physical Therapist Licensing
Examination Review, Detailed Explanations, Verified
Answers, Complete Success Workbook
Domain 1: Musculoskeletal System (44–54 items)
1. A 45-year-old male presents with right shoulder pain and limited
abduction. Passive range of motion is full but painful at end range. Which of
the following is the MOST likely diagnosis?
A) Adhesive capsulitis
B) Subacromial impingement syndrome
C) Rotator cuff tear
D) Acromioclavicular joint arthritis
Rationale: Subacromial impingement syndrome presents with painful abduction,
often with a painful arc between 60° and 120°. Passive range of motion is typically
full but painful at end range. Adhesive capsulitis would present with significant
restriction in both active and passive range of motion, particularly external
rotation. A full-thickness rotator cuff tear would present with weakness and
possible loss of active motion.
2. A patient who has Legg-Calvé-Perthes disease is MOST likely to have
which joint affected?
A) Knee joint
B) Ankle joint
C) Hip joint
D) Talonavicular joint
Rationale: Legg-Calvé-Perthes disease is an idiopathic avascular necrosis of the
femoral head in children, primarily affecting the hip joint. It commonly presents
between ages 4 and 10 with hip pain, limp, and limited abduction and internal
rotation.
,3. A physical therapist is evaluating a patient with suspected anterior cruciate
ligament (ACL) injury. Which special test has the HIGHEST sensitivity for
detecting an ACL tear?
A) McMurray test
B) Lachman test
C) Pivot shift test
D) Valgus stress test
Rationale: The Lachman test is considered the most sensitive clinical test for ACL
integrity, with sensitivity reported as high as 85–95%. The pivot shift test is highly
specific but less sensitive. The McMurray test assesses meniscal pathology, and the
valgus stress test assesses the medial collateral ligament.
4. A patient is 6 weeks status post total knee arthroplasty (TKA). Which of the
following interventions is MOST appropriate at this stage?
A) Progressive strengthening of the quadriceps and hamstrings
B) Aggressive passive range of motion beyond 120°
C) High-impact plyometric training
D) Deep squatting exercises
Rationale: At 6 weeks post-TKA, the focus is on progressive strengthening and
functional mobility. Aggressive passive range of motion, high-impact plyometrics,
and deep squatting are contraindicated due to implant protection and tissue healing
constraints.
5. A patient presents with foot drop. Which nerve is MOST likely involved?
A) Tibial nerve
B) Deep peroneal (fibular) nerve
C) Sural nerve
D) Saphenous nerve
Rationale: Foot drop is caused by weakness of the dorsiflexors, primarily the
tibialis anterior, which is innervated by the deep peroneal nerve (L4–L5). The
tibial nerve innervates the plantarflexors, the sural nerve is sensory, and the
saphenous nerve is sensory.
,6. A patient with a positive Trendelenburg sign has weakness of which
muscle?
A) Quadriceps
B) Hamstrings
C) Gluteus medius
D) Iliopsoas
Rationale: A positive Trendelenburg sign indicates weakness of the hip abductors,
primarily the gluteus medius. When the patient stands on the affected leg, the
pelvis drops on the contralateral side due to inability to stabilize the pelvis.
7. Which of the following is a contraindication for joint mobilization?
A) Joint hypomobility
B) Joint hypermobility
C) Muscle tightness
D) Painful movement
Rationale: Joint hypermobility is a contraindication for joint mobilization because
further mobilization could exacerbate instability. Joint hypomobility, muscle
tightness, and painful movement (when appropriate for the technique) are
indications for mobilization.
8. A patient is 2 weeks status post anterior cruciate ligament (ACL)
reconstruction with a patellar tendon autograft. Which of the following is the
MOST appropriate intervention?
A) Controlled range of motion and quadriceps activation
B) Full unrestricted return to sport
C) Deep squatting with weights
D) Aggressive hamstring stretching
Rationale: Early ACL reconstruction rehabilitation focuses on protecting the graft,
controlling swelling, restoring range of motion, and activating the quadriceps. Full
return to sport, deep squatting, and aggressive hamstring stretching are
inappropriate at 2 weeks.
, 9. Which of the following special tests is used to assess for a meniscal tear?
A) McMurray test
B) Lachman test
C) Neer test
D) Phalen test
Rationale: The McMurray test is used to assess for meniscal tears by applying
rotational stress to the knee. The Lachman test assesses ACL integrity, the Neer
test assesses for subacromial impingement, and the Phalen test assesses for carpal
tunnel syndrome.
10. A patient with a distal radius fracture is 4 weeks status post open
reduction internal fixation (ORIF). Which of the following is the MOST
appropriate intervention?
A) Active-assisted range of motion of the wrist and fingers
B) Aggressive passive range of motion
C) Heavy resistance strengthening
D) Immobilization in a cast
Rationale: After ORIF, early controlled motion is encouraged to prevent stiffness.
Active-assisted range of motion is appropriate at 4 weeks, while aggressive passive
range of motion and heavy resistance are contraindicated due to fracture healing.
11. Which of the following is a common gait deviation seen in a patient with a
fused ankle?
A) Absent heel strike
B) Excessive knee flexion at midstance
C) Steppage gait
D) Trendelenburg gait
Rationale: An ankle fusion eliminates ankle dorsiflexion and plantarflexion,
resulting in an absent heel strike and a flat-foot or toe-strike pattern. Steppage gait
is associated with foot drop, and Trendelenburg gait is associated with hip abductor
weakness.
