How to analyze NPTE questions in N 3 simple steps

Let’s get right into it. Read the sample NPTE question & answer set.

A physical therapist works with a patient on scapular stability. During a prone push-up, the therapist observes the medial scapular border winging away from the thorax. Upon standing from the push-up position, the patient reports severe lightheadedness and dizziness. What is the MOST appropriate physical therapist action?

  • a) Place the patient in Trendelenburg position
  • b) Place the patient in reverse Trendelenburg position
  • c) Check the patient’s blood sugar levels
  • d) Refer the patient to the emergency department

Let me guess, you read the question (stem) first. Then, before even finishing the question, you started thinking about scapular winging and possible answers. Then, you finished the question and realized it has nothing to do with scapular stability or winging. Now you have to re-read the question all over again.

The national physical therapy examination allots 5 hours to complete 250 questions. Let me do the math for you. You’re going to have about 72 seconds per question come test day. In other words, there is no time to waste. CONTINUE reading to learn 3 simple steps oh how to analyze NPTE questions and save time.

STEP # 1 – Answer Options First

 

Read the answer options below. Then, read the question.

A physical therapist works with a patient on scapular stability. During a prone push-up, the therapist observes medial scapular border winging away from the thorax. Upon standing from the push-up position, the patient reports severe dizziness. Which of the following nerves is MOST likely injured?

  • a) Thoracodorsal
  • b) Suprascapular
  • c) Long thoracic
  • d) Dorsal scapular

Notice how reading the answer options first makes reading the question easier. This method allows test-takers to extract pertinent information and disregard useless distracting data the first time they read the question.

STEP # 2 – Categorize Answer Options

Read the answer options below. Then, take a moment to broadly categorize the options. We’ll explain further.

A patient presents to physical therapy complaining of lateral ankle pain after suffering an inversion injury yesterday. There is noticeable swelling and the patient has difficulty bearing weight. Palpation reveals bony tenderness at the posterior aspect of the lateral malleolus. Which of the following is the MOST appropriate course of action?

  • a) Perform retrograde soft-tissue massage and grade I-II joint mobilizations to reduce swelling and pain
  • b) Perform pulsed ultrasound to reduce swelling
  • c) Perform gait training with an ankle stirrup and axillary crutches
  • d) Refer to the primary care physician to rule out a fracture

Read the answer options first. Then take a moment, only 5-10 seconds to see if the answer options are categorical or an obvious outlier exists. More often than not, there is an outlier in the answer options. Let’s take the answer options above to further explain.

  • a) is a manual therapy technique, which is an intervention.
  • b) is a physical modality, which is an intervention.
  • c) is assistive device and gait training, which is an intervention.
  • d) is a clinical decision to rule out a condition prior to initiating physical therapy intervention

D is the correct answer. The Ottawa ankle rules were developed to help clinicians determine when ankle or foot radiographs are indicated. In the scenario above, there is evidence of malleolar (bony) tenderness. According to the Ottawa ankle rules, this patient should have an ankle radiograph to rule out a fracture prior to initiating any physical therapy intervention.

Step # 3 – Don’t Fall Victim To Analysis Paralysis

The exam is long and difficult. There’s going to be groups of questions that frustrate you. A tough batch questions can linger in your brain for five-minutes, making it difficult to stay focused. It’s crucial to quickly move on and fuhgettaboutit! Your confidence will be shaken. Don’t abandon the answers first option methodology. Stick to your answer analysis technique and focus on the present question.

In summary, remember to read the answer options first. You will thank us later for this advice, as it will save you time and reduce test-taking errors. Take a moment to categorize answer options and you’ll start to recognize outliers. Most importantly, don’t over analyze the decisions you make. Approach each question with mental clarity. Use your best judgment and reasoning, select an answer option, then fuhgettaboutit!

Be confident and prepared. Shift the way you prepare for the most important exam in your career!

Check out Modern Learning Company for instant access to high-quality simulated PT board exams and test-taking tips.

Please feel free to contact us with questions or to obtain answers to the practice questions above!

5 surprising NPTE test prep mistakes

So you’re finishing up PT school and preparing for the National Physical Therapy Exam, but have a few doubts about your preparedness for the “big day”. How do I know if I’m ready? What is the highest yield information? Will I be able to finish in time? What if I don’t pass? Just take a deep breath and don’t make any of the these 5 mistakes.

Mistake #5 – Content Tunnel Vision

Students underestimate the vast array of content on the NPTE. The exam does not care about your desire to be an outpatient orthopedic physical therapist. That’s right, probably should’ve paid attention during your acute care rotation. The exam is designed to protect the public.

In regards to public safety, what do you think is more important to know? How to perform an anterior drawer test or how to recognize the signs and symptoms of a stroke; stage an infected decubitus ulcer; or appropriately respond to a  hypoglycemic episode?


Mistake #4 – Self Deception

Believing you’re going to fail before you even attempt the NPTE. Don’t psych yourself out reading internet posts about students who failed.  Don’t get caught up in believing the test is “tricky” or “too difficult”. Nonsense! The test is fair. The questions are peer-reviewed and screened for appropriateness.


Mistake # 3 – Unnecessary Frugality

Stop penny pinching on studying materials. I was once a student, and yes, I get it. I know $50 seems like a lot of money right now, heck, that’s a good night at the local tavern. Seriously though, spending in excess of $100,000 on PT school, only to budget on board exam study materials doesn’t make sense. It’s not logical. I’m not talking about paying hundreds of dollars on prep courses or books. Chances are you already have 15 textbooks from PT school. Review your anatomy, physiology, ortho, etc… but most importantly, take practice exams. High quality practice exams are in short supply. We can’t emphasize enough the importance of taking reliable simulated board exams. It’s the most efficient method of studying, because you’re exposing yourself to the exam formatting, learning time management, and increasing content knowledge all at once.


Mistake # 2 – Memorization vs. Rationalization

You’re mistaken if you think content knowledge alone will ensure success. Memorizing the cranial nerves is nice, but incorporating their function into a clinical scenario is entirely different.

If a patient has a palsy of cranial nerve VII, which of the following findings would you expect on examination?

  • 1) Impaired light touch over maxilla
  • 2) Inability to close the eyes
  • 3) Difficulty chewing
  • 4) Difficulty showing their teeth

Just because you know paralysis of the facial nerve is called Bell’s Palsy doesn’t mean you can recognize it clinically. The exam is clinical, not based on memorization of textbook content.

How does a student make the jump from textbook master to clinical expert without having years of experience?

Take high quality practice exams. Expose yourself to the depth and breadth of the questions. The board offers a good resource called the PEAT. Modern Learning Company also has excellent practice exams for students preparing to take the NPTE.


Mistake #1 – Practice, Practice, Practice, Practice

Don’t study for a clinical application exam by simply reading textbooks and flashcards. NPTE questions are designed to test entry-level clinical reasoning skills. Expect clinical scenarios, not recall questions. Read the two questions below to better understand what we’re talking about.

A) What nerve supplies motor to the serratus anterior muscle?

B) A physical therapist works with a patient on scapular stability. During a prone push-up, the therapist observes medial scapular border winging away from the thorax. Which of the following nerves is MOST likely injured?

  • 1) Thoracodorsal
  • 2) Suprascapular
  • 3) Long thoracic
  • 4) Dorsal scapular

Question (A) is a recall question. No clinical reasoning skills needed. The serratus anterior is innervated by the long thoracic nerve. Done.

Whereas, question (B) requires clinical reasoning skills. The test-taker must first know that medial scapular border winging during a prone push-up indicates serratus anterior weakness. Then, the test-taker must know the serratus anterior is innervated by the long thoracic nerve.

Let’s take it a step further!

C) A physical therapist works with a patient on scapular stability. During a prone push-up, the therapist observes the medial scapular border winging away from the thorax. Upon standing from the push-up position the patient reports severe lightheadedness and dizziness. What is the MOST appropriate physical therapist action?

  • 1) Place the patient in Trendelenburg position
  • 2) Place the patient in reverse Trendelenburg position
  • 3) Check the patient’s blood sugar levels
  • 4) Refer the patient to the emergency department

This question leads the test-taker to believe it’s an orthopedic question, then veers off in a different direction. Always read the answer options first! Learn how to analyze the answer sets and stems here.

What  is the most effective method to increase test-taking confidence and content knowledge?

Everyone preaches about reviewing all the textbooks and study guides over and over and over again. How much of the 1,000 page textbook are you retaining on a daily basis? Maximize your study time and increase your test-taking skills by completing practice exams….review the rationales….and reference your textbooks as needed.

Be confident and prepared. Shift how you prepare for the most important exam in your career! Take the next step and turn textbook knowledge into applicable clinical reasoning skills.

Check out Modern Learning Company for instant access to high-quality simulated PT board exams.

Please feel free to contact us with questions or to obtain answers to the practice questions above!

3 NPTE questions DPT students struggle with

Many students have the burden of trying to figure out where to start when it comes to tackling the NPTE. There are many schools of thought and study guides available, but, regardless of which you choose, it’s always best to start by understanding the question formatting and complexity. Below you will find 3 sample NPTE questions from Modern Learning. Can you get them all correct?

QUESTION 1

A physical therapist examines a 32-year-old female complaining of right-sided neck pain and headaches following a rear end motor vehicle accident three days ago. The headaches are precipitated by neck movements. She denies any neurologic symptoms or visual disturbance. The examination reveals deep neck flexor muscle endurance deficits. The cervical flexion – rotation test is positive for asymmetry of cervical rotation. The patient has 80 degrees of rotation left, but only 40 degrees of rotation right. Which of the following diagnoses and actions is the MOST appropriate?

  • A) Cervicogenic headaches. Perform an atlanto-axial joint mobilization.
  • B) Cervical Facet Syndrome. Perform supine chin tucks.
  • C) Cervical radiculopathy. Perform suboccipital soft tissue mobilization and stretching.
  • D) Cervical neck pain and headaches. Refer to primary care physician.

ANSWER 1

We have a 32-year-old female with neck pain and headaches due to a motor vehicle accident. Her headaches are precipitated by neck movements and she has deficits in deep neck flexor strength and cervical rotation right. The signs and symptoms are consistent with cervicogenic headaches, however, there is a more important finding that often gets overlooked. Follow the flow chart below.

 

This is the Canadian C-Spine Rules. The patient had a simple rear end motor vehicle collision and is unable to rotate 45 degrees right. Therefore, a referral to her primary care physician for a radiograph is warranted prior to physical therapy intervention. The correct answer is D. One of the primary reasons the National Physical Therapy Exam exists is to protect the public by ensuring every Doctor of Physical Therapy graduate is able to Safely & Competently practice. Knowing when it’s appropriate to start treatment or refer is a MUST!


QUESTION 2

A 45-year-old male presents to physical therapy with right ankle pain. He reports rolling his ankle yesterday while playing basketball. He enters the clinic with an antalgic gait pattern, but, no assistive device or brace. He has noticeable swelling on the lateral aspect of the ankle. Examination reveals tenderness along the anterior aspect of the lateral malleoli. Medial talar tilt testing is positive. Which of the following diagnoses and actions is the BEST?

  • A) Grade I lateral ankle sprain. Advise non-weight bearing, ice, compression, elevation.
  • B) Grade I lateral ankle sprain. Apply an external ankle support and advise progressive weight bearing.
  • C) Grade II lateral ankle sprain. Perform balance and proprioceptive exercises.
  • D) Malleolar fracture. Refer to primary care physician.

ANSWER 2

According to the Ottawa Ankle Rules, there is no indication for a radiograph. Answer B is correct. The patient’s signs and symptoms are most consistent with a grade I ankle sprain. He has swelling, a (+) medial talar tilt test, but minimal loss of function, as he’s able to ambulate into the clinic with no assistive device or brace. Usually, a grade II sprain presents with greater loss of function. At any rate, even if it was a grade II sprain, we would not start treatment with balance and proprioceptive exercises during the acute inflammatory/protective phase of healing. Take into account the patient’s age and tissue healing times when analyzing NPTE questions.


QUESTION 3

A physical therapist measures leg length on a patient with low back pain. While supine, the patient’s right leg is 2 cm shorter than the left. Upon moving into long sitting the right leg becomes longer than the left. Which of the following interventions is the MOST appropriate?

  • A) Muscle energy technique to facilitate right innominate posterior rotation
  • B) Muscle energy technique to facilitate right innominate anterior rotation
  • C) Muscle energy technique to facilitate left innominate anterior rotation
  • D) Backwards lunge stepping posterior with left lower extremity

ANSWER 3

Did you read the answer options first? If not, you should. Read this article for more information on question analyzation. At any rate, let’s get into this question. This is a classic example of the multiple step complexity of board exam questions. Requiring the test-taker to make in inference based on the stem to correctly select an answer is the hallmark of a quality NPTE question. Expect this formatting on the National Physical Therapy Exam!!! Ultimately, this question style minimizes the likelihood of the test-taker “guessing” the correct answer. He or she must know in order to get it correct.

The question describes the supine to long sit test, in which the patient’s right leg moves from short in supine to long in long sitting. A simple Mnemonic we use to remember the interpretation of the supine to long sit test is acknowledging our speech language pathologist friends, otherwise known as SLP (Short to Long is Posterior). When the leg moves from short to long with the long sit test it indicates a posteriorly rotated innominate. To correct a posteriorly rotated innominate we would facilitate anterior rotation on the right. Answer B is correct.


SUMMARY

Did  you get all three questions correct? Only 1% of D.P.T. graduates were able to. If you did congratulations! Simply send us an email with subject line: MLCBLOG30 to receive $30 off. Click here to send email. 

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