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2024 NPTE Changes

Everything You Need to Know

Starting in 2024, the FSBPT has announced several key changes to update the NPTE test experience.  These updates affect both the PT & PTA spaces, and it’s important to clearly understand the key changes that will affect student outcomes.

They key changes include:

  • PT updated exam design (NPTE-PT)
    • 225 items total. 180 scored + 45 unscored = 225 total
    • Up to 45 scenario-based items
    • Approximately 180 stand-alone multiple-choice items
      • Includes graphic, video, or text items
    • PTA updated exam design (NPTE-PTA)
      • 180 items total. 140 scored + 40 unscored = 180 total
      • Up to 35 scenario-based items
      • Approximately 145 stand-alone multiple-choice items
        • Includes graphic, video, or text items

The key changes include an overall reduction in the number of questions in order to accommodate the ‘scenario-based items.’

Scenario-Based Items

The key characteristics of these scenario-based items include the following:

  • A patient case/scenario is presented in ‘chart’ format as if it were a patient chart
  • There will then be a few questions associated with the scenario
    • Typically, this will be somewhere around 3-7 questions related to the patient case

Each scenario-based item will follow the same format as ‘stand-alone’ questions, where they will each be multiple-choice with 4 answer options.


Setting: Outpatient 

Age: 20 years

Sex: Female

Presenting Problem/Current Condition

  • 6-week history of left anterior shoulder pain and instability

Medical History

  • Amenorrhea
  • Osteopenia

Other Information

  • Collegiate swimmer 
  • Medications: naproxen (Aleve) 200 mg

Physical Therapy Examination(s)

  • Pain is exacerbated with arm elevation and swimming
  • Positive apprehension test
  • Positive Jobe relocation test
  • Accessory motion testing: limited posterior and inferior glide of the glenohumeral joint
  • Grade I anterior glenohumeral translation present 

Manual Muscle Testing Left Shoulder


Scapula upward rotators 


Scapula downward rotators 


Shoulder external rotators 


Shoulder internal rotators 


Which of the following interventions is MOST appropriate to address the patient’s strength deficits at the glenohumeral joint?

  1. Internal rotation at 90 degrees of abduction
  2. Standing wall push-up with scapular protraction
  3. Prone horizontal abduction
  4. Standing external rotation at 90 degrees of abduction


  1. Internal rotation at 90 degrees of abduction strengthens the subscapularis.
  2. Standing wall push-ups with scapular protraction will strengthen the serratus anterior, a primary upward rotator of the scapula without exacerbating pain with upward elevation.
  3. Prone horizontal abduction strengthens the middle trap and the rhomboids, not the trapezius or upward rotators of the shoulder.
  4. External rotation at 90 degrees of abduction strengthens the infraspinatus, teres minor and supraspinatus. In addition, this position of 90 degrees of abduction and external rotation is the same position as the apprehension test, which may aggravate the patient’s symptoms this early in the rehabilitation process.

Strategies for Answering Scenario-Based Items

When it comes to answering scenario-based questions on the exam, the strategy will not differ substantially from answering regular multiple-choice questions, however there will be some minor differences. 

Generally, follow these guidelines for answering scenario-based questions:

  1. Glance at the patient scenario (chart) to get a general idea of the main diagnosis and current state of rehab (initial visit, discharge, recent fall/trauma, etc.)
  2. Read through the multiple-choice question
    1. Determine what the stem of the question is asking specifically
    2. Read each answer option sequentially
  3. Return to the scenario to find the pertinent information to answer the question. Having seen the answer options, this narrows your focus to parse out the relevant content of the scenario to answer the question.
    1. Determine if there are any complicating factors (comorbidities, recent events) that would affect your answer choice
    2. Select the answer option that will account for ALL the information contained in the case.
  4. Repeat for each scenario-based item

In a sense, you’ll dissect these questions in a backward direction (read the question before fully analyzing the scenario to narrow your focus).

Bottom Line

Understanding scenario-based questions takes practice and should become a regular part of your studies.  As clinicians, we are accustomed to reading through patient charts to find the important information relevant to your treatment plan.  

Check out our full exam simulator, including tons of practice questions, here.