NPTE-PT Musculoskeletal System Examination — Questions and Answers

Question 1: During a manual muscle test, a patient can move through full range of motion against gravity but fatigues with minimal resistance. What MMT grade is this?

Grade 3
Grade 4- (Correct answer)
Grade 3+
Grade 4

Correct answer: Grade 4-

Grade 4- (Fair+) indicates the patient tolerates minimal resistance through full ROM but cannot sustain it against moderate resistance.

Question 2: A patient presents with pain at the lateral epicondyle that worsens with resisted wrist extension and passive wrist flexion with elbow extended. Which structure is most likely involved?

Flexor carpi radialis
Extensor carpi radialis brevis (Correct answer)
Supinator muscle
Anconeus muscle

Correct answer: Extensor carpi radialis brevis

The extensor carpi radialis brevis (ECRB) is the most commonly affected tendon in lateral epicondylalgia (tennis elbow).

Question 3: Which special test assesses the integrity of the posterior cruciate ligament (PCL)?

Lachman test
Posterior drawer test (Correct answer)
McMurray test
Valgus stress test

Correct answer: Posterior drawer test

The posterior drawer test assesses PCL integrity by applying a posterior-directed force to the proximal tibia with the knee at 90° flexion.

Question 4: A 55-year-old patient has pain with the FABER test, groin pain, and limited hip internal rotation. The most likely diagnosis is:

Iliopsoas bursitis
Hip osteoarthritis (Correct answer)
Piriformis syndrome
Femoroacetabular impingement

Correct answer: Hip osteoarthritis

Limited internal rotation, groin pain, and positive FABER test are classic signs of hip osteoarthritis due to capsular pattern restriction.

Question 5: When assessing scoliosis with the Adam's forward bend test, a positive result is indicated by:

Lateral trunk shift during forward bending
Rib hump or paraspinal prominence on one side (Correct answer)
Increased lumbar lordosis during forward bending
Pelvic obliquity when standing upright

Correct answer: Rib hump or paraspinal prominence on one side

A rib hump or paraspinal prominence during forward bending indicates rotational deformity consistent with structural scoliosis.

Question 6: The Ober test is used to assess tightness of which structure?

Piriformis muscle
Iliotibial band and tensor fascia latae (Correct answer)
Hip flexor complex
Adductor magnus

Correct answer: Iliotibial band and tensor fascia latae

The Ober test assesses the flexibility of the iliotibial band (IT band) and tensor fascia latae by observing hip adduction from a side-lying position.

Question 7: A patient with a C5-C6 disc herniation would MOST likely present with weakness in which movement?

Wrist extension and elbow flexion (Correct answer)
Finger flexion and wrist flexion
Elbow extension and wrist flexion
Intrinsic hand muscles

Correct answer: Wrist extension and elbow flexion

C5-C6 nerve roots innervate the biceps (elbow flexion) and wrist extensors; a herniation at this level typically impairs these movements.

Question 8: During gait analysis, a patient demonstrates contralateral pelvic drop during single-leg stance. This indicates weakness of which muscle?

Contralateral gluteus medius
Ipsilateral gluteus medius (Correct answer)
Ipsilateral quadratus lumborum
Contralateral piriformis

Correct answer: Ipsilateral gluteus medius

Ipsilateral gluteus medius weakness causes the pelvis to drop on the opposite (contralateral) side during single-leg stance, known as a Trendelenburg gait.

Question 9: Which ligament is tested by the anterior drawer test at the ankle?

Calcaneofibular ligament
Posterior talofibular ligament
Anterior talofibular ligament (Correct answer)
Deltoid ligament

Correct answer: Anterior talofibular ligament

The anterior drawer test at the ankle stresses the anterior talofibular ligament (ATFL), the most commonly injured ankle ligament.

Question 10: A patient presents with a positive Phalen's test and Tinel's sign at the wrist. Symptoms include numbness in the thumb, index, and middle fingers. This presentation is consistent with:

Ulnar nerve entrapment at Guyon's canal
Carpal tunnel syndrome (Correct answer)
Cubital tunnel syndrome
C6 radiculopathy

Correct answer: Carpal tunnel syndrome

Carpal tunnel syndrome involves median nerve compression at the wrist, producing sensory symptoms in the thumb, index, middle, and radial half of the ring finger.

Question 11: On joint mobilization grading (Maitland), a Grade III mobilization is BEST described as:

Small amplitude oscillation at the beginning of range
Large amplitude oscillation into resistance (Correct answer)
Small amplitude movement into end-range
Large amplitude movement up to but not into resistance

Correct answer: Large amplitude oscillation into resistance

Maitland Grade III involves large amplitude oscillations that move into tissue resistance and are used for pain management and increasing mobility.

Question 12: Which of the following findings is MOST consistent with a complete rotator cuff tear rather than tendinopathy?

Painful arc between 60-120 degrees
Positive Neer sign with pain
Significant weakness with resisted shoulder abduction (Correct answer)
Positive Hawkins-Kennedy test

Correct answer: Significant weakness with resisted shoulder abduction

Significant weakness with resisted abduction (supraspinatus) is a hallmark of a full-thickness rotator cuff tear, as the muscle-tendon unit is no longer intact.

Question 13: When measuring passive hip external rotation range of motion in supine, the standard goniometric landmark for the stationary arm is aligned with:

The anterior superior iliac spine
A vertical line through the patella
A horizontal line parallel to the treatment table (Correct answer)
The greater trochanter

Correct answer: A horizontal line parallel to the treatment table

For hip rotation in supine, the stationary arm is perpendicular to the floor (vertical), and the moving arm follows the tibial shaft or patella.

Question 14: A patient has hyperreflexia, clonus, and a positive Babinski sign in the lower extremities. These findings indicate pathology at which level of the nervous system?

Peripheral nerve
Nerve root (radiculopathy)
Upper motor neuron (spinal cord or brain) (Correct answer)
Lower motor neuron

Correct answer: Upper motor neuron (spinal cord or brain)

Hyperreflexia, clonus, and a positive Babinski sign are upper motor neuron signs indicating a lesion in the spinal cord or higher CNS structures.

Question 15: The capsular pattern of the glenohumeral joint is restriction in which order of movements?

Flexion > Abduction > External rotation
External rotation > Abduction > Internal rotation (Correct answer)
Abduction > Internal rotation > Flexion
Internal rotation > External rotation > Abduction

Correct answer: External rotation > Abduction > Internal rotation

The glenohumeral capsular pattern as described by Cyriax is greatest restriction in external rotation, followed by abduction, then internal rotation.

Question 16: A patient demonstrates weakness in toe extension (hallux) and foot drop. Which nerve is most likely injured?

Tibial nerve
Common peroneal nerve (deep branch) (Correct answer)
Superficial peroneal nerve
Femoral nerve

Correct answer: Common peroneal nerve (deep branch)

The deep peroneal (fibular) nerve innervates the tibialis anterior and extensor hallucis longus; injury causes foot drop and inability to extend the great toe.

Question 17: During the scapular winging test, medial scapular winging during a wall push-up is caused by weakness of which muscle?

Trapezius (lower fibers)
Serratus anterior (Correct answer)
Rhomboid major
Subscapularis

Correct answer: Serratus anterior

Serratus anterior weakness (long thoracic nerve palsy) causes medial scapular winging during pushing activities as the medial border lifts off the thorax.

Question 18: Which of the following BEST describes the end-feel of a normal elbow extension?

Firm (capsular)
Soft (soft tissue approximation)
Hard (bony) (Correct answer)
Empty

Correct answer: Hard (bony)

Normal elbow extension has a hard/bony end-feel due to the olecranon process contacting the olecranon fossa, abruptly stopping motion.

Question 19: Which test differentiates between lumbar spinal stenosis and vascular claudication?

Straight leg raise
Bicycle test (van Gelderen's test) (Correct answer)
Slump test
Prone knee bend

Correct answer: Bicycle test (van Gelderen's test)

The bicycle test differentiates neurogenic (spinal stenosis) from vascular claudication: symptoms with upright cycling but relief with forward-flexed cycling suggest neurogenic origin.

Question 20: A patient with SLAP (superior labrum anterior to posterior) tear would most likely test positive on which examination?

Empty can test
Speed's test and O'Brien's active compression test (Correct answer)
Drop arm test
Sulcus sign

Correct answer: Speed's test and O'Brien's active compression test

Speed's test (resisted shoulder flexion with elbow extended) and O'Brien's test are commonly positive with SLAP lesions involving the biceps anchor.

Question 21: In a patient with Achilles tendinopathy, which clinical finding would indicate a chronic degenerative (tendinosis) pattern rather than acute reactive tendinopathy?

Pain worse in the morning that eases with activity
Diffuse warmth and swelling along the tendon
Nodular thickening and pain mid-tendon with load (Correct answer)
Severe pain at rest with marked swelling

Correct answer: Nodular thickening and pain mid-tendon with load

Nodular mid-tendon thickening and load-dependent pain are characteristic of chronic tendinosis (degenerative collagen disarray) rather than acute reactive changes.

NPTE-PT Musculoskeletal System Examination

During a manual muscle test, a patient can move through full range of motion against gravity but fatigues with minimal resistance.
What MMT grade is this?

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