Pay Attention to these 3 Major Topics for the NPTE

So much information...so little time!!!

The final weeks before the July 2018 NPTE exam are upon us! While this post is not about how to study, I do want to include my TOP piece of advice: As a general rule, I cannot stress enough the importance of taking practice exams and analyzing each question (both incorrect and correct answers). I took five or more practice exams and looked through every question thoroughly. Multiple times I found myself answering questions correctly, but using the wrong clinical reasoning. Other times, I would answer a question incorrectly, but had the proper thought process. These reviews will solidify the information you know and significantly improve your weak points. To read more about how Chris, Brian, and I prepared for the exam, click HERE. 

Whether you have been studying for 3 months, 3 weeks, or 3 days, this post is a friendly reminder to spend a little extra time on 3 important subjects. I break down each one below!

Topic #1: Sensitivity, Specificity, and Likelihood Ratios

While the direct 'research based' questions are <5% of the examination, it is important to know the difference between sensitivity, specificity, and likelihood ratios. These metrics are commonly seen on various examination techniques, and give practitioners an idea regarding how beneficial that test is clinically.  Sensitivity refers to a test's ability to accurately rule out a disease and is scored between 0 and 1.00. Tests with high Sensitivity, rule Out a disease (SnOut). Specificity refers to a test's ability to accurately rule in a disease and is scored between 0 and 1.00. Tests with high Specificity, rule In a disease (SpIn). Positive and negative likelihood ratios work in a similar way but are not limited to numbers between 0 and 1.00. They act more as "persuasive information" and are more individualized than sensitivity and specificity (Jewell, 2010). Clinicians are required to determine a patient's pretest probability, then incorporate the likelihood ratio for the test and determine how "likely" the patient has the pathology. Keep in mind that the diagnostic accuracy applies to a specific patient population, and will change as other variables change. For example, the sensitivity and specificity of the Lachman's test is largely different in the acute phase of injury versus the chronic phase. Below is an example question from PT Final Exam:

If a magnetic resonance image (MRI) correctly identifies 95% of patients as positive for anterior cruciate ligament tears, then the MRI is:

1. Sensitive
2. Specific
3. Significant
4. Stable

The correct answer is:

1. This is the correct answer.  A test that is sensitive will correctly identify the true positives.  With high sensitivity, a test that is negative will likely mean that you can rule OUT the condition because positives are so reliable.
2. Specificity is the % of true negatives identified.  With high specificity, a test that is positive will rule IN the condition because the negatives are so reliable.
3. Statistically significant would mean the result is likely NOT due to chance.
4. Stable would mean the result does not fluctuate.

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Topic #2: Special Test Clusters

From the rotator cuff to the menisci, there are multiple special test clusters that exam participants must review. While these tests may lack good diagnostic accuracy individually, when clustered together, their ability to diagnosis tissue pathology significantly improves. In addition to the special test clusters, I highly recommend looking at Wells Criteria for a Deep Vein Thrombosis, the Ottowa foot and ankle rules, and hip/ knee arthritis criteria. 

Below are 4 major clinical clusters that are important for the NPTE.

View all of our special tests

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Topic #3: Cranial Nerves

While TSPT blog has a few posts on the cranial nerves, I have referred to our friends over at physiopedia for more in depth information. There will be test questions on the cranial so you must know each one and their function. "There are 12 pairs of cranial nerves and they are numbered according to their position of where they originate in the inferior surface of the brain...The names of the cranial nerves sometimes correspond with their individual function. The cranial nerves are comprised of axons that are either sensory, motor or both."  [Reference: Cranial Nerves]. Watch the video below to learn more! 

Best of luck on your final weeks studying for the NPTE!
​Jim Heafner PT, DPT, OCS

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