Preparing for the NPTE-PT 2024: Understanding the New Blueprint and Changes

Scott Giles PT, DPT, MBA
Posted 9/ 8/23

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The National Physical Therapy Examination (NPTE) is undergoing significant changes in 2024, and it's essential for aspiring physical therapists to stay informed and well-prepared. 

We will explore these changes in two specific areas PT Exam structural changes and changes in the NPTE blueprint.

PT Exam Structural Changes

The 2024 exam consists of 225 questions – 180 scored items and 45 pretest items. The 45 pretest items are not officially scored and instead are designed to allow new exam questions to be evaluated throughout the year. This process eliminates lengthy delays in score reporting when new exams are introduced. Students are unable to differentiate between pre-test and scored items on the exam. 

The academic content is randomized within each of the four exam sections and scoring is based only on the number of scored questions a candidate answers correctly. Students will have five hours to complete the 225-question exam. For comparison purposes, the former exam consisted of 250 questions - 200 scored items and 50 pretest items. 

According to the Federation of State Boards of Physical Therapy, the 225 exam questions will consist of standard, graphic, video, and scenario-based questions. 

Let’s define each type of question. 

Standard Questions
This type of question consists of text, usually multiple sentences, forming a stem along with four possible options. 

Graphic Questions
This type of question consists of text as well as a static image. Students will need to utilize both the question stem and the provided image to answer the question.

Video Questions
This type of question consists of text as well as a video. Students will need to utilize both the question stem and the provided video to answer the question.

Scenario-based Questions
This type of question consists of a standardized patient scenario that provides information on patient characteristics, pertinent medical history, and current symptoms. Students will be required to answer a variable number of questions that rely on the specific information presented in the patient scenario.

Now that you are familiar with the types of exam questions on the 2024 exam, how many questions of each type should a student expect? The actual number of questions is highly variable on each exam form. However, the FSBPT does provide some general guidelines:

•    Minimum of 180 standard, graphic, video questions (collectively)
•    Maximum of 45 scenario-based questions

Despite the total number of questions on the NPTE-PT diminishing by 25 questions (20 scored, 5 pretest), the total time available for students to complete the exam remains the same. Students will have an average of 80 seconds per question instead of 72 seconds previously. The additional time per question is primarily based on the belief that the video and scenario-based questions will take a typical student slightly longer to complete than a traditional exam question. Our experience has been that the typical student has more than ample time to comfortably complete the exam within the allotted five hours. We expect this trend to continue with the 2024 exam. Qualified individuals with disabilities will be eligible for accommodations which often include extended time and/or a private testing room. 

Let’s take a bit of a deeper dive into the most recent alternate question types - video and scenario-based questions.

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Video Questions

First introduced in late 2022, video questions represented a significant departure from the traditional text-based and graphic question format. This dynamic form of question allows students to observe a brief video, averaging less than 10 seconds, and then use the information to answer an associated multiple-choice question. Students have a variety of options when watching the video such as rewatching the video, fast forwarding, rewinding, and pausing. The video questions provide the opportunity to better simulate an actual clinical environment and, in some instances, can convey detail that would be impossible to describe in a standard question consisting of only 2-3 sentences.

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Scenario Questions

Without a doubt, the most significant development in the 2024 exam is the inclusion of scenario-based questions. This alternate form of question allows the FSBPT to deliver a series of questions that relate to a specific case. Prior to the inclusion of scenario-based questions on the exam, all exam items were completely independent. According to the FSBPT, scenario-based questions allow for the testing of more medically complex issues, mirroring the challenges encountered in actual clinical practice.

Students will be required to extract relevant pieces of information from the presented case scenario to answer each presented question. Scenario set length can vary from as few as 2 questions to as many as 6 questions. Each question, despite being associated with the same case, is completely independent. Scenario set cases will be grouped at the conclusion of an exam section. The questions will potentially be comprised of questions reflective of each of the system and content outline areas. 

Changes in the NPTE Blueprint

The NPTE blueprint, the foundation of the exam's content and structure, evolves approximately every five years. This five-year cycle was extended to six years in 2023 due to pandemic related challenges. With the upcoming 2024 exam, several aspects of the blueprint will shift. Here's what you need to know: 

Content and Weighting: The content categories of the exam (System and Content Outline) remain the exact same. The categories are outlined below along with the relative change in each category. The adjustment in the relative weighting of each category ensures that the exam accurately reflects the evolving landscape of physical therapy practice. This information is collected by the FSBPT as part of a practice analysis involving thousands of currently practicing physical therapists.

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2024 NPTE-PT System Weighting

System Weighting - % change by content area

  • Musculoskeletal (-0.55%)
  • Neuromuscular and Nervous Systems (+0.70%)
  • Cardiovascular and Pulmonary Systems (+0.85%)
  • Other Systems (-0.65%)
  • Non-Systems (+0.65%)


imagery for Preparing for the NPTE-PT 2024: Understanding the New Blueprint and Changes

2024 NPTE-PT Content Outline Weighting

Content Outline Weighting - % change by content area

  • Physical Therapy Examination (-0.85%)
  • Foundations for Evaluation, Differential Diagnosis, Prognosis (-0.50%)
  • Interventions (+2.20%)
  • Equipment, Devices, and Technologies; Therapeutic Modalities (-0.45%)
  • Safety and Protection; Professional Responsibilities, Research and Evidence-based Practice (+1.10%)

As you can see from the presented information, the relative weighting changes in the system and content outline areas are incredibly minuscule. This is welcome news especially when combined with the system and content outline categories staying intact. 

Academic Content: The introduction of a new blueprint, invariably includes the addition of new academic content and the removal of previous tested content. Here are some examples for the 2024 exam. 

Knowledge and Skill Requirements 


  • The impact of regenerative medicine on physical therapy prognosis and interventions related to musculoskeletal and neuromuscular and nervous systems diseases/conditions (e.g., platelet rich plasma, stem cells)
  • The provision and utilization of telehealth (i.e., the use of telecommunication technologies to provide healthcare information and services)


  • Phonophoresis

Work Activities


  • Taping for edema management
  • Electrodiagnostic test results
  • Gross motor development progression
  • Negative pressure wound therapy


  • Taping for lymphatic drainage
  • Phonophoresis

Preparing for the NPTE-PT 2024

It's entirely natural to feel a bit overwhelmed by these impending changes. The new blueprint, video questions, and scenario questions all add layers of complexity to the NPTE-PT. In addition, significant changes in first time passing rates are most likely to coincide with blueprint changes. 

Here are a few suggestions to help maintain your composure and help you navigate the 2024 exam.

1. Start your preparation early! Jumping into the academic review process well in advance quickly reminds you that you do in fact remember a great deal from your academic education, but it also reminds you that some dust and cobwebs have gathered. Start to get your house in order! Order a review book and start to dabble. A concerted effort over time almost always reduces stress and leads to better exam outcomes!

2. Take as many sample exams as possible. We have always been a big believer in the value of sample exams. However, with the introduction of the video and scenario-based questions this component of the study plan takes on even greater importance. It is essential for students to feel completely comfortable answering each of the question types prior to the big day.

3. Acknowledge that there is always anxiety associated with the introduction of a new exam. However, recognize that you have complete control of your own destiny. Embrace the exam changes and use this as fuel as you prepare for this critically important exam. 

Take a moment to reflect on what it will feel like when you are officially notified that you passed the exam! This should provide you with a jolt of adrenaline and a sense that your educational journey is almost completed.