Musculoskeletal and neuro are half the exam. Study in that order, and know your pace.

Musculoskeletal is the largest system on the NPTE-PT at 44-54 of the 180 scored items, spread across examination (14-18 items), foundations for evaluation and differential diagnosis (15-18) and interventions (15-18). It covers special tests and their interpretation, joint mobilisation grades, post-surgical protocols and precautions, gait deviations, posture and biomechanics, therapeutic exercise progression, and distinguishing musculoskeletal pain from referred visceral or neurological pain.

Neuromuscular and nervous systems account for 39-48 of the 180 scored items. Content covers stroke and traumatic brain injury rehabilitation, spinal-cord injury levels and expected functional outcomes, neurodegenerative conditions such as Parkinson disease and multiple sclerosis, vestibular and balance disorders, peripheral neuropathies and nerve injuries, paediatric developmental conditions, and the motor-control and motor-learning principles that govern how any of it is trained.

Cardiovascular and pulmonary systems carry 22-27 of the 180 scored items. The content covers normal and abnormal responses to exercise, exercise testing and prescription including METs and target heart rate, criteria for terminating exercise, cardiac and pulmonary rehabilitation phases and precautions, airway-clearance techniques, breathing strategies, and the lines, tubes, monitoring and medication effects that shape mobilisation in acute care.

Integumentary carries 8-11 of the 180 scored items. Content covers wound assessment and pressure-injury staging, burn depth classification and the rule of nines, selecting debridement methods, choosing dressings by wound moisture and exudate, oedema and scar management, and the precautions and contraindications that apply to modalities used on compromised skin.

These four smaller systems together carry 13-24 of the 180 scored items. The content covers diabetes and the exercise-related risks of hypoglycaemia and neuropathy, thyroid and adrenal disorders, gastrointestinal conditions that limit positioning and activity, bowel and bladder dysfunction and pelvic-floor rehabilitation, and lymphoedema staging with complete decongestive therapy and its contraindications.

System Interactions is 8-10 of the 180 scored items and appears only in the Foundations for Evaluation, Differential Diagnosis and Prognosis column. It covers presentations in which several systems interact, medical red flags that require referral rather than treatment, the effects of common medications on therapy, comorbidity-driven modification of the plan of care, and deciding when physical therapy is not the appropriate next step.

Two non-system categories together carry 9-12 of the 180 scored items: equipment, devices and technologies (5-6) and therapeutic modalities (4-6). Content covers assistive-device selection and measurement, orthotic and prosthetic components and gait deviations, wheelchair measurement and fit, and the indications, contraindications, parameters and physiological effects of thermal, electrical, mechanical and light modalities.

Three non-system categories together carry 12-17 of the 180 scored items: safety and protection (5-7), professional responsibilities (4-5) and research and evidence-based practice (3-5). Content covers infection control and standard precautions, emergency response and patient-safety events, supervision and delegation to PTAs and aides, documentation and informed consent, ethics and jurisdictional scope of practice, and research design, statistics and the appraisal of evidence.

Work out the seconds per question the NPTE actually allows, per-section checkpoints, and whether a practice attempt is running ahead or behind at any point.