NPTE Mnemonics: 12 Memory Tricks for PT Students

Cranial nerves: names, function and how to test them

“Oh Oh Oh To Touch And Feel Very Good Velvet, Such Heaven”

1. OI Olfactory - sensory: smell
2. OII Optic - sensory: acuity and visual fields
3. OIII Oculomotor - motor: most eye movements, pupil constriction, eyelid elevation
4. TIV Trochlear - motor: superior oblique (eye down and in)
5. TV Trigeminal - both: facial sensation, jaw muscles (mastication)
6. AVI Abducens - motor: lateral rectus (eye out)
7. FVII Facial - both: facial expression, taste on the front two-thirds of the tongue
8. VVIII Vestibulocochlear - sensory: hearing and balance
9. GIX Glossopharyngeal - both: taste on the back third, gag sensation, swallowing
10. VX Vagus - both: palate elevation, swallowing, voice, parasympathetic supply
11. SXI Spinal accessory - motor: sternocleidomastoid and upper trapezius (shrug, head turn)
12. HXII Hypoglossal - motor: tongue movement

Use it when: When a stem gives a deficit (double vision on looking down, weak shrug, facial droop, tongue deviation) and asks which nerve is involved, or which test checks a given nerve.

Careful: For sensory, motor or both, the companion phrase is 'Some Say Marry Money But My Brother Says Big Brains Matter Most'. The exam likes side rules: the tongue deviates TOWARD the side of a CN XII lesion, the uvula moves AWAY from the side of a CN X lesion, and a stroke (UMN) facial palsy spares the forehead while Bell's palsy (LMN, CN VII) does not. CN VIII is the vestibulocochlear nerve; older books call it auditory or acoustic.

Upper vs lower motor neuron signs

“UMN goes UP, LMN goes DOWN”

Upper motor neuron lesion (brain or spinal cord): tone goes up (velocity-dependent spasticity), reflexes go up (hyperreflexia, clonus), the big toe goes up (positive Babinski), and atrophy is mild and from disuse. Lower motor neuron lesion (anterior horn cell, nerve root or peripheral nerve): tone goes down (flaccid), reflexes go down or disappear, muscle bulk goes down (marked atrophy), and fasciculations appear.

Use it when: When a stem lists exam findings and asks where the lesion is, or whether a condition such as ALS, Guillain-Barre, cauda equina syndrome or a cord injury fits the picture.

Careful: Right after a spinal cord injury, spinal shock produces flaccid paralysis and absent reflexes below the level, so UMN signs appear only later. ALS shows UMN and LMN signs together. A Babinski response is normal in infants up to about 1-2 years. A lesion at the cauda equina, below the end of the cord, gives LMN signs even though it is a 'spinal' injury.

Dermatome landmarks

“Six-shooter thumb, belly-but-TEN, L4 on all fours”

C6 is the thumb (make a six-shooter with your thumb and index finger), C7 the middle finger and C8 the little finger. T4 runs at the nipple line and T10 at the umbilicus (belly-but-ten). L4 covers the knee and medial leg to the medial malleolus (down on all fours, on your knees), L5 the dorsum of the foot and big toe, and S1 the lateral foot and heel.

Use it when: When a stem describes numbness in a band or a part of a limb and asks for the nerve root, or asks for the sensory level in a spinal cord injury.

Careful: Dermatome maps differ between textbooks and overlap, so a single-root lesion often gives less or patchier sensory loss than the map suggests. For spinal cord injury, use the ISNCSCI key sensory points, for example C6 on the dorsal thumb, L4 at the medial malleolus, L5 at the third metatarsophalangeal joint and S1 at the lateral heel. A peripheral nerve pattern (for example median nerve in the hand) does not follow dermatomes.

Brachial plexus structure and classic injuries

“Real Texans Drink Cold Beer”

1. RRoots: C5-T1 ventral rami
2. TTrunks: upper (C5-C6), middle (C7), lower (C8-T1)
3. DDivisions: 3 anterior and 3 posterior, behind the clavicle
4. CCords: lateral, posterior and medial, named for their position around the axillary artery
5. BBranches: musculocutaneous, axillary, radial, median and ulnar

Use it when: When a stem describes a birth injury, a fall onto the shoulder or a traction injury and asks which part of the plexus or which nerve is damaged.

Careful: Know the two named palsies. Erb-Duchenne (upper trunk, C5-C6) gives the 'waiter's tip' posture: arm adducted and internally rotated, elbow extended, forearm pronated. Klumpke (lower trunk, C8-T1) gives a claw hand with intrinsic weakness and can include Horner syndrome if the T1 sympathetic fibers are involved. The posterior cord gives rise to both the axillary and radial nerves.

Capsular pattern of the shoulder

“Every Athlete Is frozen”

1. EExternal rotation: most limited
2. AAbduction: next most limited
3. IInternal rotation: least limited

Use it when: When a stem gives passive range-of-motion findings and asks whether the problem is capsular (adhesive capsulitis, arthritis) or something else.

Careful: Each joint has its own pattern, and textbooks disagree on some. Common versions (Magee): hip flexion, abduction and internal rotation (some texts put internal rotation first); knee flexion more than extension; elbow flexion more than extension; ankle plantarflexion more than dorsiflexion. If only one motion is limited, think noncapsular: a ligament, an internal derangement or a structure outside the joint.

Convex-concave rule for joint mobilization

“Convex? Contrary. Concave? Copy.”

When a convex surface moves on a fixed concave surface, it glides in the direction opposite to the bone's movement: in shoulder abduction the humeral head rolls up and glides inferiorly. When a concave surface moves on a fixed convex surface, it glides in the same direction as the bone: in open-chain knee extension the tibia glides anteriorly on the femur.

Use it when: When a stem asks which glide to use to restore a limited motion, such as an inferior glide for limited shoulder abduction or a posterior tibial glide for limited knee flexion.

Careful: Check which bone is moving. In closed-chain knee extension the convex femur moves on the fixed tibia, so the glide reverses. The rule is a starting point, not a law: in a randomized trial in adhesive capsulitis, posterior glides improved external rotation far more than the anterior glides the rule predicts (Johnson et al., JOSPT 2007).

Ottawa ankle and foot rules

“6 cm, 4 steps, 5th and navicular”

Ankle X-ray is indicated if there is pain in the malleolar zone AND bone tenderness along the distal 6 cm of the posterior edge or tip of either malleolus, OR the patient cannot bear weight for 4 steps both right after the injury and at the exam. Foot X-ray is indicated if there is midfoot pain AND bone tenderness at the base of the 5th metatarsal or the navicular, OR the same inability to take 4 steps.

Use it when: When a stem describes an acute ankle or foot injury and asks whether the patient needs referral for imaging before treatment.

Careful: The rules are built to rule fractures OUT: sensitivity is close to 100%, but specificity is low, so a positive rule means 'image', not 'fracture'. They were derived in adults and do not apply to patients who are intoxicated, have reduced sensation, or have other painful injuries that distract from the ankle.

Using sensitivity and specificity to interpret special tests

“SnNout, SpPin”

1. SnNoutA highly Sensitive test, when Negative, rules the condition out
2. SpPinA highly Specific test, when Positive, rules the condition in

Use it when: When a stem gives a special test's sensitivity and specificity and asks what a positive or negative result means, or which test best rules a condition in or out.

Careful: The shortcut only works when the value is very high; a test with 70% sensitivity cannot rule much out. Likelihood ratios are the better tool and are listed in the outline: a positive LR above 10 or a negative LR below 0.1 causes a large shift in probability. The Ottawa rules are a classic SnNout: a negative rule makes a fracture very unlikely.

Left vs right heart failure

“Left = Lungs, Right = Rest of the body”

1. LLeft-sided failure backs fluid up into the Lungs: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, crackles, cough, fatigue
2. RRight-sided failure backs fluid up into the Rest of the body: jugular vein distension, bilateral pitting edema, weight gain, enlarged liver, ascites

Use it when: When a stem lists signs and asks which side of the heart is failing, or what finding should make you hold treatment and contact the physician.

Careful: The most common cause of right-sided failure is left-sided failure, so many patients show both. Right-sided failure caused by lung disease is cor pulmonale. A sudden weight gain (about 2-3 lb in a day or 5 lb in a week), new crackles or new edema signal decompensation and are reasons to contact the medical team before exercising.

Normal heart-rate and blood-pressure response to exercise

“Systolic climbs, diastolic holds”

During graded aerobic exercise, heart rate rises roughly in a straight line with workload, systolic blood pressure rises about 10 mmHg per MET, and diastolic pressure stays about the same or changes by less than about 10 mmHg. Breathing rate and depth rise too. Anything else, such as systolic pressure that stays flat or falls, or diastolic pressure that climbs, is an abnormal response.

Use it when: When a stem gives vitals before and during exercise and asks whether the response is normal, or which finding means the session should end.

Careful: Beta-blockers blunt the heart-rate and blood-pressure rise, so use RPE as well. After a heart transplant the heart is denervated: resting heart rate is high, heart rate rises slowly through circulating catecholamines, and the patient needs a longer warm-up and cool-down. A systolic drop as workload increases is a sign to stop, not a sign of fitness.

Red flags for serious spinal pathology

“TUNA FISH”

1. TTrauma: significant, or minor in an older or osteoporotic patient
2. UUnexplained weight loss
3. NNeurological deficit: saddle anesthesia, bowel or bladder change, progressive weakness
4. AAge over 50 at onset
5. FFever or other signs of infection
6. IIV drug use
7. SSteroid use over a long period
8. HHistory of cancer

Use it when: When a stem gives a back-pain history and asks whether to treat, treat and monitor, or refer, and which finding is the most worrying.

Careful: Most single red flags have high false-positive rates; a history of cancer is the most useful flag for spinal malignancy, and older age, long-term steroid use and significant trauma point to fracture (Downie et al., BMJ 2013). Saddle anesthesia with new bowel or bladder change means possible cauda equina syndrome and needs same-day emergency referral, not a trial of treatment.

Early warning signs of cancer in screening

“CAUTION”

1. CChange in bowel or bladder habits
2. AA sore that does not heal
3. UUnusual bleeding or discharge
4. TThickening or lump in the breast or elsewhere
5. IIndigestion or difficulty swallowing
6. OObvious change in a wart or mole
7. NNagging cough or hoarseness

Use it when: When a stem includes a review of systems or a new finding during treatment and asks which one needs referral to a physician.

Careful: CAUTION is the American Cancer Society's classic list of seven warning signs, used for screening, not diagnosis. PT screening texts add findings such as proximal muscle weakness, changes in deep tendon reflexes, and pain that is constant or worse at night and not eased by rest or position. A past history of cancer raises the weight of any of these.