Overview
This guide groups four FSBPT body systems that together hold 13 to 24 of the 180 scored NPTE-PT items: Metabolic & Endocrine (4-6), Gastrointestinal (3-6), Genitourinary (2-5) and Lymphatic (4-7). Each has its own small item range in the 2024 content outline. Metabolic & Endocrine has no physical therapy examination category; the other three include examination, foundations and interventions.
Metabolic and endocrine items center on diabetes, thyroid and adrenal disorders, osteoporosis and obesity, especially how they change exercise safety. Gastrointestinal items cover visceral referred pain, tests such as the Murphy sign and McBurney point, positioning for reflux and bowel programs. Genitourinary items include incontinence types, pelvic floor retraining, biofeedback, renal disease and kidney-related referred pain. Lymphatic items cover lymphedema staging, girth and volume measurement, complete decongestive therapy and its contraindications.
How it's tested
Items here are usually short scenarios. Some ask whether exercise is safe given a lab value or symptom, some ask where pain is coming from, and some ask which intervention fits a pelvic health or lymphedema problem. Look for clues such as meal timing, insulin use, pain with eating, urinary symptoms and limb swelling patterns.
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Safe to exercise
A glucose value, thyroid status or dialysis schedule is given, and you decide whether to proceed, modify or delay exercise.
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Visceral referral
Pain in the shoulder, back or groin with GI or GU features suggests an organ source that needs medical referral.
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Program design
Incontinence type or lymphedema stage is described, and you choose pelvic floor, bladder or decongestive interventions.
A woman leaks urine when she coughs or lifts, but does not report urgency. This is stress urinary incontinence from weak pelvic floor support. Bladder retraining with timed voiding targets urge incontinence, so the stronger answer is pelvic floor muscle training, possibly with biofeedback, including a quick contraction before coughing or lifting.
Content areas 4
Official content areas from the FSBPT outline, in outline order.
5.1 Metabolic & Endocrine SystemsMetabolic and endocrine conditions, medical management, medication effects, differential diagnosis and interventions; no examination category (4-6 items).
- What it means
- This system covers diabetes, thyroid, parathyroid and adrenal disorders, osteoporosis, obesity and metabolic syndrome, and how these conditions, their tests and their drugs change physical therapy evaluation and exercise.
- What to understand
- Know signs of hypoglycemia (shaky, sweaty, confused) and hyperglycemia (thirst, polyuria, fruity breath), and common exercise rules: check glucose before activity, give carbohydrate if it is low, and avoid vigorous exercise when glucose is very high with ketones. Avoid injecting insulin into a muscle about to be exercised and watch for delayed hypoglycemia. Know hypothyroid fatigue and myopathy versus hyperthyroid tachycardia and heat intolerance. Know Cushing syndrome effects on bone and skin, osteoporosis precautions such as avoiding loaded spinal flexion, and how metformin, insulin and corticosteroids affect therapy.
- How it shows up
- Expect pre-exercise glucose decisions, signs of a hypoglycemic event during therapy, and precautions for osteoporosis.
- Common confusion
- Treating confusion and sweating during exercise in a patient with diabetes as simple fatigue.
5.2 Gastrointestinal SystemGI tests and measures such as the Murphy, Rovsing and McBurney point signs, GI conditions, medications, differential diagnosis and interventions (3-6 items).
- What it means
- This system covers examination findings and conditions of the digestive tract, liver, gallbladder and pancreas, how they refer pain to the trunk and shoulder, and interventions such as reflux positioning and bowel programs.
- What to understand
- Know visceral referral patterns: gallbladder to the right shoulder and scapula, pancreas to the mid back, appendix to the right lower quadrant, and esophagus to the chest. Know the Murphy sign for cholecystitis and the Rovsing sign and McBurney point tenderness for appendicitis, all as referral findings. Understand GERD and avoiding flat supine positions after meals, inflammatory bowel disease, hernia risk with straining, constipation from opioids, and how NSAIDs cause GI bleeding. Know bowel programs, positioning for defecation with hips flexed, and how trigger points or abdominal muscle tension can mimic visceral pain.
- How it shows up
- Questions often hide a GI cause inside a musculoskeletal complaint and ask for the right next step.
- Common confusion
- Treating right shoulder pain that worsens after fatty meals as a rotator cuff problem.
5.3 Genitourinary SystemGU tests and measures, renal and urologic conditions, medications, differential diagnosis, and interventions such as bladder programs, biofeedback and pelvic floor retraining (2-5 items).
- What it means
- This system covers the kidneys, bladder and reproductive organs as they relate to physical therapy: incontinence and pelvic floor dysfunction, renal disease and dialysis, urologic causes of back or groin pain, and pelvic health interventions.
- What to understand
- Know incontinence types: stress (leakage with cough or lift), urge (sudden strong need), mixed, overflow and functional. Match interventions: pelvic floor muscle training for stress, bladder retraining and urge suppression for urge, and environmental changes for functional incontinence. Understand biofeedback and the role of timed voiding. Know kidney referral to the flank and groin, signs of urinary tract infection, chronic kidney disease and dialysis precautions such as avoiding blood pressure measurement on the fistula arm. Recognize pelvic organ prolapse and post-prostatectomy incontinence.
- How it shows up
- Items ask which incontinence type fits the description and which program addresses it, or whether flank pain needs referral.
- Common confusion
- Prescribing bladder retraining for pure stress incontinence.
5.4 Lymphatic SystemLymphatic tests and measures, movement analysis such as compensatory movement and limb motion, lymphatic conditions, and interventions with adverse effects (4-7 items).
- What it means
- This system covers primary and secondary lymphedema, its measurement and staging, the effect of cancer treatment such as lymph node removal and radiation, and decongestive and exercise interventions and their risks.
- What to understand
- Know lymphedema stages from latent to elephantiasis and Stemmer sign, where the skin over the second toe or finger cannot be lifted. Measure with circumference at set intervals, water displacement or perometry. Complete decongestive therapy combines manual lymphatic drainage, short-stretch multilayer bandaging, exercise and skin care, followed by a maintenance phase with garments. Know contraindications, including acute infection such as cellulitis, untreated DVT and uncontrolled heart failure. Understand that progressive resistance exercise is safe for most people after breast cancer when supervised, and recognize lipedema as a different, symmetric fat disorder.
- How it shows up
- Expect questions on staging, the next phase of decongestive therapy, and when to stop and refer.
- Common confusion
- Starting manual lymphatic drainage on a red, hot, swollen arm before cellulitis is treated.
High-yield concepts
The terms, rules and formulas this domain turns into questions most often.
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Pre-exercise glucose check
Measure blood glucose before activity in insulin users.
- Remember
- Low values need carbohydrate first; very high with ketones means delay.
- Tested as
- Exercise safety items.
- Trap
- Starting exercise without checking.
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Hypoglycemia signs
Shakiness, sweating, confusion, rapid heart rate.
- Remember
- Stop and give fast-acting carbohydrate.
- Tested as
- During-session emergencies.
- Trap
- Calling it fatigue.
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Insulin injection site
Where insulin is absorbed.
- Remember
- Avoid injecting into a muscle about to be exercised.
- Tested as
- Diabetes exercise planning.
- Trap
- Ignoring absorption speed.
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Thyroid disorders
Hypo slows metabolism; hyper speeds it.
- Remember
- Hyperthyroid patients may have tachycardia and heat intolerance.
- Tested as
- Exercise response items.
- Trap
- Mixing up the signs.
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Osteoporosis precautions
Low bone density increases fracture risk.
- Remember
- Avoid loaded spinal flexion and twisting; include weight-bearing and resistance work.
- Tested as
- Exercise selection.
- Trap
- Prescribing sit-ups.
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Gallbladder referral
Biliary pain referred to the right shoulder and scapula.
- Remember
- Worse after fatty meals; Murphy sign.
- Tested as
- Screening items.
- Trap
- Treating it as a shoulder strain.
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Appendicitis signs
Inflamed appendix.
- Remember
- McBurney point tenderness and Rovsing sign; urgent referral.
- Tested as
- Screening items.
- Trap
- Treating it as a hip flexor strain.
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Reflux positioning
Positioning to reduce gastroesophageal reflux.
- Remember
- Avoid flat supine after meals; elevate the head of bed.
- Tested as
- GI interventions.
- Trap
- Using head-down drainage after meals.
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Stress incontinence
Leakage with increased abdominal pressure.
- Remember
- Pelvic floor training, including a pre-contraction before cough.
- Tested as
- Pelvic health items.
- Trap
- Choosing bladder retraining alone.
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Urge incontinence
Leakage with a sudden strong need to void.
- Remember
- Bladder retraining, urge suppression, timed voiding.
- Tested as
- Pelvic health items.
- Trap
- Treating it like stress incontinence.
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Kidney referral
Renal pain in the flank and groin.
- Remember
- Costovertebral angle tenderness with fever needs referral.
- Tested as
- Back pain screening.
- Trap
- Labeling it mechanical low back pain.
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Complete decongestive therapy
Two-phase lymphedema treatment.
- Remember
- MLD, short-stretch bandaging, exercise and skin care, then garments.
- Tested as
- Lymphedema plans.
- Trap
- Using long-stretch bandages.
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Stemmer sign
Inability to pinch skin over the second digit.
- Remember
- Positive sign supports lymphedema.
- Tested as
- Lymphatic examination.
- Trap
- Assuming a negative sign rules it out.
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CDT contraindications
Conditions that prohibit decongestive therapy.
- Remember
- Acute cellulitis, untreated DVT, uncontrolled heart failure.
- Tested as
- Safety screening.
- Trap
- Draining an infected limb.
Side by side
Concepts candidates mix up, compared on the point that decides the answer.
Urinary incontinence types
| Concept | Meaning | Key difference | Common trap |
|---|---|---|---|
| Stress | Leakage with cough, sneeze or lift | Weak pelvic floor support | Choosing bladder retraining |
| Urge | Sudden strong need to void | Detrusor overactivity | Choosing strengthening alone |
| Overflow | Incomplete emptying with dribbling | Obstruction or underactive bladder; refer | Prescribing pelvic floor training |
| Functional | Cannot reach the toilet in time | Mobility or cognitive barrier | Treating the bladder instead of access |
Hypoglycemia versus hyperglycemia
| Concept | Meaning | Key difference | Common trap |
|---|---|---|---|
| Hypoglycemia | Low blood glucose | Rapid onset, sweating, shakiness, confusion | Giving insulin |
| Hyperglycemia | High blood glucose | Slower onset, thirst, polyuria, fruity breath | Giving sugar |
Visceral referral patterns
| Concept | Meaning | Key difference | Common trap |
|---|---|---|---|
| Gallbladder | Biliary inflammation | Right shoulder and scapula, after fatty meals | Shoulder exercises |
| Pancreas | Pancreatic inflammation or tumor | Mid back and epigastric pain | Thoracic mobilization |
| Kidney | Renal infection or stone | Flank and groin pain, possible fever | Lumbar exercise |
Exam traps
Each trap is an answer that looks right. Learn the clue that should change your mind.
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Exercise through low glucose
- What candidates pick
- Begin exercise because the patient feels fine.
- Why it looks right
- No symptoms are reported yet.
- Why it's wrong
- Exercise lowers glucose further; a low starting value needs carbohydrate and a recheck first.
Clue to watch for Pre-exercise glucose below about 100 mg/dL in an insulin user.
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Inject into the exercising limb
- What candidates pick
- Approve insulin injection in the thigh before cycling.
- Why it looks right
- The thigh is a common injection site.
- Why it's wrong
- Exercise speeds absorption from active muscle and raises hypoglycemia risk.
Clue to watch for Insulin timing and site near the session.
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Shoulder pain is musculoskeletal
- What candidates pick
- Begin rotator cuff exercise for right shoulder pain.
- Why it looks right
- The complaint is in a joint area.
- Why it's wrong
- Pain linked to eating and no change with shoulder movement points to gallbladder referral.
Clue to watch for Symptoms change with meals, not motion.
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Bladder retraining for stress leakage
- What candidates pick
- Teach timed voiding and urge suppression.
- Why it looks right
- Bladder programs are listed in the outline.
- Why it's wrong
- Leakage with cough or lift reflects pelvic floor weakness; muscle training is the core treatment.
Clue to watch for Leakage tied to effort, not urgency.
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Drain an infected limb
- What candidates pick
- Start manual lymphatic drainage for a red, hot, swollen arm.
- Why it looks right
- Swelling suggests lymphedema treatment.
- Why it's wrong
- Acute infection must be treated medically before decongestive therapy.
Clue to watch for Fever, redness and warmth.
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Avoid all resistance after breast cancer
- What candidates pick
- Restrict lifting permanently after node dissection.
- Why it looks right
- Older advice stressed limb protection.
- Why it's wrong
- Supervised, progressive resistance exercise is generally safe and may help, with monitoring for swelling.
Clue to watch for Stable lymphedema or at-risk limb, no infection.
Answer framework
Apply these steps when a question involves a metabolic, GI, GU or lymphatic issue.
- Decide whether the stem is a screening question by looking for meals, bowel, bladder, fever, weight change or unexplained swelling.
- Check safety values and conditions first, such as blood glucose, thyroid status, dialysis timing, infection signs or DVT risk.
- Classify the problem: diabetes type and control, referral pattern, incontinence type or lymphedema stage.
- Choose the matching intervention, such as pelvic floor training for stress incontinence or decongestive therapy for stable lymphedema.
- Plan monitoring and education, including glucose checks, warning signs, garment use, bowel or bladder routines and when to contact the physician, and recheck the key measure at the next visit.
Practice question
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Checklist
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Study strategy
Study the four systems separately but finish them in one block. Start with diabetes, because it appears across the exam: learn glucose thresholds for exercise, hypoglycemia response, insulin timing and long-term complications such as neuropathy and retinopathy. Add thyroid, adrenal and bone disorders with one line on what each changes during exercise.
For gastrointestinal and genitourinary content, draw a body chart of visceral referral patterns and list the associated signs and tests. Then build a pelvic health table pairing each incontinence type with its mechanism and intervention, and add renal disease and dialysis precautions.
For the lymphatic system, learn staging, measurement methods, the components and phases of decongestive therapy, and the contraindications. Practice with short mixed question sets, because these items are scattered across sections. When you miss one, note whether you missed a screening cue, a safety value or the program match, and add that cue to your notes.
FAQ
How much of the NPTE-PT does this grouped domain cover?
This domain groups four FSBPT body systems with 13 to 24 of the 180 scored items combined, about 7 to 13 percent. Metabolic & Endocrine has 4-6 items, Gastrointestinal 3-6, Genitourinary 2-5 and Lymphatic 4-7.
Why are these four systems grouped together?
FSBPT lists them separately, but each has only a few items. Grouping them keeps study planning manageable while the topics on this page still follow each official system.
Is pelvic health on the NPTE-PT?
Yes. The genitourinary interventions list includes bladder programs, biofeedback and pelvic floor retraining, so expect basic pelvic health reasoning.
Which glucose values matter for exercise?
Commonly cited guidance is to give carbohydrate when pre-exercise glucose is below about 100 mg/dL and to avoid vigorous exercise when it is very high with ketones present.
Do I need to know abdominal special tests?
Know the Murphy sign, Rovsing sign and McBurney point tenderness as findings that point to a GI cause and require referral, since FSBPT names them in the outline.
What lymphedema content should I focus on?
Staging, Stemmer sign, girth and volume measurement, complete decongestive therapy components, bandaging type and contraindications such as infection and untreated DVT.
Test your Domain 5 knowledge
You have reviewed metabolic, GI, GU and lymphatic content. Check that screening cues and safety values come to mind quickly in mixed practice questions.
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