MSK Practice Questions - Full Questions, Answers, & Rationales. Update 2022

MSK Practice Questions - Full Questions, Answers, & Rationales. Update 2022 The correct answer is A: Jumpers knee. Rationale- Patellar tendonitis or Jumpers knee is an overuse injury of the quadriceps tendon. Pai ...

MSK Practice Questions - Full Questions, Answers, & Rationales. Update 2022 The correct answer is A: Jumpers knee. Rationale- Patellar tendonitis or Jumpers knee is an overuse injury of the quadriceps tendon. Pain at the lower pole of patella and stiffness after activity are main presentations. Meniscal tear (Option B) presents with popping and locking on movement. Osteochondritis dissecans (Option C) may have pain at base of patella due to traction apophysitis of the tibial tubercle but it is seen in a younger age group who are not skeletal mature. Similarly, Osgood Schlatter (Option D) is seen in younger children aged 12-14. Reference: David J Magee; Orthopedic physical examination edition 6. Page: 770 - ✔✔A 20 year old college basketball player reports of pain, stiffness and feeling of weakness in his left knee which aggravates after playing. On examination, there is no crepitus, no popping or locking of the joint movement. Palpating the lower pole of patella and quadriceps tendon reproduces pain. What is the MOST likely diagnosis? A. Jumpers knee B. Meniscal tear C. Osteochondritis dissecans D. Osgood Schlatter syndrome The correct answer is A: Strengthening of the right gluteus medius. Rationale- The picture shows the right knee in a valgus position and strengthening of hip abductors muscles will help with proximal stability. Stretching of hip adductors, not strengthening (Option B) will most likely help with knee valgus. Recent evidence suggests strengthening of the right vastus medialis (Option C) does not have any significant effect on knee valgus. Tibialis anterior (Option D) is one joint dorsiflexor and invertor and doesn't cross the knee joint. Reference- Nordin M. Basic Biomechanics of Musculosketelal system, page 148-149 - ✔✔A PT is evaluating a 24-year-old female basketball player with a vague diagnosis of right knee pain. The patient is performing a jump landing as shown in the picture below. The PT treatment should MOST likely focus on: A. Strengthening of the right gluteus medius B. Strengthening of the right adductor magnus C. Strengthening of the right vastus medialis D. Strengthening of the right tibialis anterior The correct answer is C. Apply PA glide on L3 transverse process on the left side. Rationale- Applying a Posterior- Inferior glide will move the L3 vertebrae superiorly and closer to the L2, and help improve the closing restriction. Applying PA glide on L2 transverse process on the right side (Option A) will open the L2-L3 on right side and indirectly close the left side but it is not the best option. Applying PA glide on L3 transverse process on the right side (Option B) will close the L2-L3 on the right side, and applying PA glide on L4 transverse process on the left side (Option D) will close L3-L4 on the left side. Reference: Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 501, 502 - ✔✔On examining a patient with a decreased trunk side bending to the left, the physical therapist finds a closing restriction between L2-L3 vertebrae. What is the MOST appropriate intervention to improve the restriction? A. Apply PA glide on L2 transverse process on the right side B. Apply PA glide on L3 transverse process on the right side C. Apply PA glide on L3 transverse process on the left side D. Apply PA glide on L4 transverse process on the left side The correct answer is C: Get a roller bag with wheels, and roll it on the left side. Rationale: Having a roller bag (bag with wheels) on the opposite (left) side will create a counter-clockwise torque on the right hip which will help reduce the stress (and pain) on the right hip. Holding the bag without wheels on the left side will increase the stress on the right hip making A incorrect. Roller bag on the same side (Option B ) will create a clockwise torque, which will also increase stress on the right side. Leaning of the trunk on same side decreases pain, not opposite side (Option D). Reference- Nordin M. Basic Biomechanics of the Musculoskeletal System, Page 219-220 - ✔✔A 33 year old physical therapy student presents to an outpatient clinic with history of low back pain. The patient walks home each night from the library carrying a heavy bag of NPTE books in his right hand. On examination, the PT notes right hip pain and 3+/5 strength of the right hip abductors. Which of the following is the MOST appropriate suggestion to help alleviate patients symptoms? A. Start carrying the same bag on the left side B. Get a roller bag with wheels, and roll it on the right side C. Get a roller bag with wheels, and roll it on the left side D. Encourage the patient to lean to the left to decrease pain The correct answer is C. Synovitis Rationale- Hypomobility (Option A) has decreased mouth opening but and no pain. Disc displacement with reduction (Option B) has clicking sound. Synovitis (Option C) and Capsulitis (Option D) both have decreased opening but there is no deviation in Synovitis, making option C correct. Reference- Dutton's Orthopaedic Examination; Evaluation, and Intervention, 3rd Edition Page: 1207, 1217, 1220 - ✔✔A patient presents with limited mouth opening of 25 mm due to pain. There is no complain of clicking sound or mouth deviation when he opens his mouth. The patient is unable to completely close his mouth with teeth clenched together. What is the MOST likely diagnosis based on the patient symptoms? A. Hypomobility B. Disc displacement with reduction C. Synovitis D. Capsulitis The correct answer is B: Metatarsus adductus, internal tibial torsion, increased femoral anteversion. Rationale- The position of toe-in would correlate with metatarsus adductus (forefoot adducted), internal tibial torsion (position of pronation), and increased femoral anteversion. Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 715, 897 - ✔✔A physical therapist is treating a pediatric patient with cerebral palsy. The patient is seen in standing with a toe-in posture. Which of the following postural strategies most accurately correlates with the observed foot position? A. Metatarsus abductus, internal tibial torsion, increased femoral retroversion B. Metatarsus adductus, internal tibial torsion, increased femoral anteversion C. Metatarsal adductus, external tibial torsion, increased femoral retroversion D- Metatarsal abductus, external tibial torsion, increased femoral anteversion The correct answer is D: Soleus. Rationale- Soleus and Gastroc will be stretched during passive ankle dorsiflexion. As Soleus is a one joint muscle which doesn't cross the knee joint, the position of knee shouldn't affect the passive range of motion at the ankle. Good job everyone! Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 1006 - ✔✔During an outpatient evaluation the PT checks the active and passive ankle range of motion. The patient lacks 8 degree of passive ankle dorsiflexion. The same limitation in range of motion is present whether the knee is extended or flexed. The muscle MOST likely contributing to the restriction in passive range of motion is? A. Tibialis Anterior B. Hamstrings C. Gastrocnemius D. Soleus The correct answer is C: Terminal stance. Rational-A positive thomas test indicates tightness of the hip flexors. If the hip flexors are tight, it will result in limitation in range of motion of the anatgonistic motion (hip extension). Given the hip is in extension during terminal stance, tightness of hip flexors will cause limitation in hip extension range of motion. All other options (loading response, mid stance and terminal swing) don't require end range hip extension during a typical gait cycle. Great job everyone! Reference Pg 13 Gait Analysis- Normal and Abnormal by Jacquelin Perry (2nd edition - ✔✔A physical therapist is evaluating a 34-year-old female patient with a vague diagnosis of low back pain. The patient displays a positive Thomas test during initial evaluation as shown in the picture below. Which phase of the gait cycle will MOST likely show limitation in the hip range of motion? A. Loading response B. Mid stance C. Terminal stance D. Terminal swing The correct answer is D: Radial glide at the CMC joint. Rationale- A radial glide is used to improve thumb extension to help swipe upwards. At the CMC joint, the trapezium is convex and the proximal metacarpal is concave for flexion and extension. Flexion and Extension are frontal plane movements of the thumb and concave metacarpal moves over the convex trapezoid so glide will be in the same direction. (Concave-convex rule). Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 144 - ✔✔A 24-year-old PT graduate student was using a phone with broken screen and recently upgraded to a new phone. The student is constantly on the new phone and is having difficulty swiping upwards with their thumb as shown in the picture below. What is the BEST mobilization to improve the thumb range of motion so that the student can swipe happily thereafter! A. Inferior glide at the CMC joint B. Superior glide at the CMC joint C. Ulnar glide at the CMC joint D. Radial glide at the CMC joint The correct answer is D: Right ankle plantar flexor weakness. Rationale- Possible causes for pelvic hike in swing phase are reduced hip flexion, reduced knee flexion, and/or lack of ankle dorsiflexion. Tightness (not weakness) of the plantarflexors will cause pelvic hike. Reference- Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 1006 - ✔✔While evaluating the gait cycle of a 68 year old male patient, the physical therapist observes right pelvic hike during the swing phase of the right gait cycle. Which of the following condition is LEAST likely to cause the problem? A. Reduced right hip flexion B. Inadequate right knee flexion C. Lack of right ankle dorsiflexion D. Right ankle plantar flexor weakness The correct answer is A: G Max. Rationale- The patient lacks passive flexion range of motion which suggests the G Max or Hamstrings are responsible. Given the position of knee doesn't effect the restriction in range of motion, the one joint muscle not crossing the knee (G Max) would be the correct answer. Hamstrings (Option B) is a two joint muscle which crosses the knee. Option C and D would be more appropriate options for active range of motion limitation. Reference- O'Sullivan SB; Physical Rehabilitation, 6th edition Page: 90 - ✔✔During an outpatient evaluation the therapist checks the active and passive hip range of motion. The patient lacks 20 degrees of passive hip flexion. The same limitation in range of motion is present whether the knee is extended or flexed. The muscle MOST likely contributing to the restriction in hip passive range of motion is: A. G. Max B. Hamstrings C. Illiopsoas D. Rectus femoris Correct answer is C. Pectoralis major sternal head Rationale- MMT of Pectoralis major sternal head - the motion begins at 120° of shoulder abduction and moves diagonally down and in toward the patient's opposite hip. Reference- Daniels & Worthingham's muscle testing, 8th edition, Page: 105 - ✔✔A physical therapist is performing a manual muscle test on a patient with good muscle strength. The physical therapist positions the patient as shown in the picture, and applies force down and inward toward the patient's opposite hip. Which muscle is being tested? A. Pectoralis major clavicular head B. Latissimus dorsi C. Pectoralis major sternal head D. Pectoralis minor The correct answer is B: Hip abductor contracture on right side. Rational-- Hip abductor contracture on right or weak left hip abductor causes right pelvis drop. Weak right hip abductors (Option A), or left weak hip adductors (option C) or left hip abductor contracture (option D) causes pelvic drop on the left side. Reference- J. Perry Gait textbook 2nd edition Pg 271 Figure 14.7 - ✔✔A physical therapist is examining a 44 year old patient walking at 3.3 miles/hour. The PT diagnoses a right pelvic drop during left stance phase. Which of the following is a potential cause of right pelvic drop? A. Weak hip abductors on right side B. Hip abductor contracture on right side C. Weak hip adductors on left side D. Hip abductors contracture on left side The correct answer is B: Iliopsoas. Rationale- In posterior innominate rotation, PSIS is lower and the ASIS is higher on the involved side (left in this case). It can be caused by tightening of hip extensors. Isometric contraction of iliopsoas (hip flexor) and stretching of hip extensors are interventions to treat posterior innominate rotation. Contraction of gluteus maximus will further increase the posterior innominate rotation. Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 471, 472 - ✔✔A physical therapy examination reveals posterior superior iliac spine (PSIS) is low on the left; anterior superior iliac spine (ASIS) is high on the left. Interventions should MOST likely include unilateral isometric contraction of the left hip: A. Gluteus maximus B. Iliopsoas C. Gluteus medius D. Adductor Magnus The correct answer is A: Median nerve. Rationale- Median nerve injury at the forearm or elbow results in the "hand of benediction". The index and middle finger do not flex at the IP joints due to damage to median nerve that supplies the flexor digitorum profundus and superficialis. Reference- Kisner C, Colby LA; Therapeutic Exercise: Foundations and Techniques, 6th edition Page: 379, Magee DJ; Orthopedic Physical Assessment, 6th edition Page: 415 - ✔✔During testing of the patient's grip strength, the physical therapist notices that the patient's lateral two fingers are unable to fully grip the hand held dynamometer. The physical therapist can likely conclude which of the following structures has been damaged? A. Median nerve