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Question 1. Which muscle fiber type is most resistant to fatigue and primarily used for postural activities? A) Type I (slow‑twitch) B) Type IIa (fast oxidative) C) Type IIb (fast glycolytic) D) Type IIx (intermediate) Answer: A Explanation: Type I fibers have high mitochondrial density and oxidative capacity, allowing prolonged low‑intensity activity without fatigue. Question 2. The primary cell responsible for bone resorption is: A) Osteoblast B) Osteocyte C) Osteoclast D) Chondrocyte Answer: C Explanation: Osteoclasts secrete acid and enzymes that dissolve mineralized bone matrix. Question 3. Which collagen type predominates in tendons? A) Type I B) Type II C) Type III D) Type IV Answer: A Explanation: Type I collagen provides tensile strength, the main requirement for tendons and ligaments.
Question 4. The epineurium surrounds: A) Individual muscle fibers B) A single nerve fascicle C) The entire peripheral nerve D) The perineurial sheath only Answer: C Explanation: The epineurium is the outermost connective tissue layer encasing the whole nerve. Question 5. An open kinetic chain exercise is characterized by: A) The distal segment is fixed; movement occurs proximally. B) The distal segment is free to move; multiple joints are involved. C) Only one joint moves at a time. D) No load passes through the joint. Answer: B Explanation: In open kinetic chain (e.g., leg extension), the foot is free, and movement occurs at the knee while the hip remains relatively stable. Question 6. Which type of muscle contraction lengthens the muscle while it generates force? A) Concentric B) Isometric C) Eccentric D) Isokinetic Answer: C
Answer: B Explanation: The anterior drawer test evaluates anterior translation of the tibia, indicating ACL integrity. Question 10. In a standard AP knee radiograph, the “joint space narrowing” is most indicative of: A) Ligament tear B) Meniscal tear C) Osteoarthritis D) Patellar dislocation Answer: C Explanation: Progressive loss of cartilage in OA leads to reduced joint space visible on X‑ray. Question 11. MRI is the imaging modality of choice for evaluating: A) Simple fractures B) Soft‑tissue injuries such as rotator cuff tears C) Bone mineral density D) Joint alignment in weight‑bearing positions Answer: B Explanation: MRI provides high‑resolution images of soft tissues, making it ideal for muscular and tendon pathology. Question 12. An EMG study primarily assesses: A) Bone density B) Muscle strength C) Electrical activity of muscles and nerves D) Joint range of motion
Answer: C Explanation: Electromyography records electrical potentials generated by muscle fibers and nerve conduction. Question 13. The primary pathogenic mechanism of osteoarthritis is: A) Autoimmune synovial inflammation B. Deposition of urate crystals C) Mechanical wear‑and‑tear of articular cartilage D) Metabolic bone demineralization Answer: C Explanation: OA results from progressive degeneration of cartilage due to mechanical stress and age‑related changes. Question 14. Rheumatoid arthritis most commonly spares which joint? A) Proximal interphalangeal joints B) Metacarpophalangeal joints C) Distal interphalangeal joints D) Wrist joint Answer: C Explanation: RA typically involves MCP, PIP, and wrist joints but rarely affects the DIP joints. Question 15. The crystal responsible for gout is: A) Calcium pyrophosphate dihydrate B) Monosodium urate C) Calcium oxalate
D) Bone scan Answer: B Explanation: Direct pressure measurement (>30 mm Hg) confirms compartment syndrome. Question 19. A Grade II ankle sprain involves: A) Microscopic fiber tearing only B) Partial tearing of ligament fibers with moderate swelling C) Complete rupture of the ligament D) No functional loss Answer: B Explanation: Grade II sprains are characterized by partial ligament disruption, bruising, and functional instability. Question 20. The “empty” end‑feel during ROM testing suggests: A) Capsular contracture B) Joint effusion C) Muscle spasm D) Bone-on-bone contact Answer: B Explanation: An empty end‑feel is soft and spongy, indicating fluid (effusion) within the joint capsule. Question 21. Which of the following is a common overuse injury of the shoulder? A) Anterior cruciate ligament tear B) Rotator cuff tendinopathy C) Achilles tendinopathy
D) Carpal tunnel syndrome Answer: B Explanation: Repetitive overhead activity leads to rotator cuff tendinopathy. Question 22. Stress fractures are most frequently seen in which bone of the lower extremity? A) Femur B) Tibia C) Patella D) Calcaneus Answer: B Explanation: The tibia bears repetitive load, making it prone to stress fractures in athletes and military recruits. Question 23. Osteoporosis is diagnosed when the T‑score on DEXA is: A) ≤ ‑1. B) ≤ ‑2. C) ≤ ‑3. D) ≤ 0 Answer: B Explanation: A T‑score of – 2.5 or lower indicates osteoporosis. Question 24. Paget’s disease of bone is characterized by: A) Decreased osteoclastic activity only B) Disorganized bone remodeling with both increased resorption and formation C) Purely osteoblastic activity
D) Adults with rheumatoid arthritis Answer: B Explanation: SCFE is associated with rapid growth and obesity in early adolescence. Question 28. NSAIDs exert their analgesic effect primarily by inhibiting: A) Cyclooxygenase‑2 (COX‑2) only B) Cyclooxygenase enzymes (COX‑1 and COX‑2) C) Lipoxygenase pathway D) Phospholipase A Answer: B Explanation: NSAIDs block COX enzymes, reducing prostaglandin synthesis and inflammation. Question 29. Corticosteroids reduce inflammation by: A) Blocking sodium channels B) Inhibiting phospholipase A2 and subsequent arachidonic acid production C) Enhancing GABAergic transmission D) Antagonizing NMDA receptors Answer: B Explanation: Corticosteroids induce lipocortin, which inhibits phospholipase A2, decreasing prostaglandins and leukotrienes. Question 30. Which medication is most appropriate for neuropathic pain in a patient with diabetic peripheral neuropathy? A) Ibuprofen B) Gabapentin
C) Acetaminophen D) Morphine Answer: B Explanation: Gabapentin is an anticonvulsant used to treat neuropathic pain. Question 31. Static stretching is best performed: A) With rapid, ballistic movements B) At the point of mild discomfort, held 15‑ 30 seconds C) With active contraction of the target muscle D) During the warm‑up phase only Answer: B Explanation: Static stretch involves holding a muscle at a gentle stretch for a period to improve flexibility. Question 32. Dynamic stretching is most appropriate during: A) Cool‑down B) Post‑exercise recovery C) Warm‑up to prepare muscles for activity D) After a strength training session only Answer: C Explanation: Dynamic stretching uses controlled movement to increase blood flow and range before activity. Question 33. The primary indication for total knee arthroplasty is: A) Acute ligament rupture
B) Supplies vascular nutrition to the tendon sheath C) Forms the fibrocartilage within the joint D) Produces synovial fluid Answer: B Explanation: The paratenon is a thin connective tissue layer that contains blood vessels supplying the tendon. Question 37. During muscle contraction, the sliding filament theory states that: A) Myosin filaments slide past actin filaments, shortening sarcomeres B) Actin filaments lengthen while myosin shortens C) Sarcomeres expand due to calcium influx D) Troponin detaches from tropomyosin to allow contraction Answer: A Explanation: Myosin heads bind to actin and pull, causing sarcomere shortening. Question 38. Which type of bone is characterized by a porous, lattice‑like interior? A) Cortical bone B) Trabecular (spongy) bone C) Compact bone D) Woven bone Answer: B Explanation: Trabecular bone has a honeycomb structure that provides strength with less mass. Question 39. The primary function of osteocytes is: A) Forming new bone matrix
B) Resorbing bone C) Maintaining mineral homeostasis and sensing mechanical load D) Producing cartilage Answer: C Explanation: Osteocytes act as mechanosensors and regulate remodeling. Question 40. Which nerve supplies the anterior compartment of the thigh? A) Femoral nerve B) Obturator nerve C) Sciatic nerve D) Posterior femoral cutaneous nerve Answer: A Explanation: The femoral nerve innervates the quadriceps and other anterior thigh muscles. Question 41. The “hard” end‑feel encountered at the end of shoulder abduction is most likely due to: A) Rotator cuff tightness B) Anterior capsular contracture C) Glenohumeral joint bony limitation (acromion contacting humeral head) D) Muscle spasm of the deltoid Answer: C Explanation: A hard end‑feel indicates bone‑on‑bone contact, such as the acromion limiting further abduction. Question 42. The Hoffmann sign is used to assess:
A) Closed fracture of the distal radius, initial encounter for closed fracture B) Open fracture of the distal radius, subsequent encounter C) Unspecified fracture of the forearm, healing stage D) Dislocation of the wrist Answer: A Explanation: S52.501A corresponds to a closed distal radius fracture, initial encounter. Question 46. When coding a patient with a new diagnosis of gout flare treated with colchicine, which ICD‑ 10 ‑CM code should be used for the encounter? A) M10. B) M10. C) M10. D) M10. Answer: B Explanation: M10.01 specifies gout, unspecified site, acute attack, which aligns with a gout flare. Question 47. The CPT modifier “-59” is applied when: A) A service is performed on the same day as another service but is unrelated B) The service is a routine follow‑up C) The physician is not the primary surgeon D) The claim is being denied Answer: A Explanation: Modifier ‑59 indicates a distinct procedural service.
Question 48. For a patient undergoing bilateral total hip arthroplasty in the same operative session, which CPT coding approach is correct? A) Report the procedure once with modifier “‑ 51 ” B) Report each hip separately with modifier “‑ 50 ” on the second code only C) Report each hip separately without any modifiers D) Use a single global code for both hips Answer: B Explanation: Bilateral procedures are reported with two CPT codes; the second code receives modifier ‑50 to denote bilateral. Question 49. The ICD‑ 10 ‑CM code “M80.00XA” designates: A) Osteoporosis with current pathological fracture, unspecified site, initial encounter B) Osteoporosis without fracture, unspecified site, subsequent encounter C) Osteopenia, unspecified site, initial encounter D) Osteomalacia, unspecified site, healing stage Answer: A Explanation: M80.00XA represents osteoporosis with a current pathological fracture, unspecified site, initial encounter. Question 50. In the context of CPT coding, a “global period” refers to: A) The time during which the surgeon’s services are included in the surgical package B) The period when the patient is hospitalized C) The window for filing a claim D) The time required for pre‑operative testing Answer: A Explanation: The global period includes postoperative care, routine visits, and related services.
Question 54. In a patient with an anterior cruciate ligament (ACL) tear, the Lachman test is performed with the knee in: A) Full extension (0°) B) 30° of flexion C) 90° of flexion D) 45° of flexion Answer: B Explanation: The Lachman test is most sensitive at 30° of knee flexion, assessing anterior tibial translation. Question 55. The “screw‑home” mechanism refers to: A) Rotation of the tibia during knee extension B) Internal rotation of the femur during hip flexion C) External rotation of the tibia during knee flexion D) The action of the rotator cuff during shoulder abduction Answer: A Explanation: During the final degrees of knee extension, the tibia externally rotates relative to the femur, locking the joint. Question 56. Which of the following statements about the perineurium is true? A) It surrounds individual axons. B) It provides a diffusion barrier protecting nerve fibers. C) It is the outermost covering of a nerve. D) It contains myelin-producing cells. Answer: B
Explanation: The perineurium forms tight junctions that protect fascicles from external substances. Question 57. The most common site of a stress fracture in runners is the: A) Femoral neck B) Tibial shaft C) Metatarsal head D) Calcaneus Answer: C Explanation: Metatarsal stress fractures, especially of the second metatarsal, are frequent in repetitive foot strike. Question 58. In the diagnosis of osteomyelitis, the imaging modality with the highest sensitivity early in the disease is: A) Plain radiography B) CT scan C) MRI D) Bone scan Answer: C Explanation: MRI detects marrow edema and early infection before radiographic changes appear. Question 59. Which of the following is a characteristic finding on a bone scan for a healing fracture? A) Decreased uptake at the fracture site B) Focal increased uptake (hot spot) at the fracture line C) Diffuse uptake throughout the entire bone D) No change from baseline
