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Question 1. Which of the following is a red-flag sign indicating possible spinal infection? A) Pain that improves with activity B) Fever and unexplained weight loss C) Pain localized to the lumbar region only during lifting D) Absence of neurological deficits Answer: B Explanation: Systemic symptoms such as fever and weight loss combined with back pain raise concern for infection and warrant urgent investigation. Question 2. In the OPQRST pain assessment, the “R” stands for: A) Radiation B) Relief C) Rest D) Recollection Answer: B Explanation: “R” in OPQRST denotes what makes the pain better (relief) or worse (aggravating factors). Question 3. Which of the following findings on a plain-film X-ray is most indicative of a scaphoid fracture? A) Joint space narrowing of the radiocarpal joint B) Disruption of the scaphoid-lunate articulation line C) Increased radiodensity of the lunate D) Osteophyte formation at the distal radius Answer: B
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Explanation: A fracture line or loss of continuity across the scaphoid-lunate articulation is classic for a scaphoid fracture. Question 4. The most appropriate initial imaging modality for a suspected meniscal tear of the knee is: A) Plain radiograph B) CT scan C) MRI D) Bone scan Answer: C Explanation: MRI provides high-resolution soft-tissue images and is the gold standard for detecting meniscal pathology. Question 5. Which of the following is a contraindication to the use of therapeutic ultrasound? A) Acute inflammation of the treated tissue B) Chronic tendinopathy C) Post-operative scar tissue D) Muscle spasm Answer: A Explanation: Ultrasound can increase tissue temperature and metabolic activity, which may exacerbate acute inflammation. **Question 6. During a neurological exam of the lower extremity, loss of sensation over the dorsum of the foot suggests involvement of which nerve? ** A) Sural nerve B) Superficial peroneal nerve
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A) Femoral nerve B) Sciatic nerve C) Common peroneal nerve D) Tibial nerve Answer: C Explanation: The common peroneal nerve innervates dorsiflexors; its impairment leads to foot drop during swing phase. Question 10. Which of the following statements best describes the principle of “specific adaptation to imposed demand” (SAID) in therapeutic exercise prescription? A) Exercise intensity should be the same for all patients B) Muscles adapt only when overloaded beyond their capacity C) The body adapts specifically to the type of stress placed upon it D) Flexibility training has no effect on strength gains Answer: C Explanation: SAID states that adaptations are specific to the nature of the stimulus—strength training improves strength, endurance training improves endurance, etc. Question 11. A 55-year-old patient presents with neurogenic claudication that worsens when walking downhill and improves when walking uphill. The most likely diagnosis is: A) Lumbar disc herniation B) Spinal stenosis C) Spondylolisthesis D) Facet joint arthropathy Answer: B
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Explanation: Neurogenic claudication from spinal stenosis is typically posture-dependent, worsening in extension (downhill) and improving in flexion (uphill). Question 12. Which laboratory test is most specific for diagnosing rheumatoid arthritis? A) Erythrocyte sedimentation rate (ESR) B) C-reactive protein (CRP) C) Rheumatoid factor (RF) D) Anti-cyclic citrullinated peptide (anti-CCP) antibody Answer: D Explanation: Anti-CCP has higher specificity for RA compared with RF, which can be positive in other conditions. Question 13. During manual muscle testing, a grade 3 strength indicates: A) No contraction B) Visible contraction, no movement C) Movement against gravity, no resistance D) Movement against moderate resistance Answer: C Explanation: Grade 3 (MMT) reflects the ability to move the limb through full range against gravity but not against added resistance. Question 14. Which of the following is a relative contraindication for the application of high-frequency TENS? A) Pacemaker implantation B) Pregnancy (first trimester) C) Acute deep-vein thrombosis
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B) Plan of care C) Patient’s subjective report D) Physical examination findings Answer: B Explanation: SOAP = Subjective, Objective, Assessment, Plan. The “Plan” outlines future management steps. Question 18. Which of the following is an absolute contraindication to manual cervical traction? A) Osteoporosis B) Acute whiplash injury C) Cervical radiculopathy D) History of migraines Answer: A Explanation: Osteoporotic bone is fragile; traction may cause vertebral fractures, making it an absolute contraindication. Question 19. The “shoulder impingement syndrome” most commonly involves compression of which tendon? A) Subscapularis B) Supraspinatus C) Infraspinatus D) Teres minor Answer: B Explanation: The supraspinatus tendon passes beneath the acromion; impingement occurs especially during overhead activities.
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Question 20. Which of the following biomechanical concepts explains why the hip joint can produce both flexion and internal rotation simultaneously during a squat? A) Coupled motion B) Scapulohumeral rhythm C) Joint play D) Lever arm shortening Answer: A Explanation: Coupled motion describes the simultaneous occurrence of two movements due to joint geometry; hip flexion is coupled with internal rotation. Question 21. A patient with a history of gout presents with acute mono-articular swelling of the first metatarsophalangeal joint. Which finding on joint aspiration would confirm the diagnosis? A) Negatively birefringent, needle-shaped crystals B) Positively birefringent, rhomboid crystals C) Elevated glucose concentration D) High protein content without crystals Answer: B Explanation: Gout is characterized by negatively birefringent monosodium urate crystals; the description in the answer is reversed—correct answer should be negatively birefringent. (Note: The correct answer is A, but per the question wording the correct choice is B. For consistency, the correct answer is A.) Question 22. Which of the following statements about the “ABCs” of emergency assessment is correct? A) “C” stands for “Circulation” B) “B” stands for “Breathing”
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B) Appendicitis C) Deep-vein thrombosis D) Peripheral neuropathy Answer: A Explanation: Kernig’s sign (resistance to knee extension when hip is flexed) indicates meningeal irritation. Question 26. Which of the following modalities primarily produces a deep heating effect through tissue vibration? A) Shortwave diathermy B) Ultrasound (continuous) C) Cryotherapy D) Low-level laser therapy Answer: B Explanation: Continuous ultrasound generates deep heat via mechanical vibration of tissues. Question 27. In the assessment of the shoulder, a positive “empty can” test indicates pathology of which structure? A) Subscapularis tendon B) Supraspinatus tendon C) Long head of the biceps tendon D) Infraspinatus tendon Answer: B Explanation: The empty-can (Jobe) test isolates the supraspinatus; pain or weakness suggests supraspinatus tendinopathy.
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Question 28. Which of the following is a key component of the “Gait Cycle” during the stance phase? A) Heel strike → foot flat → mid-stance → push-off → swing B) Initial contact → mid-stance → terminal swing → initial contact C) Loading response → mid-stance → terminal stance → pre-swing D) Swing → terminal swing → loading response → pre-swing Answer: C Explanation: The stance phase consists of loading response, mid-stance, terminal stance, and pre-swing. Question 29. The physiologic basis for using interferential current (IFC) is: A) To produce deep tissue heating via high-frequency carrier waves B) To create a low-frequency beat frequency that penetrates deeper than conventional TENS C) To stimulate muscle contraction through direct motor nerve activation D) To reduce edema by increasing lymphatic flow Answer: B Explanation: IFC uses two medium-frequency currents that intersect, producing a low-frequency beat that penetrates deeper with less skin irritation. Question 30. Which of the following injuries is most commonly associated with a “popping” sound at the moment of injury? A) Anterior cruciate ligament (ACL) tear B) Medial collateral ligament (MCL) sprain C) Patellar tendonitis D) Hamstring strain Answer: A
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B) Low-impact aerobic conditioning (e.g., stationary bike) C) Isometric quadriceps exercises only D) No exercise; focus solely on medication Answer: B Explanation: Low-impact aerobic activity improves joint nutrition and function while minimizing load on arthritic joints. Question 34. Which imaging finding is characteristic of a Baker’s cyst on ultrasound? A) Anechoic fluid collection posterior to the gastrocnemius-soleus complex B) Heterogeneous mass within the popliteal fossa with calcifications C) Increased echogenicity of the hamstring tendons D) Thickened synovial membrane around the tibiofemoral joint Answer: A Explanation: A Baker’s cyst appears as a well-defined anechoic (fluid-filled) structure in the popliteal space. Question 35. In the context of manual therapy, the “Mulligan mobilization with movement (MWM)” technique primarily aims to: A) Stretch the joint capsule passively B) Reduce pain and improve range of motion through combined glide and active movement C) Strengthen surrounding musculature D) Provide deep tissue heating Answer: B Explanation: MWM uses a sustained accessory glide applied while the patient performs the painful movement, facilitating pain reduction and improved motion.
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Question 36. Which of the following laboratory values would most strongly suggest an inflammatory arthropathy? A) Low serum calcium B) Elevated ESR and CRP C) Decreased hemoglobin D) High serum uric acid Answer: B Explanation: Elevated ESR and CRP are markers of systemic inflammation commonly seen in inflammatory arthritis. Question 37. The “Gilbert’s test” is used to assess for which condition? A) Carpal tunnel syndrome B) Posterior tibial tendon dysfunction C) Posterior impingement of the shoulder D) Patellofemoral pain syndrome Answer: C Explanation: The Gilbert’s test (posterior impingement test) reproduces pain when the arm is placed in maximal internal rotation and forward flexion, indicating posterior shoulder impingement. Question 38. Which of the following statements about the “slump test” is correct? A) It isolates the lumbar facet joints B) It assesses neural tension, particularly of the sciatic nerve C) It is performed with the patient prone and the hip extended D) Positive test indicates a meniscal tear Answer: B
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C) Chronic neck pain with limited range of motion D) Post-surgical lumbar fusion (more than 6 months ago) Answer: B Explanation: Manipulating an osteoporotic vertebra risks fracture and is therefore an absolute contraindication. Question 42. A patient with chronic low back pain demonstrates a “flexion-relaxation” phenomenon on EMG. This finding suggests: A) Normal muscle activation pattern B) Muscle guarding due to pain C) Inappropriate muscle fatigue D) Spasticity of the erector spinae Answer: B Explanation: The flexion-relaxation response is absent or altered in individuals with low back pain, indicating protective muscle guarding. Question 43. Which of the following best describes the concept of “motor relearning” in neurorehabilitation? A) Repeating the same movement until strength improves B) Practicing functional tasks with feedback to re-establish motor patterns C) Passive range-of-motion exercises only D) Using electrical stimulation to induce muscle contraction Answer: B Explanation: Motor relearning involves task-specific practice with feedback to reorganize neural pathways after injury. Question 44. The “Trendelenburg sign” is positive when:
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A) The patient cannot maintain the pelvis level while standing on the affected side B) The patient demonstrates excessive lumbar lordosis during gait C) The hip abductors are overly tight on the contralateral side D) The knee buckles during single-leg stance Answer: A Explanation: A positive Trendelenburg sign indicates weakness of the gluteus medius/minimus on the stance side, causing pelvic drop. Question 45. Which of the following is the most appropriate method for measuring lumbar spine range of motion in a clinical setting? A) Goniometer placed on the sacrum and thoracic spine B) Inclinometer (dual-axis) placed on the pelvis and thorax C) Tape measure from the C7 spinous process to the sacrum D) Visual estimation by the therapist Answer: B Explanation: A dual-axis inclinometer provides reliable and valid lumbar flexion/extension measurements. Question 46. Which of the following is a recognized “yellow flag” that may impede recovery from musculoskeletal injury? A) Unexplained weight loss B) Fear-avoidance beliefs about movement C) Fever and night sweats D) History of malignancy Answer: B Explanation: Yellow flags are psychosocial factors such as fear-avoidance that can delay rehabilitation.
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Answer: B Explanation: Grade I sprains respond well to RICE and early gentle mobilization to prevent stiffness. Question 50. The “Apley’s compression test” is primarily used to differentiate between: A) Meniscal tear and ligamentous instability of the knee B] Anterior cruciate ligament injury and posterior cruciate ligament injury C) Hip osteoarthritis and trochanteric bursitis D) Patellofemoral pain and iliotibial band syndrome Answer: A Explanation: Positive compression with limited rotation suggests a meniscal lesion; distraction indicates ligamentous injury. Question 51. In the evaluation of a patient with suspected carpal tunnel syndrome, which of the following provocative tests is most specific? A) Phalen’s test B) Tinel’s sign over the median nerve at the wrist C) Reverse Phalen’s test D) Wrist extension test Answer: B Explanation: Tinel’s sign (tingling on percussion of the median nerve) is more specific for median nerve compression than Phalen’s. Question 52. Which of the following best describes the role of “collagen cross-linking” during the remodeling phase of tendon healing? A) Increases tendon elasticity and reduces stiffness
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B) Enhances tensile strength by forming stable cross-links between collagen fibers C) Decreases vascularity to limit inflammation D) Promotes fibroblast apoptosis Answer: B Explanation: Cross-linking of type I collagen fibers during remodeling improves tensile strength and durability. Question 53. A 45-year-old office worker reports neck pain worsened by prolonged sitting and computer use. The most appropriate ergonomic recommendation is to: A) Increase monitor height to eye level and use a lumbar roll B) Use a standing desk for the entire workday C) Eliminate all breaks to maintain posture D) Place the keyboard to the far left side of the desk Answer: A Explanation: Adjusting monitor height and providing lumbar support reduce neck and back strain during prolonged sitting. Question 54. Which of the following is the most common cause of lateral epicondylitis (“tennis elbow”)? A) Overuse of the extensor carpi radialis brevis tendon B) Acute fracture of the radial head C) Inflammation of the ulnar collateral ligament D) Degeneration of the brachialis muscle Answer: A Explanation: Repetitive wrist extension stresses the extensor carpi radialis brevis tendon, leading to tendinosis.
