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Question 1. Which type of skeletal muscle fiber is most resistant to fatigue and primarily used for postural control? 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 rely on oxidative metabolism, giving them great endurance for sustained activities like posture. Question 2. In bone histology, which cell is primarily responsible for bone resorption? A) Osteoblast B) Osteocyte C) Osteoclast D) Chondrocyte Answer: C Explanation: Osteoclasts secrete acid and proteolytic enzymes to break down mineralized bone matrix. Question 3. The paratenon supplies blood to which structure? A) Articular cartilage B) Tendon proper C) Ligament midsubstance D) Meniscus Answer: B Explanation: The paratenon is a thin connective tissue sheath surrounding a tendon that provides its vascular supply. Question 4. Which fascial layer directly surrounds individual muscle fibers? A) Endoneurium B) Perineurium C) Epineurium
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D) Endomysium Answer: D Explanation: Endomysium encases each muscle fiber, whereas endoneurium surrounds nerve fibers. Question 5. An exercise performed where the hand remains stationary and the foot moves is an example of a: A) Open kinetic chain B) Closed kinetic chain C) Isometric contraction D) Isokinetic contraction Answer: A Explanation: In an open kinetic chain, the distal segment moves freely, as when performing a seated leg extension. Question 6. During an eccentric muscle contraction, the muscle: A) Shortens while generating force B) Lengthens while generating force C) Generates force without changing length D) Relaxes completely Answer: B Explanation: Eccentric contractions involve controlled lengthening of the muscle under load. Question 7. Which term describes the “hard” end-feel encountered at the end of knee flexion? A) Soft B) Empty C) Capsular D) Muscular Answer: C Explanation: A hard (capsular) end-feel occurs when the joint capsule limits further movement, typical at extreme knee flexion.
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C) M16.
D) M25.
Answer: A Explanation: M17.0 specifically denotes unilateral primary osteoarthritis of the knee. Question 12. Which CPT code represents a standard arthroscopic debridement of the knee? A) 29881 B) 29888 C) 27447 D) 27130 Answer: A Explanation: CPT 29881 is used for diagnostic arthroscopy with debridement of the knee joint. Question 13. A patient with gout has a serum uric acid of 9.2 mg/dL. Which ICD- 10 - CM code best captures an acute gout attack of the first metatarsophalangeal joint? A) M10. B) M10. C) M10. D) M10. Answer: A Explanation: M10.071 denotes gouty arthritis, acute, right first MTP joint; the “1” after the decimal specifies laterality. Question 14. In the management of rheumatoid arthritis, which laboratory marker is most specific for disease activity? A) ESR B) CRP C) Rheumatoid factor (RF) D) Anti-CCP antibody Answer: D
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Explanation: Anti-cyclic citrullinated peptide (anti-CCP) antibodies have high specificity for RA and correlate with disease severity. Question 15. A 68-year-old woman with a T-score of – 2.8 on DEXA is diagnosed with: A) Osteopenia B) Osteoporosis C) Osteomalacia D) Paget disease Answer: B Explanation: A T-score ≤ –2.5 defines osteoporosis. Question 16. The most common site of a stress fracture in runners is the: A) Femoral neck B) Tibial shaft C) Metatarsal neck D) Calcaneus Answer: C Explanation: The second and third metatarsal necks are frequently involved due to repetitive loading. Question 17. Which of the following is a characteristic finding on plain radiograph of Paget disease? A) Subchondral sclerosis with joint space narrowing B) “Cotton wool” appearance of skull C) Lytic lesions in vertebral bodies D) Punched-out erosions in hands Answer: B Explanation: Paget disease of bone often shows a “cotton wool” pattern due to mixed lytic and sclerotic changes. Question 18. The “golden period” for reduction of a posterior-dislocated shoulder is:
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D) Lateral femoral cutaneous nerve Answer: C Explanation: “Stingers” result from stretch or compression of the upper brachial plexus (C5-C6), causing transient paresthesia. Question 22. The ICD- 10 - CM code for a closed, transverse fracture of the mid-shaft femur is: A) S72.301A B) S72.301D C) S72.301B D) S72.301C Answer: A Explanation: The seventh character “A” indicates a closed fracture, initial encounter. Question 23. Which of the following best describes the “capsular” end-feel of the shoulder? A) Soft, yielding B) Hard, empty C) Firm, springy D) Hard, capsular Answer: D Explanation: A capsular end-feel is firm and hard, reflecting tension of the joint capsule. Question 24. In a patient with a suspected compartment syndrome, the most definitive diagnostic test is: A) Plain radiograph B) MRI C) Intracompartmental pressure measurement D) Doppler ultrasound Answer: C Explanation: Direct measurement of compartment pressure >30 mm Hg confirms compartment syndrome.
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Question 25. Which CPT code describes a diagnostic EMG of the lower extremity? A) 95860 B) 95910 C) 95957 D) 95970 Answer: B Explanation: CPT 95910 is used for needle EMG of a single limb (lower extremity). Question 26. The primary mechanism of bone remodeling in osteoporosis involves: A) Increased osteoblast activity B) Decreased osteoclast activity C) Imbalance favoring resorption D) Hyperostosis of trabecular bone Answer: C Explanation: Osteoporosis results from an imbalance where osteoclastic resorption outpaces osteoblastic formation. Question 27. Which lab value is most indicative of a gout flare? A) Serum calcium 10.5 mg/dL B) Serum uric acid > 8 mg/dL C) Serum phosphate 4.0 mg/dL D) Serum potassium 3.8 mmol/L Answer: B Explanation: Hyperuricemia (> 8 mg/dL) predisposes to monosodium urate crystal deposition and gout attacks. Question 28. A 4-year-old child presents with a waddling gait and limited hip abduction. The most likely diagnosis is: A) Developmental dysplasia of the hip (DDH)
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Explanation: The instruction requires adding a code that specifies the fracture morphology (e.g., intra-articular vs. extra-articular). Question 32. Which of the following is NOT a typical side effect of chronic NSAID therapy? A) Gastric ulceration B) Renal impairment C) Hyperglycemia D) Platelet dysfunction Answer: C Explanation: NSAIDs do not cause hyperglycemia; they mainly affect GI mucosa, renal function, and platelet aggregation. Question 33. The “sling” test for the shoulder assesses integrity of which structure? A) Subscapularis tendon B) Supraspinatus tendon C) Glenohumeral capsule D) Long head of the biceps tendon Answer: B Explanation: The empty-can (sling) test isolates the supraspinatus muscle by resisting abduction. Question 34. In the context of coding, “HCPCS Level II” codes are used primarily for: A) Surgical procedures B) Diagnostic radiology C) Medical supplies and drugs D) Evaluation and management services Answer: C Explanation: HCPCS Level II includes codes for items such as prosthetics, orthotics, and injectable drugs.
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Question 35. Which of the following best describes a “type II” rotator cuff tear? A) Partial-thickness articular-side tear B) Full-thickness supraspinatus tear C) Intra-muscular tendon degeneration D) Isolated subscapularis avulsion Answer: B Explanation: Type II rotator cuff tears refer to full-thickness tears, commonly of the supraspinatus. Question 36. The ICD- 10 - CM code for a displaced, comminuted fracture of the left distal tibia is: A) S82.202A B) S82.202D C) S82.202B D) S82.202C Answer: A Explanation: “A” denotes a closed fracture, initial encounter; “202” specifies displaced, comminuted distal tibia fracture. Question 37. Which of the following is the most accurate description of an “isokinetic” contraction? A) Constant speed throughout the range B) Constant tension while lengthening C) No movement, only tension generation D) Variable speed with constant tension Answer: A Explanation: Isokinetic exercises maintain a preset angular velocity regardless of force applied. Question 38. The “Hawkins-Kennedy” test is used to assess impingement of which structure? A) Glenohumeral labrum B) Subacromial bursa and supraspinatus tendon
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Explanation: Cyclobenzaprine is a centrally-acting muscle relaxant frequently used for acute low back pain. Question 42. In the assessment of a pediatric patient for developmental dysplasia of the hip (DDH), which physical exam maneuver is most reliable? A) Trendelenburg sign B) Barlow maneuver C) McMurray test D) Patellar apprehension test Answer: B Explanation: The Barlow maneuver attempts to dislocate an unstable hip, indicating DDH. Question 43. Which ICD- 10 - CM code corresponds to a non-specific, idiopathic inflammatory condition of the sacroiliac joints (ankylosing spondylitis)? A) M45. B) M48. C) M47. D) M50. Answer: A Explanation: M45.9 denotes ankylosing spondylitis, unspecified site, without further specification. Question 44. The “Gerdy’s tubercle” is located on which bone? A) Tibia B) Fibula C) Femur D) Humerus Answer: A Explanation: Gerdy’s tubercle is a lateral tibial prominence where the iliotibial band inserts. Question 45. Which CPT code is used for a diagnostic ultrasound of the shoulder?
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A) 73090
B) 73560
C) 76881
D) 76942
Answer: C Explanation: CPT 76881 represents an ultrasound examination of a superficial structure (e.g., shoulder). Question 46. In the context of the “open kinetic chain,” which of the following exercises is most appropriate for early quadriceps strengthening after ACL reconstruction? A) Squat B) Leg press (feet on platform) C) Seated knee extension D) Step-up Answer: C Explanation: Seated knee extensions isolate the quadriceps while the foot is free, fitting an open kinetic chain. Question 47. The primary pathophysiologic event in osteoarthritis is: A) Autoimmune synovial inflammation B) Deposition of monosodium urate crystals C) Degeneration of articular cartilage D) Bone marrow edema Answer: C Explanation: OA primarily involves progressive loss of articular cartilage, leading to joint space narrowing. Question 48. Which imaging modality is most sensitive for detecting a subtle occult fracture of the scaphoid? A) Plain radiograph B) CT scan C) MRI
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Question 52. Which CPT code corresponds to a total knee arthroplasty with computer navigation? A) 27447 B) 27446 C) 27448 D) 27449 Answer: A Explanation: CPT 27447 is the standard total knee arthroplasty; the use of computer navigation is reported with a modifier (e.g., 22) rather than a separate CPT. Question 53. In the “closed chain” squat, the ankle joint moves: A) Freely, without support B) Fixed, because the foot is planted C) In a hinged manner only D) Not at all, because the knee is locked Answer: B Explanation: In a closed kinetic chain, the distal segment (foot) remains in contact with a stable surface, limiting independent ankle motion. Question 54. Which of the following best describes a “mechanical” end-feel? A) Soft, yielding B) Hard, capsular C) Firm, springy, due to ligament tension D) Empty, due to joint effusion Answer: C Explanation: Mechanical end-feel is firm and springy, produced by tension in ligaments, tendons, or joint capsules. Question 55. A patient presents with a “double-contour” sign on ultrasound of the knee. This is most indicative of: A) Osteoarthritis B) Gout
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C) Pseudogout D) Septic arthritis Answer: B Explanation: The double-contour sign reflects urate crystal deposition on the cartilage surface, typical of gout. Question 56. The ICD- 10 - CM code for a traumatic avulsion of the right Achilles tendon is: A) S86.011A B) S86.011D C) S86.011B D) S86.011C Answer: A Explanation: “A” denotes a closed injury, initial encounter; the code specifies Achilles tendon avulsion. Question 57. Which of the following is a contraindication to performing a lumbar puncture? A) Elevated intracranial pressure B) Local infection at the puncture site C) Coagulopathy D) All of the above Answer: D Explanation: Elevated ICP, infection, and coagulopathy all increase risk and are contraindications. Question 58. The most common etiologic factor for a non-union of a tibial shaft fracture is: A) Smoking B) Early weight-bearing C) Excessive immobilization D) High-energy mechanism Answer: A
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B) Myositis C) Muscle spasm D) Myofascial pain syndrome Answer: A Explanation: M79.1 is the code for myalgia (muscle pain). Question 63. Which of the following is the most appropriate pharmacologic therapy for acute gout flares? A) Allopurinol B) Colchicine C) Febuxostat D) Probenecid Answer: B Explanation: Colchicine, NSAIDs, or corticosteroids are first-line for acute gout; allopurinol and febuxostat are chronic urate-lowering agents. Question 64. The “Hawkins-Kennedy” test is performed in which plane of motion? A) Sagittal B) Coronal C) Transverse D) Oblique Answer: B Explanation: The test involves forward flexion (sagittal) and internal rotation (transverse), but the movement occurs in the coronal plane relative to the humerus. Question 65. Which of the following best describes the “soft” end-feel? A) Capsular, firm resistance B) Empty, due to fluid C) Yielding, as in muscle stretch D) Mechanical, springy resistance Answer: C
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Explanation: A soft end-feel is produced by stretching of muscle, tendon, or ligament, offering a yielding sensation. Question 66. A 70-year-old woman presents with a low-energy femoral neck fracture. The most appropriate ICD- 10 - CM code is: A) S72.001A B) S72.001D C) S72.001B D) S72.001C Answer: A Explanation: “A” indicates a closed fracture, initial encounter; the code specifies an unspecified (non-displaced) femoral neck fracture. Question 67. In the context of rehabilitation, static stretching is performed: A) With movement throughout the stretch B) At the point of mild discomfort, held for 30 seconds C) Only after a warm-up D) With a rapid, ballistic motion Answer: B Explanation: Static stretching involves holding a muscle at a fixed length near the end-range for 15- 30 seconds. Question 68. Which of the following is a characteristic radiographic finding of osteoarthritis of the knee? A) Joint space widening B) Subchondral sclerosis and osteophytes C) Punched-out erosions D) Periosteal reaction Answer: B Explanation: OA shows joint space narrowing, osteophyte formation, and subchondral sclerosis. Question 69. The “Patellar apprehension test” evaluates stability of which structure?
