Question 1

Which statement is true about closed kinematic chain exercise when prescribed for anterior cruciate ligament (ACL) rehabilitation?
A)Places significant strain on the anterior cruciate ligament and patellofemoral joint
B)Generates low anterior shear force and tibial displacement
C)Generates more isolated muscle activity
D)Co-contraction of hamstrings and quadriceps do not occur

Accepted Answer

Generates low anterior shear force and tibial placement.
Closed kinematic chain exercises can be safely used during anterior cruciate ligament rehabilitation. The exercises do not generate isolated muscle activity so there will be no isolated muscle strengthening. Closed chain exercise places less strain on the ACL.
Open kinematic chain exercises actually result in isolated muscle activity and thereby allow more specific muscle strengthening. But when there is fatigue, the stabilizing effect of these isolated muscles may be lost which might place great strain on the ACL.

Question 2

A 28-year-old male had undergone an anterior cruciate ligament (ACL) reconstruction. During rehabilitation, there is restriction in the range of movement, inflammation of peripatellar soft tissue, extensor lag and a positive "shelf sign". What could be a potential diagnosis?
A)Patella infera
B)Excessive lateral pressure syndrome
C)Patella alta
D)Global patella pressure syndrome

Accepted Answer

Patella infera could be the diagnosis if the patient has painful restriction in the range of movement, inflammation of peripatellar soft tissue, extensor lag and a positive "shelf sign".
Patella infera or infrapatellar contracture syndrome results from hypertrophic healing response in the anterior soft tissue of the knee. It is known as infera because, in the lateral radiograph, the affected patella presents lower than the normal position. Effective quadriceps activity and knee flexion can be suggested to treat this condition. The quadriceps maintain the tension in the patellar tendon thereby limit the contracture of the tendon.
Patella alta (high riding of patella) is an abnormal high position of the patella. It may be secondary due to the patellar tendon rupture.
Global patella pressure syndrome and excessive lateral pressure syndrome are generally the features of "patella femoral compression syndrome".
Excessive lateral pressure syndrome is the presence of tightness only in the lateral retinacular structures.
Global patella pressure syndrome is associated with restricted mobility in medial and lateral directions and also often in the superior direction.

Question 3

At which degree of knee flexion does the iliotibial band cross the lateral femoral condyle?
A)10 degrees
B)20 degrees
C)40 degrees
D)30 degrees

Accepted Answer

At 30 degrees of knee flexion, the iliotibial band crosses the lateral femoral condyle.
Iliotibial band is a thick fibrous band which runs along the lateral aspect of the thigh and inserts at the gerdy tubercle on the anterolateral aspect of the proximal tibia.
When the knee flexes from full extension, the iliotibial band shifts on the lateral femoral condyle from an anterior position to posterior. This crossing from anterior to posterior occurs during the 30 degrees of knee flexion.

Question 4

Which of the following should be avoided in an iliotibial band friction syndrome?
A)Use hard shoes
B)Avoid downhill running
C)Avoid running on the pitched surface
D)Rest till the symptoms subside

Accepted Answer

Use of hard shoes should be avoided in an iliotibial band friction syndrome.
The iliotibial band is a thick fibrous band running along the lateral aspect of the thigh. It inserts at the gerdy tubercle on the anterolateral aspect of the proximal tibia.
When the knee flexes from full extension, the iliotibial band shifts on the lateral femoral condyle from an anterior position to posterior. This crossing from anterior to posterior occurs during the 30 degrees of knee flexion.
Repeated flexion and extension of the knee in activities like running can lead to irritation. It is called an iliotibial friction syndrome.
Soft running shoes should be recommended.

Question 5

What is a bipartite patella?
A)Failure in the fusion of the secondary ossification centers
B)Marginal fracture
C)Sleeve fracture
D)Transverse fracture

Accepted Answer

Failure in the fusion of the secondary ossification centers is called a bipartite patella.
A bipartite patella closely resembles a marginal fracture where there will be a fracture in the edge of the patella. In such a case, a bilateral radiograph should be taken and compared because bipartite patella usually occurs bilaterally. This condition is not tender on palpation.
Transverse fracture occurs in medial to lateral direction. It usually occurs in the central or distal third of the patella.
Sleeve fracture occurs mostly in children. The inferior pole of the patella is avulsed along with the articular cartilage. In radiograph, there will be the presence of patella alta. Sleeve fracture is usually associated with pain, tenderness of the knee, and difficulty in full extension of the knee.

Question 6

What is a "windlass effect"?
A)Dorsiflexion of metatarsophalangeal results in increased arch height
B)Ability to use the extensor tendon to extend the interphalangeal joints with passively maintained metacarpophalangeal joint in flexion
C)Movement of the lever as a result of passive pull of the muscle

Accepted Answer

Dorsiflexion of metatarsophalangeal resulting in increased arch height called the "windlass effect".
Ability to use the extensor tendon in extending the interphalangeal joints with passively maintained metacarpophalangeal joint in flexion is called Bunnell's sign.
Movement of the lever as a result of passive pull of the muscle is called tenodesis.

Question 7

What advice is given to a patient who has undergone a total hip replacement (THR)?
A)Avoid crossing the legs
B)Avoid turning the foot inward
C)Avoid low chairs
D)Avoid bringing the knee close to the chest
E)All of the above

Accepted Answer

All of the above.
The most common complication following a THR is dislocation of the prosthetic implants. So care must be taken to avoid certain postures and movements during the first few months after surgery. Crossing the legs, turning foot inward, bringing the knee close to chest, sitting in the low chair will create rotational movements of implants which will lead to dislocation , therefore all of these movements should be avoided.

Question 8

Which of the following conditions might be considered very risky for a total knee replacement (TKR) procedure?
A)Varus / valgus alignment in the X ray
B)Degenerative arthritis
C)Altered range of movement
D)Neuropathic arthropathy

Accepted Answer

Neuropathic arthropathy might be considered a very risky condition for a total knee replacement (TKR) procedure.
Neuropathic arthropathy is also called charcot joint. It is a progressive degeneration of the weight-bearing joint. The complications following a TKR in a charcot joint are high. It is not an absolute contraindication, but still it is considered to be very risky to perform the TKR.

Question 9

Which is a modifiable risk factor in the prevention of osteoporosis?
A)Gender
B)Age
C)Hormone level
D)Body size

Accepted Answer

Hormone level is a modifiable risk factor in the prevention of osteoporosis.
Naturally or surgically caused early menopause can increase the risk of developing osteoporosis. Hormone replacement therapy can be given to prevent osteoporosis.
Gender, age, and body size cannot be modified.
Women are more affected than men because of the thin bones and rapid loss of bone mass after menopause.
Small thin bone size is more prone than thick sized bones.

Question 10

Which is NOT included in the "female athlete triad"?
A)Menstrual irregularity
B)Eating disorder
C)Premature osteoporosis
D)Stress fracture

Accepted Answer

Stress fracture is not part of the "female athlete triad".
Stress fractures occur due to overuse injury. It occurs with over-training and lack of appropriate rest intervals.
Female athlete triad is a syndrome which includes menstrual irregularity, eating disorder, and premature osteoporosis. This condition is seen in females participating in sports that emphasize low body weight. The health consequences may be severe and can be fatal.

Question 11

What is the primary sign of reflex sympathetic dystrophy (RSD)?
A)Stiffness
B)Osteopenia
C)Trophic changes
D)Hyperhydrosis

Accepted Answer

Stiffness is the primary sign of reflex sympathetic dystrophy.
In RSD there will be rapid onset of swelling followed by stiffness. So physiotherapy management should be initiated as soon as possible to prevent stiffness.
RSD is a pain state maintained by sympathetic efferent activation, by circulating catecholamines, or by neurochemical action.

Question 12

A 30-year-old female, presents with low back pain, pain at the hip, posterolateral thigh, over the knee, and medial aspect of the leg. There is also presence of numbness over the anteromedial thigh and knee. Weak knee extension along with atrophy of quadriceps is noticed during the physical examination. The knee jerk is also diminished. In this case, what could be the expected level of disc herniation?
A)L3 - L4
B)L4 - L5
C)L5 - S1

Accepted Answer

L3 - L4 could be the expected level of disc herniation if the patient presents with low back pain, pain at hip, posterolateral thigh, over the knee, and medial aspect of the leg and also presence of numbness over the anteromedial thigh and knee along with weak knee extension and atrophy of quadriceps, and diminished knee jerk.
The key points to come to a conclusion in this scenario are the area of pain distribution and the diminished knee jerk.
In L4 - L5 level disc herniation, the pain will be distributed over the sacroiliac region, hip, posterolateral thigh, and anterolateral thigh. Numbness will be present over the lateral leg and first web space. There will be weak dorsiflexion of great toe and also there will be minimal calf muscle atrophy. But no reflex is affected.
In L5 - S1 level disc herniation, the pain will be distributed over the sacroiliac region, hip, posterolateral thigh, and leg. Numbness will be present over the back of the leg, heel, foot, and toe. There will be weak plantarflexion of the great toe and foot. Ankle jerk is diminished or even absent.

Question 13

Which of the following statements is true of the Berta Bobath technique?
A)Based on inhibiting abnormal reflex patterns and facilitating righting and equilibrium reaction
B)Based on enhancing the synergy patterns
C)Based on using the sensory stimulus to activate and inhibit a motor response

Accepted Answer

Berta Bobath technique is based on inhibiting abnormal reflex patterns and facilitating righting and equilibrium reaction.
Brunnstorm's approach is based on enhancing the synergy patterns.
Rood's approach is based on using the sensory stimulus to activate and inhibit a motor response

Question 14

According to the Brunnstorm's stages of recovery for upper extremity, what is Stage 3?
A)Flaccid, no voluntary movement can be initiated
B)Beginning of spasticity, presence of basic limb synergies
C)Movement deviates from synergy
D)Active initiation of synergies

Accepted Answer

Active initiation of synergies is Stage 3 of Brunnstorm's stages of recovery for upper extremity.
Brunnstorm's stage of recovery for upper extremity has 6 stages:
Stage 1 - Flaccid, no voluntary movement can be initiated
Stage 2 - Beginning of spasticity, presence of basic limb synergies
Stage 3 - Active initiation of synergies, voluntary control over synergies
Stage 4 - Movement patterns out of synergy are mastered, decrease in spasticity
Stage 5 - More complex movement combinations are learned as the basic synergies lose their dominance over motor acts, further decrease in spasticity
Stage 6 - Disappearance of spasticity. Isolated joint movements with well coordination and appears normal

Question 15

Which technique includes the 'quick icing' to facilitate muscles?
A)Vestibular stimulation technique
B)Proprioception stimulation technique
C)Exteroceptive stimulation technique

Accepted Answer

Exteroceptive stimulation technique includes the quick icing to facilitate muscles.
Exteroceptive stimulation techniques includes quick icing, prolonged icing, manual contacts, light touch, maintained touch, slow stroking, and neutral warmth.
Vestibular stimulation techniques includes slow vestibular stimulation, vestibular stimulation.
Proprioceptive stimulation techniques include quick stretch, prolonged stretch, resistance, joint approximation, joint traction, and inhibitory pressure.
All the facilitatory and inhibitory techniques from both neuromuscular and sensory stimulation are classified into proprioceptive facilitation techniques, exteroceptive facilitation techniques, vestibular stimulation techniques, augmented visual stimulation techniques, augmented auditory stimulation techniques, augmented olfactory stimulation techniques, gustatory stimulation techniques, and sensory integration techniques.

Question 16

Which proprioceptive neuromuscular facilitation (PNF) technique is based on Sherrington's principle of successive induction?
A)Repeated contractions
B)Slow reversals
C)Rhythmic stabilization
D)Rhythmic initiation

Accepted Answer

Slow reversals technique is based on Sherrington's principle of successive induction.
Repeated contraction is based on the repetition of activity against resistance which is essential for the development of muscle strength and endurance.
Rhythmic stabilization is based on isometric contraction of antagonistic muscle used to stabilize joints.
Rhythmic initiation is used as a relaxation technique. It is based on the repeated passive rhythmic movements which induces relaxation. Then it progresses to active assisted and then active exercises, where all these are done without changing the rhythm.

Question 17

Of what use is Frenkel's exercise?
A)To treat imbalance
B)To correct posture
C)To treat incordination
D)To improve range of motion

Accepted Answer

Frenkel's exercises are used to treat incordination.
Frenkel's exercises are used to establish voluntary control of movement by using the sensory mechanisms such as touch, sound, and vision. The essential components are concentration, precision, and repetition.

Question 18

Which of the following is a derived position?
A)Hanging
B)Sitting
C)Half kneeling
D)Standing

Accepted Answer

Half kneeling is a derived position.
Half kneeling is a derived position from kneeling in which one knee supports most of the body weight and the other knee is bent to create a right angle from hip and ankle. The foot is supported on the ground in a forward direction. Derived positions are derived from the starting positions to modify the gravity acting on the positioning of the body in order to perform exercises.
Hanging, sitting and standing are starting positions. Starting positions are postures from which movement is initiated.

Question 19

According to Fitts and Poster, what is the second phase of motor learning?
A)Cognitive phase
B)Autonomous phase
C)Associative phase

Accepted Answer

Associative phase is the second phase of motor learning.
In the associated phase, there will be associated aspects of motor performance of the task with success or failure. Sensory feedback is very important at this phase.
Cognitive phase is the first phase of motor learning in which the task must be thought of before executing it.
Autonomous phase is a mastered phase. The learning is complete with only little attention required.

Question 20

In the motor development of a child, when is the antigravity neck flexion achieved?
A)3 months
B)4 months
C)5 months
D)6 months

Accepted Answer

The antigravity neck flexion is achieved at 5 months.
Though the neck control starts at the 3 months of age, the antigravity movement occurs only at 5 months of age. At 3 months, the child can lift the head to 45 degrees from prone. At 4 months, the child can lift the head up to 90 degrees from prone.

Quiz 4: Interventions

Which statement is true about closed kinematic chain exercise when prescribed for anterior cruciate ligament (ACL) rehabilitation?

A 28-year-old male had undergone an anterior cruciate ligament (ACL) reconstruction. During rehabilitation, there is restriction in the range of movement, inflammation of peripatellar soft tissue, extensor lag and a positive "shelf sign". What could be a potential diagnosis?

At which degree of knee flexion does the iliotibial band cross the lateral femoral condyle?

Which of the following should be avoided in an iliotibial band friction syndrome?

What is a bipartite patella?

What is a "windlass effect"?

What advice is given to a patient who has undergone a total hip replacement (THR) ?

Which of the following conditions might be considered very risky for a total knee replacement (TKR) procedure?

Which is a modifiable risk factor in the prevention of osteoporosis?

Which is NOT included in the "female athlete triad"?

What is the primary sign of reflex sympathetic dystrophy (RSD) ?

Which of the following statements is true of the Berta Bobath technique?

According to the Brunnstorm's stages of recovery for upper extremity, what is Stage 3?

Which technique includes the 'quick icing' to facilitate muscles?

Which proprioceptive neuromuscular facilitation (PNF) technique is based on Sherrington's principle of successive induction?

Of what use is Frenkel's exercise?

Which of the following is a derived position?

According to Fitts and Poster, what is the second phase of motor learning?

In the motor development of a child, when is the antigravity neck flexion achieved?