Page 1 of 152
# SECTION I: MUSCULOSKELETAL SYSTEM
## Orthopedic Assessment & Evaluation
**Question 1**
A 45-year-old patient presents with shoulder pain and reports difficulty reaching behind their
back to fasten a bra. On examination, you note limited internal rotation. Which of the following
special tests is MOST appropriate to assess for subacromial impingement?
A. Apprehension test
B. Hawkins-Kennedy test
C. O'Brien's test
D. Speed's test
**Correct Answer: B**
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**Rationale:** The Hawkins-Kennedy test is specifically designed to assess for subacromial
impingement by forcibly internally rotating the shoulder while the arm is flexed to 90 degrees,
which compresses the supraspinatus tendon against the coracoacromial ligament. Option A
(Apprehension test) is used to assess anterior shoulder instability. Option C (O'Brien's test) is
used to assess for superior labral tears (SLAP lesions). Option D (Speed's test) is used to assess
for biceps tendinopathy.
---
**Question 2**
A patient who is 3 weeks status post total knee arthroplasty demonstrates knee flexion of 85
degrees and extension lag of 10 degrees. What is the MOST appropriate intervention to address
the extension lag?
A. Quadriceps isometrics in terminal extension
B. Hamstring stretching
C. Patellar mobilization
D. Heel slides with a towel roll
**Correct Answer: A**
**Rationale:** An extension lag indicates weakness of the quadriceps muscle, specifically the
vastus medialis obliquus (VMO), which is responsible for terminal knee extension. Quadriceps
isometrics in terminal extension directly target this weakness. Option B (Hamstring stretching)
would address tightness but not the primary cause of extension lag. Option C (Patellar
mobilization) addresses mobility restrictions. Option D (Heel slides) addresses flexion range of
motion.
---
**Question 3**
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A 28-year-old runner presents with lateral knee pain that worsens with downhill running. On
examination, tenderness is noted over the lateral femoral epicondyle. Which of the following is
the MOST likely diagnosis?
A. Patellofemoral pain syndrome
B. Iliotibial band syndrome
C. Medial collateral ligament sprain
D. Plica syndrome
**Correct Answer: B**
**Rationale:** Iliotibial (IT) band syndrome is characterized by lateral knee pain that worsens
with downhill running or running on cambered surfaces. Tenderness over the lateral femoral
epicondyle is a classic finding. Option A (Patellofemoral pain syndrome) typically presents with
anterior knee pain. Option C (MCL sprain) presents with medial knee pain. Option D (Plica
syndrome) presents with medial or anterior knee pain.
---
**Question 4**
During a 5-position grip strength test, at which grip position is the HIGHEST grip strength
typically observed?
A. First position (smallest)
B. Second position
C. Third position
D. Fifth position (largest)
**Correct Answer: C**
, Page 4 of 152
**Rationale:** Maximal grip strength occurs at the middle grip position (positions 2 and 3) due
to the length-tension relationship of the extrinsic hand muscles. The middle position allows for
optimal sarcomere length and maximal force production. The smaller positions (1-2) place the
muscles in a shortened position, reducing force production, while the larger positions (4-5) place
them in a lengthened position, also reducing force.
---
**Question 5**
A patient with a diagnosis of adhesive capsulitis has been in the "freezing" stage for 3 months.
What is the PRIMARY goal of physical therapy during this stage?
A. Aggressive stretching to regain range of motion
B. Pain management and patient education
C. Strengthening of the rotator cuff
D. Joint mobilization with high-grade oscillations
**Correct Answer: B**
**Rationale:** During the "freezing" (painful) stage of adhesive capsulitis, the primary goal is
pain management and patient education. Aggressive stretching (A) would exacerbate pain and
inflammation. Strengthening (C) is more appropriate for the "thawing" stage. High-grade joint
mobilizations (D) are contraindicated during the painful stage; low-grade oscillations are
preferred for pain modulation.
---
**Question 6**
# SECTION I: MUSCULOSKELETAL SYSTEM
## Orthopedic Assessment & Evaluation
**Question 1**
A 45-year-old patient presents with shoulder pain and reports difficulty reaching behind their
back to fasten a bra. On examination, you note limited internal rotation. Which of the following
special tests is MOST appropriate to assess for subacromial impingement?
A. Apprehension test
B. Hawkins-Kennedy test
C. O'Brien's test
D. Speed's test
**Correct Answer: B**
,Page 2 of 152
**Rationale:** The Hawkins-Kennedy test is specifically designed to assess for subacromial
impingement by forcibly internally rotating the shoulder while the arm is flexed to 90 degrees,
which compresses the supraspinatus tendon against the coracoacromial ligament. Option A
(Apprehension test) is used to assess anterior shoulder instability. Option C (O'Brien's test) is
used to assess for superior labral tears (SLAP lesions). Option D (Speed's test) is used to assess
for biceps tendinopathy.
---
**Question 2**
A patient who is 3 weeks status post total knee arthroplasty demonstrates knee flexion of 85
degrees and extension lag of 10 degrees. What is the MOST appropriate intervention to address
the extension lag?
A. Quadriceps isometrics in terminal extension
B. Hamstring stretching
C. Patellar mobilization
D. Heel slides with a towel roll
**Correct Answer: A**
**Rationale:** An extension lag indicates weakness of the quadriceps muscle, specifically the
vastus medialis obliquus (VMO), which is responsible for terminal knee extension. Quadriceps
isometrics in terminal extension directly target this weakness. Option B (Hamstring stretching)
would address tightness but not the primary cause of extension lag. Option C (Patellar
mobilization) addresses mobility restrictions. Option D (Heel slides) addresses flexion range of
motion.
---
**Question 3**
,Page 3 of 152
A 28-year-old runner presents with lateral knee pain that worsens with downhill running. On
examination, tenderness is noted over the lateral femoral epicondyle. Which of the following is
the MOST likely diagnosis?
A. Patellofemoral pain syndrome
B. Iliotibial band syndrome
C. Medial collateral ligament sprain
D. Plica syndrome
**Correct Answer: B**
**Rationale:** Iliotibial (IT) band syndrome is characterized by lateral knee pain that worsens
with downhill running or running on cambered surfaces. Tenderness over the lateral femoral
epicondyle is a classic finding. Option A (Patellofemoral pain syndrome) typically presents with
anterior knee pain. Option C (MCL sprain) presents with medial knee pain. Option D (Plica
syndrome) presents with medial or anterior knee pain.
---
**Question 4**
During a 5-position grip strength test, at which grip position is the HIGHEST grip strength
typically observed?
A. First position (smallest)
B. Second position
C. Third position
D. Fifth position (largest)
**Correct Answer: C**
, Page 4 of 152
**Rationale:** Maximal grip strength occurs at the middle grip position (positions 2 and 3) due
to the length-tension relationship of the extrinsic hand muscles. The middle position allows for
optimal sarcomere length and maximal force production. The smaller positions (1-2) place the
muscles in a shortened position, reducing force production, while the larger positions (4-5) place
them in a lengthened position, also reducing force.
---
**Question 5**
A patient with a diagnosis of adhesive capsulitis has been in the "freezing" stage for 3 months.
What is the PRIMARY goal of physical therapy during this stage?
A. Aggressive stretching to regain range of motion
B. Pain management and patient education
C. Strengthening of the rotator cuff
D. Joint mobilization with high-grade oscillations
**Correct Answer: B**
**Rationale:** During the "freezing" (painful) stage of adhesive capsulitis, the primary goal is
pain management and patient education. Aggressive stretching (A) would exacerbate pain and
inflammation. Strengthening (C) is more appropriate for the "thawing" stage. High-grade joint
mobilizations (D) are contraindicated during the painful stage; low-grade oscillations are
preferred for pain modulation.
---
**Question 6**
