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CAPR PCE Written study materials
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CAPR PCE Written practice questions

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Question 1Musculoskeletal practice

During passive ankle dorsiflexion, the therapist notes that movement stops because of sharp pain before any tissue resistance is perceived. How is this end-feel best classified?

  1. A firm end-feel with a springy quality
  2. An empty end-feel Correct answer.
  3. A soft end-feel from tissue approximation
  4. A hard bone-to-bone end-feel

Explanation

An empty end-feel occurs when pain, rather than mechanical resistance from tissue, stops the movement; the therapist feels no true endpoint. It is considered a non-mechanical finding that warrants screening for serious pathology such as infection, tumour, fracture, or acute inflammation. Firm, hard, and soft end-feels are all normal mechanical endpoints produced by different tissues.

Question 2Musculoskeletal practice

During single-leg stance, which muscle group of the stance limb prevents the contralateral side of the pelvis from dropping?

  1. Ipsilateral gluteus maximus
  2. Ipsilateral iliopsoas
  3. Contralateral hip adductors
  4. Ipsilateral gluteus medius and minimus Correct answer.

Explanation

The hip abductors of the stance limb, chiefly gluteus medius with gluteus minimus, generate a frontal-plane torque that holds the pelvis level on the unsupported side. Failure of this mechanism produces the contralateral pelvic drop seen in a positive Trendelenburg sign. The other muscles listed do not perform this frontal-plane pelvic stabilization role.

Question 3Musculoskeletal practice

Which physical test is considered the most sensitive for detecting an acute anterior cruciate ligament rupture?

  1. Lachman test Correct answer.
  2. Dial test
  3. McMurray test
  4. Thessaly test

Explanation

The Lachman test applies an anterior tibial translation force with the knee held in slight flexion, which maximizes detection of ACL deficiency and is the most sensitive clinical test for acute rupture. The McMurray and Thessaly tests assess meniscal pathology, while the dial test assesses rotational laxity of the knee or posterolateral corner.

Question 4Musculoskeletal practice

The Ottawa Ankle Rules are designed to determine which of the following?

  1. Which specific ankle ligament has been ruptured
  2. Whether the patient is ready to return to sport
  3. The degree of proprioceptive deficit at the ankle
  4. Whether radiography is indicated after an acute ankle injury Correct answer.

Explanation

The Ottawa Ankle Rules use bony tenderness and the inability to bear weight to decide whether plain radiographs are needed after ankle trauma, thereby reducing unnecessary imaging. They do not identify which ligament is injured, grade instability, or measure functional readiness.

Question 5Musculoskeletal practice

The patellar reflex is mediated primarily by which nerve root?

  1. L3
  2. S1
  3. L2
  4. L4 Correct answer.

Explanation

The knee jerk is mediated through the femoral nerve with the L4 root as its principal segment, so a diminished patellar reflex points to an L4 lesion. The L3 root contributes to a lesser degree, while S1 mediates the Achilles reflex and L5 is assessed through other movements such as great-toe extension.

Question 6Musculoskeletal practice

Which rotator cuff muscle is the primary medial (internal) rotator of the glenohumeral joint?

  1. Subscapularis Correct answer.
  2. Supraspinatus
  3. Teres minor
  4. Infraspinatus

Explanation

Subscapularis arises from the anterior scapula and inserts on the lesser tubercle, making it the principal internal rotator and an important anterior stabilizer of the shoulder. Supraspinatus initiates abduction, whereas infraspinatus and teres minor are external rotators.

Question 7Musculoskeletal practice

The empty can (Jobe) test is used to assess which structure?

  1. Supraspinatus tendon Correct answer.
  2. Acromioclavicular joint
  3. Subscapularis tendon
  4. Long head of the biceps tendon

Explanation

The empty can test positions the arm in elevation with internal rotation and resisted elevation, which loads the supraspinatus tendon. Pain or weakness reproduces supraspinatus tendinopathy or tear. Subscapularis is assessed with the lift-off or belly-press test, the biceps with Speed or Yergason tests, and the acromioclavicular joint with direct palpation or the cross-body adduction test.

Question 8Musculoskeletal practice

A patient describes constant night pain that is not relieved by rest or by changing position. How should the therapist interpret this finding?

  1. A typical mechanical pattern of osteoarthritis
  2. A normal response to delayed-onset muscle soreness
  3. A sign of muscle imbalance that requires strengthening
  4. A red flag suggesting serious pathology Correct answer.

Explanation

Pain that persists at night and is unaffected by rest or position change is a classic red flag for non-musculoskeletal pathology such as infection, malignancy, or inflammatory disease. Mechanical musculoskeletal pain characteristically varies with posture, loading, and rest. Such a finding calls for further screening and possible medical referral rather than progression of exercise loading.

Question 9Musculoskeletal practice

For a patient with mid-portion Achilles tendinopathy, which loading approach has the strongest supportive evidence?

  1. Corticosteroid injection followed by immobilization
  2. Passive stretching as the sole intervention
  3. Progressive eccentric heel-drop loading Correct answer.
  4. Complete rest until pain has fully resolved

Explanation

Progressive eccentric loading of the calf-Achilles complex is well supported for mid-portion Achilles tendinopathy, promoting tendon adaptation and pain reduction. Complete rest and stretching alone do not restore load tolerance, and corticosteroid injection carries a risk of tendon weakening and rupture even when it provides short-term relief.

Question 10Musculoskeletal practice

A patient cannot hold the arm in 90 degrees of abduction and the arm drops suddenly when the examiner releases it. This finding most likely indicates which of the following?

  1. Acromioclavicular joint osteoarthritis
  2. Cervical radiculopathy at C5
  3. A full-thickness rotator cuff tear Correct answer.
  4. Adhesive capsulitis with global stiffness

Explanation

A positive drop arm test reflects an inability to sustain active abduction, which is characteristic of a large or full-thickness rotator cuff tear involving supraspinatus. Adhesive capsulitis limits passive range as well as active range, and acromioclavicular or cervical sources would not produce a sudden drop with preserved passive elevation.

Question 11Musculoskeletal practice

Which set of findings defines a grade III ligament sprain?

  1. Complete rupture with loss of ligamentous restraint Correct answer.
  2. Partial tearing with mild laxity and a firm endpoint
  3. Bony avulsion at the ligament insertion
  4. Microscopic tearing with no detectable laxity

Explanation

Ligament sprains are graded by the extent of fibre disruption: grade I is microscopic injury without laxity, grade II is partial rupture with increased laxity but a palpable endpoint, and grade III is complete rupture with loss of the ligament's restraining function. A bony avulsion is a separate fracture pattern rather than a ligament grade.

Question 12Musculoskeletal practice

A patient with lumbar spinal stenosis typically describes which symptom pattern?

  1. Pain that is relieved only by lying prone
  2. Pain that worsens with flexion and eases with extension
  3. Night pain that is unrelieved by any change of position
  4. Leg symptoms that are relieved by sitting or leaning forward Correct answer.

Explanation

Lumbar stenosis narrows the central canal and lateral recesses, so extension increases symptoms while flexion increases canal dimensions and relieves them. Patients therefore report relief with sitting, leaning on a shopping trolley, or cycling. This flexion bias distinguishes stenosis from a typical disc or facet presentation, and unremitting night pain would instead raise red-flag concern.

Question 13Musculoskeletal practice

Which criterion is most appropriate to include when clearing an athlete for pivoting sport after anterior cruciate ligament reconstruction?

  1. Pain-free walking on level ground
  2. Twelve weeks elapsed since surgery
  3. 90% or greater limb symmetry on quadriceps strength and hop tests Correct answer.
  4. Full passive knee flexion

Explanation

Return to pivoting sport requires objective restoration of strength, power, and neuromuscular control, commonly quantified as at least 90% limb symmetry on quadriceps strength testing and single-leg hop tests alongside psychological readiness. Time since surgery alone or freedom from pain with walking does not establish the capacity to tolerate pivot and deceleration loads.

Question 14Musculoskeletal practice

A patient with a radial nerve palsy typically presents with which impairment?

  1. Clawing of the ulnar two digits
  2. Wrist drop Correct answer.
  3. Wasting of the thenar eminence
  4. Loss of sensation over the little finger

Explanation

The radial nerve supplies the wrist and finger extensors, so injury produces weakness of extension and the characteristic wrist drop. Ulnar clawing and little-finger sensory loss reflect ulnar nerve involvement, and thenar wasting reflects median nerve involvement.

Question 15Musculoskeletal practice

During the painful (freezing) stage of primary adhesive capsulitis, what is the most appropriate physiotherapy approach?

  1. Aggressive end-range stretching to restore range quickly
  2. Immediate manipulation under anaesthesia
  3. High-grade joint mobilization to stretch the capsule
  4. Pain control with gentle range of motion within pain limits Correct answer.

Explanation

The freezing stage is dominated by inflammation and pain, so treatment aims to modulate pain and maintain available motion without provoking an inflammatory flare. Aggressive stretching and high-grade mobilization during this phase tend to increase irritability. Manipulation under anaesthesia is generally reserved for later, resistant stages.

Question 16Musculoskeletal practice

How is the straight leg raise test best characterized when used for suspected lumbar disc herniation?

  1. Highly specific but poorly sensitive
  2. Highly sensitive but poorly specific Correct answer.
  3. Useful only for detecting hip joint pathology
  4. Equally sensitive and specific

Explanation

The straight leg raise is sensitive for lumbosacral nerve root irritation, so a negative result helps exclude disc-related radiculopathy, but it is poorly specific because many other conditions can reproduce the response. Diagnosis therefore relies on combining it with neurological examination and imaging where indicated.

Question 17Musculoskeletal practice

Which group of tests is used to screen for thoracic outlet syndrome?

  1. Cozen, Mill, and Maudsley tests
  2. Spurling, Bakody, and cervical distraction tests
  3. Adson, Roos, and Wright tests Correct answer.
  4. Finkelstein, Eichhoff, and Phalen tests

Explanation

Adson, Roos (elevated arm stress), and Wright tests alter the thoracic outlet position and are used to provoke neurovascular symptoms of thoracic outlet syndrome. Spurling and distraction tests assess the cervical spine, the Cozen, Mill, and Maudsley tests assess lateral elbow tendinopathy, and Finkelstein, Eichhoff, and Phalen tests assess the wrist and hand.

Question 18Musculoskeletal practice

Which intervention has the most consistent evidence for reducing pain and improving function in patellofemoral pain syndrome?

  1. Patellar taping applied without any exercise component
  2. Long-term use of a patellofemoral brace during all activity
  3. Progressive hip and knee strengthening combined with movement retraining Correct answer.
  4. Isolated quadriceps stretching performed as a stand-alone treatment

Explanation

Patellofemoral pain is multifactorial, and the strongest evidence supports combined strengthening of the hip abductors and external rotators with quadriceps exercise, alongside retraining of movement patterns. Passive measures such as bracing or taping may give short-term relief but do not address the underlying capacity deficits when used alone.

Question 19Musculoskeletal practice

Which factor most strongly increases a young female athlete's risk of a bone stress injury?

  1. Regular resistance training
  2. High dietary calcium intake
  3. Consistent sleep of eight hours per night
  4. Low energy availability with menstrual dysfunction Correct answer.

Explanation

Low energy availability, often accompanied by menstrual dysfunction and low bone mineral density, is the central feature of the female athlete triad and markedly increases bone stress injury risk. Adequate nutrition, resistance training, and sufficient sleep are protective rather than harmful.

Question 20Musculoskeletal practice

A Maitland grade III accessory joint mobilization is best described as which of the following?

  1. A small-amplitude thrust performed at the end of range
  2. Sustained traction applied without any oscillation
  3. A small-amplitude oscillation at the beginning of the available range
  4. A large-amplitude movement extending into tissue resistance Correct answer.

Explanation

Maitland grades I and II are small and large amplitude oscillations that remain before resistance, grade III is a large-amplitude oscillation taken into resistance, and grade IV is a small-amplitude oscillation at the limit of range. Grade V is the term for a manipulative thrust. Choosing a grade depends on the irritability and stage of the condition.

Question 21Musculoskeletal practice

A patient with neck pain shows a positive Hoffman sign, sustained ankle clonus, and a broad-based gait. These findings point to which condition?

  1. Isolated loss of the triceps reflex
  2. Cervical myelopathy with upper motor neuron involvement Correct answer.
  3. Unilateral dermatomal numbness at C6
  4. Reproduction of arm pain with the Spurling test

Explanation

Hoffman sign, clonus, and gait disturbance are upper motor neuron signs indicating cord compression, as in cervical spondylotic myelopathy. These findings differ fundamentally from the lower motor neuron and radicular patterns of a root lesion, and they require prompt medical referral rather than continued manual therapy.

Question 22Musculoskeletal practice

The Sharp-Purser test is used to assess which of the following?

  1. Thoracic outlet compression
  2. Cervical facet dysfunction at C4-C5
  3. Vertebral artery insufficiency
  4. Atlantoaxial instability Correct answer.

Explanation

The Sharp-Purser test assesses the integrity of the transverse ligament by detecting posterior displacement of the atlas relative to the axis during controlled neck flexion. A positive result suggests atlantoaxial instability and contraindicates upper cervical manipulation. Vertebral artery and thoracic outlet screening use different provocative manoeuvres.

Question 23Musculoskeletal practice

Two hours after a tibial shaft fracture, a patient reports escalating pain that is far worse than the injury appears and that increases with passive toe extension. What does this presentation suggest?

  1. Gradual onset over several days with mild swelling
  2. Pallor and pulselessness are the earliest and most reliable indicators
  3. Pain that resolves promptly with elevation and rest
  4. Acute compartment syndrome requiring urgent medical referral Correct answer.

Explanation

Pain out of proportion to the injury that is aggravated by passive stretch of the compartment muscles is the earliest and most reliable sign of acute compartment syndrome. Pulselessness and pallor are late findings, so waiting for them risks irreversible muscle and nerve damage. This is a medical emergency requiring urgent fasciotomy assessment.

Question 24Musculoskeletal practice

An athletic 12-year-old reports localized pain and a prominent bump at the tibial tuberosity that worsens with running and jumping. What is the most likely diagnosis?

  1. Traction apophysitis at the tibial tuberosity Correct answer.
  2. Inflammation of the infrapatellar fat pad
  3. Avulsion fracture of the tibial tuberosity requiring surgery
  4. Osteochondrosis of the inferior pole of the patella

Explanation

Osgood-Schlatter disease is a traction apophysitis of the tibial tuberosity occurring during the adolescent growth spurt, when repetitive quadriceps tension acts on an open apophysis. It is managed with load modification, activity relative rest, and progressive strengthening. Osteochondrosis of the inferior patellar pole is a separate condition, and a displaced avulsion fracture would present acutely after a distinct traumatic event.

Question 25Musculoskeletal practice

Before cervical manipulation, a patient reports transient dizziness, diplopia, and slurred speech when the neck is extended and rotated. How should this presentation be interpreted?

  1. Benign paroxysmal positional vertigo
  2. Myofascial referred pain from the upper trapezius
  3. Vertebrobasilar insufficiency Correct answer.
  4. Cervical radiculopathy

Explanation

Transient dizziness with diplopia and dysarthria provoked by extension-rotation suggests compromised vertebrobasilar blood flow and is a contraindication to cervical manipulation. These are central neurological symptoms rather than the brief positional vertigo of a vestibular disorder or the dermatomal pain of a root lesion. The patient requires medical evaluation before any further manual therapy.

Question 26Musculoskeletal practice

Which structure is the primary restraint to posterior translation of the tibia on the femur?

  1. Medial collateral ligament
  2. Anterior cruciate ligament
  3. Iliotibial band
  4. Posterior cruciate ligament Correct answer.

Explanation

The posterior cruciate ligament is the main static restraint to posterior tibial translation, and it is most loaded with the knee flexed. The anterior cruciate ligament restrains the opposite direction of translation.

Question 27Musculoskeletal practice

According to the Ottawa ankle rules, which finding alone justifies ordering radiographs after an ankle inversion injury?

  1. Mild diffuse swelling around the ankle without focal tenderness
  2. Bone tenderness over the posterior edge or tip of the lateral malleolus Correct answer.
  3. Pain at the end range of active dorsiflexion
  4. Ability to take four full weight-bearing steps in the clinic

Explanation

The Ottawa ankle rules indicate radiography when there is pain in the malleolar zone plus bony tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps. Swelling and end-range pain alone do not meet the criteria.

Question 28Musculoskeletal practice

After a traumatic anterior shoulder dislocation, a patient typically supports the arm in which position?

  1. Shoulder extension with the hand behind the back
  2. Fully elevated overhead with the elbow extended
  3. Adducted and internally rotated against the trunk
  4. Slight abduction and external rotation with the forearm supported Correct answer.

Explanation

Anterior dislocation leaves the humeral head anterior to the glenoid, and patients guard in slight abduction and external rotation, often supporting the forearm. Internal rotation and adduction tend to increase discomfort in this pattern.

Question 29Musculoskeletal practice

Which test is used to reproduce the symptoms of De Quervain tenosynovitis?

  1. Tinel sign at the wrist
  2. Finkelstein test Correct answer.
  3. Watson scaphoid shift test
  4. Phalen test

Explanation

Finkelstein test uses thumb-in-fist wrist ulnar deviation to compress the first dorsal compartment, reproducing pain in De Quervain tenosynovitis. The other tests target nerve compression or carpal instability.

Question 30Musculoskeletal practice

Lateral epicondylalgia most commonly involves which structure?

  1. Common extensor tendon origin, particularly the extensor carpi radialis brevis Correct answer.
  2. The ulnar nerve within the cubital tunnel
  3. The distal biceps tendon at the radial tuberosity
  4. Common flexor tendon origin at the medial epicondyle

Explanation

Lateral epicondylalgia is a tendinopathy of the wrist extensor origin, with the extensor carpi radialis brevis most consistently involved. Pain is reproduced with resisted wrist extension and gripping.

Question 31Musculoskeletal practice

Which precaution is appropriate after total hip arthroplasty performed through a posterior approach?

  1. Avoid all active hip abduction for the first three months
  2. Avoid combined hip flexion beyond 90 degrees, adduction, and internal rotation Correct answer.
  3. Maintain strict non-weight-bearing for six weeks in all cases
  4. Avoid hip extension past neutral for six weeks

Explanation

The posterior approach disrupts posterior capsular and short external rotator tissue, so the hip is protected from the combined flexion-adduction-internal rotation position that risks posterior dislocation. Abduction and extension are generally permitted and encouraged.

Question 32Musculoskeletal practice

Which ligament is most frequently injured in a lateral ankle sprain?

  1. Anterior talofibular ligament Correct answer.
  2. Posterior talofibular ligament
  3. Calcaneofibular ligament
  4. Deltoid ligament

Explanation

The anterior talofibular ligament is the weakest and most anteriorly positioned lateral ligament, so it fails first during inversion and plantar flexion. The calcaneofibular and posterior talofibular ligaments are injured in more severe sprains.

Question 33Musculoskeletal practice

The McMurray test is used to assess which structure?

  1. Patellofemoral joint
  2. Medial collateral ligament
  3. Anterior cruciate ligament
  4. Meniscal cartilage Correct answer.

Explanation

The McMurray test applies flexion, rotation, and extension to trap and load a meniscal tear, producing a click or pain at the joint line. Ligament stress tests and patellar compression tests address the other structures.

Question 34Musculoskeletal practice

A patient is three weeks after arthroscopic repair of a full-thickness supraspinatus tear. Which rehabilitation approach is most appropriate at this stage?

  1. Allow unrestricted active overhead motion and return to lifting
  2. Begin resisted band strengthening into abduction and external rotation
  3. Defer all shoulder motion until eight weeks postoperatively
  4. Protect the repair with passive and active-assisted motion within protocol limits, avoiding active elevation against gravity Correct answer.

Explanation

Early tendon-to-bone healing is vulnerable, so protected passive and active-assisted motion is used in the first weeks while avoiding active loading of the repair. Progression to active and resisted work follows a staged timeline.

Question 35Musculoskeletal practice

Which exercise prescription is best supported for a patient with painful knee osteoarthritis?

  1. Pool exercise only, with no land-based strengthening
  2. Supervised land-based strengthening combined with aerobic exercise Correct answer.
  3. High-impact plyometric training to build joint resilience
  4. Rest and avoidance of weight-bearing activity until pain resolves

Explanation

Clinical guidelines consistently recommend structured strengthening and aerobic exercise, delivered with supervision and progression, for reducing pain and improving function in knee osteoarthritis. Neither rest nor high-impact loading is recommended.

Question 36Musculoskeletal practice

A patient reports repeated lateral ankle sprains with episodes of giving way and poor single-leg balance. What should be the main focus of rehabilitation?

  1. Six weeks of rigid immobilization to allow ligament healing
  2. Passive calf stretching performed daily as the sole intervention
  3. Progressive balance, proprioceptive, and peroneal strengthening training, with bracing as an adjunct Correct answer.
  4. Long-term use of a brace without any exercise component

Explanation

Chronic ankle instability reflects impaired sensorimotor control and strength after repeated sprains, so progressive balance and strengthening training is the core intervention, with bracing used to support return to sport. Immobilization and passive measures alone do not restore control.

Question 37Musculoskeletal practice

Which clinical pattern is most characteristic of hip osteoarthritis?

  1. Groin pain with restricted internal rotation and a capsular pattern of movement loss Correct answer.
  2. Buttock pain radiating below the knee with a positive straight leg raise
  3. Pain localized to the greater trochanter reproduced by side-lying palpation
  4. Pain provoked mainly by repeated lumbar extension

Explanation

Hip osteoarthritis typically produces groin or anterior thigh pain with loss of internal rotation first, followed by a capsular pattern affecting flexion, abduction, and rotation. Pain confined to the greater trochanter suggests a lateral hip soft tissue source.

Question 38Musculoskeletal practice

Three weeks after a distal radius fracture, a patient reports burning pain out of proportion to the injury, along with swelling, colour and temperature changes, and marked hypersensitivity in the hand. What is the most likely explanation?

  1. Expected inflammatory response of normal fracture healing
  2. Complex regional pain syndrome Correct answer.
  3. Carpal tunnel syndrome
  4. De Quervain tenosynovitis

Explanation

Disproportionate pain with vasomotor, sudomotor, and sensory changes after a distal radius fracture fits complex regional pain syndrome, which requires early recognition and appropriate pain-focused rehabilitation. The presence of autonomic and trophic features distinguishes it from simple healing pain.

Question 39Musculoskeletal practice

Medial winging of the scapula is most commonly caused by weakness of which muscle?

  1. Upper trapezius
  2. Rhomboid major
  3. Serratus anterior Correct answer.
  4. Levator scapulae

Explanation

The serratus anterior protracts and holds the scapula against the rib cage, so its weakness, often from long thoracic nerve involvement, produces medial border winging. The trapezius and rhomboids influence scapular position but do not cause classic medial winging.

Question 40Musculoskeletal practice

Which approach is best supported for a patient with chronic nonspecific low back pain?

  1. Passive electrotherapy modalities used as the only intervention
  2. Bed rest until the pain has fully resolved
  3. Repeated imaging to identify a structural cause before starting exercise
  4. Exercise therapy combined with education and encouragement to stay active Correct answer.

Explanation

Guidelines recommend exercise therapy alongside education and reassurance that activity is safe, because this improves function and reduces disability in chronic nonspecific low back pain. Passive treatments and rest are not effective as the main strategy.

Question 41Musculoskeletal practice

The Thompson test is used to identify which condition?

  1. Achilles tendon rupture Correct answer.
  2. Achilles tendinopathy
  3. Posterior tibial tendon dysfunction
  4. Plantar fasciitis

Explanation

Squeezing the calf with the patient prone should produce ankle plantar flexion; absence of that movement indicates a disrupted Achilles tendon. Tendinopathy and plantar heel pain do not abolish the squeeze response.

Question 42Musculoskeletal practice

Which training programme has the strongest evidence for reducing the incidence of hamstring strain injury in soccer players?

  1. Hip flexor stretching before each session
  2. A Nordic hamstring eccentric strengthening programme Correct answer.
  3. Daily static hamstring stretching as a standalone measure
  4. Upper body plyometric training performed twice weekly

Explanation

Eccentric hamstring loading with the Nordic exercise increases fascicle length and eccentric strength, and team-based programmes reduce hamstring injury rates. Stretching alone has not been shown to prevent these injuries.

Question 43Musculoskeletal practice

Which exercise type is recommended to support bone health in a postmenopausal woman with osteoporosis?

  1. Prolonged cycling at low intensity only
  2. Static stretching performed in supine
  3. Progressive weight-bearing and resistance training Correct answer.
  4. Swimming as the primary mode of exercise

Explanation

Bone responds to mechanical loading, so progressive weight-bearing impact and resistance exercise are recommended to maintain or improve bone mineral density. Non-weight-bearing modes such as swimming and cycling do not provide the same osteogenic stimulus.

Question 44Musculoskeletal practice

A patient presents with a single knee that became hot and swollen over 12 hours, a temperature of 38.5 degrees Celsius, and an inability to bear weight. What is the most appropriate action?

  1. Begin eccentric quadriceps strengthening and monitor progress
  2. Refer urgently for medical assessment to rule out septic arthritis Correct answer.
  3. Apply ice and compression and review the knee in one week
  4. Provide a knee brace and advise relative rest at home

Explanation

A rapidly developing hot, swollen joint with fever and inability to bear weight raises concern for septic arthritis, which is a medical emergency requiring urgent aspiration and treatment. Delay risks irreversible joint destruction.

Question 45Musculoskeletal practice

What is the best-supported early management for an acute grade I or II lateral ankle sprain?

  1. Immediate surgical ligament repair
  2. Six weeks of cast immobilization to protect the ligaments
  3. Functional management with early protected weight bearing, exercise, and external support Correct answer.
  4. Complete rest until the patient is entirely pain free

Explanation

Functional treatment with early protected weight bearing, exercise, and bracing or taping produces better outcomes than prolonged immobilization for grade I and II sprains. Surgery is reserved for select severe or chronic instability cases.

Question 46Musculoskeletal practice

A 15-year-old gymnast reports three months of insidious low back pain that worsens with extension and is associated with focal paraspinal tenderness, without neurological signs; plain radiographs are normal. What is the most appropriate approach?

  1. Manage as a suspected bone stress injury with activity modification and further imaging such as MRI Correct answer.
  2. Perform lumbar spine manipulation at the painful level and continue full training
  3. Reassure the athlete and allow unrestricted training to continue
  4. Prescribe flexion-based exercises only and disregard the extension-related pain

Explanation

Extension-related pain in a young repetitive-extension athlete suggests spondylolysis, which is a bone stress injury and is often radiographically silent early on. Activity modification with further imaging allows confirmation and prevents progression to non-union.

Question 47Musculoskeletal practice

A 58-year-old presents with gradual-onset shoulder pain, a painful arc between 60 and 120 degrees of elevation, night pain when lying on the affected side, full passive range of motion, and pain on resisted abduction. Which condition is most likely?

  1. Rotator cuff tendinopathy with subacromial pain Correct answer.
  2. Glenohumeral osteoarthritis
  3. Cervical radiculopathy
  4. Adhesive capsulitis

Explanation

A painful arc with preserved passive range and pain on resisted contraction points to a rotator cuff tendon source rather than capsular restriction or joint degeneration. Adhesive capsulitis and glenohumeral arthritis both markedly restrict passive movement.

Question 48Musculoskeletal practice

Which combination of factors is most consistently associated with slower recovery after a whiplash injury?

  1. Low initial pain intensity and rapid return to normal activity
  2. Receiving an explanation of the injury and a home exercise programme
  3. Male sex and older age alone
  4. High initial pain intensity and high pain catastrophizing Correct answer.

Explanation

Prognostic studies identify high initial pain and disability, along with catastrophic thinking and fear of movement, as strong predictors of persistent symptoms after whiplash. Early reassurance and graded activity are associated with better rather than worse outcomes.

Question 49Musculoskeletal practice

A 22-year-old hockey player reports deep groin pain that is worse with prolonged sitting and with deep hip flexion, and has limited hip internal rotation and a positive flexion-adduction-internal rotation test. Which condition best fits this presentation?

  1. Lumbar radiculopathy
  2. Greater trochanteric pain syndrome
  3. Hip osteoarthritis
  4. Femoroacetabular impingement with possible labral pathology Correct answer.

Explanation

Deep groin pain provoked by hip flexion, restricted internal rotation, and a positive flexion-adduction-internal rotation test in a young athlete fit femoroacetabular impingement and labral involvement. Lateral hip pain and age-related joint changes describe different patterns.

Question 50Musculoskeletal practice

An athlete sustains a forced external rotation and dorsiflexion injury and now has pain above the ankle joint line, tenderness over the distal tibiofibular area, and a positive squeeze test, with no malleolar fracture on imaging. What is the most likely diagnosis?

  1. Syndesmotic (high) ankle sprain Correct answer.
  2. Peroneal tendon tendinopathy
  3. Lateral ankle sprain involving the anterior talofibular ligament
  4. Achilles tendon rupture

Explanation

Pain above the joint line with distal tibiofibular tenderness, a positive squeeze test, and an external rotation mechanism indicate injury to the distal tibiofibular syndesmosis. These injuries require longer protected weight bearing than a routine lateral sprain.