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HK Physio Registration practice questions

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Question 1Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which structure forms the primary stabilising ligament on the lateral aspect of the ankle, resisting inversion?

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

Explanation

The lateral collateral complex comprises the anterior talofibular, calcaneofibular and posterior talofibular ligaments. The anterior talofibular ligament is the weakest and most commonly injured, being the first structure to fail during forced plantarflexion and inversion.

Question 2Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

During quiet inspiration, which muscle is the principal driver of the increase in thoracic volume?

  1. External intercostal
  2. Rectus abdominis
  3. Diaphragm Correct answer.
  4. Sternocleidomastoid

Explanation

The diaphragm contracts and descends, accounting for the majority of tidal volume during quiet breathing. Its dome-shaped attachments to the lower ribs, lumbar vertebrae and xiphoid allow it to act as a piston, and phrenic nerve supply (C3-C5) is essential to this function.

Question 3Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

A patient sustains a fracture through the surgical neck of the humerus. Which nerve is most at risk of injury?

  1. Axillary nerve Correct answer.
  2. Median nerve
  3. Musculocutaneous nerve
  4. Radial nerve

Explanation

The axillary nerve winds around the surgical neck of the humerus with the posterior circumflex humeral artery, placing it at risk in fractures and shoulder dislocations. Injury produces deltoid weakness and sensory loss over the lateral shoulder.

Question 4Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which component of the cardiac conduction system normally acts as the pacemaker of the heart?

  1. Atrioventricular node
  2. Sinoatrial node Correct answer.
  3. Bundle of His
  4. Purkinje fibres

Explanation

The sinoatrial node in the upper right atrium has the steepest spontaneous phase 4 depolarisation and therefore the highest intrinsic rate, so it sets the sinus rhythm. Lower pacemakers are suppressed by overdrive pacing from above.

Question 5Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which type of muscle fibre is characterised by high myoglobin content, dense capillary supply and resistance to fatigue?

  1. Type IIb
  2. Type IIa
  3. Type IIx
  4. Type I Correct answer.

Explanation

Type I (slow oxidative) fibres rely on aerobic metabolism, are rich in mitochondria and myoglobin, and are highly fatigue-resistant, making them suited to postural and endurance activity. Fast glycolytic fibres trade endurance for rapid force generation.

Question 6Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which hormone is released from the posterior pituitary?

  1. Growth hormone
  2. Prolactin
  3. Antidiuretic hormone Correct answer.
  4. Adrenocorticotropic hormone

Explanation

The posterior pituitary stores and releases antidiuretic hormone (vasopressin) and oxytocin, both synthesised in hypothalamic nuclei and transported down axons. The remaining options are anterior pituitary hormones under hypothalamic control.

Question 7Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which receptor type mediates the fast excitatory response at the neuromuscular junction?

  1. GABA-A receptor
  2. Alpha-1 adrenoceptor
  3. Nicotinic acetylcholine receptor Correct answer.
  4. Muscarinic M2 receptor

Explanation

Acetylcholine released from the motor nerve terminal binds nicotinic receptors on the motor endplate, opening a non-selective cation channel that produces a rapid depolarising endplate potential. This is a ligand-gated ion channel, giving millisecond-scale transmission.

Question 8Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

A patient with a complete lesion of the common fibular (peroneal) nerve at the fibular neck presents with which pattern of weakness?

  1. Weakness of knee flexion and hip extension
  2. Weakness of toe flexion and intrinsic foot muscles
  3. Weakness of ankle plantarflexion and inversion
  4. Weakness of ankle dorsiflexion and eversion Correct answer.

Explanation

The common fibular nerve divides into deep and superficial branches supplying the dorsiflexors and evertors respectively. Injury produces foot drop and loss of eversion, with sensory loss over the dorsum of the foot and lateral leg.

Question 9Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which change in lung mechanics is most characteristic of pulmonary fibrosis?

  1. Increased airway resistance with normal compliance
  2. Increased compliance with reduced elastic recoil
  3. Reduced residual volume with increased compliance
  4. Reduced compliance with increased elastic recoil Correct answer.

Explanation

Fibrotic lung tissue is stiffer, so compliance falls and elastic recoil rises, producing restrictive physiology with reduced total lung capacity and vital capacity. The increased recoil tends to hold airways open and raises the work of breathing.

Question 10Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which mechanism best explains the oedema seen in nephrotic syndrome?

  1. Increased capillary hydrostatic pressure due to right heart failure
  2. Lymphatic obstruction by tumour infiltration
  3. Increased capillary permeability from histamine release
  4. Reduced plasma oncotic pressure from hypoalbuminaemia Correct answer.

Explanation

Heavy urinary protein loss lowers serum albumin, reducing plasma oncotic pressure so that fluid moves into the interstitium according to Starling forces. Sodium retention also contributes, but hypoalbuminaemia is the defining mechanism.

Question 11Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

During a closed-chain squat, which muscle action occurs at the knee as the body descends under control?

  1. Eccentric contraction of quadriceps Correct answer.
  2. Isometric contraction of hamstrings
  3. Concentric contraction of quadriceps
  4. Concentric contraction of hamstrings

Explanation

As the body lowers, the quadriceps lengthen while generating tension to control knee flexion, which is an eccentric action. Eccentric work absorbs energy and is associated with delayed-onset muscle soreness after unaccustomed exercise.

Question 12Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which arterial structure is most directly compressed in thoracic outlet syndrome involving the interscalene triangle?

  1. Radial artery
  2. Subclavian artery Correct answer.
  3. Axillary artery
  4. Brachial artery

Explanation

The subclavian artery and the brachial plexus pass between the anterior and middle scalene muscles in the interscalene triangle. Compression there can produce arterial insufficiency and lower plexus symptoms, whereas more distal vessels are unaffected.

Question 13Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which finding is most consistent with an upper motor neuron lesion?

  1. Fasciculations with reduced deep tendon reflexes
  2. Spasticity with hyperreflexia and an extensor plantar response Correct answer.
  3. Flaccid paralysis with marked muscle wasting
  4. Loss of proprioception with a positive Romberg sign

Explanation

Interruption of the corticospinal tract removes descending inhibition, producing increased tone, exaggerated reflexes and a Babinski response. Wasting is typically mild because the lower motor neuron and muscle remain innervated.

Question 14Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which phase of the cardiac cycle corresponds to the first heart sound?

  1. Rapid ventricular filling
  2. Opening of the atrioventricular valves
  3. Closure of the atrioventricular valves Correct answer.
  4. Closure of the semilunar valves

Explanation

The first heart sound arises from closure of the mitral and tricuspid valves at the onset of ventricular systole, when ventricular pressure exceeds atrial pressure. The second sound reflects semilunar valve closure at the end of systole.

Question 15Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which renal structure is primarily responsible for creating the medullary osmotic gradient?

  1. Macula densa
  2. Glomerular basement membrane
  3. Podocyte foot processes
  4. Loop of Henle Correct answer.

Explanation

The countercurrent multiplier of the loop of Henle, with active sodium chloride reabsorption in the thick ascending limb and water permeability in the descending limb, establishes the corticomedullary osmotic gradient. This gradient permits concentration of urine under ADH influence.

Question 16Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

A patient reports burning pain and numbness in the thumb, index and middle fingers that wakes them at night. Which structure is most likely compressed?

  1. Radial nerve at the spiral groove
  2. Ulnar nerve at the cubital tunnel
  3. Median nerve at the carpal tunnel Correct answer.
  4. Posterior interosseous nerve at the arcade of Frohse

Explanation

The median nerve supplies the lateral three and a half digits and passes beneath the flexor retinaculum, where raised pressure produces nocturnal paraesthesia and thenar wasting. Symptoms spare the little finger, which is ulnar territory.

Question 17Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which statement best describes the role of surfactant in the alveolus?

  1. It increases surface tension to prevent alveolar collapse
  2. It transports oxygen across the alveolar membrane
  3. It reduces surface tension, lowering the work of breathing and stabilising alveolar size Correct answer.
  4. It increases alveolar surface area by relaxing smooth muscle

Explanation

Surfactant is secreted by type II pneumocytes and reduces surface tension according to Laplace's law, decreasing collapsing pressure in small alveoli. This improves compliance, reduces the work of breathing and limits alveolar collapse at end-expiration.

Question 18Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which adaptation of the musculoskeletal system is expected after several weeks of progressive resistance training?

  1. Reduced tendon stiffness
  2. Conversion of type I fibres into type II fibres
  3. Muscle fibre hypertrophy with increased cross-sectional area Correct answer.
  4. Reduced motor unit recruitment at a given load

Explanation

Resistance training increases myofibrillar protein synthesis, producing hypertrophy and greater cross-sectional area, which raises force-generating capacity. Neural adaptations also improve recruitment, but fibre type conversion from I to II is not a typical response.

Question 19Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which feature distinguishes the right coronary artery territory from the left in the normal heart?

  1. It supplies the anterior two-thirds of the interventricular septum
  2. It arises from the left sinus of Valsalva
  3. It gives off the circumflex artery
  4. It most commonly supplies the sinoatrial node and the right ventricle Correct answer.

Explanation

The right coronary artery arises from the right aortic sinus and in most people supplies the SA node via an atrial branch, along with the right ventricle and inferior wall. The left coronary artery supplies most of the left ventricle and anterior septum.

Question 20Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

In a patient with chronic obstructive pulmonary disease, which arterial blood gas pattern is most typical of acute decompensation with CO2 retention?

  1. Low PaO2 with low PaCO2 and raised pH
  2. Normal PaO2 with raised PaCO2 and raised pH
  3. Raised PaO2 with low PaCO2 and low pH
  4. Low PaO2 with raised PaCO2 and normal or low pH Correct answer.

Explanation

Alveolar hypoventilation in COPD causes type 2 respiratory failure with hypoxaemia and hypercapnia. Renal bicarbonate retention compensates chronically, so pH may be near normal, but acute rises in CO2 lower pH.

Question 21Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which structure must be protected during a posterior approach to the hip to preserve hip abduction?

  1. Superior gluteal nerve Correct answer.
  2. Sciatic nerve
  3. Femoral nerve
  4. Obturator nerve

Explanation

The superior gluteal nerve supplies gluteus medius and minimus, the principal hip abductors, and is vulnerable during posterior and lateral approaches. Injury produces a positive Trendelenburg sign and abductor lurch.

Question 22Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

A patient has a lesion of the medial lemniscus. Which sensory deficit is expected?

  1. Loss of pain and temperature from the contralateral body
  2. Loss of taste from the anterior tongue
  3. Loss of fine touch and vibration from the contralateral body Correct answer.
  4. Loss of pain and temperature from the ipsilateral face

Explanation

The dorsal column-medial lemniscus pathway carries discriminative touch, vibration and proprioception, decussating in the medulla. A medial lemniscus lesion therefore causes contralateral loss of these modalities, while spinothalamic function is preserved.

Question 23Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which factor most increases the risk of deep vein thrombosis by promoting venous stasis in an immobile patient?

  1. Endothelial release of tissue plasminogen activator
  2. Increased fibrinogen synthesis
  3. Reduced platelet adhesion
  4. Loss of the calf muscle pump Correct answer.

Explanation

Venous return from the legs depends heavily on the calf muscle pump, which is lost during immobility and allows blood to pool in the valve cusps. Stasis is one element of Virchow's triad, alongside endothelial injury and hypercoagulability.

Question 24Anatomy, Physiology and Pathophysiology (basic biomedical sciences)

Which mechanism explains the hyperkalaemia seen in acute metabolic acidosis?

  1. Reduced dietary potassium intake
  2. Shift of potassium from intracellular to extracellular fluid Correct answer.
  3. Increased aldosterone secretion
  4. Increased renal potassium excretion

Explanation

In acidosis, hydrogen ions enter cells in exchange for potassium, which moves into the extracellular compartment and raises serum potassium. The effect is amplified in mineral acidosis such as diabetic ketoacidosis.

Question 25Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

In the Hong Kong physiotherapy clinic, a patient with a suspected complete rupture of the Achilles tendon is assessed. Which clinical test result most strongly supports a complete rupture?

  1. Pain on active resisted plantarflexion with intact tendon contour
  2. Positive Simmonds-Thompson test with no plantarflexion on calf squeeze Correct answer.
  3. Positive Matles test where the foot plantarflexes to neutral in prone
  4. Reduced passive dorsiflexion with a palpable gap 2 cm above the calcaneus

Explanation

The Simmonds-Thompson (calf squeeze) test is the key bedside test for Achilles rupture; absence of plantarflexion indicates loss of continuity of the tendon. A palpable gap and abnormal Matles test support the diagnosis, but the squeeze test is the most definitive bedside sign of complete rupture.

Question 26Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A 55-year-old woman presents with lateral elbow pain reproduced by resisted wrist extension and gripping. Which finding best supports a diagnosis of lateral epicondylalgia over cervical radiculopathy?

  1. Reduced biceps jerk reflex on the affected side
  2. Symptoms reproduced by Cozen test with no neurological deficit in the C6 or C7 myotome Correct answer.
  3. Paraesthesia in the little finger after sustained neck extension
  4. Positive Spurling test with radiating pain into the thumb

Explanation

Lateral epicondylalgia is a local tendinopathy of the common extensor origin, so pain is provoked by resisted wrist extension (Cozen test) without myotomal weakness or reflex change. Cervical radiculopathy would typically produce dermatomal or myotomal signs and a positive Spurling test.

Question 27Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which statement best describes the typical clinical presentation of polymyalgia rheumatica in an older adult?

  1. Distal interphalangeal joint erosions with positive rheumatoid factor
  2. Acute monoarthritis of the first metatarsophalangeal joint with tophi
  3. Symmetrical shoulder and pelvic girdle stiffness lasting more than 45 minutes, with markedly raised ESR Correct answer.
  4. Asymmetrical small joint swelling of the hands with sparing of the shoulder girdle

Explanation

Polymyalgia rheumatica classically causes bilateral girdle pain and morning stiffness in patients over 50, with a high erythrocyte sedimentation rate and rapid response to low-dose corticosteroids. It affects proximal muscles and girdles rather than distal small joints.

Question 28Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with acute low back pain and suspected lumbar disc herniation reports pain radiating below the knee. Which nerve root is most commonly implicated when the L4-L5 disc herniates posterolaterally?

  1. L5 Correct answer.
  2. S2
  3. S1
  4. L3

Explanation

A posterolateral L4-L5 disc herniation typically compresses the traversing L5 nerve root, producing pain and sensory change in the L5 dermatome. The L4 root is more commonly affected by L3-L4 herniation, and the S1 root by L5-S1 herniation.

Question 29Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which clinical feature is most characteristic of a complete anterior cruciate ligament rupture on physical examination?

  1. Medial joint line tenderness with a positive McMurray test
  2. Increased anterior tibial translation with a soft endpoint on the Lachman test Correct answer.
  3. Restricted knee extension with a positive patellar apprehension test
  4. Lateral joint line opening on varus stress at 30 degrees of knee flexion

Explanation

An ACL rupture produces excessive anterior tibial translation relative to the femur with a soft or absent endpoint on the Lachman test. The Lachman test is the most sensitive clinical test for ACL integrity at about 20-30 degrees of knee flexion.

Question 30Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with a Colles fracture has been immobilised in a cast for two weeks. Which early physiotherapy intervention is most appropriate to prevent secondary complications?

  1. Immediate weight-bearing through the affected hand to stimulate bone healing
  2. Active range of motion of the shoulder, elbow, and fingers with elevation to control oedema Correct answer.
  3. Progressive resisted wrist flexion against the cast for strengthening
  4. Passive wrist extension beyond the cast limit to maintain length of the wrist extensors

Explanation

During cast immobilisation, the physiotherapist maintains movement in adjacent joints and controls oedema while protecting the fracture site. Resisted or passive movement at the fracture site could displace the fracture and is avoided until union is confirmed.

Question 31Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which finding on history most strongly suggests a diagnosis of adhesive capsulitis (frozen shoulder) rather than rotator cuff tendinopathy?

  1. Painful arc between 60 and 120 degrees of abduction with full passive range
  2. Weakness on empty can test with full painless passive range
  3. Pain reproduced by resisted external rotation with normal passive range
  4. Global restriction of both active and passive shoulder movement, particularly external rotation Correct answer.

Explanation

Adhesive capsulitis is characterised by a capsular pattern of restriction, with global loss of both active and passive range and external rotation most affected. Rotator cuff tendinopathy typically preserves passive range and reproduces pain with resisted or arc movements.

Question 32Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

In a patient with rheumatoid arthritis, which physiotherapy goal is most appropriate during an acute flare of a small joint?

  1. Encourage prolonged end-range stretching to prevent contracture
  2. Apply prolonged deep transverse friction massage to the inflamed joint
  3. Maintain joint range with gentle active-assisted movement within pain limits and rest the inflamed joint Correct answer.
  4. Perform high-load resistance training to prevent muscle atrophy

Explanation

During an acute rheumatoid flare, the priority is to protect the inflamed joint with relative rest and gentle movement within pain limits to maintain range. Intense loading or aggressive soft tissue work during active inflammation can worsen symptoms.

Question 33Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient reports insidious-onset lateral hip pain that is worse when lying on the affected side and on single-leg stance. Which structure is most likely involved?

  1. Iliofemoral ligament at the anterior hip capsule
  2. Gluteus medius and minimus tendons at the greater trochanter Correct answer.
  3. Ischial bursa at the ischial tuberosity
  4. Adductor longus origin at the pubic symphysis

Explanation

Greater trochanteric pain syndrome involves the gluteus medius and minimus tendons, producing lateral hip pain that is aggravated by side-lying and single-leg stance. This pattern reflects compressive and tensile load on the abductor tendons.

Question 34Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with chronic mechanical neck pain is being assessed for cervical facet joint involvement. Which clinical feature most supports a facet joint source?

  1. Unilateral neck pain with referral to the shoulder, eased by ipsilateral rotation and extension Correct answer.
  2. Pain reproduced by axial compression with multisegmental hypermobility
  3. Bilateral arm paraesthesia in a glove distribution with normal reflexes
  4. Constant night pain with unexplained weight loss

Explanation

Cervical facet joint pain is typically unilateral, refers to the shoulder or scapular region, and is often eased by ipsilateral rotation and extension. Bilateral glove-distribution symptoms or red-flag features suggest other pathology.

Question 35Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which manual therapy technique is most appropriate for a patient with a hypomobile mid-thoracic spine and no contraindications?

  1. Grade III central posteroanterior mobilisation to the hypomobile thoracic segments Correct answer.
  2. Grade I oscillatory mobilisation applied for 20 minutes to the thoracic spine
  3. Grade V high-velocity thrust to the cervical spine without prior assessment
  4. Sustained traction of the thoracic spine with the patient in sitting

Explanation

Grade III posteroanterior mobilisation is appropriate for a hypomobile thoracic segment, producing movement into the resistance range to improve mobility. The technique must be applied to the assessed hypomobile level after screening for contraindications.

Question 36Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with a suspected scaphoid fracture has tenderness in the anatomical snuffbox but normal initial radiographs. What is the most appropriate physiotherapy action?

  1. Begin aggressive wrist mobilisation to prevent stiffness
  2. Discharge the patient as radiographs are normal
  3. Keep the wrist immobilised and refer for repeat imaging or clinical review rather than starting mobilisation Correct answer.
  4. Apply ultrasound to the snuffbox to promote bone healing

Explanation

Scaphoid fractures may not be visible on initial radiographs, and missed fractures risk non-union and avascular necrosis. The physiotherapist should maintain immobilisation and arrange repeat imaging or medical review before commencing mobilisation.

Question 37Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

In a patient with ankylosing spondylitis, which exercise approach is best supported for maintaining spinal mobility?

  1. Passive-only stretching with no active participation
  2. Prolonged flexed sitting to reduce pain during active inflammation
  3. A supervised programme of extension, rotation, and deep breathing exercises performed regularly Correct answer.
  4. High-impact jumping exercises to stimulate bone density

Explanation

Ankylosing spondylitis causes progressive spinal stiffness and kyphosis, so regular extension, rotation, and breathing exercises help maintain mobility and chest expansion. Supervised exercise is superior to passive or flexion-biased approaches.

Question 38Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient presents with a positive Finkelstein test and pain over the radial styloid. Which condition is most likely?

  1. Dupuytren contracture
  2. De Quervain tenosynovitis of the first dorsal compartment Correct answer.
  3. Trigger finger of the index finger
  4. Carpal tunnel syndrome

Explanation

A positive Finkelstein test with radial styloid pain indicates De Quervain tenosynovitis involving the abductor pollicis longus and extensor pollicis brevis tendons. The test stretches the first dorsal compartment and reproduces the characteristic pain.

Question 39Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which finding on assessment of a patient with shoulder pain suggests a full-thickness rotator cuff tear rather than subacromial impingement?

  1. Pain on resisted empty can test with full active range
  2. Painful arc in mid-range abduction with preserved strength
  3. Positive Neer impingement sign with pain at end-range elevation
  4. Marked weakness in abduction and external rotation with a positive drop arm test Correct answer.

Explanation

A full-thickness rotator cuff tear produces substantial weakness in abduction and external rotation, and the drop arm test is often positive due to loss of active control. Impingement typically shows a painful arc with relatively preserved strength.

Question 40Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with knee osteoarthritis is being prescribed exercise. Which programme is best supported by current evidence?

  1. Strict rest with avoidance of all weight-bearing exercise
  2. Supervised strengthening and aerobic exercise tailored to the patient's tolerance Correct answer.
  3. Passive joint mobilisation as the sole intervention
  4. High-intensity plyometric training to remodel cartilage

Explanation

Clinical guidelines recommend exercise as a core treatment for knee osteoarthritis, combining strengthening and aerobic activity tailored to the individual. Exercise improves pain and function without accelerating joint damage.

Question 41Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with chronic plantar heel pain has pain on first weight-bearing in the morning that eases with activity. Which management approach is most appropriate initially?

  1. Regular corticosteroid injection combined with bed rest
  2. Progressive plantarflexor and intrinsic foot strengthening with load management and stretching Correct answer.
  3. Immediate corticosteroid injection as first-line physiotherapy
  4. Complete non-weight-bearing immobilisation for six weeks

Explanation

Plantar heel pain is a degenerative fasciopathy best managed initially with load management, progressive strengthening of the calf and intrinsic foot muscles, and stretching. Injections are reserved for selected cases and are not first-line physiotherapy.

Question 42Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which clinical presentation is most consistent with a medial collateral ligament sprain of the knee?

  1. Positive posterior drawer test with posterior tibial sag
  2. Positive Lachman test with a soft endpoint
  3. Lateral joint line tenderness with increased varus laxity
  4. Medial joint line tenderness with increased valgus laxity at 30 degrees of flexion Correct answer.

Explanation

The medial collateral ligament resists valgus stress, so a sprain produces medial tenderness and increased valgus laxity when tested at about 30 degrees of knee flexion. Testing at 30 degrees isolates the ligament from the joint capsule.

Question 43Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with a distal radius fracture treated with open reduction and internal fixation is six weeks post-surgery. Which finding would most warrant caution before progressing to resisted wrist strengthening?

  1. Persistent disproportionate pain, swelling, and hypersensitivity suggesting complex regional pain syndrome Correct answer.
  2. Reduced grip strength compared with the unaffected side
  3. Painless limitation of forearm supination
  4. Mild stiffness in wrist extension with no swelling

Explanation

Disproportionate pain, swelling, and hypersensitivity after distal radius fracture raise suspicion of complex regional pain syndrome, which requires modified management and medical review. Simple stiffness or weakness is expected and does not preclude graded strengthening.

Question 44Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which statement about the Ottawa Ankle Rules is correct when applied in an emergency or clinic setting?

  1. They confirm the diagnosis of an ankle fracture without imaging
  2. They help decide whether radiography is needed based on bony tenderness and inability to weight-bear Correct answer.
  3. They replace clinical assessment of ligament integrity
  4. They apply only to children under 12 years of age

Explanation

The Ottawa Ankle Rules are a clinical decision tool that uses bony tenderness and weight-bearing ability to determine the need for radiography. They reduce unnecessary X-rays but do not themselves diagnose a fracture.

Question 45Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with long-standing diabetes and shoulder pain has restricted passive external rotation, a positive drop arm test, and marked weakness. Which diagnosis should be considered first?

  1. Frozen shoulder without tendon involvement
  2. Adhesive capsulitis with possible rotator cuff tear Correct answer.
  3. Acute subacromial bursitis alone
  4. Cervical spondylosis with C5 radiculopathy

Explanation

Diabetes is a strong risk factor for adhesive capsulitis, and the combination of restricted passive external rotation with marked weakness and a positive drop arm test suggests coexisting rotator cuff pathology. Both components require assessment and appropriate imaging or referral.

Question 46Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

Which finding is most consistent with a posterior cruciate ligament injury?

  1. Medial opening on valgus stress at 30 degrees
  2. Positive McMurray test with joint line tenderness
  3. Anterior tibial translation with a soft endpoint on the Lachman test
  4. Posterior tibial sag with a positive posterior drawer test at 90 degrees of knee flexion Correct answer.

Explanation

The posterior cruciate ligament prevents posterior translation of the tibia, so injury produces a posterior sag and a positive posterior drawer test. The posterior drawer test is performed at about 90 degrees of knee flexion.

Question 47Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A physiotherapist is assessing a patient with suspected cervical myelopathy. Which cluster of findings most strongly supports this diagnosis?

  1. Bilateral hand clumsiness, gait disturbance, and a positive Hoffmann sign Correct answer.
  2. Localised tenderness over the upper trapezius with normal reflexes
  3. Unilateral neck pain with restricted rotation and no neurological signs
  4. Bilateral arm pain relieved by cervical traction

Explanation

Cervical myelopathy produces upper motor neuron signs such as a positive Hoffmann sign, together with hand clumsiness and gait disturbance. These features reflect cord compression and warrant urgent medical referral.

Question 48Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with a total hip replacement performed via the posterior approach is being mobilised on day one. Which precaution is most important to reduce dislocation risk?

  1. Permit side-lying on the operated side without a pillow between the legs
  2. Allow unrestricted deep squatting to strengthen hip muscles
  3. Encourage full hip extension and external rotation during transfers
  4. Avoid combined hip flexion, adduction, and internal rotation beyond the prescribed limits Correct answer.

Explanation

The posterior approach disrupts the posterior capsule and short external rotators, so combined flexion, adduction, and internal rotation risks posterior dislocation. Movement precautions are applied until soft tissue healing occurs.

Question 49Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A patient with chronic low back pain demonstrates a positive prone instability test and aberrant movement during flexion. Which exercise approach is best supported?

  1. Strict flexion-based stretching of the lumbar spine only
  2. High-load deadlifting on the first session
  3. Motor control training targeting the deep abdominal and multifidus muscles with graded functional progression Correct answer.
  4. Prolonged bed rest until pain resolves

Explanation

A positive prone instability test with aberrant movement suggests impaired motor control of the deep trunk muscles. Motor control training with graded progression to functional tasks is supported for this presentation.

Question 50Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy)

A 28-year-old runner reports deep buttock pain and pain at the posterior hip on resisted hip external rotation while seated, with no lumbar pain on extension. Which structure is most likely implicated?

  1. Lumbar facet joint
  2. Sacroiliac joint
  3. Piriformis muscle Correct answer.
  4. Gluteus medius tendon

Explanation

Pain in the deep buttock reproduced by resisted seated hip external rotation points to the piriformis and short external rotators, which are the prime movers tested in that position. The seated position flexes the hip and stabilises the pelvis so the resistance isolates external rotation.