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FSEM MSK Diploma study materials
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FSEM MSK Diploma practice questions

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Question 1Musculoskeletal assessment and diagnosis

Which description corresponds to grade 3 on the Medical Research Council muscle power scale?

  1. Grade 4: full active movement against gravity and some resistance
  2. Grade 3: full active movement against gravity, not resistance Correct answer.
  3. Grade 1: palpable muscle contraction without joint movement
  4. Grade 2: full active movement with gravity eliminated

Explanation

The MRC scale runs from 0 (no contraction) to 5 (normal power). Grade 3 means the muscle can move the joint through its full range against gravity but fails as soon as the examiner adds resistance. Once resistance can be overcome, the grade becomes 4.

Question 2Musculoskeletal assessment and diagnosis

A patient describes numbness over the dorsum of the foot and the great toe. Which nerve root is most likely involved?

  1. L4
  2. S2
  3. S1
  4. L5 Correct answer.

Explanation

The L5 root supplies the dorsum of the foot and the great toe, largely through the deep peroneal nerve. L4 sensation is felt at the medial malleolus and S1 at the lateral border of the foot and sole. S2 covers the posterior thigh and popliteal fossa.

Question 3Musculoskeletal assessment and diagnosis

According to the Ottawa ankle rules, which finding is an indication for ankle radiography?

  1. Ability to take four weight-bearing steps in the department
  2. Pain on active eversion with no bony tenderness
  3. Soft tissue swelling over the lateral malleolus
  4. Bony tenderness over the posterior edge of the lateral malleolus Correct answer.

Explanation

The Ottawa ankle rules rely on bony tenderness at defined landmarks and on the ability to weight-bear. Tenderness over the posterior edge or tip of either malleolus, or over the navicular or base of the fifth metatarsal, justifies imaging. Swelling and non-bony pain do not.

Question 4Musculoskeletal assessment and diagnosis

Which structure does the Lachman test primarily assess?

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

Explanation

The Lachman test is performed with the knee at about 20 to 30 degrees of flexion and assesses anterior tibial translation with a firm endpoint. It is the most sensitive clinical test for an anterior cruciate ligament rupture. Posterior translation would indicate a posterior cruciate ligament problem.

Question 5Musculoskeletal assessment and diagnosis

A prone patient with the knee flexed to 90 degrees has the calf squeezed, and no plantarflexion occurs. What does this finding indicate?

  1. Complete Achilles tendon rupture Correct answer.
  2. Posterior tibial tendon dysfunction
  3. Deep posterior compartment syndrome
  4. Plantaris muscle strain

Explanation

This is the Thompson test. Squeezing the gastrocnemius-soleus complex should produce passive plantarflexion; absent movement implies a complete rupture of the Achilles tendon. Partial ruptures may give a weak or sluggish response.

Question 6Musculoskeletal assessment and diagnosis

A painful arc between 60 and 120 degrees of active shoulder abduction most suggests which diagnosis?

  1. Acromioclavicular osteoarthritis
  2. Subacromial impingement Correct answer.
  3. Adhesive capsulitis
  4. Glenohumeral instability

Explanation

Pain in the mid-range of abduction that eases above 120 degrees is the classic painful arc. It reflects compression of subacromial structures, such as the rotator cuff tendons and bursa, as they pass beneath the acromion. Pain at the very end of range is more typical of acromioclavicular or glenohumeral joint disease.

Question 7Musculoskeletal assessment and diagnosis

During a straight leg raise the patient reports shooting pain radiating below the knee at about 40 degrees of hip flexion. What does this most likely indicate?

  1. Lumbar nerve root irritation Correct answer.
  2. Hip osteoarthritis
  3. Hamstring tightness
  4. Sacroiliac joint dysfunction

Explanation

A straight leg raise is considered positive when it reproduces radicular pain below the knee between roughly 30 and 70 degrees of hip flexion. This suggests tension or irritation of the lower lumbar roots, most often L5 or S1. Discomfort felt only in the posterior thigh without radiation is more typical of hamstring tightness.

Question 8Musculoskeletal assessment and diagnosis

Tapping over the cubital tunnel reproduces tingling in the little finger. Which nerve is being assessed?

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

Explanation

A Tinel sign at the cubital tunnel indicates irritability of the ulnar nerve as it passes behind the medial epicondyle. Ulnar nerve symptoms affect the little finger and the ulnar half of the ring finger. Median nerve percussion is performed at the carpal tunnel.

Question 9Musculoskeletal assessment and diagnosis

Which combination of findings most urgently requires same-day emergency referral?

  1. Unilateral calf pain with a positive Homan sign
  2. Morning hand stiffness that improves with activity
  3. Night pain in a young adult relieved by aspirin
  4. Saddle anaesthesia with new urinary retention Correct answer.

Explanation

Saddle anaesthesia with bladder or bowel dysfunction suggests cauda equina syndrome, which is a surgical emergency requiring immediate imaging and decompression. Delay risks permanent sphincter and sensory deficit. Night pain with aspirin relief suggests an osteoid osteoma, which is not an emergency.

Question 10Musculoskeletal assessment and diagnosis

A hot, swollen knee is aspirated. Which synovial fluid result most strongly supports septic arthritis?

  1. White cell count 1,200/mm3 with 20% neutrophils
  2. Blood-stained fluid containing fat droplets
  3. White cell count 15,000/mm3 with urate crystals
  4. White cell count 60,000/mm3 with 90% neutrophils Correct answer.

Explanation

Septic synovial fluid is typically purulent, with a white cell count above about 50,000/mm3 and neutrophil predominance over 75%. Gram stain and culture confirm the organism. Crystal arthropathy raises the count but usually below septic levels.

Question 11Musculoskeletal assessment and diagnosis

Which clinical test is most useful for identifying the hip joint as the source of groin pain?

  1. Single-leg stance with observation of the pelvis
  2. Side-lying hip abduction against gravity
  3. Flexion, adduction and internal rotation of the hip Correct answer.
  4. Prone knee flexion with hip extension

Explanation

The FADIR test places the hip in flexion, adduction and internal rotation, compressing the anterosuperior labrum and capsule. It is sensitive for intra-articular pathology such as femoroacetabular impingement or labral tear, though it is not specific. Pain reproduced in the groin supports a hip joint source.

Question 12Musculoskeletal assessment and diagnosis

When a patient stands on one leg, the opposite side of the pelvis drops. Which muscle group is weak?

  1. Gluteus medius on the stance side Correct answer.
  2. Gluteus maximus on the swing side
  3. Adductor longus on the swing side
  4. Iliopsoas on the stance side

Explanation

This is a positive Trendelenburg sign. The gluteus medius and minimus of the stance limb normally hold the contralateral hemipelvis level during single-leg stance. If they are weak, the unsupported side drops.

Question 13Musculoskeletal assessment and diagnosis

A palpable click with pain is reproduced on external rotation of the flexed knee during a McMurray test. Which structure is most likely torn?

  1. Anterior cruciate ligament
  2. Lateral meniscus
  3. Medial meniscus Correct answer.
  4. Patellar tendon

Explanation

In the McMurray test the knee is flexed, then the tibia is externally rotated and the knee extended, which loads the medial meniscus. Internal rotation loads the lateral meniscus. A painful click localised to the joint line supports a meniscal tear.

Question 14Musculoskeletal assessment and diagnosis

A patient with neck pain has the head extended, laterally flexed and rotated towards the symptomatic side, which reproduces arm pain. What does this positive test indicate?

  1. Cervical myelopathy
  2. Thoracic outlet syndrome
  3. Vertebral artery insufficiency
  4. Cervical nerve root compression Correct answer.

Explanation

This is Spurling's test, which narrows the intervertebral foramen on the side of lateral flexion. Reproduction of radiating arm pain suggests cervical radiculopathy. The test has high specificity but modest sensitivity.

Question 15Musculoskeletal assessment and diagnosis

After an external rotation injury, a player has pain above the ankle and squeezing the tibia and fibula together reproduces it. Which structure is most likely injured?

  1. Calcaneofibular ligament
  2. Tibiofibular syndesmosis Correct answer.
  3. Anterior talofibular ligament
  4. Achilles tendon

Explanation

The squeeze test compresses the proximal tibiofibular joint and stresses the distal syndesmosis. Pain above the ankle after an external rotation or high-energy injury suggests a syndesmotic injury, which needs a longer period of protected weight-bearing than a simple sprain.

Question 16Musculoskeletal assessment and diagnosis

A young adult falls on an outstretched hand and has tenderness in the anatomical snuffbox, but plain radiographs are normal. What is the most appropriate management?

  1. Immobilise the wrist and arrange repeat imaging Correct answer.
  2. Encourage full wrist mobilisation immediately
  3. Discharge with analgesia and advice to return if symptoms persist
  4. Apply a compression bandage and refer to physiotherapy

Explanation

Snuffbox tenderness after a fall on the outstretched hand is a scaphoid fracture until proven otherwise, and up to a fifth of fractures are invisible on initial films. The wrist should be immobilised and imaging repeated, or cross-sectional imaging arranged. Missed fractures risk non-union and avascular necrosis.

Question 17Musculoskeletal assessment and diagnosis

Which test measures lumbar flexion by marking a point 10 cm below the lumbosacral junction and recording separation of the marks on forward bending?

  1. Thomas test
  2. Gaenslen test
  3. Lasègue test
  4. Schober test Correct answer.

Explanation

The modified Schober test records the increase in distance between the two marks on maximal forward flexion. A normal increase is about 5 cm; less than that suggests restricted lumbar mobility, as in ankylosing spondylitis.

Question 18Musculoskeletal assessment and diagnosis

Resisted wrist extension reproduces lateral elbow pain in a patient with a tender lateral epicondyle. What is the most likely diagnosis?

  1. Lateral epicondylitis Correct answer.
  2. Medial epicondylitis
  3. Olecranon bursitis
  4. Cubital tunnel syndrome

Explanation

Pain on resisted wrist extension with tenderness at the lateral epicondyle is the Cozen test, indicating lateral epicondylitis. The extensor carpi radialis brevis origin is the usual site. Medial epicondylitis is provoked by resisted wrist flexion.

Question 19Musculoskeletal assessment and diagnosis

A child's distal radius fracture runs through the physis and exits through the metaphysis. Which Salter-Harris type is this?

  1. Type II Correct answer.
  2. Type I
  3. Type III
  4. Type IV

Explanation

Salter-Harris II fractures pass through the physis and out through the metaphysis, producing a Thurston-Holland fragment. They are the commonest physeal injuries. Type I involves the physis alone, type III the physis and epiphysis, and type IV the metaphysis, physis and epiphysis.

Question 20Musculoskeletal assessment and diagnosis

Six hours after a tibial shaft fracture, a patient has severe pain worsened by passive toe extension, together with paraesthesia and a tense calf. What is the most appropriate next step?

  1. Elevate the limb above heart level and reassess in four hours
  2. Arrange urgent MRI of the lower leg
  3. Arrange urgent fasciotomy Correct answer.
  4. Escalate analgesia and continue observation

Explanation

Pain out of proportion, pain on passive stretch of the compartment muscles and paraesthesia are the earliest signs of acute compartment syndrome. Definitive treatment is urgent surgical decompression; waiting for pulselessness risks irreversible necrosis.

Question 21Musculoskeletal assessment and diagnosis

A patient cannot hold the arm abducted, and it drops when the examiner taps the forearm. What does this most suggest?

  1. Cervical radiculopathy at C5
  2. Full-thickness rotator cuff tear Correct answer.
  3. Adhesive capsulitis with global restriction
  4. Suprascapular nerve entrapment

Explanation

A positive drop arm test indicates that the patient cannot maintain abduction once the examiner's support is removed, which is typical of a large or full-thickness rotator cuff tear. It is a test of function, not of pain provocation. Mild tendinopathy usually produces a painful arc with preserved power.

Question 22Musculoskeletal assessment and diagnosis

A native knee aspirate shows a white cell count of 55,000/mm3 with 92% neutrophils and Gram-positive cocci in clusters. Which organism is most likely?

  1. Neisseria gonorrhoeae
  2. Staphylococcus aureus Correct answer.
  3. Mycobacterium tuberculosis
  4. Pseudomonas aeruginosa

Explanation

Gram-positive cocci in clusters in a native joint with a purulent effusion point to Staphylococcus aureus, the commonest cause of septic arthritis in adults. Neisseria gonorrhoeae is a Gram-negative diplococcus associated with sexually active young adults. Pseudomonas is a Gram-negative rod seen in intravenous drug users and immunosuppressed patients.

Question 23Musculoskeletal assessment and diagnosis

A 13-year-old footballer has activity-related anterior knee pain directly over the tibial tuberosity, with a tender bony prominence there. What is the most likely diagnosis?

  1. Osgood-Schlatter disease Correct answer.
  2. Sinding-Larsen-Johansson syndrome
  3. Patellar tendinopathy
  4. Referred pain from the hip

Explanation

Osgood-Schlatter disease is traction apophysitis at the tibial tuberosity insertion of the patellar tendon in a growing adolescent. Pain is localised over the tuberosity and worsens with sport, and radiographs may show fragmentation. Sinding-Larsen-Johansson affects the inferior pole of the patella.

Question 24Musculoskeletal assessment and diagnosis

Which test specifically assesses the integrity of the anterior talofibular ligament?

  1. External rotation stress test
  2. Anterior drawer test Correct answer.
  3. Talar tilt test
  4. Squeeze test

Explanation

The anterior drawer test of the ankle applies anterior force to the talus with the foot in slight plantarflexion. Laxity with a soft endpoint indicates an anterior talofibular ligament tear, the commonest ligament injured in inversion sprains. The talar tilt assesses the calcaneofibular ligament.

Question 25Musculoskeletal assessment and diagnosis

A young swimmer describes a feeling that the shoulder is about to dislocate when the arm is abducted and externally rotated. Which test reproduces this symptom?

  1. Jobe empty can test
  2. Neer impingement test
  3. Speed's test
  4. Apprehension test Correct answer.

Explanation

The apprehension test positions the shoulder in abduction and external rotation, which reproduces the sensation of instability in anterior glenohumeral instability. A positive test is one of apprehension rather than pain alone. Pain alone in that position is less specific.

Question 26Musculoskeletal assessment and diagnosis

A patient with knee pain is examined supine. The examiner flexes the knee to about 30 degrees, stabilizes the distal femur, and pulls the proximal tibia anteriorly, noting a soft endpoint. Which structure is primarily being assessed?

  1. Anterior cruciate ligament Correct answer.
  2. Posterior cruciate ligament
  3. Lateral meniscus
  4. Medial collateral ligament

Explanation

This describes the Lachman test, which assesses anterior translation of the tibia relative to the femur. The anterior cruciate ligament is the primary restraint to this movement, and testing near 30 degrees of flexion reduces the restraining effect of the hamstrings and joint capsule. A soft endpoint suggests loss of ligament integrity.

Question 27Musculoskeletal assessment and diagnosis

During a neurological examination, the examiner taps the biceps tendon with a reflex hammer and observes elbow flexion. Which nerve root is primarily being tested?

  1. T1
  2. C7
  3. C5 Correct answer.
  4. C4

Explanation

The biceps reflex is mediated mainly by the C5 nerve root, with a possible C6 contribution. Tapping the biceps tendon causes elbow flexion and is used to localize a C5 lesion. The other roots have different reflex or motor signatures.

Question 28Musculoskeletal assessment and diagnosis

A patient reports night-time numbness in the thumb, index and middle fingers. The examiner asks the patient to hold both wrists in full flexion for one minute, which reproduces the symptoms. Which condition is this test most used to support?

  1. Radial tunnel syndrome
  2. de Quervain tenosynovitis
  3. Carpal tunnel syndrome Correct answer.
  4. Cubital tunnel syndrome

Explanation

This is Phalen's test, which increases pressure in the carpal tunnel and reproduces median nerve symptoms. The median nerve supplies the thumb, index, middle and radial half of the ring finger. Symptoms in that distribution support carpal tunnel syndrome.

Question 29Musculoskeletal assessment and diagnosis

With the elbow flexed to 90 degrees and tucked to the side, a patient is asked to rotate the forearm outward against resistance. This most directly tests which muscle?

  1. Infraspinatus Correct answer.
  2. Pectoralis major
  3. Teres major
  4. Latissimus dorsi

Explanation

Resisted shoulder external rotation with the elbow at the side primarily tests the infraspinatus, with assistance from teres minor. These muscles are the main external rotators of the shoulder. The other muscles listed are primarily adductors and internal rotators.

Question 30Musculoskeletal assessment and diagnosis

A supine patient lies with one knee flexed toward the chest while the examiner extends the opposite hip. The thigh rises off the table before full extension. Which finding does this test most directly indicate?

  1. Gluteus maximus weakness
  2. Adductor tightness
  3. Hip flexor tightness Correct answer.
  4. Hamstring tightness

Explanation

This describes the Thomas test, which assesses hip flexor length. If the thigh rises as the hip is extended, the iliopsoas or rectus femoris is likely tight. Hamstring tightness would more typically limit straight leg raise or knee extension.

Question 31Musculoskeletal assessment and diagnosis

A patient lies on the side with the lower hip flexed. The examiner abducts the upper hip, extends it, and allows it to adduct. The upper thigh remains abducted and does not drop. Which structure is most likely tight?

  1. Rectus femoris
  2. Iliotibial band Correct answer.
  3. Hip adductors
  4. Hip external rotators

Explanation

This is the Ober test, which assesses the iliotibial band and tensor fascia lata. Failure of the thigh to adduct toward the table indicates tightness of that lateral structure. The test is commonly used in patients with lateral hip or thigh pain.

Question 32Musculoskeletal assessment and diagnosis

A patient with shoulder pain has the arm elevated to 90 degrees in the scapular plane, internally rotated so the thumb points down. Resisted elevation reproduces pain. Which rotator cuff tendon is this test designed to assess?

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

Explanation

This is the empty can or Jobe test, which places the supraspinatus under tension. Pain or weakness with resisted elevation in this position suggests supraspinatus tendinopathy or tear. It is one of the standard tests for the rotator cuff.

Question 33Musculoskeletal assessment and diagnosis

A patient has anterior shoulder pain. With the elbow extended and forearm supinated, the examiner resists shoulder flexion. Pain is reproduced in the bicipital groove. Which test is being performed?

  1. Lift-off test
  2. Hawkins-Kennedy test
  3. Speed test Correct answer.
  4. Apprehension test

Explanation

The Speed test loads the long head of the biceps against resistance with the elbow extended and forearm supinated. Pain in the bicipital groove suggests biceps tendinopathy or tenosynovitis. It is distinct from tests for impingement and instability.

Question 34Musculoskeletal assessment and diagnosis

A patient has pain at the radial aspect of the wrist. The examiner grasps the thumb and quickly ulnar-deviates the wrist while holding the thumb in the palm. This reproduces sharp pain. Which diagnosis is most likely?

  1. Scaphoid fracture
  2. Carpal tunnel syndrome
  3. Thumb carpometacarpal osteoarthritis
  4. de Quervain tenosynovitis Correct answer.

Explanation

This is the Finkelstein test, which stretches the first dorsal compartment tendons. Pain at the radial styloid supports de Quervain tenosynovitis involving the abductor pollicis longus and extensor pollicis brevis. The maneuver is not designed to detect fracture or median nerve compression.

Question 35Musculoskeletal assessment and diagnosis

A patient has subacromial shoulder pain. With the shoulder flexed to 90 degrees and the elbow flexed to 90 degrees, the examiner forcibly internally rotates the shoulder. This reproduces pain. Which test is being described?

  1. Hawkins-Kennedy test Correct answer.
  2. Neer impingement test
  3. Empty can test
  4. External rotation resistance test

Explanation

The Hawkins-Kennedy test brings the greater tuberosity against the coracoacromial arch by internally rotating the flexed shoulder. Pain suggests subacromial impingement or rotator cuff tendinopathy. It differs from the Neer test, which uses passive forward elevation.

Question 36Musculoskeletal assessment and diagnosis

A patient has knee pain after a dashboard injury. The knee is flexed to 90 degrees and the examiner pushes the proximal tibia posteriorly. There is increased posterior translation. Which structure is most likely injured?

  1. Patellar tendon
  2. Anterior cruciate ligament
  3. Lateral collateral ligament complex
  4. Posterior cruciate ligament Correct answer.

Explanation

This describes the posterior drawer test, which assesses posterior translation of the tibia. Increased posterior translation indicates posterior cruciate ligament insufficiency, often after a dashboard injury. The ACL and collateral ligaments are tested differently.

Question 37Musculoskeletal assessment and diagnosis

A patient has medial knee pain after a valgus force. The examiner applies a valgus stress with the knee slightly flexed. The medial joint line opens. Which structure is most likely injured?

  1. Lateral collateral ligament complex
  2. Medial collateral ligament Correct answer.
  3. Anterior cruciate ligament
  4. Posterior cruciate ligament

Explanation

Valgus stress opens the medial compartment and primarily tests the medial collateral ligament. Testing near 30 degrees of flexion isolates the collateral ligament from the cruciate ligaments. Increased opening compared with the other side indicates injury.

Question 38Musculoskeletal assessment and diagnosis

A young athlete has groin pain. With the hip flexed to 90 degrees and adducted, the examiner internally rotates the hip, reproducing sharp pain. Which diagnosis does this test most support?

  1. Symptomatic hip osteoarthritis
  2. Adductor muscle strain
  3. Piriformis muscle syndrome
  4. Femoroacetabular impingement Correct answer.

Explanation

This is the FADIR test, which combines flexion, adduction and internal rotation. It narrows the anterior hip joint space and is commonly positive in femoroacetabular impingement and labral pathology. The test is provocative rather than diagnostic on its own.

Question 39Musculoskeletal assessment and diagnosis

A patient with shoulder instability is examined sitting. The examiner pulls the arm downward while stabilizing the scapula, and a visible dimple appears below the acromion. This finding most directly indicates which direction of instability?

  1. Posterior instability
  2. Inferior instability Correct answer.
  3. Anterior instability
  4. Superior labral tear

Explanation

A positive sulcus sign reflects inferior translation of the humeral head relative to the acromion. It indicates inferior laxity or multidirectional instability. Anterior and posterior instability are assessed with different provocative tests.

Question 40Musculoskeletal assessment and diagnosis

A patient with neck pain reports an electric shock sensation down the spine and into both legs when the neck is flexed. This finding most suggests which underlying process?

  1. Lumbar spinal stenosis
  2. Cervical radiculopathy
  3. Thoracic outlet syndrome
  4. Cervical myelopathy Correct answer.

Explanation

This is Lhermitte sign, an electric shock-like sensation on neck flexion. It suggests irritation or dysfunction of the cervical spinal cord, particularly the dorsal columns, and raises concern for cervical myelopathy. It is not a dermatomal radicular pattern.

Question 41Musculoskeletal management and rehabilitation

A runner has a 3-month history of midportion Achilles tendon pain. Which exercise approach is most appropriate as first-line loading therapy?

  1. Corticosteroid injection followed by two weeks of rest
  2. Passive calf stretching performed several times daily
  3. Progressive eccentric heel raises with load increase Correct answer.
  4. Complete rest from all weight-bearing until pain resolves

Explanation

Eccentric loading is well supported for midportion Achilles tendinopathy because it progressively loads the tendon while allowing pain-guided activity. Complete rest and passive stretching alone do not provide the controlled tensile load needed for tendon adaptation. Injection may give short-term relief but does not replace rehabilitation.

Question 42Musculoskeletal management and rehabilitation

Which finding best supports starting straight-line running after ACL reconstruction?

  1. Minimal effusion and good quadriceps control Correct answer.
  2. Six weeks elapsed since surgery
  3. Hamstring strength 50% of uninvolved side
  4. The patient reports no pain while walking on flat ground

Explanation

Running after ACL reconstruction requires adequate joint homeostasis, full extension, and quadriceps control to avoid altered mechanics. Time alone or pain-free walking does not confirm readiness. Strength should be assessed with validated criteria rather than a low threshold.

Question 43Musculoskeletal management and rehabilitation

In rotator cuff-related shoulder pain, which principle should guide progressive exercise?

  1. Train to maximal fatigue at every session
  2. Use gradual loading within an acceptable pain response Correct answer.
  3. Perform only passive range-of-motion exercises
  4. Avoid all overhead activity for at least six months

Explanation

Progressive loading within an acceptable pain response promotes tendon and muscle adaptation without provoking persistent symptoms. Complete avoidance and passive-only work may lead to stiffness and weakness. Maximal fatigue every session can overload the tissue.

Question 44Musculoskeletal management and rehabilitation

For an older adult with osteoporosis and no recent fracture, which exercise component is most appropriate for fracture prevention?

  1. Progressive resistance plus balance training Correct answer.
  2. Prolonged bed rest to protect the spine
  3. High-impact jumping on a hard surface every day
  4. Seated spinal flexion stretches only

Explanation

Progressive resistance and balance training address bone loading and fall risk, both relevant to fracture prevention. High-impact jumping may be unsuitable without assessment. Spinal flexion loading and bed rest do not provide the needed stimulus and can be harmful.

Question 45Musculoskeletal management and rehabilitation

Which exercise prescription is most appropriate first-line for knee osteoarthritis?

  1. Daily high-impact running to stimulate cartilage
  2. Swimming only, with no land-based exercise
  3. Aerobic exercise plus quadriceps strengthening Correct answer.
  4. Passive joint mobilization as the sole treatment

Explanation

Land-based aerobic and strengthening exercise is recommended first-line for knee osteoarthritis, with supervision improving adherence. Swimming can be useful but need not be the only option. High-impact running may aggravate symptoms, and passive mobilization alone is insufficient.

Question 46Musculoskeletal management and rehabilitation

Six weeks after immobilization for a healed distal radius fracture, which rehabilitation priority is most appropriate?

  1. Immediate heavy resisted gripping
  2. Continued immobilization of the wrist for another six weeks
  3. Wrist and hand range of motion, then graded strength Correct answer.
  4. Avoiding all use of the hand during activities

Explanation

After fracture healing and immobilization, the priority is to regain range of motion and then progressively strengthen. Heavy resistance too early can provoke pain and injury. Prolonged immobilization and complete avoidance worsen stiffness and function.

Question 47Musculoskeletal management and rehabilitation

Which criterion best supports return to sport after a hamstring strain?

  1. Two weeks since the initial injury
  2. Normal appearance on ultrasound imaging of the hamstring
  3. Pain-free sprinting and near-baseline eccentric strength Correct answer.
  4. Pain-free walking without a limp

Explanation

Return to sport after hamstring strain requires sport-specific function, including maximal sprinting and eccentric strength comparable to the uninvolved side. Time since injury and normal imaging do not confirm readiness. Pain-free walking is a low-level milestone.

Question 48Musculoskeletal management and rehabilitation

Which approach is appropriate in the functional rehabilitation of a repaired Achilles tendon rupture?

  1. Avoiding all ankle movement for six months
  2. Immediate jumping and plyometric loading
  3. Early controlled weight-bearing in a protected protocol Correct answer.
  4. Twelve weeks of strict non-weight-bearing immobilization

Explanation

Modern protocols use early controlled weight-bearing and progressive loading within protection to reduce stiffness and improve function. Prolonged immobilization and complete avoidance delay recovery. Immediate jumping risks re-rupture.

Question 49Musculoskeletal management and rehabilitation

Which precaution is commonly advised after total hip replacement via a posterior approach?

  1. Avoid hip extension and forced external rotation
  2. Avoid flexion past 90 degrees and internal rotation Correct answer.
  3. Avoid hip abduction in lying
  4. Remain non-weight-bearing for six weeks after surgery

Explanation

Posterior-approach precautions typically limit hip flexion beyond 90 degrees, adduction, and internal rotation to reduce dislocation risk. Extension and abduction are not restricted. Weight-bearing status depends on the surgical protocol, not routinely six weeks non-weight-bearing.

Question 50Musculoskeletal management and rehabilitation

Which is a key early rehabilitation goal after total knee replacement?

  1. Performing deep squats daily
  2. Avoiding walking until six weeks after surgery
  3. Full extension with active quadriceps contraction Correct answer.
  4. Return to running within two weeks after surgery

Explanation

Early after total knee replacement, full extension and quadriceps activation are essential for gait and function. Deep squats and running are not early goals. Early mobilization is encouraged rather than avoiding walking.