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Physiotherapy Licensing practice questions

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Question 1Basic and Clinical Sciences

Which muscle is the primary flexor of the hip during the swing phase of gait?

  1. Adductor magnus
  2. Biceps femoris
  3. Gluteus maximus
  4. Iliopsoas Correct answer.

Explanation

Iliopsoas, composed of psoas major and iliacus, crosses the anterior hip joint and is the strongest hip flexor, driving limb advancement in swing. The other muscles listed act at the hip but are primarily extensors or adductors.

Question 2Basic and Clinical Sciences

A patient sustained a lesion of the common fibular (peroneal) nerve at the fibular neck. Which clinical sign is most characteristic?

  1. Loss of knee flexion
  2. Inability to plantarflex the ankle
  3. Inability to dorsiflex the ankle Correct answer.
  4. Loss of hip adduction

Explanation

The common fibular nerve supplies the deep fibular nerve (tibialis anterior, dorsiflexors) and superficial fibular nerve (evertors), so its injury produces foot drop with impaired dorsiflexion. Plantarflexion is preserved because it is mediated by the tibial nerve.

Question 3Basic and Clinical Sciences

Which type of muscle contraction produces tension while the muscle lengthens?

  1. Eccentric Correct answer.
  2. Isokinetic
  3. Isometric
  4. Concentric

Explanation

An eccentric contraction generates force as the muscle-tendon unit lengthens under load, as when lowering a weight slowly. This mode produces high force with relatively low metabolic cost and is associated with delayed-onset muscle soreness.

Question 4Basic and Clinical Sciences

During normal quiet inspiration, which muscle is the principal driver of ventilation?

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

Explanation

The diaphragm descends during inspiration, increasing thoracic volume and generating most of the tidal volume at rest. Accessory muscles contribute mainly when demand is elevated or the diaphragm is impaired.

Question 5Basic and Clinical Sciences

A patient with chronic obstructive pulmonary disease is prescribed pursed-lip breathing. What is the main physiological rationale?

  1. It decreases functional residual capacity acutely
  2. It maintains positive airway pressure during expiration to reduce dynamic hyperinflation Correct answer.
  3. It strengthens the diaphragm concentrically
  4. It increases inspiratory flow rate

Explanation

Pursed-lip breathing creates back-pressure during expiration, splinting small airways open and reducing air trapping and dynamic hyperinflation. This improves gas exchange and reduces dyspnea in obstructive disease.

Question 6Basic and Clinical Sciences

Which joint position is the close-packed position of the knee?

  1. 30 degrees of flexion
  2. Full extension with tibial external rotation Correct answer.
  3. 90 degrees of flexion
  4. Full flexion

Explanation

The close-packed position of the knee is full extension combined with external rotation of the tibia, where the ligaments are maximally taut and joint surfaces most congruent. This position is used to stabilize the joint and is not the position of choice for joint mobilization.

Question 7Basic and Clinical Sciences

According to the convex-concave rule, how does the tibia move on the femur during open-chain knee extension?

  1. Tibia glides without rolling
  2. Tibia rolls and glides in opposite directions Correct answer.
  3. Tibia rolls and glides in the same direction
  4. Tibia rolls anteriorly and glides posteriorly

Explanation

The tibial plateau is concave, so when the concave surface moves on a convex femur, the roll and glide occur in opposite directions. This rule guides the direction of accessory glide used during mobilization.

Question 8Basic and Clinical Sciences

Which finding is most consistent with an upper motor neuron lesion rather than a lower motor neuron lesion?

  1. Hyperreflexia Correct answer.
  2. Areflexia
  3. Fasciculations
  4. Marked muscle atrophy

Explanation

Upper motor neuron lesions interrupt descending inhibitory pathways, producing hyperreflexia, spasticity, and a positive Babinski sign. Lower motor neuron lesions remove trophic and reflex drive, causing flaccidity, atrophy, fasciculations, and areflexia.

Question 9Basic and Clinical Sciences

A patient with a complete T6 spinal cord injury is at risk of autonomic dysreflexia. Which trigger is most typical?

  1. Upper limb exercise
  2. Ambient heat
  3. Auditory stimulus
  4. Distended bladder Correct answer.

Explanation

Autonomic dysreflexia is triggered by noxious stimuli below the lesion level, most commonly bladder distension, bowel impaction, or a pressure injury. The resulting mass sympathetic discharge causes severe hypertension and headache.

Question 10Basic and Clinical Sciences

Which cranial nerve is tested by asking the patient to shrug the shoulders against resistance?

  1. Glossopharyngeal nerve
  2. Accessory nerve Correct answer.
  3. Hypoglossal nerve
  4. Facial nerve

Explanation

The spinal accessory nerve (CN XI) innervates the trapezius and sternocleidomastoid, so shoulder shrug and head rotation test its function. Weakness suggests injury along its course, often after neck surgery.

Question 11Basic and Clinical Sciences

Which outcome measure is most appropriate for quantifying balance and fall risk in an older adult who can walk independently?

  1. Glasgow Coma Scale
  2. Berg Balance Scale Correct answer.
  3. Visual Analogue Scale
  4. Modified Ashworth Scale

Explanation

The Berg Balance Scale assesses static and dynamic balance through functional tasks and is validated for predicting fall risk in ambulatory older adults. It provides a scored profile rather than a single symptom rating.

Question 12Basic and Clinical Sciences

A patient reports sharp pain and tingling in the lateral three and a half digits that worsens at night. Which condition is most likely?

  1. De Quervain tenosynovitis
  2. Dupuytren contracture
  3. Cubital tunnel syndrome
  4. Carpal tunnel syndrome Correct answer.

Explanation

Median nerve compression at the carpal tunnel produces sensory symptoms in the lateral three and a half digits, often nocturnal and relieved by shaking the hand. Thenar weakness may develop in advanced cases.

Question 13Basic and Clinical Sciences

Which structure is the primary stabilizer preventing anterior translation of the tibia on the femur?

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

Explanation

The anterior cruciate ligament resists anterior tibial translation and controls rotational stability. The Lachman test and anterior drawer test are used to assess its integrity.

Question 14Basic and Clinical Sciences

Which gait deviation is most characteristic of a patient with a painful hip osteoarthritis?

  1. Scissoring gait
  2. Trendelenburg sign with contralateral pelvic drop Correct answer.
  3. Festinating gait
  4. Steppage gait

Explanation

Hip abductor weakness or pain causes the pelvis to drop on the contralateral side during single-leg stance, known as Trendelenburg sign. Patients often lean the trunk over the affected hip to reduce abductor demand (compensated Trendelenburg).

Question 15Basic and Clinical Sciences

Which intervention is a contraindication for continuous ultrasound application over a region?

  1. Applying over a muscle belly
  2. Applying over an acute fracture site Correct answer.
  3. Applying over a chronic tendinopathy
  4. Applying over a healed scar

Explanation

Continuous ultrasound delivers thermal energy and is contraindicated over acute fractures, active infection, malignancy, and the pregnant uterus. Thermal effects may impair healing and increase bleeding at a fresh fracture.

Question 16Basic and Clinical Sciences

Which type of electrical current is most appropriate for strengthening a denervated muscle?

  1. Russian current at 2500 Hz
  2. High-frequency interferential current
  3. Direct current with long-duration pulses Correct answer.
  4. Low-frequency TENS

Explanation

Denervated muscle lacks nerve conduction, so it requires long-duration pulses (often 100 ms or more) to directly depolarize the muscle membrane. Direct current or long-pulse stimulation is used to preserve muscle excitability.

Question 17Basic and Clinical Sciences

Which cardiovascular response is expected during a bout of moderate-intensity aerobic exercise?

  1. Decreased stroke volume
  2. Increased systemic vascular resistance
  3. Increased heart rate and cardiac output Correct answer.
  4. Decreased venous return

Explanation

Aerobic exercise increases sympathetic drive, raising heart rate and cardiac output while systemic vascular resistance falls in active muscle beds. Stroke volume and venous return also increase, supporting oxygen delivery.

Question 18Basic and Clinical Sciences

A patient with heart failure has an ejection fraction of 30 percent. Which exercise parameter should be monitored most carefully during rehabilitation?

  1. Joint position sense
  2. Grip strength
  3. Range of motion
  4. Perceived exertion and heart rate response Correct answer.

Explanation

In reduced ejection fraction, the heart has limited reserve, so monitoring heart rate, blood pressure, and perceived exertion prevents decompensation. Exercise intensity is prescribed conservatively and progressed based on symptom response.

Question 19Basic and Clinical Sciences

Which of the following best describes the purpose of the Ottawa Ankle Rules?

  1. To determine the need for radiography after ankle injury Correct answer.
  2. To grade ankle ligament sprain severity
  3. To measure ankle proprioception
  4. To predict return to sport after ankle sprain

Explanation

The Ottawa Ankle Rules use clinical criteria-bony tenderness and inability to bear weight-to decide whether radiographs are needed, reducing unnecessary imaging. They are a screening tool, not a grading or prognostic instrument.

Question 20Basic and Clinical Sciences

Which type of joint mobilization is used to restore joint play by applying a small-amplitude oscillation near the beginning of range?

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

Explanation

Grade I mobilization uses small-amplitude oscillations at the beginning of the range, mainly to modulate pain and maintain joint play. Higher grades progress further into range for stiffness.

Question 21Basic and Clinical Sciences

A patient is 48 hours after an uncomplicated total hip arthroplasty via a posterior approach. Which precaution is most appropriate?

  1. Cross the legs freely during transfers
  2. Sleep in the prone position with the hip extended
  3. Perform deep squatting exercises
  4. Avoid hip flexion beyond 90 degrees and adduction across midline Correct answer.

Explanation

Posterior-approach precautions limit hip flexion past 90 degrees, adduction, and internal rotation to reduce dislocation risk. These restrictions are applied until soft tissue healing provides sufficient stability.

Question 22Basic and Clinical Sciences

Which statement about muscle fiber types is correct?

  1. Type IIa fibers are the most fatigue resistant
  2. Type I fibers generate the greatest peak force
  3. Type I fibers have high oxidative capacity and fatigue resistance Correct answer.
  4. Type IIx fibers have high oxidative capacity

Explanation

Type I (slow-twitch) fibers are rich in mitochondria and myoglobin, giving high oxidative capacity and resistance to fatigue. Type II fibers produce greater peak force but fatigue more quickly.

Question 23Basic and Clinical Sciences

A patient with a cerebellar lesion is asked to touch the therapist's finger and then their own nose. Which finding is most likely?

  1. Resting tremor
  2. Hyporeflexia
  3. Dysmetria Correct answer.
  4. Cogwheel rigidity

Explanation

Cerebellar dysfunction impairs the scaling and timing of movement, producing dysmetria with overshooting or undershooting on finger-to-nose testing. Coordination and error correction are affected rather than resting tone.

Question 24Basic and Clinical Sciences

Which finding on a chest radiograph most directly supports a diagnosis of pneumonia in a patient with fever and productive cough?

  1. Lobar consolidation Correct answer.
  2. Cardiomegaly
  3. Pleural thickening alone
  4. Hyperinflation of the lungs

Explanation

Lobar consolidation reflects alveolar filling with exudate and is the radiographic hallmark of bacterial pneumonia. It correlates with clinical features such as fever, cough, and focal crackles.

Question 25Basic and Clinical Sciences

Which physiological change is expected with normal aging of the musculoskeletal system?

  1. Increased tendon stiffness with decreased collagen cross-linking
  2. Increased type II fiber proportion
  3. Increased resting metabolic rate
  4. Decreased bone mineral density and reduced muscle mass Correct answer.

Explanation

Aging reduces bone mineral density and lean muscle mass (sarcopenia), with changes in collagen cross-linking that alter tendon mechanics. These changes increase fracture and fall risk and inform exercise prescription.

Question 26Basic and Clinical Sciences

During normal skeletal muscle contraction at the sarcomere level, which event directly follows calcium binding to troponin C?

  1. ATP is hydrolyzed to detach myosin from actin
  2. The sarcoplasmic reticulum reabsorbs calcium ions
  3. Tropomyosin shifts and exposes actin binding sites for myosin heads Correct answer.
  4. Acetylcholine is released from the presynaptic terminal

Explanation

Calcium binding to troponin C moves tropomyosin away from the actin filament, uncovering the myosin binding sites. This crossbridge formation is the immediate consequence and precedes the power stroke and subsequent ATP-dependent detachment. Acetylcholine release and calcium reuptake are separate steps occurring before and after the contraction cycle.

Question 27Basic and Clinical Sciences

A patient's deep tendon reflex is graded 3+ with a sustained clonus at the ankle. Which interpretation is most accurate?

  1. Hyperreflexia suggesting an upper motor neuron lesion Correct answer.
  2. Areflexia indicating complete nerve transection
  3. Normal reflex consistent with healthy function
  4. Hyporeflexia suggesting a peripheral nerve lesion

Explanation

A 3+ reflex with clonus indicates hyperreflexia, which points to loss of descending corticospinal inhibition, i.e., an upper motor neuron lesion. Clonus in particular reflects exaggerated stretch reflex excitability. Hyporeflexia and areflexia instead suggest lower motor neuron or peripheral nerve pathology.

Question 28Basic and Clinical Sciences

Which muscle is the primary flexor of the hip during the swing phase of gait when the limb is unloaded?

  1. Gluteus maximus
  2. Adductor magnus
  3. Biceps femoris
  4. Iliopsoas Correct answer.

Explanation

Iliopsoas is the principal hip flexor, especially active during swing phase to advance the limb. Gluteus maximus is a hip extensor, and biceps femoris is primarily a knee flexor and hip extensor. Adductor magnus adducts and extends the hip.

Question 29Basic and Clinical Sciences

A patient reports burning pain in the distribution of the median nerve with weakness of thumb abduction. Which clinical finding would most support a median nerve lesion at the wrist?

  1. Positive straight leg raise test
  2. Positive McMurray test
  3. Positive apprehension test of the shoulder
  4. Positive Phalen test with thenar wasting Correct answer.

Explanation

Phalen test provokes median nerve compression at the carpal tunnel, and thenar wasting reflects median nerve motor loss to the abductor pollicis brevis. Together these findings localize the lesion to the wrist. The other special tests assess lumbar nerve root irritation, meniscal pathology, and shoulder instability respectively.

Question 30Basic and Clinical Sciences

A patient is 3 days after an acute myocardial infarction and is beginning phase I cardiac rehabilitation. Which parameter most appropriately guides the intensity of ambulation?

  1. Performing heavy resistance training to increase cardiac output
  2. Rating of perceived exertion and heart rate response within a prescribed range Correct answer.
  3. Working to volitional fatigue to build endurance
  4. Achieving a target of 85 percent of age-predicted maximum heart rate

Explanation

Early inpatient cardiac rehabilitation uses symptom-limited activity guided by perceived exertion and heart rate response within a safe prescribed range, often 20 to 30 beats above resting. High-intensity targets, volitional fatigue, and heavy resistance work are inappropriate in the early post-infarction period.

Question 31Basic and Clinical Sciences

A patient with chronic obstructive pulmonary disease adopts pursed-lip breathing. What is the primary physiological benefit of this technique?

  1. It increases inspiratory muscle strength acutely
  2. It reduces the work of the diaphragm during inhalation
  3. It decreases functional residual capacity immediately
  4. It maintains airway pressure during exhalation to prevent small airway collapse Correct answer.

Explanation

Pursed-lip breathing creates back pressure during exhalation, which splints small airways open and reduces dynamic hyperinflation and air trapping. This improves gas exchange and dyspnea rather than acutely strengthening muscles. Functional residual capacity is not immediately reduced by the maneuver.

Question 32Basic and Clinical Sciences

A patient presents with a foot drop and sensory loss over the dorsum of the foot. Which nerve is most likely affected?

  1. Tibial nerve
  2. Femoral nerve
  3. Common fibular (peroneal) nerve Correct answer.
  4. Sural nerve

Explanation

The common fibular nerve innervates the dorsiflexors and evertors and supplies sensation to the dorsum of the foot. Injury produces foot drop and dorsum sensory loss, often at the fibular neck. The tibial nerve affects plantarflexion and the sole, the sural nerve is purely sensory to the lateral foot, and the femoral nerve supplies the quadriceps.

Question 33Basic and Clinical Sciences

Which histological feature best distinguishes skeletal muscle from cardiac muscle?

  1. Single central nucleus in skeletal muscle fibers
  2. Branching fibers in skeletal muscle
  3. Peripheral, multiple nuclei in skeletal fibers Correct answer.
  4. Intercalated discs in skeletal fibers

Explanation

Skeletal muscle fibers are multinucleated with nuclei located peripherally, whereas cardiac muscle cells have a single central nucleus, branching fibers, and intercalated discs. This peripheral multinucleation is a defining histological marker of skeletal muscle.

Question 34Basic and Clinical Sciences

During a graded exercise test, a patient's systolic blood pressure falls below resting values as workload increases. What is the most appropriate interpretation?

  1. An abnormal response warranting test termination Correct answer.
  2. Evidence of improved cardiac efficiency
  3. A normal response to increasing workload
  4. An expected finding in trained athletes only

Explanation

A fall in systolic blood pressure with increasing workload is an abnormal, potentially dangerous response suggesting inadequate cardiac output, ischemia, or aortic outflow obstruction. The test should be terminated and the patient evaluated. Normal exercise produces a progressive rise in systolic pressure.

Question 35Basic and Clinical Sciences

A patient with a complete C5 spinal cord injury is being taught transfers. Which muscle group is most critical for enabling independent sliding board transfers?

  1. Ankle dorsiflexors and plantarflexors
  2. Shoulder extensors and scapular depressors Correct answer.
  3. Hip flexors and adductors
  4. Diaphragm and intercostals

Explanation

At C5, elbow flexors and deltoids are preserved, but wrist extensors and triceps are not. Patients rely on shoulder extension and scapular depression to lift and shift the body during sliding board transfers. Lower extremity muscles and diaphragm alone do not provide the trunk and shoulder support for this transfer.

Question 36Basic and Clinical Sciences

A patient with a healed fracture of the distal radius has limited wrist extension. Which mobilization technique is indicated to increase wrist extension range of motion?

  1. Lateral glide of the radius on the ulna
  2. Posterior glide of the carpal row on the radius
  3. Anterior glide of the carpal row on the radius Correct answer.
  4. Long-axis traction of the radiocarpal joint only

Explanation

Based on the convex-concave relationship at the radiocarpal joint, the convex carpal row moving into extension requires an anterior glide to restore motion. The glide direction follows the arthrokinematic rule for a convex moving surface. Posterior glide or lateral glide would not target extension restriction.

Question 37Basic and Clinical Sciences

A patient with a recent total knee arthroplasty has a warm, swollen, and increasingly painful knee on postoperative day 4. Which action is most appropriate?

  1. Hold aggressive range-of-motion exercise and refer for urgent medical evaluation Correct answer.
  2. Begin vigorous patellar mobilization to break adhesions
  3. Apply deep transverse friction massage over the incision
  4. Progress to high-resistance strengthening immediately

Explanation

Increasing pain, warmth, and swelling at postoperative day 4 raise concern for infection or deep vein thrombosis, which require urgent medical assessment. Aggressive exercise, deep massage, or vigorous mobilization could worsen the condition. Therapy should pause until the cause is clarified.

Question 38Basic and Clinical Sciences

A patient with Parkinson disease demonstrates a festinating gait. Which intervention is most directly aimed at reducing this pattern?

  1. Cueing with auditory rhythm and visual targets to regulate step length Correct answer.
  2. Stretching the hip flexors to increase stride length
  3. Strengthening the ankle plantarflexors in isolation
  4. Prescribing a rigid ankle-foot orthosis to block dorsiflexion

Explanation

Festinating gait involves short, accelerating steps driven by impaired basal ganglia control of movement amplitude. External auditory and visual cues help patients regulate cadence and step length by bypassing the defective internal pacing. Isolated strengthening or stretching does not address the underlying timing deficit.

Question 39Basic and Clinical Sciences

A patient with a complete T4 spinal cord injury develops a pounding headache, profuse sweating above the lesion, and a blood pressure of 180/110 mmHg. Which initial action is most appropriate?

  1. Administer a hot pack to the abdomen to relieve spasm
  2. Encourage the patient to perform a Valsalva maneuver
  3. Place the patient supine and elevate the legs
  4. Sit the patient upright and check for bladder distension or other noxious stimuli Correct answer.

Explanation

This is autonomic dysreflexia, a hypertensive emergency triggered by noxious stimuli below the lesion, most often bladder distension. The immediate step is to sit the patient upright to lower blood pressure and identify and remove the trigger. Supine positioning, heat, or Valsalva would worsen the crisis.

Question 40Basic and Clinical Sciences

A patient with a suspected rotator cuff tear has pain with resisted external rotation and a positive drop arm sign. Which structure is most likely involved?

  1. Supraspinatus tendon Correct answer.
  2. Serratus anterior muscle
  3. Subscapularis tendon
  4. Long head of the biceps tendon

Explanation

A positive drop arm sign indicates a significant supraspinatus tear, as the muscle cannot hold the arm abducted. Supraspinatus initiates abduction and is the most commonly torn rotator cuff tendon. Subscapularis, biceps, and serratus anterior produce different clinical patterns.

Question 41Examination, Evaluation, and Diagnosis

During a musculoskeletal assessment, a therapist documents that a patient's knee flexion range of motion is 120 degrees. Which type of range of motion is being described when the therapist passively moves the joint through its available arc?

  1. Active range of motion
  2. Active-assisted range of motion
  3. Passive range of motion Correct answer.
  4. Resistive range of motion

Explanation

Passive range of motion is the arc through which a joint moves when an external force, here the therapist, produces the movement without voluntary muscle contraction by the patient. Active range is produced by the patient's own muscular effort, and active-assisted combines both.

Question 42Examination, Evaluation, and Diagnosis

A patient reports sharp pain in the lateral elbow that worsens with resisted wrist extension. Which special test is most appropriate to help confirm lateral epicondylalgia?

  1. Tinel sign at the wrist
  2. Cozen test Correct answer.
  3. Phalen test
  4. Finkelstein test

Explanation

The Cozen test applies resisted wrist extension with the elbow flexed to provoke pain at the common extensor origin, supporting a diagnosis of lateral epicondylalgia. The other listed tests evaluate different regions and pathologies of the upper limb.

Question 43Examination, Evaluation, and Diagnosis

A therapist wants to quantify a patient's knee extensor strength using manual muscle testing. The patient can move the knee through full extension against gravity but cannot tolerate any added resistance. Which grade is most appropriate?

  1. Grade 3 Correct answer.
  2. Grade 5
  3. Grade 4
  4. Grade 2

Explanation

Grade 3 indicates the muscle can move the joint through the full available range against gravity but cannot tolerate additional manual resistance. Grade 4 requires holding against moderate resistance, and grade 5 requires holding against maximal resistance.

Question 44Examination, Evaluation, and Diagnosis

During gait observation, a patient's pelvis drops on the side of the swinging limb. Which muscle group weakness is most directly implicated?

  1. Bilateral knee extensors
  2. Ipsilateral hip flexors
  3. Contralateral hip abductors Correct answer.
  4. Contralateral ankle dorsiflexors

Explanation

A Trendelenburg pattern with pelvic drop on the swing side reflects weakness of the stance-limb hip abductors, which are contralateral to the dropping side. The abductors normally stabilize the pelvis in the frontal plane during single-limb support.

Question 45Examination, Evaluation, and Diagnosis

A patient with suspected cervical radiculopathy reports pain radiating into the thumb and index finger. Which nerve root level is most consistent with this distribution?

  1. C7
  2. T1
  3. C6 Correct answer.
  4. C4

Explanation

The C6 dermatome covers the lateral forearm, thumb, and index finger, so radiating pain in that pattern points to C6 root involvement. C7 distributes to the middle finger, and C4 covers the shoulder region.

Question 46Examination, Evaluation, and Diagnosis

A therapist is assessing a patient with suspected adhesive capsulitis of the shoulder. Which finding is most characteristic of this condition?

  1. Painless full passive range with weakness in abduction
  2. Isolated loss of active elevation with normal passive range
  3. Hypermobility in all planes with negative apprehension
  4. Marked loss of passive external rotation with a capsular pattern Correct answer.

Explanation

Adhesive capsulitis typically presents with a capsular pattern in which external rotation is most restricted, followed by abduction and internal rotation, with both active and passive limitation. Painless full passive range or isolated active loss suggests other diagnoses.

Question 47Examination, Evaluation, and Diagnosis

A patient's deep tendon reflex at the biceps is graded 1+. How should the therapist interpret this finding?

  1. An absent reflex
  2. A hyperactive reflex with clonus
  3. A normal reflex
  4. A diminished but present reflex Correct answer.

Explanation

On the standard 0 to 4+ scale, 1+ represents a diminished but obtainable reflex, while 2+ is normal. Grades 3+ and 4+ indicate hyperreflexia, and 0 indicates absence.

Question 48Examination, Evaluation, and Diagnosis

A therapist performs the straight leg raise test on a patient with low back pain. At what angle, and with which added movement, does the test most strongly suggest lumbar nerve root irritation?

  1. At any angle with reproduction of contralateral knee pain
  2. Beyond 90 degrees with reproduction of buttock pain only
  3. Below 30 degrees with reproduction of local hamstring tightness
  4. Between 30 and 70 degrees with reproduction of radicular pain on ankle dorsiflexion Correct answer.

Explanation

The straight leg raise is considered positive for nerve root irritation when radicular pain is reproduced between roughly 30 and 70 degrees of hip flexion, and sensitizing maneuvers such as ankle dorsiflexion aggravate it. Pain below 30 degrees or isolated hamstring tightness is less specific.

Question 49Examination, Evaluation, and Diagnosis

A patient with a suspected stroke is being screened for upper motor neuron signs. Which finding is most consistent with an upper motor neuron lesion?

  1. Fasciculations with reduced reflexes
  2. Hyperreflexia with a positive Babinski sign Correct answer.
  3. Marked atrophy with areflexia
  4. Hypotonia with preserved Babinski response

Explanation

Upper motor neuron lesions produce hyperreflexia, spasticity, and an extensor plantar response known as the Babinski sign. Lower motor neuron lesions instead cause flaccidity, atrophy, fasciculations, and reduced reflexes.

Question 50Examination, Evaluation, and Diagnosis

During cranial nerve examination, a patient cannot shrug the shoulders against resistance and reports difficulty turning the head. Which cranial nerve is most likely affected?

  1. Spinal accessory nerve (CN XI) Correct answer.
  2. Facial nerve (CN VII)
  3. Trigeminal nerve (CN V)
  4. Hypoglossal nerve (CN XII)

Explanation

The spinal accessory nerve supplies the trapezius and sternocleidomastoid, so weakness in shoulder shrugging and head turning implicates CN XI. The other cranial nerves listed control facial movement, tongue movement, and facial sensation or mastication.