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Kuwait MOH Physiotherapist study materials
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Kuwait MOH Physiotherapist practice questions

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Question 1Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which muscle is the primary flexor of the elbow and is innervated by the musculocutaneous nerve?

  1. Brachialis Correct answer.
  2. Brachioradialis
  3. Anconeus
  4. Triceps brachii

Explanation

Brachialis is a pure elbow flexor lying deep to biceps brachii and receives innervation from the musculocutaneous nerve (C5-C6). Biceps brachii also flexes the elbow but additionally supinates the forearm, and brachioradialis is supplied by the radial nerve.

Question 2Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

During normal quiet inspiration, which muscle is the principal driver of lung volume increase?

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

Explanation

The diaphragm generates roughly 70-80% of tidal volume during quiet breathing by contracting and descending, which enlarges the thoracic cavity vertically. The external intercostals assist but are not the primary muscle of quiet inspiration.

Question 3Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient stands on one leg. Which hip abductor must generate the greatest force to keep the pelvis level?

  1. Gluteus medius Correct answer.
  2. Iliopsoas
  3. Iliacus
  4. Adductor longus

Explanation

Gluteus medius (with gluteus minimus) abducts the hip and stabilises the pelvis in single-leg stance, preventing the contralateral pelvis from dropping (Trendelenburg sign when weak). The iliopsoas and iliacus are hip flexors, and adductor longus is an adductor.

Question 4Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which nerve is most commonly compressed in carpal tunnel syndrome?

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

Explanation

The median nerve passes through the carpal tunnel beneath the flexor retinaculum and is the nerve compressed in carpal tunnel syndrome, producing numbness of the lateral three and a half digits. The ulnar nerve travels in Guyon's canal, and the radial and axillary nerves are not in the wrist.

Question 5Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which type of collagen predominates in hyaline articular cartilage and provides tensile strength?

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

Explanation

Hyaline cartilage matrix is composed mainly of type II collagen, which forms a network that resists tensile forces while proteoglycans resist compression. Type I dominates in bone, tendon, and fibrocartilage.

Question 6Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which spinal tract carries conscious proprioception and discriminative touch to the somatosensory cortex?

  1. Dorsal column-medial lemniscus pathway Correct answer.
  2. Corticospinal tract
  3. Spinocerebellar tract
  4. Spinothalamic tract

Explanation

The dorsal column-medial lemniscus pathway transmits fine touch, vibration, and conscious proprioception, decussating in the medulla. The spinothalamic tract carries pain and temperature, whereas the corticospinal tract is motor.

Question 7Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which muscle group is the primary ankle dorsiflexor?

  1. Gastrocnemius and soleus
  2. Tibialis anterior and extensor digitorum longus Correct answer.
  3. Flexor hallucis longus
  4. Peroneus longus and brevis

Explanation

The anterior compartment muscles, chiefly tibialis anterior with extensor digitorum longus and extensor hallucis longus, dorsiflex the ankle and are innervated by the deep peroneal nerve. The calf and peroneal muscles act in the opposite direction or as evertors.

Question 8Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

In a first-class lever system, where is the fulcrum located relative to the effort and load?

  1. Between the effort and the load Correct answer.
  2. At one end, with load between fulcrum and effort
  3. Nowhere, because levers require two fulcrums
  4. At one end, with effort and load on the same side

Explanation

A first-class lever places the fulcrum between the effort and the load, as in a see-saw or the atlanto-occipital joint during head extension. Second-class levers place the load between fulcrum and effort, and third-class levers place effort between fulcrum and load.

Question 9Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which drug class is most likely to cause myopathy and tendon rupture, particularly of the Achilles tendon, in an older patient?

  1. Thiazide diuretics
  2. Proton pump inhibitors
  3. Fluoroquinolones Correct answer.
  4. Beta-blockers

Explanation

Fluoroquinolones such as ciprofloxacin and levofloxacin carry a recognised risk of tendinopathy and tendon rupture, especially in older adults and those taking corticosteroids. Physiotherapists should be alert when a patient on these agents reports new tendon pain.

Question 10Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient with a complete lesion of the C5-C6 nerve roots presents with which pattern of weakness?

  1. Weakness of shoulder abduction and elbow flexion Correct answer.
  2. Spastic paraparesis of both lower limbs
  3. Isolated weakness of the intrinsic hand muscles
  4. Loss of wrist extension and finger extension only

Explanation

C5-C6 supply the deltoid, supraspinatus, biceps, and brachialis, so lesions here impair shoulder abduction and elbow flexion. This pattern corresponds to Erb's palsy and spares the distal hand muscles supplied by lower roots.

Question 11Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

During a concentric contraction of the quadriceps, what happens to the muscle-tendon unit?

  1. It shortens without producing any tension
  2. It lengthens while producing tension
  3. It shortens while producing tension Correct answer.
  4. It maintains constant length with no tension change

Explanation

A concentric contraction produces tension while the muscle shortens, as in the rising phase of a squat. Lengthening under tension is eccentric, and constant length with tension is isometric.

Question 12Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

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

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

Explanation

The anterior cruciate ligament resists anterior tibial translation and controls rotational stability. The posterior cruciate ligament resists posterior translation, while the collateral ligaments resist varus and valgus stress.

Question 13Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

In a patient with chronic obstructive pulmonary disease, pursed-lip breathing is taught primarily to achieve which effect?

  1. Maintain positive airway pressure and prevent dynamic airway collapse Correct answer.
  2. Increase respiratory rate to reduce work of breathing
  3. Reduce oxygen consumption by inducing breath-holding
  4. Eliminate the need for diaphragmatic contraction

Explanation

Pursed-lip breathing creates back-pressure that splints the airways open during expiration, reducing air trapping and dyspnoea in obstructive disease. It slows the respiratory rate rather than increasing it and does not eliminate diaphragmatic work.

Question 14Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which type of bone healing occurs when fracture fragments are compressed and stabilised with minimal callus formation?

  1. Delayed union
  2. Secondary bone healing
  3. Avascular necrosis
  4. Primary bone healing Correct answer.

Explanation

Primary (direct) bone healing occurs with rigid fixation and anatomical compression, proceeding through cutting cones without a cartilaginous callus. Secondary healing involves callus formation and is typical of conservative management.

Question 15Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which of the following best describes the role of the sarcoplasmic reticulum in skeletal muscle contraction?

  1. It stores and releases calcium ions on excitation Correct answer.
  2. It synthesises actin and myosin filaments
  3. It generates ATP through oxidative phosphorylation
  4. It transmits action potentials to the sarcolemma

Explanation

The sarcoplasmic reticulum stores calcium and releases it when an action potential travels down the T-tubules, triggering cross-bridge cycling. ATP production occurs in mitochondria, and action potential propagation along the sarcolemma is a separate membrane event.

Question 16Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient reports burning pain and numbness over the lateral forearm and thumb after a humeral shaft fracture. Which nerve is most likely injured?

  1. Median nerve
  2. Radial nerve Correct answer.
  3. Long thoracic nerve
  4. Ulnar nerve

Explanation

The radial nerve runs in the spiral groove of the humerus and is injured in shaft fractures, causing weakness of wrist extension and sensory loss over the posterior arm, lateral forearm, and dorsum of the hand. The ulnar and median nerves are not typically injured at this level.

Question 17Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which joint position is most commonly associated with anterior dislocation of the shoulder?

  1. Arm in abduction and external rotation Correct answer.
  2. Arm in flexion and internal rotation
  3. Arm in extension and internal rotation
  4. Arm in adduction and internal rotation

Explanation

Anterior shoulder dislocation typically occurs with the arm abducted and externally rotated, a position that levers the humeral head anteriorly out of the glenoid. This is the common mechanism in falls and contact sport injuries.

Question 18Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which statement about the stretch reflex is correct?

  1. It is initiated by joint capsule receptors
  2. It is mediated by muscle spindles and a monosynaptic pathway Correct answer.
  3. It is a purely voluntary cortical response
  4. It is mediated by Golgi tendon organs and polysynaptic pathways

Explanation

The stretch (myotatic) reflex is elicited when muscle spindles detect stretch and signal via Ia afferents to alpha motor neurons in a monosynaptic arc, producing contraction of the stretched muscle. Golgi tendon organs mediate the inverse stretch reflex and are not the primary sensor here.

Question 19Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient taking warfarin for atrial fibrillation is referred for exercise therapy. Which precaution is most appropriate?

  1. Use deep soft tissue massage over the calves routinely
  2. Monitor for bruising and avoid contact sports and high-impact activities Correct answer.
  3. Avoid all weight-bearing exercise indefinitely
  4. Double the warfarin dose before exercise to prevent clots

Explanation

Warfarin increases bleeding risk, so therapists should watch for bruising and avoid contact or high-impact activity and vigorous deep massage. Exercise is not contraindicated outright, and the therapist must never adjust anticoagulant dosing.

Question 20Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which muscle acts as the main stabiliser of the scapula against winging by protracting and rotating it upward?

  1. Levator scapulae
  2. Serratus anterior Correct answer.
  3. Pectoralis minor
  4. Rhomboid major

Explanation

Serratus anterior, supplied by the long thoracic nerve, protracts the scapula and rotates it upward, holding it against the thoracic wall. Its weakness produces medial scapular winging.

Question 21Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which factor most directly increases the risk of pressure injury development in a patient with spinal cord injury?

  1. Prolonged unrelieved pressure over bony prominences Correct answer.
  2. Use of a pressure-redistributing mattress
  3. Regular position changes every two hours
  4. Increased sensory input over bony prominences

Explanation

Pressure injury results from sustained pressure over bony prominences that exceeds capillary closing pressure, causing ischaemia, compounded by shear and impaired sensation. Regular repositioning and pressure-redistributing surfaces reduce rather than increase risk.

Question 22Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which statement best explains why eccentric exercise produces greater muscle soreness than concentric exercise of equal load?

  1. Eccentric contractions use no ATP and cause immediate necrosis
  2. Eccentric contractions exclusively recruit slow-twitch fibres
  3. Eccentric contractions recruit fewer motor units and cause greater mechanical strain per fibre Correct answer.
  4. Eccentric contractions cause no sarcomere disruption

Explanation

During eccentric work, fewer motor units are recruited for a given load, so each active fibre bears more mechanical stress, leading to sarcomere disruption and delayed-onset muscle soreness. ATP is still required, and the damage is not immediate necrosis.

Question 23Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient with a lesion of the lateral corticospinal tract above the pyramidal decussation would show which pattern of motor deficit?

  1. Ipsilateral flaccid weakness at the level of the lesion only
  2. Bilateral loss of pain and temperature sensation
  3. Ipsilateral spastic weakness below the lesion
  4. Contralateral spastic weakness below the lesion Correct answer.

Explanation

The lateral corticospinal tract has already decussated in the medulla, so a lesion above that level produces contralateral upper motor neuron signs below the lesion. A lesion below the decussation would produce ipsilateral signs.

Question 24Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which biomechanical change best explains the increased fall risk in an older adult with reduced ankle plantarflexor power?

  1. Decreased ability to generate a plantarflexion moment for push-off and balance recovery Correct answer.
  2. Reduced thoracic kyphosis
  3. Increased type II muscle fibre diameter
  4. Increased dorsiflexion range of motion

Explanation

Plantarflexor weakness limits push-off power and the rapid ankle strategy needed to recover from a forward sway, raising fall risk. Ageing typically reduces dorsiflexion range and type II fibre size and increases kyphosis, so the other options describe the opposite of age-related change.

Question 25Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

In a patient with rheumatoid arthritis, which pattern of joint involvement is most characteristic?

  1. Asymmetrical sacroiliac and lumbar spine involvement
  2. Symmetrical involvement of the metacarpophalangeal and proximal interphalangeal joints Correct answer.
  3. Isolated involvement of the first metatarsophalangeal joint
  4. Asymmetrical involvement of the distal interphalangeal joints with Heberden nodes

Explanation

Rheumatoid arthritis typically causes symmetrical synovitis of the small joints of the hands and feet, especially the MCP and PIP joints, with ulnar deviation and swan-neck deformity. Distal interphalangeal involvement with Heberden nodes suggests osteoarthritis, and isolated first MTP involvement suggests gout.

Question 26Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

Which type of muscle contraction produces tension while the muscle lengthens, as when the quadriceps controls the body's descent during stair climbing?

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

Explanation

An eccentric contraction occurs when external resistance exceeds the tension produced, so the muscle lengthens while still generating force. This action absorbs energy and is used to decelerate movement, such as lowering the body onto a step.

Question 27Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient with a complete lesion of the lateral corticospinal tract above the pyramidal decussation would show which pattern of motor impairment?

  1. Contralateral loss of pain and temperature sensation below the lesion
  2. Ipsilateral flaccid weakness at the level of the lesion
  3. Ipsilateral spastic weakness below the lesion
  4. Contralateral spastic weakness below the lesion Correct answer.

Explanation

Corticospinal fibres decussate in the medulla, so a lesion above this level produces contralateral upper motor neuron signs, including spastic weakness. Ipsilateral deficits occur only when the lesion is below the decussation.

Question 28Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

During normal quiet inspiration, which muscle is the principal generator of the pressure change that draws air into the lungs?

  1. The transversus thoracis
  2. The rectus abdominis
  3. The serratus posterior inferior
  4. The diaphragm Correct answer.

Explanation

The diaphragm is the chief muscle of quiet inspiration; its descent enlarges the thoracic cavity and lowers intrathoracic pressure, drawing air in. The other muscles listed act on the trunk or rib cage in ways that assist forced expiration or postural control, not quiet inspiration.

Question 29Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A physiotherapist is assessing a patient with a suspected lesion of the median nerve at the wrist. Which muscle test would most directly support this localization?

  1. Abduction of the thumb by abductor pollicis brevis Correct answer.
  2. Adduction of the thumb by adductor pollicis
  3. Flexion of the little finger by flexor digiti minimi
  4. Extension of the wrist by extensor carpi radialis

Explanation

Abductor pollicis brevis is innervated by the recurrent branch of the median nerve and is a classic distal median-nerve target. Testing it helps distinguish a wrist-level median lesion from more proximal or ulnar-innervated patterns.

Question 30Basic and Applied Sciences (anatomy, physiology, biomechanics, kinesiology, pathology, pharmacology relevant to physiotherapy)

A patient with a chronic inflammatory myopathy has marked proximal weakness. Which pathophysiological mechanism best explains the predominant involvement of proximal limb muscles in this condition?

  1. Selective immune-mediated injury to type I fibers, which predominate in proximal postural muscles Correct answer.
  2. Impaired neuromuscular junction transmission in fast-twitch distal muscles
  3. Preferential loss of alpha motor neurons supplying distal muscles
  4. Compression of distal peripheral nerves by inflamed fascia

Explanation

Inflammatory myopathies such as polymyositis and dermatomyositis produce symmetric proximal weakness through immune-mediated muscle fiber injury, and type I fibers are relatively abundant in proximal postural musculature. This contrasts with neuropathic processes that often produce distal weakness.

Question 31Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient 6 weeks after total knee arthroplasty has 5–90° of active knee flexion and cannot perform a straight leg raise. Which finding most directly limits functional stair descent?

  1. Persistent knee joint effusion
  2. Loss of terminal knee extension
  3. Reduced patellar mobility
  4. Reduced quadriceps eccentric control in available range Correct answer.

Explanation

Descending stairs requires eccentric quadriceps control as the knee flexes under body weight, so poor quadriceps activation and the inability to perform a straight leg raise directly compromise this task. Extension loss matters more for stance and gait length, while effusion and patellar stiffness are contributing factors rather than the most direct limitation.

Question 32Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

In a patient with acute lateral ankle sprain, which structure is most commonly injured first when the foot is forced into inversion and plantarflexion?

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

Explanation

The anterior talofibular ligament is the weakest and most anteriorly placed of the lateral complex, so it ruptures first in inversion-plantarflexion. The calcaneofibular ligament is injured with greater force, and the posterior talofibular ligament rarely tears in isolation.

Question 33Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A 55-year-old with knee osteoarthritis reports pain that worsens with walking and improves with rest, with morning stiffness lasting 10 minutes. Which feature best supports a mechanical rather than inflammatory pattern?

  1. Symmetrical small joint swelling
  2. Brief morning stiffness relieved by activity Correct answer.
  3. Elevated erythrocyte sedimentation rate
  4. Prolonged stiffness exceeding one hour

Explanation

Mechanical knee osteoarthritis typically produces short morning stiffness, usually under 30 minutes, that eases with movement and worsens with load. Prolonged stiffness, symmetrical small joint disease, and raised inflammatory markers point toward an inflammatory arthropathy such as rheumatoid arthritis.

Question 34Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which manual therapy technique is directed at restoring glenohumeral joint accessory glide in a patient with adhesive capsulitis who has a firm capsular end-feel in external rotation?

  1. Grade I oscillation for pain relief only
  2. Sustained longitudinal traction of the cervical spine
  3. Grade III anterior glide of the humeral head Correct answer.
  4. Transverse friction to the supraspinatus tendon

Explanation

A firm capsular end-feel with restricted external rotation indicates the anterior capsule is the limiting structure, so graded anterior glide mobilisation at the glenohumeral joint targets that restriction. Pain-only oscillations and cervical traction do not address the capsular limitation.

Question 35Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

During an anterior drawer test of the knee at 90° flexion, the tibia translates 8 mm more than the uninjured side with a soft end-feel. Which structure is most likely deficient?

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

Explanation

Increased anterior tibial translation with a soft endpoint at 90° flexion indicates anterior cruciate ligament insufficiency. The posterior cruciate ligament is tested with the posterior drawer, and collateral ligaments are tested with varus and valgus stress.

Question 36Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with rheumatoid arthritis and longstanding wrist disease presents with sudden inability to extend the fingers and thumb actively, while passive extension remains full and painless. Which diagnosis should be suspected?

  1. Extensor tendon rupture Correct answer.
  2. de Quervain tenosynovitis
  3. Radial nerve palsy
  4. Dupuytren contracture

Explanation

Loss of active finger and thumb extension with preserved passive movement in rheumatoid wrist disease suggests attritional rupture of the extensor tendons over the distal ulna. Radial nerve palsy would also impair wrist extension and sensation, and Dupuytren disease causes flexion contracture rather than extension loss.

Question 37Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which outcome measure is most appropriate for quantifying perceived disability in a patient with chronic low back pain over a course of physiotherapy?

  1. Oswestry Disability Index Correct answer.
  2. Visual analogue scale for pain at rest
  3. Goniometric lumbar flexion range
  4. Manual muscle test of hip abductors

Explanation

The Oswestry Disability Index is a validated condition-specific questionnaire that captures how back pain limits daily activities, making it suitable for tracking disability over time. Pain scales, range measurement, and strength tests capture single constructs rather than overall disability.

Question 38Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient 3 days after rotator cuff repair is prescribed passive range of motion only. Which precaution is most important during this early phase?

  1. Encourage active abduction against gravity to stimulate healing
  2. Avoid active contraction of the repaired cuff and limit passive elevation as specified by the surgeon Correct answer.
  3. Begin resisted internal rotation to prevent atrophy
  4. Perform overhead strengthening to restore function quickly

Explanation

Early protected motion after cuff repair avoids active tension on the repair while controlled passive movement limits stiffness, with ranges set by the surgical protocol. Resisted and active exercises in the first days risk disrupting the repair.

Question 39Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

In a patient with suspected cervical radiculopathy at C6, which finding is most consistent with this level?

  1. Weakness of wrist extension with reduced brachioradialis reflex Correct answer.
  2. Weakness of finger abduction with reduced triceps reflex
  3. Weakness of shoulder abduction with absent biceps reflex
  4. Weakness of elbow flexion with reduced biceps reflex

Explanation

The C6 nerve root supplies the brachioradialis reflex and wrist extensors, so weakness of wrist extension with a diminished brachioradialis reflex is the expected pattern. Elbow flexion and biceps reflex reflect C5, while finger abduction and triceps reflex reflect C7 and C8 respectively.

Question 40Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which finding on physical examination best distinguishes greater trochanteric pain syndrome from hip joint pathology?

  1. Positive Thomas test with fixed flexion deformity
  2. Restricted hip flexion below 90°
  3. Pain at the end range of passive hip internal rotation
  4. Pain reproduced by resisted hip abduction and direct palpation over the greater trochanter Correct answer.

Explanation

Greater trochanteric pain syndrome arises from the gluteal tendons and trochanteric bursa, so tenderness over the trochanter and pain with resisted abduction are characteristic. End-range internal rotation pain, flexion restriction, and fixed flexion deformity point to intra-articular hip disease.

Question 41Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with acute lumbar disc herniation reports increased leg pain when the hip is flexed to 70° with the knee extended, and relief when the knee is flexed. Which test is being described?

  1. Straight leg raise test Correct answer.
  2. Slump test with cervical flexion
  3. Femoral nerve stretch test
  4. Prone knee bend test

Explanation

The straight leg raise stretches the lumbosacral nerve roots, and reproduction of leg pain between 30° and 70° that eases with knee flexion indicates nerve root mechanosensitivity. The femoral nerve test uses prone knee bending, and the slump test adds spinal and cervical flexion.

Question 42Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which intervention has the strongest evidence for reducing pain and improving function in acute Achilles tendinopathy when introduced alongside load management?

  1. Corticosteroid injection into the tendon
  2. Complete immobilisation for six weeks
  3. Passive stretching alone
  4. Progressive eccentric heel-drop loading Correct answer.

Explanation

Progressive eccentric loading of the calf–Achilles unit is a well-supported approach for midportion Achilles tendinopathy, restoring tendon capacity while managing load. Prolonged immobilisation, intratendinous steroid, and passive stretching alone do not build tendon capacity.

Question 43Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with frozen shoulder is in the freezing stage with severe pain and marked restriction. Which approach is most appropriate initially?

  1. Aggressive end-range stretching to restore range quickly
  2. High-grade mobilisation into end range at every session
  3. Resisted strengthening through the painful arc
  4. Pain-modulating modalities and gentle range within pain tolerance Correct answer.

Explanation

In the painful freezing stage, treatment aims to modulate pain and maintain tolerable movement rather than force range. Aggressive end-range mobilisation and resisted work through the painful arc typically aggravate symptoms and reduce participation.

Question 44Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which gait deviation is most characteristic of a patient with a complete common peroneal nerve lesion?

  1. Steppage gait with foot drop Correct answer.
  2. Trendelenburg gait
  3. Antalgic gait with shortened stance on the painful side
  4. Circumduction due to hip adductor spasticity

Explanation

Loss of dorsiflexion and eversion after common peroneal nerve injury produces foot drop, so the patient lifts the hip and knee excessively to clear the toe, producing a steppage pattern. Trendelenburg gait reflects abductor weakness, and antalgic gait reflects pain.

Question 45Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with lateral epicondylalgia has pain reproduced by resisted wrist extension and by gripping. Which muscle group is primarily implicated?

  1. Deep cervical flexors
  2. Thenar musculature
  3. Wrist flexor–pronator group
  4. Common extensor origin of the wrist extensors Correct answer.

Explanation

Lateral epicondylalgia involves the common extensor origin, particularly the extensor carpi radialis brevis, so resisted wrist extension and gripping provoke symptoms. The flexor–pronator group relates to medial epicondylalgia.

Question 46Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient 4 weeks after open reduction and internal fixation of a distal radius fracture has a stiff wrist and hand oedema. Which intervention is most appropriate to address the oedema while protecting the fixation?

  1. Elevation, active finger movement, and retrograde massage Correct answer.
  2. Passive wrist extension beyond the surgical limit
  3. Resisted wrist extension against heavy load
  4. Vigorous joint mobilisation of the radiocarpal joint

Explanation

Elevation, active finger motion, and retrograde massage promote oedema clearance without stressing the healing fracture site. Forcing passive wrist extension, high-grade mobilisation, and heavy resistance risk displacing or stressing the fixation.

Question 47Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which clinical feature most strongly suggests polymyalgia rheumatica rather than rheumatoid arthritis in an older adult with shoulder and hip girdle pain?

  1. Nodular swelling of the proximal interphalangeal joints
  2. Positive rheumatoid factor with prolonged morning stiffness
  3. Marked elevation of inflammatory markers with rapid response to low-dose corticosteroid Correct answer.
  4. Symmetrical small joint erosions on radiography

Explanation

Polymyalgia rheumatica presents with girdle pain and stiffness, markedly raised inflammatory markers, and a dramatic response to low-dose corticosteroids. Erosive small joint disease, rheumatoid factor, and interphalangeal swelling point toward rheumatoid arthritis.

Question 48Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with chronic mechanical neck pain shows fear-avoidance beliefs and reduced cervical range. Which approach best reflects current best practice?

  1. Passive traction as the sole intervention
  2. Graded activity and education targeting fear-avoidance beliefs Correct answer.
  3. Long-term collar use to protect the neck
  4. Rest until pain resolves completely

Explanation

Graded activity combined with education that addresses unhelpful beliefs is supported for chronic neck pain, reducing disability and improving function. Collar use, rest until pain-free, and traction alone reinforce avoidance and do not build capacity.

Question 49Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

Which finding on the Ottawa Ankle Rules indicates that radiography is required after an ankle inversion injury?

  1. Pain on active eversion without bony tenderness
  2. Mild swelling over the lateral malleolus
  3. History of a previous sprain five years ago
  4. Inability to bear weight four steps immediately and in the clinic Correct answer.

Explanation

The Ottawa Ankle Rules require radiography when there is bony tenderness at the malleolar or midfoot zones or an inability to bear weight four steps both immediately and in the clinic. Swelling alone, pain on eversion, and remote injury history do not meet the criteria.

Question 50Musculoskeletal Physiotherapy (orthopaedics, rheumatology, manual therapy, post-operative rehabilitation)

A patient with patellofemoral pain has pain during squatting and stairs, with no effusion or instability. Which exercise approach is best supported?

  1. Isolated quadriceps open-chain extension to fatigue daily
  2. Hip abductor and quadriceps strengthening with load modification Correct answer.
  3. Complete avoidance of all weight-bearing exercise
  4. Immediate patellar taping as the sole long-term treatment

Explanation

Patellofemoral pain responds best to combined hip and knee strengthening with load modification to allow gradual tolerance. Taping may help briefly but is not a stand-alone long-term solution, and avoiding weight-bearing or repeatedly fatiguing open-chain extension is not recommended.