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OMSB Physiotherapy study materials
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OMSB Physiotherapy practice questions

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Question 1Musculoskeletal Physiotherapy

A patient with a complete rupture of the anterior cruciate ligament is most likely to report which mechanism of injury?

  1. A direct blow to the anterior tibia with the knee fully extended
  2. A non-contact pivoting or deceleration movement with the knee slightly flexed Correct answer.
  3. A valgus load applied to a fully flexed knee
  4. A forced hyperextension injury while the foot is firmly planted

Explanation

Most ACL ruptures occur without contact during deceleration, landing, or a cutting manoeuvre, when the knee is near extension and the tibia rotates internally. This produces a pivot-shift event that overloads the ligament. Hyperextension and valgus loading can also injure the ACL, but they are not the classic mechanism described in the stem.

Question 2Musculoskeletal Physiotherapy

Which clinical test is designed to assess the integrity of the posterior cruciate ligament?

  1. Patellar apprehension test
  2. Lachman test
  3. Posterior drawer test Correct answer.
  4. McMurray test

Explanation

The posterior drawer test applies a posteriorly directed force to the proximal tibia with the knee flexed to about 90 degrees, directly loading the posterior cruciate ligament. A greater than normal posterior translation indicates PCL insufficiency. The other listed tests assess different structures.

Question 3Musculoskeletal Physiotherapy

In a patient with a suspected meniscal tear, which clinical feature most strongly suggests a meniscal rather than a ligamentous source of knee pain?

  1. Diffuse warmth and erythema over the whole joint
  2. Positive posterior drawer sign
  3. Pain reproduced by resisted knee extension in mid-range
  4. Joint line tenderness with mechanical catching or locking Correct answer.

Explanation

Localised joint line tenderness combined with mechanical symptoms such as catching, clicking, or true locking points to a meniscal lesion. Mechanical block occurs when a meniscal fragment displaces into the joint. Ligament injuries usually present with instability rather than a true mechanical block.

Question 4Musculoskeletal Physiotherapy

Which structure is most commonly affected in lateral epicondylalgia of the elbow?

  1. The ulnar collateral ligament
  2. The common flexor origin at the medial epicondyle
  3. The origin of extensor carpi radialis brevis Correct answer.
  4. The biceps brachii distal tendon

Explanation

Lateral epicondylalgia, often called tennis elbow, involves degenerative change at the common extensor origin, most consistently the extensor carpi radialis brevis tendon. Pain is reproduced by resisted wrist extension and gripping. The medial epicondyle is the site of the separate medial epicondylalgia.

Question 5Musculoskeletal Physiotherapy

A physiotherapist is teaching a patient with adhesive capsulitis about expected movement restriction. Which pattern of loss is most characteristic in the capsular (frozen) stage?

  1. Isolated loss of elbow flexion
  2. Greater loss of external rotation than other shoulder movements Correct answer.
  3. Isolated loss of scapular retraction
  4. Greater loss of shoulder abduction than external rotation

Explanation

Adhesive capsulitis produces a global capsular restriction in which external rotation is typically the most limited movement, followed by abduction and internal rotation. This capsular pattern helps distinguish it from rotator cuff pathology. Loss of external rotation is therefore the hallmark.

Question 6Musculoskeletal Physiotherapy

Which finding best supports a diagnosis of carpal tunnel syndrome during physical examination?

  1. Positive Tinel sign over the cubital tunnel
  2. Positive Cozen test
  3. Positive Phalen test reproducing median nerve symptoms Correct answer.
  4. Positive Finkelstein test

Explanation

The Phalen test places the wrist in sustained flexion, raising carpal tunnel pressure and reproducing median nerve symptoms such as numbness in the thumb, index, and middle fingers. It is a standard provocative test for carpal tunnel syndrome. The other tests assess different structures.

Question 7Musculoskeletal Physiotherapy

Which muscle is the primary dynamic stabiliser preventing anterior translation of the humeral head during throwing?

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

Explanation

The subscapularis is an internal rotator and anterior stabiliser of the glenohumeral joint, and its contraction helps resist anterior humeral head translation. In throwing athletes it works with the other rotator cuff muscles to compress the head into the glenoid. The posterior cuff muscles contribute mainly to external rotation and posterior stability.

Question 8Musculoskeletal Physiotherapy

A patient reports insidious onset of anterior hip and groin pain that worsens with deep squatting and prolonged sitting. Which condition should be highest on the differential list?

  1. Greater trochanteric pain syndrome
  2. Proximal hamstring tendinopathy
  3. Lumbar facet arthropathy
  4. Femoroacetabular impingement syndrome Correct answer.

Explanation

Femoroacetabular impingement classically presents with anterior hip or groin pain provoked by deep hip flexion, squatting, and prolonged sitting. These positions bring the femoral neck against the acetabular rim. The other conditions produce pain at different anatomical sites.

Question 9Musculoskeletal Physiotherapy

Which exercise progression is most appropriate for early rehabilitation after an acute grade II lateral ankle sprain?

  1. Protected weight-bearing with progressive range of motion and isometric strengthening Correct answer.
  2. Immobilisation in a cast for six weeks
  3. Aggressive passive inversion stretching to end range
  4. Immediate full-weight-bearing plyometric hopping

Explanation

Early management of a grade II lateral ankle sprain aims to control pain and swelling while restoring protected movement. Progressive range of motion and isometric strengthening maintain muscle activation without stressing healing ligaments. High-level loading and aggressive stretching are introduced later in the rehabilitation continuum.

Question 10Musculoskeletal Physiotherapy

A patient has a positive drop arm test and marked weakness of shoulder abduction. Which rotator cuff tendon is most likely involved?

  1. Supraspinatus Correct answer.
  2. Teres minor
  3. Subscapularis
  4. Long head of biceps

Explanation

The drop arm test assesses the ability to control the arm in abduction, a function dominated by the supraspinatus. A positive test with weakness of abduction suggests a supraspinatus tear. The other muscles listed have different primary actions.

Question 11Musculoskeletal Physiotherapy

Which clinical presentation is most consistent with a complete rupture of the Achilles tendon?

  1. Medial ankle pain reproduced by resisted inversion
  2. Lateral ankle pain with a positive anterior drawer test
  3. Gradual posterior ankle pain with a positive squeeze test and intact heel raise
  4. A palpable gap above the calcaneus with inability to perform a single-leg heel raise Correct answer.

Explanation

A complete Achilles rupture typically presents with a palpable gap in the tendon, a positive Thompson squeeze test, and inability to perform a single-leg heel raise. The stem asks for the complete rupture pattern. The other options describe tendinopathy or ligament injuries.

Question 12Musculoskeletal Physiotherapy

Which factor most increases the risk of developing a stress fracture in a distance runner?

  1. Adequate dietary calcium intake
  2. Regular strength training twice weekly
  3. Use of cushioned running shoes
  4. A sudden increase in training volume with inadequate recovery Correct answer.

Explanation

Stress fractures result from repetitive submaximal loading that exceeds the bone's capacity to remodel. A rapid increase in training volume without adequate recovery is a well-recognised risk factor. Protective factors include appropriate nutrition, footwear, and graded loading.

Question 13Musculoskeletal Physiotherapy

A patient with chronic low back pain demonstrates excessive lumbar extension during a hip hinge. Which cue is most appropriate to improve the movement pattern?

  1. Instruct the patient to hold the breath and brace maximally throughout
  2. Instruct the patient to posteriorly tilt the pelvis and maintain a neutral spine while pushing the hips backward Correct answer.
  3. Instruct the patient to flex the thoracic spine fully before moving the hips
  4. Instruct the patient to increase lumbar lordosis before bending

Explanation

Excessive lumbar extension during a hip hinge reflects poor dissociation between hip and lumbar movement. Cueing a posterior pelvic tilt with a neutral spine and hip-hinge initiation reduces lumbar extension. Breath-holding and thoracic flexion do not address the underlying control problem.

Question 14Musculoskeletal Physiotherapy

Which outcome measure is most appropriate for quantifying functional limitation in a patient with knee osteoarthritis?

  1. WOMAC osteoarthritis index Correct answer.
  2. Goniometric measurement of knee flexion only
  3. Manual muscle testing of the quadriceps only
  4. Visual analogue scale for pain alone

Explanation

The WOMAC index captures pain, stiffness, and physical function specific to hip and knee osteoarthritis. It is a validated, condition-specific patient-reported outcome. Impairment measures such as goniometry and manual muscle testing do not capture functional limitation.

Question 15Musculoskeletal Physiotherapy

Which finding is most consistent with a diagnosis of cervical radiculopathy at the C6 level?

  1. Numbness of the little finger with intrinsic hand weakness
  2. Weakness of elbow extension with reduced triceps reflex
  3. Weakness of elbow flexion with reduced biceps reflex Correct answer.
  4. Weakness of shoulder abduction with reduced deltoid reflex

Explanation

The C6 nerve root supplies the biceps brachii and brachioradialis, so C6 radiculopathy typically causes weakness of elbow flexion and a reduced biceps reflex. Sensation is affected over the lateral forearm and thumb. Other levels produce different patterns.

Question 16Musculoskeletal Physiotherapy

A patient with a suspected frozen shoulder is being assessed for glenohumeral versus scapulothoracic movement. Which approach best isolates glenohumeral motion?

  1. Measure active forward flexion only
  2. Stabilise the scapula while measuring passive glenohumeral elevation Correct answer.
  3. Observe total shoulder elevation without stabilising the scapula
  4. Ask the patient to shrug the shoulders actively

Explanation

Scapulohumeral rhythm means that total shoulder elevation combines glenohumeral and scapulothoracic motion. Stabilising the scapula during passive testing isolates glenohumeral movement. This helps identify true capsular restriction.

Question 17Musculoskeletal Physiotherapy

Which of the following is the most appropriate initial physiotherapy approach for a patient with acute, uncomplicated mechanical neck pain?

  1. Perform high-velocity cervical manipulation without assessment
  2. Prescribe cervical traction as the sole intervention
  3. Advise activity modification, education, and graded exercise Correct answer.
  4. Apply prolonged bed rest for two weeks

Explanation

Current evidence supports staying active, providing education, and using graded exercise for uncomplicated acute mechanical neck pain. This approach reduces the risk of chronicity associated with prolonged rest. Traction and manipulation are not first-line for uncomplicated acute cases.

Question 18Musculoskeletal Physiotherapy

A patient with patellofemoral pain syndrome has increased dynamic knee valgus during a single-leg squat. Which intervention most directly addresses this movement fault?

  1. Strengthening of gluteus medius and hip external rotators Correct answer.
  2. Stretching of the hip flexors only
  3. Strengthening of the hip adductors
  4. Isolated ankle dorsiflexion stretching

Explanation

Dynamic knee valgus during weight-bearing is often driven by insufficient hip abductor and external rotator control. Strengthening gluteus medius and the deep hip external rotators improves frontal-plane control of the femur. The other options do not directly target the valgus fault.

Question 19Musculoskeletal Physiotherapy

Which of the following best describes the role of eccentric exercise in the management of chronic midportion Achilles tendinopathy?

  1. It progressively loads the tendon to stimulate remodelling and improve load tolerance Correct answer.
  2. It eliminates the need for any load progression
  3. It should be performed only after complete pain resolution
  4. It replaces all strengthening of the triceps surae

Explanation

Eccentric exercise applies controlled progressive load to the tendon, stimulating collagen remodelling and improving load tolerance. It is a cornerstone of tendinopathy rehabilitation. It is not a substitute for graded progression or overall strengthening.

Question 20Musculoskeletal Physiotherapy

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

  1. Begin aggressive wrist mobilisation to prevent stiffness
  2. Immobilise and refer for further imaging or orthopaedic review Correct answer.
  3. Apply heat and proceed with strengthening
  4. Discharge the patient because radiographs are normal

Explanation

Scaphoid fractures may not appear on initial radiographs, and missed fractures risk non-union and avascular necrosis. The safe approach is immobilisation and referral for repeat imaging or orthopaedic review. Mobilisation or discharge would be unsafe.

Question 21Musculoskeletal Physiotherapy

A patient with long-standing diabetes develops a painless, swollen shoulder with marked loss of external rotation. Which diagnosis should be considered?

  1. Adhesive capsulitis associated with diabetes Correct answer.
  2. Septic arthritis of the shoulder
  3. Calcific tendinitis of the supraspinatus
  4. Acute rotator cuff tear

Explanation

Diabetes is a recognised risk factor for adhesive capsulitis, which can present with insidious, often less painful onset and marked loss of external rotation. The painless, stiff presentation in a person with diabetes fits this pattern. The other options typically present with acute pain or systemic features.

Question 22Musculoskeletal Physiotherapy

A patient with a suspected lumbar disc herniation reports shooting pain down the posterior thigh and lateral calf, with weakness of ankle dorsiflexion. Which nerve root is most likely affected?

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

Explanation

The L5 nerve root supplies the tibialis anterior, so L5 radiculopathy causes weakness of ankle dorsiflexion. Pain typically radiates down the lateral calf to the dorsum of the foot. S1 radiculopathy affects plantarflexion and the Achilles reflex.

Question 23Musculoskeletal Physiotherapy

A patient with lateral hip pain has tenderness over the greater trochanter and pain reproduced by resisted hip abduction in extension. Which structure is most implicated?

  1. Rectus femoris origin
  2. Adductor longus tendon
  3. Iliopsoas tendon
  4. Gluteus medius and minimus tendons Correct answer.

Explanation

Greater trochanteric pain syndrome involves the gluteus medius and minimus tendons at their insertion on the greater trochanter. Resisted hip abduction in extension loads these tendons and reproduces symptoms. The other structures are located elsewhere.

Question 24Musculoskeletal Physiotherapy

A patient with a chronic, stiff knee after intra-articular fracture has limited flexion. Which factor most limits the effectiveness of passive stretching alone?

  1. Preserved joint play
  2. Absence of pain
  3. Underlying joint capsule and periarticular soft tissue fibrosis Correct answer.
  4. Normal muscle length

Explanation

Post-traumatic stiffness involves fibrosis of the joint capsule and periarticular tissues, which resists passive elongation. Stretching alone is less effective because the restricting tissue is the capsule and surrounding connective tissue. Mobilisation and sustained loading are often needed.

Question 25Musculoskeletal Physiotherapy

A patient with chronic low back pain reports fear of movement and avoids activity. Which intervention is most consistent with a cognitive-behavioural approach?

  1. Repeated passive treatment with no active component
  2. Strict avoidance of all lifting tasks
  3. Graded exposure to feared movements with education about pain Correct answer.
  4. Reassurance that the spine is fragile and must be protected

Explanation

Cognitive-behavioural approaches address unhelpful beliefs and fears by combining education with graded exposure to feared activities. This reduces avoidance and improves function. Reassurance about fragility and passive-only treatment reinforce fear-avoidance.

Question 26Musculoskeletal Physiotherapy

A patient with a lateral ankle sprain is being assessed for ligamentous integrity. Which manoeuvre applies an inversion force to the plantarflexed ankle to stress the anterior talofibular ligament?

  1. Anterior drawer test of the ankle Correct answer.
  2. External rotation stress test of the ankle
  3. Squeeze test of the distal tibiofibular joint
  4. Talar tilt test in dorsiflexion

Explanation

The anterior drawer test is performed with the ankle in slight plantarflexion and applies an anterior translation force to the talus, stressing the anterior talofibular ligament, which is the most commonly injured structure in lateral ankle sprains. The talar tilt assesses the calcaneofibular ligament in a more neutral position.

Question 27Musculoskeletal Physiotherapy

Which structure is most commonly impinged in subacromial impingement syndrome during overhead elevation?

  1. Supraspinatus tendon beneath the acromion Correct answer.
  2. Long head of biceps tendon within the bicipital groove
  3. Teres minor tendon at the glenoid rim
  4. Subscapularis tendon deep to the coracoid process

Explanation

Subacromial impingement classically involves compression of the supraspinatus tendon and subacromial bursa between the humeral head and the acromion during elevation. The critical zone of the supraspinatus is poorly vascularised, which contributes to degenerative change.

Question 28Musculoskeletal Physiotherapy

A patient reports pain over the lateral elbow that is reproduced by resisted wrist extension with the elbow extended. Which structure is most likely involved?

  1. Common flexor origin at the medial epicondyle
  2. Biceps brachii distal tendon
  3. Common extensor origin at the lateral epicondyle Correct answer.
  4. Ulnar collateral ligament

Explanation

Resisted wrist extension with the elbow extended loads the wrist extensors, particularly extensor carpi radialis brevis, at their common origin on the lateral epicondyle. This is the characteristic finding in lateral epicondylalgia.

Question 29Musculoskeletal Physiotherapy

Which gait deviation is most characteristic of a patient with a painful hip who avoids loading the affected limb through stance?

  1. Antalgic gait with shortened stance phase on the painful side Correct answer.
  2. Steppage gait with excessive hip flexion
  3. Trendelenburg gait with contralateral pelvic drop
  4. Circumduction gait with wide hip abduction

Explanation

An antalgic gait is driven by pain avoidance, producing a shortened stance phase on the affected side and a rapid transfer of weight. Trendelenburg gait reflects abductor weakness rather than pain alone.

Question 30Musculoskeletal Physiotherapy

Which muscle group should be prioritised in strengthening for a patient with a tendency to fall forward at the trunk during standing balance training?

  1. Lumbar extensors
  2. Hip adductors
  3. Hip flexors
  4. Ankle dorsiflexors Correct answer.

Explanation

Ankle dorsiflexors generate a plantarflexion torque strategy that moves the centre of mass posteriorly, counteracting forward sway during standing balance. Hip flexors would tend to pull the trunk further forward.

Question 31Musculoskeletal Physiotherapy

A patient with a Colles-type distal radius fracture is immobilised in a cast. Which movement should be avoided during early rehabilitation while the fracture is still healing?

  1. Shoulder and elbow range of motion
  2. Resisted wrist extension Correct answer.
  3. Isometric grip without load
  4. Active finger flexion and extension

Explanation

Resisted wrist extension generates tensile and bending loads across the healing distal radius and can displace the fracture, so it is deferred until union is confirmed. Finger and proximal joint movements are safe and help limit stiffness.

Question 32Musculoskeletal Physiotherapy

Which clinical test is used to assess for a meniscal tear by applying a valgus stress with external rotation of the tibia while flexing the knee from full extension?

  1. McMurray test Correct answer.
  2. Lachman test
  3. Patellar apprehension test
  4. Clarke's test

Explanation

The McMurray test combines knee flexion with rotation and valgus or varus stress to trap and load a meniscal segment, reproducing pain or a click. It is a standard provocative test for meniscal pathology.

Question 33Musculoskeletal Physiotherapy

Which condition is best managed initially with relative rest, activity modification, and a progressive loading programme for the patellar tendon?

  1. Complete quadriceps tendon rupture
  2. Septic arthritis of the knee
  3. Patellar tendinopathy Correct answer.
  4. Acute patellar dislocation

Explanation

Patellar tendinopathy is a degenerative load-related condition managed with activity modification and progressive tendon loading, typically eccentric or heavy slow resistance exercise. It does not require immobilisation or surgery initially.

Question 34Musculoskeletal Physiotherapy

A patient with chronic mechanical neck pain has reduced cervical rotation to the left. Which manual therapy approach is most appropriate as an adjunct to active exercise?

  1. Sustained high-velocity thrust manipulation of the upper cervical spine without assessment
  2. Passive stretching of the left sternocleidomastoid only
  3. Traction applied in full cervical extension
  4. Grade III oscillatory mobilisation of the left cervical spine within a pain-free to mildly painful range Correct answer.

Explanation

Low-velocity oscillatory mobilisation in the mid-ranges is a safe adjunct that can improve mobility and reduce pain when combined with exercise. It should follow assessment and be applied within a range the patient tolerates.

Question 35Musculoskeletal Physiotherapy

A patient with adhesive capsulitis is in the freezing stage with severe pain and marked loss of external rotation. Which approach is most appropriate at this stage?

  1. Pain-modulating modalities and gentle range-of-motion exercise within pain limits Correct answer.
  2. High-load rotator cuff strengthening through full range
  3. Aggressive end-range stretching to restore full rotation
  4. Manipulation under anaesthesia

Explanation

During the painful freezing stage, the priority is pain control and maintaining tolerable movement rather than forcing range, because aggressive stretching can increase inflammation and prolong symptoms. Strengthening and manipulation are reserved for later stages.

Question 36Musculoskeletal Physiotherapy

A patient reports tingling in the thumb, index, and middle fingers that is reproduced by sustained wrist flexion. Which nerve is most likely affected?

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

Explanation

The median nerve supplies sensation to the thumb, index, middle, and radial half of the ring finger, and Phalen's manoeuvre (sustained wrist flexion) increases carpal tunnel pressure. This distribution and provocation are consistent with median nerve compression.

Question 37Musculoskeletal Physiotherapy

A patient with a grade I hamstring strain wants to return to sprinting. Which criterion best indicates readiness for progressive sprint loading?

  1. Normal knee radiograph
  2. Complete resolution of bruising
  3. Full pain-free hamstring stretch and pain-free submaximal running at near-full speed Correct answer.
  4. Absence of pain at rest only

Explanation

Return to sprinting requires the tissue to tolerate stretch and high-velocity lengthening loads, so pain-free full stretch and near-maximal running are meaningful criteria. Rest pain alone does not reflect load tolerance.

Question 38Musculoskeletal Physiotherapy

A patient with a total knee replacement has a warm, swollen knee and limited flexion on day three after surgery. Which intervention is most appropriate?

  1. Immediate resisted quadriceps strengthening at maximum effort
  2. Aggressive passive flexion beyond 110 degrees
  3. Delayed mobilisation until swelling resolves completely
  4. Elevation, cryotherapy, and gentle active-assisted range of motion Correct answer.

Explanation

Early post-operative management prioritises oedema control and gentle movement to restore range without provoking inflammation. Elevation, cryotherapy, and active-assisted exercise achieve this while protecting the healing tissues.

Question 39Musculoskeletal Physiotherapy

A patient with a lateral ankle sprain has persistent instability and recurrent giving way despite rehabilitation. Which impairment is most important to address?

  1. Reduced thoracic extension
  2. Reduced great toe extension strength
  3. Restricted hip internal rotation
  4. Impaired balance and peroneal reaction time Correct answer.

Explanation

Chronic ankle instability involves both mechanical and sensorimotor deficits, particularly impaired postural control and delayed peroneal activation. Balance and perturbation training targeting these deficits is central to rehabilitation.

Question 40Musculoskeletal Physiotherapy

A patient with a suspected anterior cruciate ligament rupture has a positive pivot shift. What does this finding indicate?

  1. Posterior translation of the tibia on the femur
  2. Rotational instability with anterior subluxation of the lateral tibial plateau Correct answer.
  3. Medial collateral ligament laxity
  4. Meniscal locking in extension

Explanation

The pivot shift reproduces anterior subluxation of the lateral tibial plateau that reduces with flexion, reflecting rotational instability from anterior cruciate ligament deficiency. It is highly specific for anterior cruciate ligament rupture.

Question 41Musculoskeletal Physiotherapy

A patient with plantar heel pain has pain on the first steps in the morning that eases with walking. Which management strategy is most supported initially?

  1. Progressive calf and plantar fascia loading with activity modification Correct answer.
  2. Complete non-weight-bearing immobilisation for six weeks
  3. Corticosteroid injection as first-line treatment
  4. Immediate surgical release of the plantar fascia

Explanation

Plantar heel pain is a degenerative load-related condition, and progressive loading of the calf and plantar fascia alongside activity modification is the mainstay of initial care. Injections and surgery are reserved for refractory cases.

Question 42Musculoskeletal Physiotherapy

A patient with low back pain has pain that worsens with lumbar extension and improves with sitting. Which direction of exercise is most likely to be beneficial?

  1. Repeated extension in standing
  2. Repeated flexion in lying Correct answer.
  3. Rotation combined with extension
  4. Sustained extension in prone

Explanation

Symptoms provoked by extension and relieved by sitting suggest a flexion-biased directional preference, so repeated flexion movements are likely to centralise or reduce pain. This reflects a directional preference examination approach.

Question 43Musculoskeletal Physiotherapy

A patient with a proximal humerus fracture is cleared for rehabilitation after conservative management. Which exercise is most appropriate in the first phase?

  1. Push-ups against a wall
  2. Pendulum exercises and active-assisted range of motion Correct answer.
  3. Weighted shoulder abduction beyond 90 degrees
  4. Overhead press with resistance

Explanation

Early rehabilitation after a proximal humerus fracture focuses on gentle motion to prevent stiffness while the fracture consolidates. Pendulum and active-assisted exercises achieve this without significant load through the healing bone.

Question 44Musculoskeletal Physiotherapy

A patient with femoroacetabular impingement reports pinching pain in deep hip flexion. Which activity modification is most appropriate?

  1. Encouraging deep squatting to stretch the hip capsule
  2. Running uphill to improve hip flexion range
  3. Avoiding end-range hip flexion and strengthening hip abductors and extensors Correct answer.
  4. Prolonged static stretching into hip flexion

Explanation

Femoroacetabular impingement is provoked by end-range flexion and rotation where the femoral head-neck junction contacts the acetabular rim, so avoiding these positions while strengthening the hip stabilisers reduces symptoms. Stretching into impingement typically aggravates pain.

Question 45Musculoskeletal Physiotherapy

A patient with chronic low back pain has been walking 10 minutes daily. Using a graded activity approach, which progression is most appropriate next?

  1. Stop walking and rest until pain resolves
  2. Increase to 20 minutes daily and monitor symptom response Correct answer.
  3. Double the duration to 20 minutes only on days with no pain
  4. Add running intervals immediately

Explanation

Graded activity uses baseline tolerance and controlled progression with monitoring of symptom response, allowing gradual increases in capacity. A structured increase to 20 minutes with review is consistent with this principle.

Question 46Musculoskeletal Physiotherapy

A patient with a complete Achilles tendon rupture is managed conservatively in a functional brace. Which loading principle guides early rehabilitation?

  1. Early dorsiflexion stretching beyond neutral
  2. Protected weight-bearing in plantarflexion with progressive range increase Correct answer.
  3. Isometric calf loading at maximum effort in week one
  4. Immediate full weight-bearing without a brace

Explanation

Conservative management of Achilles rupture uses a brace holding the ankle in plantarflexion to approximate tendon ends, with protected weight-bearing and gradual range increase over weeks. This balances early loading with protection of the repair.

Question 47Musculoskeletal Physiotherapy

A patient with a chronic grade II medial collateral ligament sprain has valgus laxity but no pain at rest. Which rehabilitation emphasis is most appropriate?

  1. Immediate return to pivoting sports without bracing
  2. Progressive quadriceps and medial hamstring strengthening with functional valgus control training Correct answer.
  3. Passive valgus stretching to improve flexibility
  4. Complete immobilisation in a hinged brace for twelve weeks

Explanation

Chronic medial collateral ligament laxity is addressed by strengthening the dynamic medial stabilisers, particularly the quadriceps and medial hamstrings, and by retraining frontal plane control. Passive stretching would increase laxity further.

Question 48Musculoskeletal Physiotherapy

A patient with rotator cuff related shoulder pain has pain with overhead activity and weakness in external rotation. Which exercise approach is best supported?

  1. Unloaded overhead range only until pain resolves
  2. Complete rest of the shoulder for eight weeks
  3. Passive stretching into painful elevation
  4. Progressive resistance training for the rotator cuff and scapular muscles within a tolerable pain range Correct answer.

Explanation

Progressive resistance training for the rotator cuff and scapular stabilisers improves function and reduces pain in rotator cuff related shoulder pain, and loading within a tolerable pain range is acceptable. Complete rest and painful stretching are not supported.

Question 49Musculoskeletal Physiotherapy

A patient with knee osteoarthritis and varus malalignment reports medial joint pain. Which intervention is most likely to reduce medial compartment load during walking?

  1. Prolonged knee immobilisation
  2. High-impact plyometric training
  3. Lateral wedge shoe insert Correct answer.
  4. Medial wedge shoe insert

Explanation

A lateral wedge insole shifts the centre of pressure laterally and reduces the external knee adduction moment, lowering load on the medial compartment. A medial wedge would increase medial loading.

Question 50Musculoskeletal Physiotherapy

A patient with a traumatic anterior shoulder dislocation has a positive apprehension test. Which rehabilitation focus is most important before returning to overhead sport?

  1. Immediate return to throwing at full intensity
  2. Dynamic stabilisation with rotator cuff and scapular control in progressively provocative positions Correct answer.
  3. Strengthening the shoulder internal rotators in isolation
  4. Passive anterior stretching of the capsule

Explanation

After anterior dislocation, the priority is restoring dynamic stability through rotator cuff and scapular muscle control, progressed into positions that challenge the anterior capsule. This prepares the shoulder for overhead loads.