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I Multiple choice questions (20 points)

Choose only ONE appropriate answer:

1. Which ligaments are most important in keeping the knee from wiggling medially to laterally?

a) The menisci

b) The collaterals

c) The cruciates

d) The patellar ligaments

e) The popliteal ligaments

2. The condition in which the patella rubs on the femur at the knee joint is called:

a) Tendonitis

b) Epicondylitis

c) Synovitis

d) Chondromalacia

e) Osteoarthritis

3. The posterior cruciate ligament:

a) Prevents posterior sliding of the tibia when the leg is flexed

b) Prevents anterior sliding of the tibia when the leg is flexed

c) Holds the patella close to the femur

d) All the above

e) None of the above

4. Bursitis is an inflammation of:

a) A sesamoid bone at a joint

b) A synovial sac containing fluid

c) A cavity in a long bone

d) A skeletal muscle

e) A ligament

5. A slipped intervertebral disc at the level of L5-S1 will compress the:

a) L4 nerve root

b) L5 nerve root

c) S1 nerve root

d) All the above

e) None of the above

6. A fall onto an outstretched hand could result in:

a) Clavicular frature

b) Scaphoid fracture

c) Colle’s fracture

d) All the above

e) None of the above

7. Anterior compartment syndrome (shinsplints) can result from pressure on which muscle or

muscle group:

a) Soleus & gastocnemius

b) Tibialis anterior

c) Hamstrings

d) Iliopsoas

e) None of the above

8. Which of the following is not a muscle comprising what is known as the rotator cuff:

a) Supraspinatus

b) Infraspinatus

c) Teres major

d) Teres minor

e) Subscapularis

9. Patellectomy is indicated in the treatment of which type of patellar fractures?

a) Comminuted fracture

b) Stellate fracture

c) Transverse fracture

d) Both a and b

e) Both b and c

10. Medial epicondylitis occurs at:

a) The site of origin of the wrist extensors

b) The site of origin of the wrist flexors

c) The site of origin of the biceps tendon

d) Both a and b

e) Both b and c

11. Lachman test is positive when:

a) The tibia can be rotated on the femur

b) The tibia can be moved posteriorly on the femur

c) The tibia can be moved anteriorly on the femur

d) Both b and c

e) None of the above

12. Referred pain in the L5 dermatome could arise:

a) From irritation around the L5 nerve root

b) From an L5 disc causing pressure on the L5 nerve root

c) From facet joint involvement at L4-L5 causing irritation of the L5 nerve root

d) From any visceral structures having L5 innervation

e) None of the above

13. One of the major signs of lateral epicondylitis is:

a) Pain on isometric contraction at the elbow

b) Pain on isometric contraction at the wrist

c) Increase in the last few degrees of passive extension

d) Both a and b

e) All the above

14. Repeated overhead movements, on the long run, could lead to impingement of:

a) The supraspinous ligament

b) The supraspinatus tendon

c) The deltoid tendon

d) Both a and b

e) All the above

15. Anterior dislocation of the shoulder is associated with injury to the:

a) Axillary nerve

b) Musculocutaneous nerve

c) Radial nerve

d) Median nerve

e) Ulnar nerve

16. Facet joint dislocation may arise due to:

a) Compression injury

b) Rotation injury

c) Extension with rotation injury

d) Flexion with rotation injury

e) All the above

17. Fracture of human bones implies:

a) Complete break of the bone

b) Crack in the bone (incomplete break)

c) Subluxation

d) Both a and b

e) Both b and c

18. Spiral fractures usually occur due to:

a) Direct force

b) Compression force

c) Twisting (torsional) force

d) All the above

e) None of the above

19. With respect to healing of fractures, formation of new trabeculae occurs in which stage:

a) Haematoma formation

b) Periosteal proliferation

c) Fibrocartilaginous callus formation

d) Bony callus formation

e) Bone remodeling

20. Dinner fork deformity is a complication of:

a) Monteggia fracture

b) Colle’s fracture

c) Scaphoid fracture

d) Bennett’s fracture

e) Lunate fracture

II True or False questions (4 points)

First, indicate if the statement is true or false, then EXPLAIN WHY if the statement is false.

1. Ligament injuries of the knee may have poorer prognosis compared to fracture of the humerus.

True. Because ligaments never heal soundly or regain their normal strength, as bone does.

(1/2 point)

2. Physical therapy following an anterior cruciate ligament injury should focus on building the

strength of the quadriceps muscle.

False. Physical therapy should focus on building strength of the hamstring because the hamstring

prevents forward movement of the tibia on the femur. (1 point)

3. Wasting and paralysis of the thenar muscles is a sign of ulnar nerve palsy.

False. Due to median nerve palsy because the median nerve supply the thenar muscles. (1 point)

4. Cancellous bone heals more quickly than compact bone.

True. (1/2 point)

5. Braces that have hinges to allow movement cause delayed union of the fracture.

False. Functional bracing promotes union by improving the area’s blood supply as a result of

movement. (1 point)

III Short answers (8 points)

1. Posterior dislocation of the hip could cause damage to the SCIATIC nerve. (1/2 point)

2. Haemoarthrosis is: BLEEDING WITHIN THE JOINT FOLLOWING LIGAMENTOUS

INJURY. (1 point)

3. Achilles tendonitis is: INFLAMMATION, IRRITATION, AND SWELLING OF THE

ACHILLES TENDON (tendonitis of the heel). (1 point)

4. Bicipital tendonitis is caused by impingement of the biceps tendon against the ACROMIAL

ARCH (1/2 point)

5. Calcification and bone formation in a muscle due to early movement of the joint following an

injury is known as: MYOSITIS OSSIFICANS (1/2 point)

6. In children, incomplete fractures are commonly known as GREENSTICK fractures.(1/2 point)

7. Crepitus is: AUDIBLE GRATING BETWEEN THE BONE ENDS (1 point)

8. “Crutch palsy” occurs as a result of prolonged compression on the RADIAL nerve. (1/2 point)

9. The three principles of fracture management include: (1.5 point)

1. REDUCTION of fracture

2. IMMOBILIZATION of fracture fragments long enough to allow union

3. REHABILITATION of the soft tissues and joints

10. Volkmann’s ischaemic contracture may develop following a fracture of the CONDYLES of

humerus, due to damage to the BRACHIAL ARTERY resulting in bleeding in the flexor

compartment. (1 point)

IV Case studies

1. A father wanted to play with his 2 year old son, so he picked him up by both hands and swung

him around in a circle. The child suddenly started to cry, saying his elbow hurts. (2 points)

a) What in your opinion happened to the child?

PULLED ELBOW = caused by subluxation of the head of radius after the sudden traction

applied to the child’s arm.

b) Which ligament was injured?

Transverse tear in the ANNULAR LIGAMENT

2. During a game of hockey, a player got a severe blow to the lateral surface of his left knee.

Examination revealed that the head and neck of the fibula were broken. (2 points)

a) Which nerve has been damaged?

COMMON PERONEAL NERVE

b) Which primary movements of the ankle and foot are impaired in this patient?

EVERTION & DORSIFLEXION

3. A young man traveling at a high speed on a motorcycle, when he was suddenly hit by a car.

The man was thrown off his motorcycle and landed on his right shoulder and right side of his

head. After 3 weeks of hospitalization, it was noticed that he kept his right arm internally rotated

by his side with the forearm pronated. (4 points)

a) What is the classical name for this type of injury?

ERB’S PALSY

b) Which part of the brachial plexus was injured?

THE UPPER CORDS ARE DAMAGED (C5/6 PARALYSIS)

c) What are the muscles or muscle groups affected?

Muscle involved include: DELTOID, EXTERNAL ROTATORS OF THE SHOULDER,

ELBOW FLEXORS, WRIST EXTNSORS, AND SUPINATOR

d) Name the deformity associated with this condition.

WAITER’S TIP DEFORMITY