MSK

Question 1

Which clinical examination finding is most specific for a scaphoid fracture in this patient?

Answer 1

Tenderness over the scaphoid tubercle

is considered the most specific clinical sign for scaphoid fractures, with specificity greater than 70%. The scaphoid tubercle is located on the volar (palmar) aspect of the wrist at the base of the thenar eminence.

Palpation over this area elicits pain specifically related to scaphoid fractures, making it the most indicative examination finding among the options provided.

Question 2

Which part of the scaphoid bone is most commonly fractured?

Answer 2

The waist

This is due to the biomechanical stresses placed on the scaphoid during a fall onto an outstretched hand, which is the typical mechanism of injury.

When the wrist is hyperextended and radially deviated, axial compression forces are transmitted through the scaphoid waist, making it susceptible to fracture.
Clinical features include
1. pain along the radial aspect of the wrist,
2. tenderness in the anatomical snuffbox,
and
3. decreased grip strength.

Question 4

Acromegaly more commonly causes carpal tunnel syndrome after age 50.

Answer 4

because at that age is where tissues naturally lose elasticity, making them less able to accommodate swelling or structural changes.

Question 5

What is the term used to describe a visible angular deformity in the thoracic region?

Answer 5

kyphosis

Question 6

What is the term for an abnormal lateral curvature in any spinal region?

Answer 6

Scoliosis” (always pathological, unlike kyphosis/lordosis, which can be normal or exaggerated).

Question 7

the normal spine has lordotic and kyphotic regions.

Answer 7

Cervical spine Lordosis

Thoracic Kyphosis

Lumbar Lordosis

Question 8

When palpating in the midline of the spine, from cranially to caudally (top to bottom), what structures are you palpating?

Question 3Select one:

a.
The spinous processes

b.
The transverse processes

c.
The vertebral bodies

d.
The paraspinal muscles

Answer 8

The spinous processes

Question 9

When palpating down each side of the midline of the spine, from cranially to caudally (top to bottom), what structures are you palpating?

Question 4Select one:

a.
The spinous processes

b.
The transverse processes

c.
The vertebral bodies

d.
The paraspinal muscle

Answer 9

The paraspinal muscles

Explanation:
When palpating each side of the midline (paravertebral regions) from top to bottom (cranially to caudally), you are primarily palpating the paraspinal muscles (also called erector spinae or intrinsic back muscles). These muscles run longitudinally alongside the spinous processes and help stabilize and move the spine.

b. Transverse processes: These lie deeper and are not typically palpable in most individuals

Question 10

During palpation of the spine, you will palpate both sacroiliac joints and note any tenderness.

What are the sacroiliac joints?

Question 5Select one:

a.
The bony joints between the spine and pelvis

b.
The bony joints between the bottom two sections of the spine

c.
The site of important muscle attachments

Answer 10

👉 a. The bony joints between the spine and pelvis

Explanation:
The sacroiliac (SI) joints are located where the sacrum (the triangular bone at the base of the spine) meets the ilium of the pelvis — one on each side. These joints:

Connect the spine to the pelvis

Play a key role in weight transfer between the upper body and legs

Can become tender or painful in conditions like sacroiliitis or SI joint dysfunction

Question 11

Consider assessing the range of movement in the spine examination. In which two regions of the spine does the majority of movement occur and are thus the two regions formally assessed during examination?

Question 6Select one or more:

a.
Cervical

b.
Thoracic

c.
Lumbar

Answer 11

Of the three main regions of the spine - cervical, thoracic and lumbar - it is the cervical and lumbar regions in which the majority of movement occur and are thus these are the two regions formally assessed during examination.

The main role of the thoracic spine is to provide an axial attachment for the thorax. Of course, some movement does occur in this region but it is not formally tested.

The correct answers are: Cervical, Lumbar

Question 12

Consider assessment of the range of movement of the cervical spine; which types of movement are assessed?

Select all the relevant types of movements from the options below.

Question 7Select one or more:

a.
Flexion / extension

b.
Lateral flexion (left and right)

c.
Rotation (left and right)

Answer 12

ALL When assessing cervical spine range of motion, you should evaluate all three planes of movement:

Flexion / Extension:

Flexion: Chin to chest

Extension: Looking up at the ceiling

Lateral flexion:

Ear toward shoulder on each side

Rotation:

Turning the head left and right (like checking blind spots)

Question 13

onsider assessment of the range of movement of the lumbar spine; which types of movement are assessed?

Select all the relevant types of movements from the options below.

Question 8Select one or more:

a.
Flexion / extension

b.
Lateral flexion (left and right)

c.
Rotation (left and right)

Answer 13

During lumbar spine range of motion assessment, you typically evaluate:

Flexion / Extension:

Flexion: Bending forward to touch toes

Extension: Bending backward while standing

Lateral flexion:

Side bending left and right with arms sliding down the side of the legs

❗ Rotation is not formally assessed in the lumbar spine because:

The lumbar vertebrae are anatomically structured to limit rotational movement.

Most rotation occurs higher up, especially in the thoracic spine.

Question 14

Range of flexion of the lumbar spine is measured quantitatively by performing Schober’s test. In this test, marks are made placed on the midline of the patient’s spine in the lumbar region. The distance between these marks should increase to 20cms when the patient bends forward and the space between the spinous processes increases.

From the following options, select the correct description of the marks made during Schober’s test.

Question 9Select one:

a.
Identify the level of the sacroiliac joints; make a mark 10cms above this level and 5cms below.

b.
Identify the level of the sacroiliac joints; make a mark at the level and 15cms below.

c.
Identify the level of the sacroiliac joints; make a mark at the level and 15cms above.

d.
Identify the level of the sacroiliac joints; make a mark 5cms above this level and 10cms below.

Question 15

KNEE EXAMINATION:

True or false: Patients lower limbs must be exposed up to at least the mid-thigh level for adequate inspection as part of the knee examination.

Question 1Select one:
True
False

Answer 15

True

Question 16

Whilst the patient is standing you will inspect the relevant lower limb; comparing it to the contralateral side. You will inspect first from the font and then from behind. From the list below, match the characteristics you will inspect for to the best viewing point (anteriorly from the front or posteriorly from the back).

Quadricep muscle bulk

Limb alignment: Genu valgus or varus

Swelling in the popliteal fossa

Hamstring muscle bulk

Answer 16

Answer 1
Anteriorly (from the front)
Answer 2
Anteriorly (from the front)
Answer 3
Posteriorly (from the back)
Answer 4
Posteriorly (from the back)

Question 17

During the knee examination, if it seems sensible to do so (ie the patient isn’t in severe pain and is able to weight bear) you will ask the patient to walk to assess their gait.

True or false: You should do an extensive gait analysis as part of your knee examination.

Question 3Select one:
True
False

Answer 17

During a knee examination, you do assess the patient’s gait, but it is not an extensive gait analysis like you’d perform in a full neurological or musculoskeletal assessment.

Question 18

With the patient lying on the couch, you will inspect the knee. You may compare it to the other side when necessary.

From the following list, select the things you will look of on knee examination:

Question 4Select one or more:

a.
Effusion

b.
Skin changes - such as eczema or psoriasis

c.
Erythema

d.
Generalised swelling in the soft tissues around the joint

e.
Scars (traumatic or from surgery)

f.
Bruising

Answer 18

All of the above – a, b, c, d, e, f are correct.

Question 19

KNEE EXAMINATION:

There are two possible tests to confirm an effusion. You will only ever select one to perform; the one you choose will depend on whether swelling in the knee joint is visible on inspection.

In the two following scenarios, select the effusion test you would perform.

There is no visible swelling in the patient’s knee; it looks normal compared to the other side. You perform the test which confirms whether a small-to-medium effusion is present.

Answer 1 Question 5
Choose…
There is a large swelling of the knee joint. The swelling obeys the boundaries of the knee capsule and you decide this is an effusion within the joint, not a generalised swelling of the surrounding soft tissues. You perform the test which confirms the presence of a large effusion.

Answer 2 Question 5
Choose…

Answer 19

Medial gutter sweep is for small-to-medium effusions when there’s no obvious visible swelling.

You perform the test which confirms the presence of a large effusion. → Patellar tap test

Question 20

This isn’t in the video but we would like you to bear it in mind for the future when you come into the clinical knee lectures!

Several different pathologies will cause swelling within the knee joint. The type of fluid that has accumulated is related to what the cause of the swelling is.

Match each of the following conditions or injuries to the type of fluid that would collect in the knee joint.

A tibial plateau fracture (a fracture of the proximal tibia, communicating with the knee joint)

Answer 1 Question 6
Choose…
Osteoarthritis

Answer 2 Question 6
Choose…
Septic arthritis (infection of the knee joint)

Answer 3 Question 6
Choose…
Gout

Answer 4 Question 6
Choose…
An anterior cruciate ligament rupture

Answer 5 Question 6
Choose…
An acute meniscal tear

Answer 6 Question 6
Choose…

Answer 20

Tibial plateau fracture → Lipohaemarthrosis

Osteoarthritis → Synovial fluid

Septic arthritis → Pus

Gout → Crystal-enriched synovial fluid

ACL rupture → Haemarthrosis

An acute meniscal tear → Synovial fluid

Question 21

Match the following tests to what they test for:

Patellar grind test

Answer 1 Question 7
Choose…
Patellar apprehension test

Answer 2 Question 7
Choose…
Palpation for patello-femoral crepitations

Answer 3 Question 7
Choose…

Answer 21

Patellar grind test → Patello-femoral arthritis

Patellar apprehension test → Patellar instability (previous subluxation or dislocation)

Palpation for patello-femoral crepitations → Patellar instability (previous subluxation or dislocation)

Question 22

True or false: If the patient has generalised joint line tenderness, typical of osteoarthritic changes with degenerative meniscal tears, you should perform a Steinmann’s test.

Question 8Select one:
True
False

Answer 22

False

Explanation:
The Steinmann’s test is used to assess meniscal tears, but it is not typically performed when there is generalized joint line tenderness or signs that suggest osteoarthritis (OA) with degenerative meniscal tears.

other specific tests for meniscal tears, such as:

McMurray’s test

Apley’s compression test

Question 23

True or false: The normal relationship is that the anterior aspect of the tibia sits slightly forward to the femoral condyles.

Question 9Select one:
True
False

Answer 23

Ture it allow more smooth, efficient movement during activities

Question 24

True or false: When testing knee extension, you will always perform heel height testing as this is the most accurate way to assess range of extension.

Question 12Select one:
True
False

Answer 24

False The primary way to assess knee extension is through manual examination, where the knee is extended passively (or actively, depending on the patient’s ability) and compared to the normal range of motion.

Question 25

Hamstring muscle bulk Answer 1 Question 2 Posteriorly (from the back) Gluteal muscle mass Answer 2 Question 2 Posteriorly (from the back) Quadricep muscle bulk Answer 3 Question 2 Anteriorly (from the front)

Question 26

muscles by performing Trendelenburg’s test. Ask the patient to put their hands on yours for balance and then to stand on each leg in turn. The leg in contact with the floor is the side being assessed. If the **ABductor muscle**s are weak, the standing leg will move into ADduction and the iliac crest on the contralateral side will move down. This indicates a positive Trendelenburg test. In a negative or normal test, the pelvis will remain neutral."

Answer 26

"If the **gluteus medius and gluteus minimus are weak responsible for abduction**, the standing leg will move into adduction, and the iliac crest on the contralateral side will move down. This indicates a positive Trendelenburg test. In a negative or normal test, the pelvis will remain neutral." The gluteus medius and gluteus minimus muscles are responsible for stabilizing the pelvis during single-leg stance. Weakness in these muscles can cause the pelvis to drop on the opposite side when standing on one leg, which is the basis of a positive Trendelenburg test. | gluteus medius and minimus supplied by suprerior gluteal nerve

Question 27

From the following list, select the things you will look for in this part of the hip examination: Question 4Select one or more: a. Skin changes - such as erythema, eczema or psoriasis b. Scars (traumatic or from surgery) c. Effusion d. Bruising

Answer 27

ALL EXCEPT for an effusion. The hip is a deep joint (unlike the knee) and therefore you would NOT see an effusion, even if it were present.

Question 28

Particular changes to the attitude of the affected limb are typical of an extracapsular neck of femur fracture. From the options below, pick the two descriptors typical of the limb attitude in an extracapsular neck of femur fracture. Question 5Select one or more: a. Internal rotation b. External rotation c. Limb shortening d. Limb lengthening

Answer 28

For an extracapsular neck of femur fracture, the two typical descriptors of the limb attitude are: b. External rotation c. Limb shortening

Question 29

Apparent limb length Answer 1 Question 6 The xiphisternum to the tip of the medial malleolus True limb length Answer 2 Question 6 The anterior superior iliac spine (ASIS) to the tip of the medial malleolus

Answer 29

Apparent limb length: The xiphisternum to the tip of the medial malleolus — This measures the apparent length of the limb, which may be influenced by factors like pelvic tilt or postural changes. True limb length: The anterior superior iliac spine (ASIS) to the tip of the medial malleolus — This is the true measurement of the limb length from the hip (ASIS) to the ankle, representing the actual bone length without being affected by posture or tilting.

Question 30

Mid-point of the groin Answer 1 Question 7 hip fracture or arthritis Answer 2 Question 7 Trochanteric bursitis

Answer 30

Mid-point of the groin Answer 1:The hip joint lies deep to the mid-point of the groin. Therefore, tenderness here suggests hip pathology, such as a hip fracture or arthritis Greater trochanter Answer 2: Trochanteric bursitis The greater trochanter is the bony prominence on the outside of the hip. Trochanteric bursitis refers to inflammation of the bursa overlying the greater trochanter, causing pain in that specific area.

Question 31

What finding does a positive Thomas' test indicate? Question 9Select one: a. A painful hip b. A fixed flexion deformity (loss of full hip flexion) c. A fixed flexion deformity (loss of hip extension)

Answer 31

Thomas’s test is performed to look for a fixed flexion deformity of the hip, which is loss of hip extension. during thomas test you looking if the oppsoite leg will that is extended will flex along with the other flex leg

Question 32

Answer 32

Sternoclavicalr joint dislocation

Question 33

Answer 33

This protrusion or swelling is overlying the acromioclavicular joint as suggests dislocation of this joint. This area would be tender, the movement of the joint may be reduced due to pain in this area and they will have a positive Scarf test.

Question 34

Answer 34

The normally smooth contour of the clavicle is disrupted and, with a history that fits, would suggest an injury to the clavicle fracture.

Question 35

Answer 35

The contour of the right shoulder is abnormal. Look at the normal right side with the smooth shape produced by the trapezium muscle and the deltoid muscle. However on the left side it looks 'squared off'. This is caused by the prominence of the acromion joint because the head of the humerus is displaced anteriorly and medially in this anterior shoulder dislocation.

Question 36

Answer 36

A: This is the site of supraspinatus (above the spine of the scapula). B: This is the site if infraspinatus (below the spine of the scapula).

Question 37

he shoulder is a ball and socket joint. From the options below select the movements that are assessed during examination of shoulder range of movement. Question 6Select one or more: a. Internal rotation b. Abduction c. External rotation d. Adduction e. Extension f. Flexion

Answer 37

Of the 6 movements possible at the shoulder, 4 are tested during the shoulder examination.** Neither ADduction nor extension are particularly important movements functionally.** The correct answers are: Flexion, Abduction, External rotation, Internal rotation

Question 38

True or false: During the shoulder examination, range of movement is tested. Active range of movement should be tested tested first, always followed by passive range of movements. Question 7Select one: True False

Answer 38

This is false. It is true that you would start by testing the active range of movement at the shoulder and comparing this to the contralateral side. However, only if active range of movement was reduced would you then test that movement passively. In this situation, if the passive movement was also reduced, it would suggest stiffness of the joint but if passive movement is full, it suggests a muscle weakness. The correct answer is 'False'.

Question 39

True or false: A painful arc is suggestive of rotator cuff tendon impingement. Question 8Select one: True False

Answer 39

A painful arc is a common sign of rotator cuff tendon impingement, where pain is typically felt when the arm is raised between 60 and 120 degrees. This pain occurs due to compression of the rotator cuff tendons, usually beneath the acromion (part of the shoulder blade). A painful arc = pain when lifting the arm between ~60° and 120° → suggests impingement of the rotator cuff or bursa.

Question 40

Rotator cuff tests: A positive Jobe's test suggests a supraspinatus tear. What symptom or sign would indicate a positive Jobe's test? Question 9Select one: a. Weakness b. Numbness c. Pain

Answer 40

It is pain on Jobe's test that indicates a positive test, not weakness. You actually perform a Jobe's test every time you test the power of supraspinatus as it is the same action. Weakness suggests supraspinatus weakness but pain suggests a supraspinatus tear. The correct answer is: Pain

Question 41

True or false: A positive sulcus sign suggests significant shoulder instability. Question 10Select one: True False

Answer 41

True

Question 42

If you were to suspect shoulder instability, two of the tests you would perform would be the anterior and posterior apprehension tests. What symptom would a patient exhibit to indicate a positive apprehension test? Question 11Select one: a. Stiffness b. Pain c. Apprehension

Answer 42

As the name suggests, an apprehension test is positive when the patient exhibits apprehension. This apprehension is caused by the instability of the joint. As the humeral head starts to skip off the glenoid, the proprioreceptors are stretched and this is recognised by the patient as what happens when the joint subluxes or dislocates. This causes apprehension and sometimes the patient will resist this movement. In relation to the anterior apprehension test, the relocation test will produce patient reassurance as the pressure relocates the dislocating humeral head. The correct answer is: Apprehension