Trail Questions

Question 1

Amputations and Prosthetics

Which position would be least likely to contribute to a hip flexion contracture?
* prone
* sidelying
* sitting
* supine

Answer 1

Prone
A prone position would require the hip to remain in an extended position and therefore would not contribute to a hip flexion contracture

Question 2

Amputations and Prosthetics

Which level of amputation is most consistent with a Syme’s amputation?
* surgical removal of the lower extremity through the knee joint
* surgical removal of the foot at the ankle joint with removal of the malleoli
* surgical removal at the level of the midtarsal joint
* surgical removal of the midsection of the metatarsals

Answer 2

Surgical removal of the foot at the ankle joint with removal of the malleoli
A Syme’s amputation refers to surgical removal of the foot at teh ankle joint with removal of the maleoli. The most common indication for a Syme’s aputation is infection

Question 3

Amputations and Prosthetics

For a patient with a transtibial amputation, what is considered appropriate positioning?
* prone with a pillow under the hips
* prone with a pillow under the distal residual limb
* supine with a pillow under the knee
* supine with a pillow under the distal residual limb

Answer 3

Supine with a pillow under the distal residual limb
For a patient with a transtibial amputation, prolonged hip and knee flexion should be avoided as this could result in the development of contractures. With the patient in supine, a pillow placed under the distal residual limb would place the knee in extension and the hip in only slight flexion. All the other options place the hip and/or knee in flexion.

Question 4

Amputations and Prosthetics

Which of the following is least likely to result in a lower extremity amputation?
* peripheral vascular disease
* severe infection
* congenital limb deficiency
* diabetes

Answer 4

Congenital limb deficiency
Congenital limb deficiency accounts for approximately 5% of lower limb amputations. The remaining options are common causes of lower extremity amputations.

Question 5

Amputations and Prosthetics

What is the most common cause of upper limb amputation?
* peripheral vascular disease
* tumor
* congenital limb deficiency
* trauma

Answer 5

Trauma
Approximately 85% of all upper limb amputations result from trauma. Traumatic amputations in general tend to occur most commonly in younger adults while amputations as a result of diabetes and peripheral vascular disease are more common in the elderly.

Question 6

Amputations and Prosthetics

Which of the following amputations would be defined as the removal of a toe and all or part of the corresponding metatarsal?
* toe amputation
* ray resection
* midfoot amputation
* hindfoot amputation

Answer 6

Ray Resection
A ray resection is defined as the removal of a toe and all or part of the corresponding metatarsal. Although a ray resection on the first ray is often difficult to manage, a ray resection of the 2nd, 3rd, 4th, or 5th digit is far less problematic.

Question 7

Amputations and Prosthetics

Which of the following contractures is most commonly observed following a transfemoral amputation?
* hip extension and adduction
* hip extension and abduction
* hip flexion and abduction
* hip flexion and adduction

Answer 7

Hip flexion and abduction
The most common contracture seen after a transfemoral amputation is hip flexion and abduction. Due to the high energy requirement of ambulation using a transfemoral prosthesis, many patients with a cardiovascular co-morbidities may not be able to functionally ambulate.

Question 8

Amputations and Prosthetics

Which requirement would be least important prior to being considered a candidate for a transfemoral prosthesis?
* the ability to independently transfer from a bed to a chair
* the ability to independently rise from sitting to standing
* the ability to ambulate up and down parallel bars using a single leg
* the ability to ambulate up and down 10 stairs with axillary crutches

Answer 8

The ability to ambulate up and down 10 staris with axillary crutches
The ability to ambulate up and down 10 staurs with axillary crutches is not a requirement for an individual to be a candidate for a transfemoral prosthesis. The remaining options are general skills required to be successful with a transfemoral prosthesis.

Question 9

Amputations and Prosthetics

Which level of amputation would be most likely to use crutches for funtctional mobility instead of a prosthesis?
* hip disarticulation
* transtibial amputation
* Syme’s amputation
* transhumeral amputation

Answer 9

Hip disarticulation
A patient is most likely to forgo a prosthesis and opt for crutches for mobility following a hip disarticulation. Many individuals fin ambulation with a prosthesis at this level extremly challenging due to the high energy requirements of controlling three prosthetic joints.

Question 10

Amputations and Prosthetics

A long transtibial amputation refers to an amputation that takes place at:
* distal third of the lower extremity below the knee joint
* distal third of the lower extremity above the knee joint
* proximal third of the lower extremity below the knee joint
* procimal third of the lower extremity above the knee joint

Answer 10

Distal third of the lower extremity below the knee joint
A transtibial amputation refers to the surgical removal of the lower extremity below the knee joint, while a transfemoral amputation is above the knee joint. A long transtibial amputation refers to removal of the distal third of the tibia. A short transtibial amputation refers to the surgical removal of the lomb at the proximal third of the tibia.

Question 11

Amputations and Prosthetics

What is the most likely prosthetic cause for excessive knee flexion during stance phase in a patient with a transtibial amputation?
* excessive plantar flexion
* excessive dorsiflexion
* soft heel cushion
* low shoe heel

Answer 11

Excessive dorsiflexion
If the prosthetic foot is aligned into excessive dorsiflexion, there is potential for knee instability (buckling) during the laoding response. The excessive dorsiflexion creates a flexion moment at the knee upon loading on the prosthetic side. Knee instability can primarily result from malalignment, weakness, and contracture.

Question 12

Amputations and Prosthetics

A limitation in which motion of a prosthetic limb would be most likely to interfere with walking forward up a hill with a step-over-step pattern?
* dorsiflexion
* plantar flexion
* hip flexion
* hip extension

Answer 12

Dorsiflexion
A limitation in dorsiflexion of the prosthesis will result in hyperextension of the knee in order to attain foot flat. This hyperextension may result in damage to the knee in an individual with a transtibial amputation, and provide extreme difficulty for an individual with a transfemoral amputation. For this reasion, the safest and most efficient way for an individual with a prosthetic limb to ascend a hill or a ramp is to side step with the sound limb leading the movement and the prosthetic limb trailing.

Question 13

Amputations and Prosthetics

What is the most improtant variable to consider when determining if a patient is a candidate for a prosthesis?
* prior level of activity
* level of amputation
* comorbidities
* age

Answer 13

Prior level of activity
The most important factor to determine candidacy for a prosthesis is the patient’s prior activity level. Comorbidities and the extent of injury should be considered, but a patient who lef an active lifestyle prior to an amputation is likely to become a functional prosthetic user if they can demonstrate good balance and coordination.

Question 14

Amputations and Prosthetics

Which of the following permits the attachment of a pylon for early ambulation following amputation?
* Unna boot
* elastic shrinker
* semi-rigid dressing
* plaster of Paris

Answer 14

Plaster of Paris
The rigid dressing is made from plaster or prefabricated plastic. They are primarily used for resifdual limb protection and edema control. A pylon can be attached for early ambulation and the prefabricated versions can be adjusted in response to girth changes in the residual limb.

Question 15

Amputations and Prosthetics

Which of the following require sutures to be removed from the amputation site prior to use?
* Unna boot
* elastic shrinker
* semi-rigid dressing
* removable rigid dressing

Answer 15

Elastic shrinker
Elastic shrinkers are conical shaped, sock-like garments that are used for edema control and residual limb shaping. Due to the possible stress on the incision site, elastic shrinkers are not recommended until the sutures have been removed from the amputation site.

Question 16

Amputations and Prosthetics

When wrapping a residual limb of a patient following a transtibial amputation, what size elastic bandages would be the most appropriate?
* two six-inch bandages
* one four-inch bandage
* two four-inch bandages
* one six-inch bandage and one four-inch bandage

Answer 16

Two four-inch bandages
When wrapping the residual limb of a patient who has had a transtibial amputation, two four-inch bandages should be used. The limb should be wrapped with a figure-eight pattern for equal pressure and appropriate limb shaping.

Question 17

Amputations and Prosthetics

What is the primary area of the residual limb that is used for weight bearing in a transtibial knee prosthesis?
* patella tendon
* distal end of the residual limb
* lateral tibial condyle
* fibular head

Answer 17

Patella tendon
A patellar tendon bearing socket is the most common type of socket used by a patient with a transtibial amputation. This type of socket is designed to facilitate weight bearing on pressure tolerant areas such as the patellar tendon and muscle tissue. The socket avoids placing excessive pressure on less tolerant areas such as the distal end of the tibia, tibial tuberosity, and fibular head.

Question 18

Amputations and Prosthetics

Which area would be considered pressure tolerant in a transtibial residual limb?
* patella
* patellar tendon
* fibular head
* tibial crest

Answer 18

Patellar tendon
The residual limb can tolerate forces in some areas, and less so in others. The prosthesis is molded to relieve pressure in the sensitive areas, and the apply pressure in the more tolerant areas.

Question 19

Amputations and Prosthetics

Painful sensation that originates from an aputated limb is called:
* residual limb pain
* referred pain
* radicular pain
* phantom pain

Answer 19

Phantom pain
Phantom pain sensations are described as perceptions that an individual experiences relating to a limb or an organ that is no longer physically part of the body.

Question 20

Amputations and Prosthetics

Which of the following would be most likely benefit an individual with phantom limb pain?
* aerobic exercise
* electrical stimulation
* paraffin
* mirror therapy

Answer 20

Mirror therapy
Mirror therapy has been shown to be effective for treating phantom limb pain. The principle of mirror therapy is the use of a mirror to create a reflextive illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain.

Question 21

Musculoskeletal

Which muscle does not act to extend the shoulder?
* latissimus dorsi
* triceps brachii (long head)
* anterior deltoid
* teres major

Answer 21

Anterior Deltoid
The anterior deltoid acts to forward flex the shoulder and does not participate in extension. The posterior deltoid acts to extend the shoulder.

Question 22

Musculoskeletal

Which of the following is an example of a contractile source of motion restriction?
* bursa
* capsule
* ligament
* tendon

Answer 22

Tendon
A tendon is a potential source of motion restriction since it functions as a contractile component of the musculocutaneous unit.

Question 23

Musculoskeletal

Which of the following muscles works in opposition to the deltoid to prevent scapular winging?
* rhomboid major
* rhomboid minor
* trapezius
* serratus anterior

Answer 23

Serratus Anterior
The serratus anterior originates on the 1st through 8th ribs on the lateral chest wall and inserts along the medial border of the scapula. This muscle acts to stabilize the scapula against the chest wall.

Question 24

Musculoskeletal

What is the primary action of the dorsal interossei on the metacarpophalangeal joints of the index, middle, and ring fingers?
* abduction
* adduction
* flexion
* extension

Answer 24

Abduction
There are four dorsal interossei whose primary action is abduction of the metacarpophalangeal (MCP) joints of the index, middle, and ring fingers. The secondary action is flexion of the MCP joints for the index, middle, and ring fingers and extension of the proximal and distal interphalangeal joints for the index, middle, and ring fingers.

Question 25

# Musculoskeletal Which bone is most susceptible to necrosis following a fracture? * Scaphoid * Trapezium * Triquetrum * Lunate

Answer 25

Scaphoid The scaphoid is supplied by the palmar branch of the radial artery and the dorsal carpal branch of the radial artery. If the scaphoid is fractured, the disrupted blood supply can significantly inhibit the ability of the bone to heal which can result in necrosis.

Question 26

# Musculoskeletal Which of the following muscles share a common insertion site? * coracobrachialis and pectoralis minor * brachioradialis and brachialis * tibialis anterior and peroneus longus * sartorius and rectus femoris

Answer 26

Tibialis Anterior and Peroneus Longus The tibialis anterior and peroneus longus both insert at the base of the first metatarsal and medial cuneiform. The coracobrachialis and pectoralis minor have a common origin or insertion, however, the coracobrachialis originates at the coracoid process while the pectoralis minor inserts at the same structure. The remaining muscles do not share common origins or insertions.

Question 27

# Musculoskeletal The elbow ligament that allows the head of the radius to rotate and retain contact with the radial notch of the ulna is known as: * the annular ligament * the anterior ligament * the posterior ligament * the radial collateral ligament

Answer 27

The Annular Ligament The annular ligament consists of a band of fibers that surrounds the head of the radius. It allows the head of the radius to rotate and maintain contact with the radial notch of the ulna.

Question 28

# Musculoskeletal All of the following muscles act to extend the hip except: * gluteus maximus * gluteus minimus * semitendinosus * biceps femoris

Answer 28

Gluteus Minimus The gluteus minimus acts to abduct the hip and is innervated by the superior gluteal nerve. The gluteus medius, piriformis, obturator internus, and tensor fasciae latae also abduct the hip.

Question 29

# Musculoskeletal What structure on the scapula does the humeral head most approximate during abduction? * clavicle * acromion process * suprascapular notch * coracoid process

Answer 29

Acromion Process The acromion process refers to the lateral extension of the spine of the scapula. During abduction the humeral head slides inferiorly while rolling superiorly which results in the humeral head closely approximating the acromion process.

Question 30

# Musculoskeletal All of the following muscles act to evert the ankle except: * peroneus longus * tibialis posterior * peroneus brevis * peroneus tertius

Answer 30

Tibialis Posterior The tibialis posterior muscle acts to plantar flex and invert the ankle and is innervated by the tibial nerve. Other plantar flexors include the soleus, gastrocnemius, peroneus longus, peroneus brevis, plantaris, and flexor hallucis muscles. Other muscles that invert the ankle include the tibialis anterior and the flexor digitorum longus.

Question 31

# Musculoskeletal All of the following spinal ligaments limit flexion except: * ligamentum flavum * anterior longitudinal ligament * supraspinous ligament * posterior longitudinal ligament

Answer 31

Anterior Longitudinal Ligament The anterior longitudinal ligament limits thoracolumbar extension and reinforces the anterior portion of the intervertebral disks and vertebrae.

Question 32

# Musculoskeletal Which muscle plays a significant role in depressing the mandible during mouth opening? * medial pterygoid * temporalis * lateral pterygoid * masseter

Answer 32

Lateral Pterygoid The lateral pterygoid is made up of two heads. It is one of the few muscles of mastication that opens the mouth.

Question 33

# Musculoskeletal Which action is not performed by the latissimus dorsi? * glenohumeral external rotation * glenohumeral internal rotation * glenohumeral adduction * glenohumeral extension

Answer 33

Glenohumeral external rotation The latissimus dorsi acts to internally rotate, adduct, and extend the arm. The latissimus dorsi is innervated by the thoracodorsal nerve.

Question 34

# Musculoskeletal What is the lateral articular surface of the distal humeras called? * capitulum * trochlea * olecranon fossa * coronoid fossa

Answer 34

Capitulum The capitulum is the lateral portion of the distal humerus that articulates with the head of the radius.

Question 35

# Musculoskeletal The adductor tubercle of the femur is the insertion of which muscle? * pectineus * adductor magnus * sartorius * gracilis

Answer 35

Adductor Magnus The adductor magnus is a large triangular muscle situated on the medial thigh that has two parts. The adductor portion is innervated by the obturator nerve and acts to adduct the hip. The hamstring portion of the adductor magnus is innervated by the tibial nerve and acts to extend the hip.

Question 36

# Musculoskeletal What tendon surrounds the pisiform bone? * palmaris longus * flexor carpi ulnaris * adductor pollicis * lumbricals

Answer 36

Flexor carpi ulnaris The pisiform bone is a sesamoid bone that is surrounded by the flexor carpi ulnaris. The flexor carpi ulnaris is a primary wrist flexor and ulnar deviator. The muscle is innervated by the ulnar nerve.

Question 37

# Musculoskeletal Which muscle actively contributes to producing a tenodesis grip? * flexor digitorum profundus * extensor digitorum * palmaris * opponens pollicis

Answer 37

Extensor Digitorum A tenodesis grip is a method of grasping used by patients with C6 and C7 tetraplegia who have paralysis of the finger and thumb flexor muscles, but active wrist extensors. The grip is most effective with shortened wrist and finger flexors.

Question 38

# Musculoskeletal What muscle originates on the coracoid process? * brachioradialis * extensor digitorum * short head of the biceps brachii * latissimus dorsi

Answer 38

Short head of the biceps brachii The long head of the biceps brachii originates on the supraglenoid tubercle and the short head originates on the coracoid process. The muscle is innervated by the musculoskeletal nerve.

Question 39

# Musculoskeletal Which of the following is not part of the anatomical snuff box? * extensor pollicis brevis * extensor pollicis longus * extensor pollicis brevis * abductor pollicis longus

Answer 39

Abductor Pollicis Brevis The abductor pollicis brevis is not part of the anatomical snuff box. When the hand is ulnarly deviated the scaphoid bone becomes palpable in the anatomical snuffbox region.

Question 40

# Musculoskeletal What is the common origin of the wrist flexors? * lateral epicondyle of the humerus * medial epicondyle of the humerus * radial head * ulnar styloid

Answer 40

Medial epicondyle of the humerus The medial epicondyle of the humerus is the common origin for the flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, and pronator teres. Medial epicondylitis is usually caused by repetitive wrist flexion.

Question 41

# Musculoskeletal Which structure is not a component of the femoral triangular? * inguinal ligament * adductor longus * sartorius * iliotibial band

Answer 41

Iliotibial band The femoral triabgle is comprised of the inguinal ligament, adductor longus, and sartorius. Within the femoral triangle is the femoral nerve, femoral artery, and femoral vein.

Question 42

# Arthrokinematics - Osteokinematics Which arthrokiematic motion is coupled with cervial rotation? * flexion * extension * lateral flexion * rotation

Answer 42

Lateral Flexion cervical rotation is coupled with lateral flexion of the cervical spine due to the shape of the articulating facet joints. Lateral flexion is not always coupled in the same direction as rotation, depending on the arthrokinematics of each specific motion

Question 43

# Arthrokinematics - Osteokinematics Which terms best describes an anterior motion of the mandible in relation to the maxilla? * depressino * lateral excursion * protrusion * retrusion

Answer 43

Protrusion Protrusion refers to the anterior motion of the mandible in relation to the maxilla. Normal protrusion is less than 10 millimeters

Question 44

# Arthrokinematics - Osteokinematics Which of the following correctly describes the arthrokinematics of closed-chain knee extension? * posterior roll and anterior slide of the femur * anterior roll and posterior slide of the femur * anterior roll and anterior slide of the femur * posterior roll and posterior slide of the femur

Answer 44

Anterior Roll and Posterior Slide of the Femur In closed-chain knee extension, the convex femur rolls anteriorly and slides posteriorly relative to the concave tibia to achieve knee extension