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Physiology & Rehabilitation MCQs

Practice Set 18 of 26

This practice set contains high-yield board review questions covering key concepts in Physiology & Rehabilitation. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 341

Topic: Physiology & Rehabilitation

Which of the following is considered a hallmark clinical feature differentiating an intramedullary spinal tumor from an extradural tumor?

. Radicular pain
. Progressive motor weakness
. Early dissociated sensory loss (loss of pain/temp with preserved touch/proprioception)
. Bowel and bladder dysfunction
. Local back pain

Correct Answer & Explanation

. Early dissociated sensory loss (loss of pain/temp with preserved touch/proprioception)

Explanation

Early dissociated sensory loss (syringomyelic pattern), where pain and temperature sensation are lost while touch and proprioception are preserved, is a hallmark feature of intramedullary lesions, especially those causing a syrinx or affecting the spinothalamic tracts crossing in the central cord. This is due to disruption of the decussating spinothalamic fibers. While other symptoms like motor weakness, pain, and bladder dysfunction can occur with any spinal tumor, this specific sensory pattern points strongly to an intramedullary pathology.

Question 342

Topic: Physiology & Rehabilitation

A 50-year-old patient presents with lateral epicondylitis. An occupational therapist recommends an eccentric exercise program. What is the primary theoretical benefit of eccentric exercises in tendinopathy rehabilitation?

. To increase tendon length and flexibility.
. To reduce inflammation within the tendon.
. To induce collagen remodeling and strengthen the tendon.
. To increase concentric muscle strength for improved performance.
. To improve joint proprioception.

Correct Answer & Explanation

. To induce collagen remodeling and strengthen the tendon.

Explanation

The primary theoretical benefit of eccentric exercises in tendinopathy rehabilitation is to induce collagen remodeling, strengthen the tendon, and improve its load-bearing capacity. While they may contribute to flexibility and improved performance (by strengthening the entire muscle-tendon unit), the specific effect on tendon structure and resistance to injury is the key. They do not directly reduce inflammation, and proprioception is a secondary benefit. The progressive loading during the lengthening phase of muscle contraction is thought to stimulate fibroblast activity and collagen synthesis in a more organized fashion.

Question 343

Topic: Physiology & Rehabilitation

In a patient with chronic lateral ankle instability, what is the 'star excursion balance test' primarily used to assess?

. Static balance and ankle range of motion.
. Dynamic balance, proprioception, and neuromuscular control.
. Strength of the peroneal muscles.
. Ligamentous laxity of the ankle joint.
. Pain levels during functional activities.

Correct Answer & Explanation

. Dynamic balance, proprioception, and neuromuscular control.

Explanation

The Star Excursion Balance Test (SEBT) is a commonly used clinical assessment tool for dynamic balance, proprioception, and neuromuscular control of the lower extremity. It requires the patient to maintain balance on one leg while reaching with the contralateral leg in various directions, thereby challenging the ankle's stability in a functional manner. It does not directly measure static balance, muscle strength, ligamentous laxity, or pain levels, though it can be influenced by these factors.

Question 344

Topic: Physiology & Rehabilitation

Which of the following types of ankle instability is characterized by a feeling of 'giving way' without objective evidence of ligamentous laxity on examination or stress radiographs?

. Mechanical instability
. Chronic instability
. Functional instability
. Combined instability
. Acute instability

Correct Answer & Explanation

. Functional instability

Explanation

Functional instability describes the subjective sensation of the ankle 'giving way' or feeling unstable, without demonstrable objective laxity (e.g., on stress radiographs). This is often attributed to impaired proprioception and neuromuscular control deficits. Mechanical instability, on the other hand, involves objective ligamentous laxity. Chronic instability refers to persistent symptoms, which can be either mechanical, functional, or both.

Question 345

Topic: Physiology & Rehabilitation

What aspect of chronic lateral ankle instability is most effectively addressed by a comprehensive physiotherapy program, even if mechanical laxity persists?

. Complete restoration of torn ligamentous structures.
. Correction of significant cavovarus foot deformity.
. Improvement of functional stability through enhanced proprioception and neuromuscular control.
. Elimination of all pain and swelling completely.
. Direct repair of associated osteochondral lesions.

Correct Answer & Explanation

. Improvement of functional stability through enhanced proprioception and neuromuscular control.

Explanation

A comprehensive physiotherapy program is highly effective in improving functional stability, even when some degree of mechanical laxity persists. This is achieved by enhancing proprioception, strengthening dynamic stabilizers (peroneals), and improving neuromuscular control. Physiotherapy cannot directly restore torn ligaments, correct structural deformities like cavovarus foot, or directly repair OCLs. While it aims to reduce pain and swelling, complete elimination is not always possible without addressing underlying mechanical issues or other pathologies.

Question 346

Topic: Physiology & Rehabilitation

The 'red-red zone' of the meniscus refers to the region that is:

. Innervated by pain receptors and highly vascularized.
. Vascularized and capable of intrinsic healing.
. Predominantly composed of type I collagen and avascular.
. Where the meniscus attaches directly to the tibial plateau.
. Responsible for proprioception but lacks direct blood supply.

Correct Answer & Explanation

. Vascularized and capable of intrinsic healing.

Explanation

The 'red-red zone' is the outermost peripheral region of the meniscus (approximately 10-30% of its width) that receives a direct blood supply from the perimeniscal capillary plexus. Tears in this zone have the best potential for biological healing due to the presence of blood-borne healing factors and cells.

Question 347

Topic: Physiology & Rehabilitation

Which aspect of meniscal function is most impaired by a total meniscectomy?

. Proprioception.
. Joint lubrication.
. Load distribution and shock absorption.
. Ligamentous stability.
. Synovial fluid production.

Correct Answer & Explanation

. Load distribution and shock absorption.

Explanation

A total meniscectomy profoundly impairs the meniscus's primary biomechanical functions: load distribution and shock absorption. By removing the menisci, the contact area between the femoral and tibial condyles is significantly reduced, leading to a marked increase in peak contact stresses and accelerated articular cartilage degeneration. While proprioception and lubrication also suffer, the load-bearing deficit is the most critical factor for long-term joint health.

Question 348

Topic: Physiology & Rehabilitation

The presence of sensory nerve endings (mechanoreceptors and nociceptors) in the menisci suggests their role in:

. Joint lubrication and nutrient transport.
. Shock absorption and load distribution.
. Proprioception and pain perception.
. Immunological response to joint injury.
. Regulation of synovial fluid production.

Correct Answer & Explanation

. Proprioception and pain perception.

Explanation

The menisci are innervated, particularly in their peripheral vascularized zones and horn attachments, by both mechanoreceptors (e.g., Ruffini endings, Pacinian corpuscles, Golgi tendon organ-like endings) and free nerve endings (nociceptors). This innervation indicates their crucial role in providing proprioceptive feedback (sense of joint position and movement) to the central nervous system and in mediating pain perception.

Question 349

Topic: Physiology & Rehabilitation

During an eccentric muscle contraction, which of the following statements best describes the physiological mechanics occurring within the sarcomere?

. The muscle generates force while the overall length of the sarcomere decreases.
. The A-band shortens as the myosin heads detach.
. The muscle generates force while actin filaments are pulled away from the center of the sarcomere.
. ATP is not required for cross-bridge cycling during this contraction phase.
. The I-band remains constant in length.

Correct Answer & Explanation

. The muscle generates force while actin filaments are pulled away from the center of the sarcomere.

Explanation

In an eccentric contraction, the muscle lengthens while generating force. The actin filaments are pulled away from the center of the sarcomere (M-line) by external forces that exceed the force generated by the cross-bridges. The A-band remains constant in length, while the I-band lengthens.

Question 350

Topic: Physiology & Rehabilitation

During rehabilitation, patients perform various types of muscle contractions. Which type of contraction generates the highest maximum force and is most commonly associated with delayed onset muscle soreness (DOMS)?

. Isotonic concentric
. Isometric
. Isokinetic
. Eccentric
. Tetanic

Correct Answer & Explanation

. Eccentric

Explanation

Eccentric contractions occur when a muscle lengthens while under tension. They can generate the highest forces of any contraction type but are also most highly correlated with microtrauma and subsequent delayed onset muscle soreness.

Question 351

Topic: Physiology & Rehabilitation

During the normal human gait cycle, which muscle group undergoes a critical eccentric contraction during the initial contact to the loading response phase to control joint motion and absorb shock?

. Quadriceps
. Hamstrings
. Gastrocnemius
. Gluteus maximus
. Iliopsoas

Correct Answer & Explanation

. Quadriceps

Explanation

From initial contact (heel strike) to the loading response, the knee flexes slightly to absorb the shock of body weight. The quadriceps muscle group contracts eccentrically during this brief period to control the rate and extent of knee flexion, thereby stabilizing the limb as weight is accepted.

Question 352

Topic: Physiology & Rehabilitation

Postural muscles, such as the soleus, are uniquely adapted to resist fatigue during prolonged standing. Which of the following profiles best describes the predominant muscle fiber type found in the soleus?

. Fast twitch, anaerobic, low fatigue resistance
. Fast twitch, aerobic, high fatigue resistance
. Slow twitch, aerobic, high mitochondrial density
. Slow twitch, anaerobic, high glycogen content
. Fast twitch, high force production, low myoglobin content

Correct Answer & Explanation

. Slow twitch, aerobic, high mitochondrial density

Explanation

The soleus is primarily composed of Type I muscle fibers. Type I fibers are slow-twitch, highly oxidative (aerobic), rich in myoglobin and mitochondria, and highly resistant to fatigue.

Question 353

Topic: Physiology & Rehabilitation

Type I (slow-twitch) skeletal muscle fibers are specialized for endurance activities. Compared to Type IIb fibers, Type I fibers possess which of the following characteristics?

. Lower myoglobin content
. Dependence on anaerobic metabolism
. Higher mitochondrial density
. Faster contraction speed
. Larger fiber cross-sectional diameter

Correct Answer & Explanation

. Higher mitochondrial density

Explanation

Type I muscle fibers are optimized for aerobic metabolism and fatigue resistance. They have a higher mitochondrial density, higher myoglobin content, greater capillary density, and rely primarily on oxidative phosphorylation.

Question 354

Topic: Physiology & Rehabilitation

During the normal human gait cycle, the peak joint reaction force at the hip occurs during which specific phase?

. Initial contact (heel strike)
. Loading response
. Terminal stance
. Pre-swing
. Mid-swing

Correct Answer & Explanation

. Terminal stance

Explanation

The peak joint reaction force at the hip reaches approximately 2.5 to 3 times body weight and occurs during the terminal stance phase. This peak is driven primarily by the contraction of the hip abductor muscles to stabilize the pelvis prior to toe-off.

Question 355

Topic: Physiology & Rehabilitation

During a rehabilitation exercise protocol for a patient recovering from a patellar tendon repair, the physical therapist instructs the patient to slowly lower a weight from full knee extension to 90 degrees of flexion. In this phase, the quadriceps muscle is actively generating force while simultaneously lengthening. This type of muscle contraction is defined as:

. Concentric
. Isometric
. Isokinetic
. Isotonic
. Eccentric

Correct Answer & Explanation

. Eccentric

Explanation

An eccentric contraction occurs when the muscle lengthens while under tension (generating force). A concentric contraction occurs when the muscle shortens while generating force. An isometric contraction occurs when tension is generated without a change in muscle length. Isokinetic refers to contraction at a constant speed, and isotonic refers to contraction against a constant load.

Question 356

Topic: Physiology & Rehabilitation

During a rehabilitation protocol following a major orthopedic surgery, a physical therapist emphasizes eccentric muscle contractions. Which of the following statements best describes an eccentric contraction?

. The muscle shortens while generating constant tension
. The muscle lengthens while generating force
. The muscle generates force without changing length
. The muscle shortens at a constant velocity
. The muscle relaxes entirely to allow passive stretch

Correct Answer & Explanation

. The muscle lengthens while generating force

Explanation

An eccentric contraction occurs when a muscle generates force while actively lengthening. This often occurs during deceleration activities (e.g., the quadriceps during the downward phase of a squat). Eccentric contractions can generate the highest forces and are most associated with delayed onset muscle soreness (DOMS).

Question 357

Topic: Physiology & Rehabilitation

Delayed onset muscle soreness (DOMS) following intensive physical activity is most strongly associated with which type of muscle contraction?

. Concentric
. Eccentric
. Isometric
. Isokinetic
. Plyometric

Correct Answer & Explanation

. Eccentric

Explanation

Delayed onset muscle soreness (DOMS) is primarily caused by eccentric muscle contractions, where the muscle lengthens while under active tension. This mechanical stress leads to microtrauma of the muscle fibers and a subsequent inflammatory response.

Question 358

Topic: Physiology & Rehabilitation

Skeletal muscle contractions are classified by how the muscle changes length under tension. Which type of contraction generates the highest amount of force and is most commonly associated with delayed onset muscle soreness (DOMS)?

. Concentric contraction
. Eccentric contraction
. Isometric contraction
. Isokinetic contraction
. Isotonic contraction

Correct Answer & Explanation

. Eccentric contraction

Explanation

Eccentric contractions occur when the muscle lengthens while under tension, and they can generate greater force than concentric or isometric contractions. They are the primary cause of muscle microtrauma leading to delayed onset muscle soreness (DOMS).

Question 359

Topic: Physiology & Rehabilitation

Following a traumatic nerve transection, skeletal muscle undergoes characteristic physiologic changes. Which of the following is a classic finding in denervated skeletal muscle at 3-4 weeks post-injury?

. Upregulation of extrajunctional acetylcholine receptors
. Hypertrophy of type I muscle fibers
. Increased resting membrane potential
. Conversion of type IIb to type IIa fibers
. Decreased spontaneous fibrillation potentials on EMG

Correct Answer & Explanation

. Upregulation of extrajunctional acetylcholine receptors

Explanation

Following denervation, skeletal muscle becomes hypersensitive to acetylcholine due to the massive upregulation and spread of extrajunctional acetylcholine receptors across the entire sarcolemma. This manifests as spontaneous fibrillation potentials on EMG.

Question 360

Topic: Physiology & Rehabilitation

During a normal human gait cycle, at what specific phase does the tibialis anterior exhibit its peak electromyographic (EMG) activity?

. Initial contact (heel strike) to loading response
. Mid-stance to terminal stance
. Pre-swing
. Initial swing
. Mid-swing

Correct Answer & Explanation

. Initial contact (heel strike) to loading response

Explanation

The tibialis anterior peaks in activity during the transition from initial contact to the loading response. It fires eccentrically during this phase to control ankle plantar flexion and prevent 'foot slap'.

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