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 361
Topic: Physiology & Rehabilitation
During a prolonged, low-intensity endurance activity such as marathon running, which of the following muscle fiber types is predominantly recruited, and what is its primary metabolic pathway?
Correct Answer & Explanation
. Type I; oxidative phosphorylation
Explanation
Type I muscle fibers are slow-twitch, fatigue-resistant fibers that are rich in mitochondria and myoglobin. They rely predominantly on oxidative phosphorylation for energy during prolonged endurance activities.
Question 362
Topic: Physiology & Rehabilitation
During an eccentric muscle contraction, how does the force-velocity relationship primarily differ from that of a concentric muscle contraction?
Correct Answer & Explanation
. Force increases as the velocity of lengthening increases
Explanation
In an eccentric contraction, the muscle lengthens while contracting against a load. The force generated increases as the velocity of lengthening increases until a plateau is reached, generating forces greater than maximum isometric force.
Question 363
Topic: Physiology & Rehabilitation
Which of the following physiologic and morphologic characteristics best describes Type I skeletal muscle fibers?
Correct Answer & Explanation
. High myoglobin content, aerobic metabolism, fatigue resistant
Explanation
Type I muscle fibers are "slow-twitch" fibers that rely heavily on aerobic metabolism. They possess high myoglobin content, high capillary density, and are highly fatigue-resistant, making them ideal for postural control and endurance.
Question 364
Topic: Physiology & Rehabilitation
During rehabilitation of a reconstructed anterior cruciate ligament, understanding muscle physiology is critical. Which type of muscle contraction generates the highest maximal force or tension within the muscle-tendon unit?
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction, where the muscle lengthens while under tension, is capable of generating the highest maximum force. This is why eccentric exercises are associated with the highest risk of muscle strains and tendinopathies.
Question 365
Topic: Physiology & Rehabilitation
During a marathon, a runner relies primarily on Type I skeletal muscle fibers. Which of the following best describes the metabolic characteristics of Type I fibers?
Correct Answer & Explanation
. Slow twitch, aerobic, high mitochondria
Explanation
Type I muscle fibers are slow-twitch, highly oxidative (aerobic), and possess abundant mitochondria and myoglobin. They are highly resistant to fatigue, making them ideal for endurance activities.
Question 366
Topic: Physiology & Rehabilitation
A patient walks with a compensatory Trendelenburg gait, shifting their trunk laterally over the stance leg. This gait adaptation is primarily designed to reduce the mechanical demand on which of the following muscles?
Correct Answer & Explanation
. Ipsilateral gluteus medius
Explanation
Shifting the trunk laterally over the stance leg (abductor lurch) decreases the lever arm of the body's center of gravity relative to the hip joint. This reduces the joint reactive force and the force required by the ipsilateral gluteus medius to maintain a level pelvis.
Question 367
Topic: Physiology & Rehabilitation
During the descent phase of a deep squat, the quadriceps muscle actively lengthens to control the downward movement. Which type of muscle contraction is taking place?
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction occurs when a muscle generates tension while it actively lengthens. This type of contraction is highly energy-absorbent and is commonly used for deceleration, such as controlling the descent of a squat.
Question 368
Topic: Physiology & Rehabilitation
During the early stance phase of the normal gait cycle, the quadriceps muscle contracts to control knee flexion. This type of muscle contraction is best described as:
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction occurs when a muscle lengthens while under tension, serving to decelerate a joint. The quadriceps act eccentrically during early stance to absorb shock and prevent the knee from buckling.
Question 369
Topic: Physiology & Rehabilitation
During the normal gait cycle, the knee relies on the 'screw-home' mechanism for locking in full terminal extension. Which muscle is primarily responsible for 'unlocking' the knee from extension to initiate flexion?
Correct Answer & Explanation
. Popliteus
Explanation
The popliteus muscle acts to internally rotate the tibia on a fixed femur (or externally rotate the femur on a fixed tibia) to unlock the knee from its terminal extension (screw-home) position. This action is essential to initiate knee flexion from a fully extended stance.
Question 370
Topic: Physiology & Rehabilitation
Which of the following physiologic characteristics is true regarding Type I skeletal muscle fibers when compared to Type IIb fibers?
Correct Answer & Explanation
. Higher concentration of mitochondria
Explanation
Type I muscle fibers are 'slow-twitch' endurance fibers. They are rich in myoglobin (appearing red), have a high concentration of mitochondria, and rely primarily on aerobic oxidative phosphorylation. In contrast, Type IIb fibers are 'fast-twitch' fibers that rely on anaerobic glycolysis, fatigue rapidly, and have a higher glycogen content.
Question 371
Topic: Physiology & Rehabilitation
During the normal gait cycle, at what phase does the maximum force on the hip joint occur?
Correct Answer & Explanation
. Mid-stance
Explanation
Maximum force across the hip joint occurs during mid-stance when the abductors (primarily gluteus medius) must contract forcefully to stabilize the pelvis while the entire body weight is supported on one leg. The joint reaction force can reach 2.5 to 3 times body weight.
Question 372
Topic: Physiology & Rehabilitation
During a physical therapy session, a patient is performing a quadriceps strengthening exercise on a specialized machine that provides accommodating resistance to maintain a constant angular velocity of the knee joint throughout the entire range of motion. What type of muscle contraction is this?
Correct Answer & Explanation
. Isokinetic contraction
Explanation
Isokinetic contractions occur when a muscle contracts at a constant velocity throughout the range of motion. Because mechanical advantage changes with joint angle, maintaining a constant velocity requires specialized equipment (like a Cybex machine) that provides accommodating resistance. Isometric equals constant length; Isotonic equals constant tension.
Question 373
Topic: Physiology & Rehabilitation
During the normal human gait cycle, at what point does the maximum compressive force occur across the hip joint?
Correct Answer & Explanation
. Mid-stance
Explanation
During the single-limb support phase (mid-stance), the center of gravity shifts and the hip abductor muscles must fire forcefully to maintain a level pelvis. The combination of body weight and the powerful contraction force of the hip abductors results in the maximum joint reaction force (compressive force) across the hip, which can reach 2.5 to 3 times body weight.
Question 374
Topic: Physiology & Rehabilitation
A 45-year-old weightlifter experiences an acute distal biceps tendon rupture. This specific injury biomechanically occurs most frequently during which type of muscle contraction?
Correct Answer & Explanation
. Eccentric
Explanation
Eccentric contractions occur when a muscle generates tension while actively lengthening, yielding the highest peak force of any contraction type. This massive force generation renders the muscle-tendon unit most susceptible to mechanical failure and rupture.
Question 375
Topic: Physiology & Rehabilitation
During the controlled descent phase of a barbell squat, the quadriceps muscle lengthens while continuing to generate tension to control the rate of knee flexion. What type of muscle contraction is primarily occurring in the quadriceps?
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction occurs when the muscle lengthens while under tension, typically to decelerate a joint motion against gravity. Concentric contractions involve muscle shortening while generating force. Isometric contractions involve force generation with no change in muscle length. Eccentric contractions generate the highest forces and are most commonly associated with muscle strains and delayed onset muscle soreness (DOMS).
Question 376
Topic: Physiology & Rehabilitation
Following an inadvertently intravascular injection of bupivacaine during a hematoma block, a patient develops perioral numbness, tinnitus, and generalized seizures. This local anesthetic systemic toxicity (LAST) is primarily mediated by the blockade of which of the following channels in the central nervous and cardiovascular systems?
Correct Answer & Explanation
. Voltage-gated sodium channels
Explanation
All local anesthetics (amides and esters) work by binding to the intracellular portion of voltage-gated sodium channels, preventing sodium influx and halting action potential propagation. When toxic levels reach the systemic circulation, this same blockade disrupts central nervous system and cardiac conducting tissues, leading to seizures and potentially fatal arrhythmias.
Question 377
Topic: Physiology & Rehabilitation
Which of the following lubrication mechanisms relies primarily on the glycoprotein lubricin (PRG4) to prevent cartilage-to-cartilage contact under conditions of high load and low relative velocity?
Correct Answer & Explanation
. Boundary lubrication
Explanation
Boundary lubrication predominates in high-load, low-velocity situations (e.g., standing). It involves a single layer of lubricant molecules (primarily lubricin/PRG4) directly bound to the articular surfaces to prevent physical contact. Fluid-film (elastohydrodynamic) lubrication relies on a wedge of pressurized fluid to separate surfaces and operates during high-velocity motions (e.g., the swing phase of gait).
Question 378
Topic: Physiology & Rehabilitation
During a normal adult walking gait cycle, the peak maximum muscle contraction of the ankle plantar flexors (gastrocnemius-soleus complex) occurs during which specific phase?
Correct Answer & Explanation
. Terminal stance
Explanation
The peak activity of the gastrocnemius-soleus complex occurs during terminal stance. During this phase, the heel rises off the ground, and powerful plantar flexion ('push-off') accelerates the body forward. During mid-stance, the calf muscles contract eccentrically to control tibial advancement over the planted foot.
Question 379
Topic: Physiology & Rehabilitation
During the normal human gait cycle, at which phase does the tibialis anterior muscle reach its absolute peak of electrical activity?
Correct Answer & Explanation
. Initial contact (heel strike) to loading response
Explanation
The tibialis anterior has two peaks of activity during the gait cycle. Its maximum peak occurs during initial contact (heel strike) to loading response, where it contracts eccentrically to decelerate plantar flexion, preventing the foot from slapping against the ground. The second, smaller peak occurs during the initial and mid-swing phases, where it contracts concentrically to dorsiflex the ankle and clear the toes.
Question 380
Topic: Physiology & Rehabilitation
During the rehabilitation phase following an Achilles tendon repair, a patient performs 'heel drops', slowly lowering their heel below the level of a stair step. Which type of muscle contraction is predominantly utilized by the gastrocnemius-soleus complex during the lowering phase?
Correct Answer & Explanation
. Isotonic eccentric
Explanation
An isotonic eccentric contraction occurs when the muscle lengthens while under tension. During the lowering phase of a heel drop, the gastrocnemius-soleus complex is actively firing to control the descent, but the muscle-tendon unit is lengthening. Concentric contraction occurs when the muscle shortens (e.g., raising the heel). Isometric occurs when length does not change.
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