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 141
Topic: Physiology & Rehabilitation
The primary type of nerve fiber responsible for transmitting the acute, sharp pain signals associated with an acute fracture or injury to the periosteum is:
Correct Answer & Explanation
. Small myelinated A-delta fibers
Explanation
Nociceptive (pain-sensing) nerve fibers are broadly classified into A-delta fibers and C fibers. A-delta fibers are small, thinly myelinated fibers that conduct impulses faster than C fibers. They are responsible for transmitting the "first pain" sensation β sharp, well-localized, and acute pain, such as that experienced immediately after a fracture or periosteal injury. C fibers are unmyelinated, conduct impulses more slowly, and are responsible for the "second pain" β dull, aching, burning, and poorly localized pain. A-alpha and A-beta fibers are large, heavily myelinated fibers associated with proprioception, motor control, and touch/pressure, respectively, not primary pain transmission.
Question 142
Topic: Physiology & Rehabilitation
During sustained, high-intensity muscle activity (e.g., a sprint), skeletal muscle primarily generates ATP through which metabolic pathway?
Correct Answer & Explanation
. Anaerobic glycolysis
Explanation
Skeletal muscle can generate ATP through several pathways depending on the intensity and duration of activity. During sustained, high-intensity exercise (e.g., sprinting), the demand for ATP outpaces the oxygen supply for aerobic metabolism. In this scenario, anaerobic glycolysis becomes the primary pathway. Glucose is broken down into pyruvate, which is then converted to lactate in the absence of oxygen, rapidly producing a small amount of ATP. While less efficient than oxidative phosphorylation, it provides a quick burst of energy for maximal effort activities. Oxidative phosphorylation is the main pathway for prolonged, lower-intensity exercise.
Question 143
Topic: Physiology & Rehabilitation
During the single-leg stance phase of gait, the hip joint experiences forces significantly greater than body weight. This is primarily due to the contribution of which of the following?
Correct Answer & Explanation
. Abductor muscle contraction
Explanation
During single-leg stance, the hip joint is subjected to forces substantially greater than body weight. This is primarily because the hip abductor muscles (gluteus medius and minimus) must contract powerfully to counteract the adduction moment created by the body's center of gravity acting on a long lever arm relative to the hip joint center. The force generated by these muscles, combined with the body weight acting through its lever arm, results in a significantly elevated hip joint reaction force, often estimated at 2.5 to 3 times body weight in normal gait. The ground reaction force is a component, but the muscle force is the major additive factor.
Question 144
Topic: Physiology & Rehabilitation
The main function of the sarcoplasmic reticulum in skeletal muscle cells is to:
Correct Answer & Explanation
. Store and release calcium ions
Explanation
The sarcoplasmic reticulum (SR) is a specialized endoplasmic reticulum found in muscle cells. Its primary and critical function is to store and rapidly release calcium ions (Ca2+) in response to an action potential. The release of Ca2+ into the sarcoplasm initiates muscle contraction by binding to troponin, while its re-uptake by SR calcium pumps leads to muscle relaxation. This precise control of intracellular calcium levels is central to excitation-contraction coupling.
Question 145
Topic: Physiology & Rehabilitation
During normal human gait, the peak force across the hip joint occurs during which phase of the gait cycle, and is primarily generated by the contraction of which muscle group?
Correct Answer & Explanation
. Mid-stance; hip abductors
Explanation
The peak joint reaction force across the hip occurs during the single-leg stance phase (mid-stance). It is driven predominantly by the strong contraction of the hip abductors (gluteus medius and minimus) acting to level the pelvis against the body weight's moment arm.
Question 146
Topic: Physiology & Rehabilitation
During rehabilitation of a quadriceps tendon rupture, the physiotherapist emphasizes specific muscle contractions. According to muscle physiology, which type of muscle contraction generates the highest maximal tension within the muscle fibers?
Correct Answer & Explanation
. Eccentric isotonic contraction
Explanation
Eccentric contractions (muscle lengthening under tension) generate the highest maximal force compared to isometric or concentric contractions. This mechanism is crucial in deceleration activities and is frequently implicated in tendon ruptures.
Question 147
Topic: Physiology & Rehabilitation
During the normal human gait cycle, at what specific phase does the gluteus maximus exhibit its peak electromyographic (EMG) activity?
Correct Answer & Explanation
. Terminal swing and initial contact (heel strike)
Explanation
The gluteus maximus works eccentrically at terminal swing to decelerate the forward momentum of the swinging leg, and then achieves peak concentric activity immediately after initial contact (heel strike) to extend the hip and stabilize the trunk from pitching forward.
Question 148
Topic: Physiology & Rehabilitation
Which of the following physiological characteristics best distinguishes Type I (slow-twitch) skeletal muscle fibers from Type II (fast-twitch) skeletal muscle fibers?
Correct Answer & Explanation
. Higher mitochondrial density and oxidative capacity
Explanation
Type I muscle fibers are 'slow-twitch' and fatigue-resistant. They rely primarily on oxidative phosphorylation for energy production. Consequently, they possess a higher mitochondrial density, higher myoglobin content (giving them a red appearance), and greater capillary density. In contrast, Type II fibers have faster myosin ATPase activity, rely more on glycolysis, and generate greater peak force but fatigue much more rapidly.
Question 149
Topic: Physiology & Rehabilitation
According to Saunders et al., the determinants of normal human gait function to minimize the vertical and lateral displacement of the body's center of gravity. Which of the following movements is a primary determinant that specifically acts to reduce the peak of the vertical center of gravity trajectory?
Correct Answer & Explanation
. Knee flexion in the stance phase
Explanation
Saunders et al. described six determinants of gait. Knee flexion in the stance phase (typically around 15 degrees) serves to lower the peak of the vertical displacement of the center of gravity, thereby reducing the metabolic energy required for walking.
Question 150
Topic: Physiology & Rehabilitation
During the descent phase of a squat exercise, the quadriceps muscle actively lengthens while remaining under tension to control knee flexion. What type of muscle contraction does this describe?
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction occurs when the muscle lengthens while actively producing force (e.g., the quadriceps during the descent phase of a squat acting as a brake). Concentric contractions occur when the muscle shortens, and isometric contractions occur when there is no change in muscle length.
Question 151
Topic: Physiology & Rehabilitation
A 72-year-old man with cervical spondylosis falls forward, striking his forehead. He presents with profound bilateral upper extremity weakness but retains moderate strength in his lower extremities. Which of the following is true regarding his condition?
Correct Answer & Explanation
. It typically carries a better prognosis for ambulatory recovery than complete cervical cord injuries.
Explanation
This presentation is classic for Central Cord Syndrome, which disproportionately affects upper extremities. It carries a favorable prognosis for functional ambulation compared to complete injuries, with hand recovery typically being the last to return.
Question 152
Topic: Physiology & Rehabilitation
During skeletal muscle contraction, maximum isometric tension is generated at optimal resting length. This length corresponds physiologically to which of the following states?
Correct Answer & Explanation
. Maximum overlap of thick and thin filaments without interference
Explanation
Maximum isometric tension occurs at optimal resting length due to the maximum number of cross-bridges formed between overlapping actin and myosin filaments without spatial interference.
Question 153
Topic: Physiology & Rehabilitation
In myelinated peripheral nerves, saltatory conduction occurs rapidly due to the high concentration of which specific ion channels at the Nodes of Ranvier?
Correct Answer & Explanation
. Voltage-gated sodium channels
Explanation
Nodes of Ranvier contain highly concentrated voltage-gated sodium channels, which allow rapid depolarization and propagation of action potentials from node to node, known as saltatory conduction.
Question 154
Topic: Physiology & Rehabilitation
During a normal human gait cycle, maximum muscle activity of the tibialis anterior occurs at which specific phase to prevent foot drop?
Correct Answer & Explanation
. Heel strike (Initial contact)
Explanation
The tibialis anterior peaks in activity just after heel strike (initial contact). It fires eccentrically to control plantarflexion of the foot, preventing it from slapping against the ground.
Question 155
Topic: Physiology & Rehabilitation
Which type of muscle contraction generates the highest maximum force, and what is its associated physiological energy characteristic?
Correct Answer & Explanation
. Eccentric contraction; lowest energy expenditure for a given force
Explanation
Eccentric contractions generate the highest maximum force while consuming less ATP compared to concentric contractions. However, they are more frequently associated with delayed-onset muscle soreness.
Question 156
Topic: Physiology & Rehabilitation
During the normal human gait cycle, which muscle group demonstrates peak activity during the initial contact (heel strike) to loading response phase to safely lower the foot?
Correct Answer & Explanation
. Dorsiflexors (tibialis anterior) eccentrically
Explanation
At initial contact to loading response, the tibialis anterior contracts eccentrically to smoothly lower the foot to the ground. This prevents the rapid plantar flexion known as "foot slap".
Question 157
Topic: Physiology & Rehabilitation
Type I (slow-twitch) skeletal muscle fibers are primarily characterized by which type of metabolism and fatigue resistance?
Correct Answer & Explanation
. Oxidative metabolism; high resistance to fatigue
Explanation
Type I muscle fibers rely on oxidative metabolism and have a high density of mitochondria and myoglobin. This allows them to maintain sustained, low-intensity contractions with a very high resistance to fatigue.
Question 158
Topic: Physiology & Rehabilitation
A physical therapy protocol specifies a muscle contraction where tension remains constant while the muscle actively lengthens to control a decelerating load. Which of the following best describes this type of muscle contraction?
Correct Answer & Explanation
. Eccentric
Explanation
An eccentric contraction occurs when a muscle lengthens while simultaneously generating tension, typically acting to decelerate a joint or resist gravity. It generates the highest forces compared to other contraction types and is primarily responsible for delayed onset muscle soreness (DOMS).
Question 159
Topic: Physiology & Rehabilitation
During the normal gait cycle, maximum physiological dorsiflexion of the ankle occurs at which of the following phases?
Correct Answer & Explanation
. Terminal stance
Explanation
Maximum ankle dorsiflexion (approximately 10 degrees) occurs at the end of the terminal stance phase, immediately prior to heel-off. This pre-loads the gastrocsoleus complex for the rapid plantarflexion required during pre-swing (toe-off).
Question 160
Topic: Physiology & Rehabilitation
Because of the avascular nature of articular cartilage, chondrocytes reside in a relatively hypoxic environment. Which of the following represents the primary metabolic pathway utilized by mature chondrocytes for ATP production?
Correct Answer & Explanation
. Anaerobic glycolysis
Explanation
Mature articular chondrocytes operate in a characteristically low-oxygen environment and therefore rely almost exclusively on anaerobic glycolysis for cellular ATP production. This process results in the constant generation of lactic acid, which diffuses out into the synovial fluid.
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