PMR 1 - anatomy

Question 1

What type of joint is the hip?
a. Ball and socket
b. Hinged
c. Pivot
d. Gliding

Answer 1

A) Hinged joints only allow a small range of motion (ROM) (e.g., the humerus with the ulna and radius). Pivot joints allow a wide ROM, but not as much freedom as ball and socket joints (between atlas and axis). Gliding joints allow sliding motion between two bones (e.g., wrist and ankle). Ball and socket joints have full ROM (hips, shoulders).

Question 2

Which is not a hip flexor muscle?
a. lliopsoas
b. Gracilis
c. Adductor magnus
d. Rectus femoris

Answer 2

C) The adductor magnus is a hip extensor.
All of the other muscles are hip flexors.

Question 3

Which is not a hip abductor?
a. Gluteus medius
b. Gluteus minimus
c. Long head of biceps femoris
d. Piriformis

Answer 3

C) The long head of the biceps femoris is a hip adductor. The gluteus medius and minimus muscles abduct the hip. The piriformis muscle abducts, internally rotates, and extends the hip.

Question 4

Which muscle is an internal rotator of the hip?
a. Obturator internus
b. Semitendinosus
c. Quadratus femoris
d. Superior gemellus

Answer 4

B) The semitendinosus is an internal rotator of the hip. All the other muscles are external rotators.

Question 5

Which muscle is an external rotator of the hip?
a. Tensor fasciae lata
b. Gluteus maximus
c. Gluteus medius
d. Gracilis

Answer 5

B) The gluteus maximus is an external rotator of the hip. All the other muscles are internal rotators.

Question 6

Whatis the function of the iliofemoral ligament?
a. Limit extension, abduction, and external rotation of the hip
b. Limit extension, adduction, and internal rotation of the hip
c. Limit flexion, abduction, and external rotation of the hip
d. Limit flexion, adduction, and internal rotation of the hip

Answer 6

A) The iliofemoral ligament is the strongest ligament of the body and limits extension, abduction, and external rotation of the hip.

Question 7

What is the normal range of motion for hip flexion in adults?
a. 0-150 degrees
b. 10-140 degrees
c. 0-100 degrees
d. 0-120 degrees

Answer 7

D) 0-120 degrees.

Question 8

Which of the following is not a joint of the
pelvic girdle?
a. Femoroacetabular (hip) joint
b. The pubic symphysis
c. Bilateral sacroiliac (SI) joints
d. Lumbosacral joint

Answer 8

D) Lumbosacral joint.

Question 9

What does FABERE (Patrick’s test) test for?
a. Hip joint dysfunction
b. Gluteus medius weakness
c. Femoral nerve irritation
d. Iliotibial band tightness

Answer 9

A) (F) Flex, (AB) abduct (ER) externally rotate the hip, with downward force causing (E) extension is the FABERE test. Anterior hip/groin pain is suggestive of hip joint pathology.

Question 10

What is the test to check for contraction of the iliotibial band?
a. Thomson’s test
b. Painful arc test
c. Ober test
d. Yergason’s test

Answer 10

C) Thomson’s test checks for hip flexion contractures. Painful arc checks for impingement of the supraspinatus.
Yergason’s test is used to assess for bicipital tendonitis. Ober
test abducts the involved leg as far as possible with the knee flexed to 90 degrees and the hip extended to 0. The leg is lowered.
If the leg remains abducted, the test is positive and indicates tightness in the iliotibial band.

Question 11

What are the signs of a positive
Trendelenburg test?
a. When the pelvis on the unsupported side stays the same height
b. When the pelvis on the unsupported side is elevated slightly
c. When the pelvis on the unsupported side descends
d. When the pelvis on the supported side stays level

Answer 11

C) The Trendelenburg sign tests for gluteus medius weakness. The strength of the gluteus medius (which acts as an abductor) is assessed. If the unsupported side descends, this is a positive test. For example, pelvic drop on the right side in a patient standing on left leg indicates left gluteus medius weakness.

Question 12

How do you measure for leg length discrepancy?
a. Anterior superior iliac spine (ASIS) to lateral malleolus
b. Posterior superior iliac spine (PSIS) to lateral malleolus
c. ASIS to medial mallelus
d. PSIS to medial malleolus

Answer 12

C) To assess for a leg length discrepancy, measure from the anterior superior iliac spine to the medial malleolus.

Question 13

If a patient is supine with knees flexed to
90 degrees and feet flat on the table, how will it be determined if the right femur is longer than the left?
a. Left knee is higher than the right
b. Right knee is higher than the left
c.Left knee is anterior to the right
d. Right knee is anterior to the left

Answer 13

D) If one knee projects further anteriorly in the position described, then that femur is longer. In this case, the right knee will be anterior to the left. If one knee is higher than the other, that tibia is longer.

Question 14

During which type of contraction is a hamstring injury most likely to occur?
a. Concentric muscle contraction
b. Eccentric muscle contraction
c. Isometric contractions
d. Isotonic contractions

Answer 14

B) During concentric contractions, muscles shorten. In eccentric contractions, the muscle lengthens. This usually occurs under tension, and the muscles are more prone to injury. Isometric contractions are static where muscle fibers do not change length. Isotonic contractions involve muscle length changes and encompass both concentric and eccentric contraction.

Question 15

All of the following are true about piriformis syndrome except:
a. The sciatic nerve may be involved because in some individuals the nerve runs through the piriformis muscle fibers
b. Pain may be in lateral buttock, posterior hip and thigh, sciatica-like pain
c. Pain with flexion, abduction, and external rotation
d. Pain may be exacerbated by walking up stairs or prolonged sitting

Answer 15

C) The provocative test for piriformis syndrome is FAIR (flexion, adduction, and internal rotation), which helps reproduce the symptoms.

Question 16

All of the following are true about iliopsoas bursitis and tendonitis except:
a. Condition may cause snapping hip svndrome with flexion
b. Pain with hip extension
c. Pain is usually noted deep in the groin and radiates to the front of hip
d. Refers to a stretch, tear, or complete rupture of your iliopsoas muscle and tendon where the tendon attaches to the femur

Answer 16

B) Pain is elicited with hip flexion. The acute injury often involves eccentric contraction of the iliopsoas muscle or rapid flexion against extension force/resistance but may less
commonly result from direct trauma. The overuse phenomenon may occur in any activity resulting in repeated hip flexion or external rotation of the femur.

Question 17

Which of the following is false about hip dislocation?
a. The most common type is anterior hip dislocation
b. Sciatic nerve may be stretched or compressed during posterior hip dislocations
c. Femoral nerve may be injured during anterior hip dislocation
d. Motor vehicle accidents are the most common cause of hip dislocations

Answer 17

A) The most common type of hip dislocation is posterior (90%).

Question 18

In a posterior hip dislocation, how will the leg be positioned?
a. Extended, adducted, internally rotated
b. Flexed, adducted, internally rotated
c. Extended, abducted, externally rotated
d. Flexed, adducted, externally rotated

Answer 18

B) The hip will be flexed, adducted, and internally rotated. The affected leg is shorter because the dislocated femoral head is higher than on the normal side, and the patient will be unable to abduct the affected side.

Question 19

What is the pathophysiology behind avascular necrosis of the femoral head?
a. Sepsis
b. Crystalline deposits
c. Interruption of the vascular supply
d. Friction

Answer 19

C) Also known as osteonecrosis of the hip or aseptic necrosis of the hip, this condition is characterized by destruction of the femoral head without sepsis. Interruption of the vascular supply is the defining common pathway of the disease process. The most common
causes in adults are steroid use or alcohol abuse.

Question 20

What is not true about hip fractures?
a. Females are more likely than males to sustain a hip fracture
b. Most common underlying cause is weakened bone from metastatic disease
c. Approximately 25% of patients over age 50 with hip fractures die within 1 year
d. About 50% of hip fracture patients require some form of assistive device

Answer 20

B) The most common cause of hip fractures is due to osteoporosis. In the vast majority of cases, a hip fracture is a fragility fracture due to a fall or minor trauma in someone
with weakened, osteoporotic bone. They are classified as intracapsular, which includes femoral head and neck fractures, or extracapsular, which includes trochanteric, intertrochanteric,
and subtrochanteric fractures. The location of the fracture and the amount of angulation and comminution play integral roles in the overall morbidity of the patient, as does the preexisting physical condition of the individual. The other options are all
true.

Question 21

What is the most common type of hip fracture?
a. Femoral neck
b. Intracapsular
c. Intertrochanteric
d. Subtrochanteric

Answer 21

C) An intertrochanteric hip fracture occurs three to four inches from the hip joint. This type of fracture does not interrupt the blood supply to the bone and may be easier to repair.

Question 22

Normal range of motion for the knee is:
a. 0-90 degrees
b. 0-135 degrees
c. 10-150 degrees
d. 0-170 degrees

Answer 22

B) 0-135 degrees.

Question 23

Which muscle is a knee flexor?
a. Rectus femoris
b. Vastus lateralis
c. Vastus medialis obliques
d. Biceps femoris

Answer 23

D) The rest of the muscles are knee extensors.

Question 24

Which muscle is a knee extensor?
a. Gracilis
b. Semimembranosus
c. Vastus intermedius
d. Biceps femoris.

Answer 24

C) The gracilis, semimembranosus, and biceps femoris are all knee flexors.

Question 25

Which nerve roots innervate the quadriceps?
a. L1, L2, L3
b. L2, L3, L4
C. L3, L4, L5
d. L4, L5, S1

Answer 25

B) The femoral nerve receives innervation from the L2, L3, and L4 nerve roots. The femoral nerve innervates the four heads of the quadriceps muscle as well supplying sensation to the medial surface of the thigh.

Question 26

The gastrocnemius muscle is supplied by which nerve?
a. Femoral nerve
b.Obturator nerve
c. Common peroneal nerve
d. Tibial nerve

Answer 26

D) The tibial nerve is a branch of the sciatic nerve. The tibial nerve innervates the gastrocnemius, popliteus, soles, and plantaris muscles. The sural nerve is a cutaneous branch of the tibial, but also receives innervation from the peroneal nerve.

Question 27

Which ligament of the spine resists extension?
a. Posterior longitudinal ligament
b. Ligamentum fl avum and facet joint capsule
C. Anterior longitudinal ligament
d. Interspinous and supraspinous ligaments

Answer 27

C) The anterior longitudinal ligament runs anteriorly and vertically attaching to the front of each vertebra. It traverses all of the vertebral bodies and intervertebral discs.

Question 28

Which muscle is a lateral (external) rotator of the leg?
a. Biceps femoris
b. Semitendinosus
c. Sartorius
d. Gracilis

Answer 28

A) The primary action of the long head of the biceps femoris is extension of the hip. The primary actions of the short head of the biceps femoris are knee flexion and lateral rotation.

Question 29

Which nerve root will most likely be affected by a posterior L3-L4 herniated disc?
a. L2
b. L3
c. L4
d. L5

Answer 29

C) Posterior herniations commonly miss the nerve in the foramen, and instead tends to affect the nerve one level distal. This is because the roots from the level below are located more laterally before exiting the canal, making them more vulnerable to impingement.

Question 30

All of the following are true about the anterior cruciate ligament (ACL) except:
a. It originates in the medial femoral condyle and attaches to the lateral tibial eminence
b. It draws the femoral condyles anteriorly during flexion
C. Prevents hyperextension of the knee and backward sliding of the femur
d. Internal rotation of the femur tightens it, and external rotation loosens it

Answer 30

A) The ACL originates in the lateral femoral condyle and attaches to the medial tibial eminence
after traveling through the intercondylar notch.

Question 31

What part of the meniscus of the knee is poorly vascularized?
a. Peripheral outer 1/3
b. Peripheral outer 2/3
c. Inner 2/3
d. Inner 1/3

Answer 31

C) Most meniscal tissue is avascular and depends on passive diffusion and mechanical pumping to provide nutrition to the fibrocytes within the meniscal substance. The limited peripheral blood supply originates from the medial and lateral inferior and superior geniculate arteries. Repair is usually only successful in well-vascularized areas.

Question 32

Which is not an anterior bursa of the knee?
a. Prepatellar bursa
b. Pes anserine bursa
c. Deep infrapatellar bursa
d. Suprapatellar bursa

Answer 32

B) The pes anserine bursa is a medial bursa. There are four anterior bursae: prepatellar, suprapatellar, deep infrapatellar, and superficial (subcutaneous infrapatellar) bursa.

Question 33

What is located at the attachment of the tendons of the sartorius, gracilis, semitendinosus, and the medial collateral ligament?
a. Baker’s cyst
b. Pes anserine bursa
c. Posterior bursa
d. Deep infrapatellar bursa

Answer 33

B) Baker’s cyst is a distended bursa located between the medial head of the gastrocnemius and capsule extending under the semimembranosus. There is a second posterior bursa located between the lateral head of the gastrocnemius and the capsule.
The deep infrapatellar bursa is located between the patellar tendon and the tibia.

Question 34

What is the “terrible triad”?
a. Medial/lateral meniscal injury with anterior cruciate ligament (ACL) tear
b. ACL, medial cruciate ligament (MCL), and medial meniscus injury
c. ACL, posterior cruciate ligament (PCL), lateral meniscus injury
d. ACL, MCL, and PCL

Answer 34

B) This injury usually occurs due to a lateral blow to the knee causing a rupture in the ACL, MCL, and medial meniscus. This occurs when a lateral force is applied to the knee when the foot is fixed to the ground causing a rotational force to tear all three structures.

Question 35

Which test helps determine if a patient has an anterior cruciate ligament injury?
a. McMurray’s test
b. Apley grind test
c. Lachman test
d. Quadriceps active test

Answer 35

C) Lachman test is the most sensitive test for A CL injury or laxity. McMurray’s and Apley grind tests assess injury to the lateral meniscus and medial meniscus. The quadriceps active test assesses posterior collateral ligament disruption.

Question 36

What is the medical term for “knock-kneed”?
a. Genu varum
b. Genu valgum
c. Genu recurvatum
d. Genu anterium

Answer 36

B) Genu valgum is excessive valgum or
“knock kneed.” Genu varum is “bow legged.”
Hyperextension or “back kneed” is genu recurvatum. Genu anterium is not a medical
definition.

Question 37

Which of the following is true about the posterior cruciate ligament (PCL)?
a. Primary function is to restrain posterior tibial translation
b. Inserts on superior aspect of medial tibia
c. Tightens in extension
d. It attaches to the medial meniscus

Answer 37

A) PCL primarily restrains posterior tibial translation. It originates from the medial femoral condyle and inserts on the posterior aspect of tibial plateau. It loosens with extension, and becomes tighter with flexion.

Question 38

Which ligament can be mistaken for a tear of the posterior horn of the lateral meniscus on MRI?
a. Anterior cruciate ligament (ACL)
b. Posterior cruciate ligament (PCL)
C. Arcuate popliteal ligament complex
(APLC)
d. Oblique popliteal ligament (OPL)

Answer 38

C) APLC. The arcuate popliteal ligament complex provides attachment for the posterior lateral meniscus, and this site can be mistaken for a posterior tear of the lateral meniscus.

Question 39

Which meniscus is “O” shaped in the knee?
a. Medial meniscus
b. Anterior meniscus
c. Lateral meniscus
d. Posterior meniscus

Answer 39

C) The lateral meniscus is larger than the medial meniscus, which is shaped like a “C.”
There are no structures named anterior or posterior meniscus.

Question 40

Which muscle is an ankle dorsiflexor and inverter?
a. Tibialis anterior
b.Peroneus tertius
c. Peroneus brevis
d. Plantaris

Answer 40

A) Tibialis anterior is an ankle dorsiflexor and inverter. Peroneus tertius dorsiflexes and everts the foot. Peroneus brevis everts and plantar flexes the foot. The plantaris is a weak plantar flexor.

Question 41

Which is not a compartment of the lower leg?
a. Lateral compartment
b. Anterior compartment
c. Superficial posterior compartment
d. Medial compartment

Answer 41

D) The deep posterior, superficial posterior, lateral, and anterior compartment makes up the four compartments of the lower leg.

Question 42

What forms the medial malleolus?
a. Talus and calcaneus
b. Distal tibia
c. Distal fibula
d. Cuneiform bones

Answer 42

B) The medial malleolus is the prominence on the inner side of the ankle, formed by the lower end of the tibia.

Question 43

What forms the lateral malleolus?
a. Distal tibia
b. Distal fibula
c. Talus
d. Navicular

Answer 43

B) The distal fibula forms the lateral malleolus of the ankle and is joined to the tibia and to the talus.

Question 44

Which ligament is the weakest of the ankle ligaments?
a. Deltoid ligament
b. Calcaneofibular ligament
c. Anterior talofibular ligament
d. Posterior talofibular ligament

Answer 44

C) Most sprains affect the anterior talofibular ligament. The ligament comes under strain and is vulnerable to injury; particularly when the foot is inverted.

Question 45

Which ligament stabilizes the medial ankle?
a. Posterior talofi bular ligament
b. Deltoid ligament
c. Anterior talofi bular ligament
d. Calcaneofi bular ligament

Answer 45

B) The deltoid ligament functions to support the medial surface of the ankle. It helps to connect the tibia to the calcaneus, navicular, and talus bones.

Question 46

What is the function of the Lisfranc ligament?
a. Connects the distal tibia to the talus
b. Connects the second metatarsal.
head to the first cuneiform
c. Preserves the medial longitudinal arch of the foot
d. Primary ankle stabilizer

Answer 46

B) Lisfranc ligament connects the base of the medial cuneiform to the base of the second metatarsal. It is injured or disrupted in a Lisfranc fracture.

Question 47

What the normal range of motion for plantar flexion of the ankle?
a. 20 degrees
b. 30 degrees
c. 50 degrées
d. 90 degrees

Answer 47

C) Normal ROM for the ankle is 50 degrees
of plantar flexion and 20 degrees of dorsiflexion.

Question 48

Which nerve innervates the flexor hallucis longus (FHL)?
a. Medial plantar nerve
b. Superficial peroneal nerve
c. Sural nerve
d. Tibial nerve

Answer 48

D) The tibial nerve innervates the FHL.

Question 49

What does the anterior drawer test assess in the ankle?
a. Integrity of calcaneofi bular ligament
b. Integrity of anterior talofi bular ligament
c. Integrity of posterior talofi bular ligament
d. Integrity of deltoid ligament

Answer 49

B) Anterior talofi bular ligament. To perform this test, stabilize the distal part of the leg with one hand and apply anterior force to the heel with the other hand. This attempts to sublux the talus anteriorly from beneath the tibia when performing the test.

Question 50

An Achilles tendon injury is most likely to occur with what action?
a. Sudden pivoting
b. Internal rotation of the ankle
c. Abruptly starting a sprint
d. Walking uphill

Answer 50

C) The Achilles tendon attaches the gastrocnemius to the heel. As the muscle shortens, the tendon plantarflexes the foot.
An acute injury occurs when a healthy tendon is subjected to a sudden, unexpected force, such as pushing off for a sprint or landing from a jump.

Question 51

Where is the most common location of an
Achilles tendon rupture?
a. At the attachment to the calcaneus
b. At the aponeurosis of the gastrocnemius
c. 2-5 cm proximal to tendon insertion at calcaneus
d. Near the soleus

Answer 51

C) The “watershed zone” of the Achilles is in the substance of the tendoachilles, approximately 2 to 5 cm above the calcaneal insertion of the tendon. This is an area of hypovascularity and where most ruptures occur.

Question 52

Which is not a characteristic of plantar fasciitis?
a. Affects females more than males
b. Tenderness over lateral aspect of the heel
c. Pain is worse in the morning
d. Heel spurs may contribute to the etiology

Answer 52

B) Tenderness occurs over the medial aspect of the heel in plantar fasciitis.

Question 53

Where are motor axons found?
a. Mainly in anterior (ventral) nerve roots
b. Mainly in posterior (dorsal) nerve
roots
c. Dorsal root ganglion
d. Proximal nerve roots

Answer 53

A) The anterior nerve roots contain mostly motor axons, whereas posterior nerve roots are mainly sensory. The dorsal root ganglion contains cell bodies of sensory axons.

Question 54

The patellar tendon reflex assesses which nerve root?
a. L1
b. L4
c. L5
d. S1

Answer 54

B) Striking the tendon just below the patella stretches the muscle spindle in the quadriceps femoris muscle. This produces a monosynaptic reflex arc back to the spinal cord and synapses at the level of L4 in the spinal cord. From there, an alpha-motor neuron conducts an efferent impulse back to the quadriceps femoris muscle, triggering contraction resulting in knee extension.

Question 55

The Achilles reflex assesses which nerve root?
a. L4
b. L5
C. S1
d. S3

Answer 55

C) The ankle jerk (Achilles reflex), occurs when the Achilles tendon is tapped when the foot is slightly dorsiflexed and produces plantar flexion.

Question 56

If someone has weak knee extension and hip flexion, what nerve is most likely injured?
a. Obturator nerve
b. Femoral nerve
C. Sciatic nerve
d. Tibial nerve

Answer 56

B) The femoral nerve is formed from the
L2-4 nerve roots. The main motor component innervates the iliopsoas (hip flexor) and the quadriceps (knee extensor).

Question 57

A tibial nerve injury is characterized by:
a. Weak hip adduction
b. Weak foot eversion and dorsiflexion
c. Weak foot inversion and plantar flexion
d. Weak knee extension

Answer 57

C) Tibial nerve arises from L4-S3. In the popliteal fossa, the nerve branches off to the gastrocnemius, popliteus, soleus, and plantaris muscles. The nerve’s primary actions are foot inversion and ankle plantar flexion.