CCEP Diagnosis & Assessment Techniques 4 — Questions and Answers
Question 1: In assessing patellofemoral syndrome, the Clarke's test (patellar grind test) is performed by applying pressure where?
- Medial border of the patella during passive knee flexion
- Superior pole of the patella while asking the patient to contract the quadriceps (Correct answer)
- Lateral retinaculum during passive patellar glide
- Inferior pole of the patella during active extension
Correct answer: Superior pole of the patella while asking the patient to contract the quadriceps
Clarke's test compresses the patella against the femoral condyles at the superior pole while the patient contracts the quadriceps, reproducing retropatellar pain if patellofemoral syndrome is present.
Question 2: Which goniometric measurement represents the normal range of motion for forearm pronation?
- 45 degrees
- 60 degrees
- 80 degrees (Correct answer)
- 90 degrees
Correct answer: 80 degrees
Normal forearm pronation is approximately 80 degrees, measured from the neutral position with the elbow at 90 degrees of flexion.
Question 3: A positive Spurling's test during cervical examination reproduces arm symptoms when performing which combined maneuvers?
- Cervical flexion with contralateral rotation
- Cervical compression with ipsilateral rotation and lateral flexion (Correct answer)
- Cervical distraction with bilateral shoulder depression
- Cervical rotation alone with overpressure
Correct answer: Cervical compression with ipsilateral rotation and lateral flexion
Spurling's test combines axial compression with ipsilateral lateral flexion and rotation to narrow the neural foramen and reproduce radicular symptoms.
Question 4: On a normal wrist X-ray, Gilula's arcs help identify carpal instability. Which carpal row forms the distal arc (Arc III)?
- Proximal surfaces of the proximal carpal row
- Distal surfaces of the proximal carpal row
- Proximal surfaces of the distal carpal row (Correct answer)
- Distal surfaces of the hamate and capitate
Correct answer: Proximal surfaces of the distal carpal row
Gilula's third arc traces the proximal surfaces of the distal carpal row (trapezoid, capitate, hamate); disruption suggests midcarpal instability.
Question 5: The Lachman test for ACL integrity is preferred over the anterior drawer test because it is more sensitive at which knee flexion angle?
- 90 degrees
- 45 degrees
- 20–30 degrees (Correct answer)
- 0 degrees (full extension)
Correct answer: 20–30 degrees
At 20–30 degrees of knee flexion, the hamstrings are more relaxed and the ACL's anteromedial bundle is under maximum tension, making the Lachman test more sensitive.
Question 6: When assessing shoulder instability, the sulcus sign is elicited by applying which force to the arm?
- Anterior directed force on the proximal humerus
- Inferior traction on the arm with the patient seated (Correct answer)
- Posterior directed force with the arm at 90 degrees
- Superior compression through the long axis of the humerus
Correct answer: Inferior traction on the arm with the patient seated
The sulcus sign is created by applying inferior traction to the arm, causing a visible depression (sulcus) below the acromion if inferior glenohumeral laxity is present.
Question 7: Which diagnostic imaging modality is the gold standard for assessing articular cartilage integrity in extremity joints?
- Plain radiography
- Computed tomography (CT)
- Magnetic resonance imaging (MRI) (Correct answer)
- Diagnostic ultrasound
Correct answer: Magnetic resonance imaging (MRI)
MRI provides superior soft tissue contrast and is the gold standard for evaluating articular cartilage lesions, menisci, ligaments, and other intra-articular structures.
CCEP Diagnosis & Assessment Techniques 4
In assessing patellofemoral syndrome, the Clarke's test (patellar grind test) is performed by applying pressure where?