NPTE-PT Musculoskeletal System Examination 5 — Questions and Answers
Question 1: A patient presents with a positive Thompson test (no plantar flexion with calf squeeze). This indicates rupture of which structure?
- Plantaris tendon
- Posterior tibialis tendon
- Achilles tendon (Correct answer)
- Flexor hallucis longus
Correct answer: Achilles tendon
The Thompson test assesses Achilles tendon continuity; absence of plantar flexion when the calf is squeezed indicates a complete Achilles tendon rupture.
Question 2: Which of the following describes the Cyriax concept of a 'non-capsular pattern' of restriction?
- All motions equally limited as in joint ankylosis
- Restriction in a specific ratio dictated by the joint capsule
- Limitation of only one or two movements not following capsular ratio (Correct answer)
- Pain at end range in all directions
Correct answer: Limitation of only one or two movements not following capsular ratio
A non-capsular pattern involves restriction of one or two movements not in the proportions expected for capsular involvement, suggesting ligament adhesion, loose body, or extra-articular pathology.
Question 3: A patient has decreased sensation on the medial forearm and weak elbow flexion after a humeral fracture. Which nerve is most likely injured?
- Radial nerve
- Median nerve
- Musculocutaneous nerve (Correct answer)
- Ulnar nerve
Correct answer: Musculocutaneous nerve
The musculocutaneous nerve innervates the biceps and coracobrachialis (elbow flexion/supination) and provides sensation to the lateral forearm via the lateral antebrachial cutaneous nerve — medial forearm loss suggests this nerve.
Question 4: When using a goniometer to measure knee flexion in prone, the stationary arm is aligned with:
- The tibial shaft
- The lateral femur parallel to the femoral shaft (Correct answer)
- The fibular head to lateral malleolus
- The anterior superior iliac spine
Correct answer: The lateral femur parallel to the femoral shaft
For knee flexion, the stationary arm follows the lateral femoral shaft (toward the greater trochanter), and the moving arm follows the fibular shaft toward the lateral malleolus.
Question 5: A positive Apley compression test combined with a negative Apley distraction test at the knee indicates pathology of which structure?
- Collateral ligaments
- Cruciate ligaments
- Menisci (Correct answer)
- Patellofemoral joint
Correct answer: Menisci
Apley compression loads the menisci between the femur and tibia (positive = meniscal pain), while distraction unloads the menisci but stresses the ligaments.
Question 6: During cervical spine assessment, Spurling's test (cervical quadrant test) is performed to reproduce which type of symptom?
- Vertebral artery insufficiency
- Upper cervical instability
- Cervical radiculopathy (Correct answer)
- Cervicogenic headache
Correct answer: Cervical radiculopathy
Spurling's test (cervical compression with ipsilateral side-bending and rotation) reproduces radicular arm pain by narrowing the neural foramen and compressing nerve roots.
Question 7: Which of the following BEST describes the end-feel found in an acutely inflamed joint?
- Firm capsular end-feel
- Hard bony end-feel
- Springy or boggy end-feel
- Empty end-feel (Correct answer)
Correct answer: Empty end-feel
An empty end-feel occurs when the patient stops the examiner before the true end of range due to severe pain, with no tissue resistance reached — typical of acute inflammation or serious pathology.
NPTE-PT Musculoskeletal System Examination 5
A patient presents with a positive Thompson test (no plantar flexion with calf squeeze).
This indicates rupture of which structure?