LE 2

Question 1

The knee is the largest joint in the body and it is among the most frequently injured joints within athletic and industrial environments. The following statements apply correctly to this joint, EXCEPT:
I. It is a complex joint with three bones, two degrees of freedom of motion, and three articulating surfaces.
II. The medial tibiofemoral, lateral tibiofemoral, and patellofemoral articulations are enclosed by a common joint capsule.
III. The knee can support the body weight in the erect position without muscle activity.
IV. In walking and running, the normal knee requires vertical and lateral oscillations of the center of gravity of the body while sustaining vertical forces equal to 4 to 6 times the body weight.
V. The relatively shallow joint provides for limited motion, but the joint configuration means that the knee must rely on soft tissue structures for its primary support and stability.
a. All of these
b. I, II and III
c. II, III, IV
d. IV and V
e. Only V

Answer 1

Only V

note: the knee joint is a diarthrodial modified hinge joint, therefore it does not have limited motion

Question 2

Quadriceps muscle paralysis occurs with severance of the femoral nerve from a gunshot or other trauma. Various compensations can be used so people with quadriceps weakness can walk and function in a safe manner without a noticeable limp. Which of these compensations is/are applicable?
a. Momentum from the hip can be used to straighten the knee in walking.
b. Use the gluteus maximus to extend the knee in closed chain motion.
c. The hand on the side of the weak quadriceps is used to push on the anterior thigh.
d. A slight forward lean from the hips to place the center of gravity of HAT in front of the knee’s axis of motion in the sagittal plane
e. All of these

Answer 2

All of these

Question 3

Your patient suffered from a patellar dislocation. What is the most common direction of dislocation?
a. Superior
b. Inferior
c. Medial
d. Lateral
e. Anterior

Answer 3

Lateral

Question 4

You have a patient with a knee flexion contracture. Your goal is to increase knee extension by doing a stretching exercise. Which of the following does not need to be stretched?
a. Hamstring muscle
b. Gastrocnemius muscle
c. Infrapatellar tendon
d. None of these

Answer 4

Infrapatellar tendon

Note: infrapatellar tendon is already stretched in flexion

Question 5

A 14-year-old athletic boy has a painful bump in the anterior tibial tubercles. He experiences pain during running and jumping. X-ray findings are normal except for soft tissue swelling over the tubercles. He may be suffering from:
a. Osgood-Schlatter disease
b. Osteogenesis imperfecta
c. Sinding-Larsen-Johansson disease
d. Jumper’s knee
e. Osteochondritis dissecans

Answer 5

Osgood-Schlatter disease

note:
Osteogenesis imperfecta - brittle bones; easily fractured; blue or gray sclera

Sinding-Larsen-Johansson disease - osteochondritis that affects inferior pole of patella

Jumper’s knee - patellar tendinitis

Osteochondritis dissecans - most common joint affected is the knee joint, specifically the lateral aspect of the medial femoral condyle

Question 6

The Cinema sign which is pain on the knee increased on stair climbing, and relief on standing is observed in patients with:
a. Patellar subluxation
b. Chondromalacia patella
c. Patellar dislocation
d. Osteoarthritis of patella

Answer 6

Chondromalacia patella

Question 7

In acute patellar dislocation, this muscle is usually disrupted or impaired:
a. Vastus intermedius
b. Rectus femoris
c. Vastus lateralis
d. Vastus medialis

Answer 7

Vastus medialis

Question 8

The Q-angle is considered excessive if it is over:
a. 20 degrees
c. 10 degrees
b. 15 degrees
d. 0 degrees

Answer 8

20 degrees

Question 9

The compression reaction force on the patella is highest in:
a. Crossed leg position
b. Straight-leg raising exercise
c. Squatting
d. Crawling

Answer 9

Squatting

Question 10

The mechanism of injury for the posterior cruciate ligament is:
a. A forceful landing on the anterior tibia with the knee hyperflexed.
b. An anterior force to the tibia while the foot is fixed.
c. Internal rotation of the leg with external rotation of the body.
d. A valgus force to the knee while the foot is fixed.

Answer 10

A forceful landing on the anterior tibia with the knee hyperflexed.

Question 11

A predisposing factor to recurrent knee dislocation is:
a. Marked genu varum
b. Deep patellar groove
c. Weak vastus medialis
d. Lateral capsule laxity

Answer 11

Weak vastus medialis

Question 12

Why is the lateral meniscus injured less often than the medial meniscus?
a. It is more mobile.
b. It is thinner.
c. It is longer in diameter.
d. It is stabilized by the hamstrings

Answer 12

It is more mobile

Question 13

Medial collateral ligament rupture in the knee is due to excessive:
a. Varus
b. External rotation
c. Internal rotation
d. Valgus

Answer 13

Valgus

Question 14

“Charley horse” is the contusion and tearing of
muscle fibers resulting into the muscle from
damaged vessels. Its most common site is the:
a. Pectineus
c. Pes anserinus
b. Adductors
d. Quadriceps

Answer 14

Quadriceps

Question 15

The most common knee deformity seen in
patients with degenerative osteoarthritis is:
a. Genu valgum
c. Tibial torsion
b. Genu varum
d. Genu recurvatum

Answer 15

Genu varum

Question 16

A terminal lateral rotation of the tibia is said to
“lock” the joint when the knee is fully extended.
The key is the:
a. Biceps femoris
b. Popliteus
c. Piriformis
d. Gastrocnemius
e. Soleus

Answer 16

Popliteus

Question 17

The joint capsule of the knee is supported
superiorly by the oblique popliteal ligament. This
is an expansion of what muscle?
a. Semitendinosus
b. Semimembranosus
c. Biceps femoris
d. Gastrocnemius

Answer 17

Semimembranosus

Question 18

In squatting, knee flexion is produced by:
a. Gravity with concentric contraction of
hamstrings
b. Gravity with eccentric contraction of
quadriceps
c. Gravity with concentric contraction of
quadriceps
d. Gravity with eccentric contraction of the
iliopsoas

Answer 18

Gravity with eccentric contraction of
quadriceps

Question 19

The following statements describe the cruciate
ligaments of the knee, EXCEPT:
a. The PCL is attached to the lateral
meniscus.
b. The ACL moves upward and backward to
attach to the lateral femoral condyles.
c. The PCL prevents anterior displacement
of the tibia.
d. The ACL prevents hyperextension of the
knee

Answer 19

The PCL prevents anterior displacement
of the tibia

Question 20

A therapist positions a patient in prone to measure
knee flexion. Range of motion may be limited in
this position due to:
a. Passive insufficiency of the knee
extensors
b. Passive insufficiency of the sacrospinalis
group
c. Active insufficiency of the knee extensors
d. Passive insufficiency of the knee flexors
e. Active insufficiency of the knee flexors

Answer 20

Passive insufficiency of the knee
extensors

Question 21

Position of the knee where ACL is taut:
a. Full flexion
b. 30-degree flexion
c. Extension and IR
d. Full extension and ER
e. 90 degrees flexion

Answer 21

Extension and IR

Question 22

False about screw home mechanism:
a. Occurs on the last 20 degrees of knee
extension
b. IR of tibia in closed kinematic chain
motion
c. IR of femur in closed kinematic chain
motion
d. ER of tibia in open kinematic chain motion

Answer 22

IR of tibia in closed kinematic chain
motion

Question 23

A client with confirmed PCL tear is able to return to
full dynamic activities following rehabilitation.
Which of the following does not serve as
secondary restrain to PCL?
a. ITB
b. Popliteus
c. LCL
d. MCL

Answer 23

ITB

note:
anterior translation of tibia
primary restraint - ACL
secondary restraint - MCL, LCL, ITB

posterior translation of tibia
primary restraint - PCL
secondary restraint - MCL, LCL, popliteus

Question 24

A therapist observes a patient complete full active
knee flexion ROM. Which of the following is not a
component of knee flexion?
a. Medial rotation of the tibia on femur
b. Superior movement of the patella
c. Inferior movement of the fibula
d. Posterior glide of tibia on femur

Answer 24

Superior movement of the patella

Question 25

Medial rotators of the tibia include the following: I. Gracilis II. Semitendinosus III. Sartorius IV. Popliteus a. All of these b. I, II, and III c. I and III d. II and IV e. Only IV

Answer 25

All of these

Question 26

A patient’s severe knee sprain resulted from medial rotation of the femur on the tibia with simultaneous application of valgus force while the foot was placed on the ground. Which structures are most likely to be involved? a. MCL, PCL, and lateral meniscus b. MCL, LCL, and PCL c. LCL, ACL, and medial meniscus d. MCL, ACL, and medial meniscus

Answer 26

MCL, ACL, and medial meniscus

Question 27

All are causes of PFPS, EXCEPT: a. Femoral anteversion b. Foot pronation c. Genu valgum d. External tibial torsion e. None of these

Answer 27

None of these

Question 28

A therapist observing a patient complete a leg curl exercise notices 2 prominent tendons visible on the posterior surface of the patient’s knee. The visible tendons are most likely associated with the: a. Semimembranosus and semitendinosus b. Semitendinosus and biceps femoris c. Popliteus and semitendinosus d. Semimembranosus and biceps femoris

Answer 28

Semitendinosus and biceps femoris

Question 29

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

Answer 29

Inner 2/3

Question 30

Although knee motion occurs primarily in one plane, tibial rotation is possible when the knee is positioned in 90 degrees or more of flexion because in this position: a. Tension of the ligaments is decreased. b. Patella deviates inferiorly. c. Hamstrings act as a rotating force. d. Condyles of the femur glide posteriorly on the condyles of the tibia

Answer 30

Tension of the ligaments is decreased

Question 31

Contents of the popliteal fossa from the deepest to the most superficial: a. Posterior tibial nerve, popliteal vein, popliteal artery b. Popliteal artery, popliteal vein, posterior tibial nerve c. Popliteal vein, popliteal artery, posterior tibial nerve d. Posterior tibial nerve, popliteal artery, popliteal vein e. Popliteal vein, posterior tibial nerve, popliteal artery

Answer 31

Popliteal artery, popliteal vein, posterior tibial nerve

Question 32

Possible causes of genu recurvatum: I. Quadriceps weakness II. Quadriceps spasticity III. Plantarflexor spasticity IV. Plantarflexor weakness a. I, II, and III b. I and III c. II and IV d. All of these e. None of these

Answer 32

I, II, and III

Question 33

The bursa that is affected in Baker’s cyst: a. Prepatellar bursa b. Suprapatellar bursa c. Infrapatellar burse d. Popliteal bursa e. Pes anserine bursa

Answer 33

Popliteal bursa

Question 34

A stab wound to the popliteal fossa will primarily injure which structure: a. Posterior tibial nerve b. Popliteus c. Common peroneal nerve d. Popliteal artery

Answer 34

Posterior tibial nerve

Question 35

Course of the anterior cruciate ligament: a. Upward, backward, medial b. Upward, forward, lateral c. Upward, forward, medial d. Upward, backward, lateral

Answer 35

Upward, backward, lateral

Question 36

Meniscal tears in the knee joint usually result from: a. Hyperextension b. Hyperflexion c. Rotation in full extension d. Rotation in partial flexion

Answer 36

Rotation in partial flexion note: knee in extension cannot rotate bc it is locked

Question 37

Partial tearing to this ligament occurs at its femoral or tibial attachment and is a result of forced abduction of the tibia in the femur: a. Lateral collateral ligament b. Anterior cruciate ligament c. Medial collateral ligament d. Posterior cruciate ligament

Answer 37

Medial collateral ligament

Question 38

The following statements are true of the patella, EXCEPT: a. Decreases pressure and distribute forces on the femur. b. It is unable to prevent damaging forces on the quadriceps tendon in resisted knee flexion. c. Increases the leverage of the quadriceps femoris. d. When the knee is flexed, it provides bony protection to the distal joint surfaces of the femoral condyles

Answer 38

It is unable to prevent damaging forces on the quadriceps tendon in resisted knee flexion

Question 39

The following statements are true of the terminal rotation of the knee, EXCEPT: a. Allows humans with an energy-efficient mechanism a mechanical stability to stand erect without quadriceps muscle contraction. b. Terminal rotation is seen as internal rotation of the femur on the fixed tibia in a closed chain motion. c. In the last 20 degrees of knee extension, the tibia externally rotates about 20 degrees on the fixed femur. d. It is a mechanical event that occurs only in active knee extension and can voluntarily be prevented.

Answer 39

It is a mechanical event that occurs only in active knee extension and can voluntarily be prevented.

Question 40

In actions such as jumping with knees bent, the femur has a marked tendency to slide forwards off the plateau-like tibial surface. This ligament resists this tendency: a. Posterior cruciate ligament b. Lateral collateral ligament c. Medial collateral ligament d. Anterior cruciate ligament

Answer 40

Posterior cruciate ligament

Question 41

With the subject sitting and the knee relaxed in 90 degrees of flexion, these distal enlargements of the femur can be felt anteriorly on both sides of the patella: a. None of these b. Condyles c. Epicondyles d. Medial collateral ligaments

Answer 41

Condyles

Question 42

The aponeurotic insertion of the large extensor muscle of the knee largely provides the fibrous capsule for the front and sides of the joint. In the tendon of this powerful muscle, a sesamoid bone developed and became articular. Name this bone: a. Tibia b. Femoral condyle c. Patella d. Lateral condyle

Answer 42

Patella

Question 43

The following statements are true of the knee joint, EXCEPT: a. Limitation by the two-joint rectus femoris muscle decreases knee flexion ROM when the hip is in flexion. b. End-feel for extension or hyperextension is firm. c. End-feel for passive knee flexion is soft. d. It possesses two degrees freedom and range of flexion is from 120 to 150 degrees.

Answer 43

Limitation by the two-joint rectus femoris muscle decreases knee flexion ROM when the hip is in flexion.

Question 44

Which of the following is true of the hamstring? a. All of these b. None of these c. They extend the hip and/or flex the knee. d. Rotates the knee joint when the joint is fully extended.

Answer 44

They extend the hip and/or flex the knee. note: knee cannot rotate when extended

Question 45

The attachments of this structure can be palpated and identified by placing the index finger on the lateral epicondyle of the femur and middle finger on the head of the fibula: a. Lateral collateral ligament b. None of these c. Medial meniscus d. Medial collateral ligament

Answer 45

Lateral collateral ligament

Question 46

The following describe the lateral meniscus, EXCEPT: a. There is an area of no point attachment to the tibia from under the anterior cruciate ligament to the anterior margin of the tibia. b. May move anteriorly-posteriorly as the condyle does. c. The lateral meniscus is much less secure than the medial of movement by the lateral femoral condyle over the lateral plateau of the tibia. d. Has considerably less mobility than the medial meniscus and by its shape and contour tends to be controlled much more by the femoral condyle

Answer 46

Has considerably less mobility than the medial meniscus and by its shape and contour tends to be controlled much more by the femoral condyle note: it should be more mobile

Question 47

Patient X landed with his knees hyperextended. A maneuver yields excessive anterior translation of the tibia on the femur. The patient shows apprehension upon doing this maneuver. The ruptured ligament is: a. ACL b. PCL c. LCL d. MCL e. Normal

Answer 47

ACL

Question 48

In screw-home mechanism, at the last 20 degrees of knee extension on open kinematic chain, the tibia: a. Externally rotates. b. Internally rotates. c. Moves variably. d. Is immobile. e. None of these

Answer 48

Externally rotates

Question 49

The following statements are true of the collateral ligaments, EXCEPT: a. Lateral collateral ligament connects the femur and the fibula. b. These ligaments may be easily injured when force is applied to the knee while a person’s leg is extended with his foot firmly planted on the ground. c. Medial collateral ligament connects the femur to the tibia. d. Prevent side-to-side movement by tightening during leg extension. e. The collateral ligaments can tear when the femur is externally rotated on the tibia

Answer 49

The collateral ligaments can tear when the femur is externally rotated on the tibia note: all collaterals are taut in ER of the tibia all cruciates are taut during IR of the tibia *when femur externally rotates, tibia internally rotates, therefore collaterals are slack*

Question 50

Which of the following structures form the angle of the Q-angle? a. ASIS, mid patella, tibial tubercle b. AIIS, mid patella, tibial tuberosity c. PSIS, ligamentum patellae, tibial tubercle d. PIIS, ligamentum patellae, tibial tuberosity

Answer 50

ASIS, mid patella, tibial tubercle