Lec 1

Multiple Choice Questions (MCQs)

1. **What does MMT stand for in the context of physical therapy?**
- A. Manual Movement Therapy
- B. Manual Muscle Testing
- C. Muscle Measurement Therapy
- D. Movement Measurement Test

**Answer: B. Manual Muscle Testing**

2. **What is the main purpose of using Manual Muscle Testing (MMT)?**

- A. To increase muscle strength
- B. To evaluate muscle strength and assign a muscle test grade
- C. To measure bone density
- D. To assess joint flexibility

**Answer: B. To evaluate muscle strength and assign a muscle test grade**

3. **Which of the following best describes the 'Break Test' in MMT?**

- A. Assessing passive muscle length
- B. Isometric resistance at test position after ensuring full active ROM against gravity
- C. Measuring the circumference of limbs
- D. Passive stretching of muscles

**Answer: B. Isometric resistance at test position after ensuring full active ROM against gravity**

4. **Which plane separates the body into anterior and posterior halves?**
- A. Sagittal (longitudinal) plane
- B. Transverse (axial) plane
- C. Coronal (frontal) plane
- D. Horizontal plane

**Answer: C. Coronal (frontal) plane**

5. **What happens during active insufficiency in a two-joint muscle?**

- A. The muscle can shorten enough to cause full ROM of both joints it crosses
- B. The muscle cannot shorten enough to cause full ROM of both joints it crosses at the same time
- C. The muscle can be stretched enough to permit full ROM at both joints
- D. The muscle is in a state of rest

**Answer: B. The muscle cannot shorten enough to cause full ROM of both joints it crosses at the same time**

6. **What is the main difference between 'Break Test' and 'Make Test' in MMT?**
- A. Break Test uses concentric resistance while Make Test uses isometric resistance
- B. Break Test uses isometric resistance while Make Test uses concentric resistance
- C. Both use the same type of resistance
- D. Neither involve muscle resistance

**Answer: B. Break Test uses isometric resistance while Make Test uses concentric resistance**

7. **Which muscle action occurs when muscles contract simultaneously to neutralize movement?**
- A. Agonist
- B. Antagonist
 - C. Synergist
- D. Stabilizer

**Answer: C. Synergist**

8. **What is the role of stabilization in MMT?**

- A. To allow substitution movements
- B. To prevent substitution and ensure accurate measurement
- C. To relax the muscle being tested
- D. To increase muscle fatigue

**Answer: B. To prevent substitution and ensure accurate measurement**

9. **When performing MMT, where should resistance be applied?**

- A. On the muscle belly
- B. On the proximal joint segment
- C. On the distal joint segment
- D. On the bone

**Answer: C. On the distal joint segment**

10. **What should a therapist do if positioning for MMT is not possible?**

- A. Skip the test
- B. Use alternate methods such as assistance/resistance to resemble gravity-minimized or gravity-resisted positions
- C. Apply maximum force to the muscle
- D. Test a different muscle

**Answer: B. Use alternate methods such as assistance/resistance to resemble gravity-minimized or gravity-resisted positions**

### True/False Questions

1. **Manual Muscle Testing (MMT) is an ordinal scale of 0-5.**
- **Answer: True**

2. **Passive insufficiency occurs when a muscle cannot be stretched enough to permit full ROM at both joints it crosses at the same time.**
- **Answer: True**

3. **The 'Make Test' in MMT requires less skill and is more reliable than the 'Break Test'.**
- **Answer: False**

4. **The transverse plane separates the body into upper (superior) and lower (inferior) halves.**
- **Answer: True**

5. **Active movement occurs without any external force, while passive movement involves external force.**
- **Answer: True**
Lec 2

### Multiple-Choice Questions (MCQs):

1. **Which of the following is true regarding the manual muscle testing (MMT) grading scale?**
- A) Grade 5 indicates no resistance can be applied
- B) Grade 1 involves visible contraction without movement
- C) Grade 4 is the highest grade indicating maximal strength
- D) Grade 0 indicates normal muscle function
- **Answer:** B) Grade 1 involves visible contraction without movement
2. **What is the primary purpose of using the "Break Test" in MMT?**
- A) To test muscle endurance
- B) To assess muscle strength through resistance after the patient holds a position
- C) To test muscle flexibility
- D) To evaluate joint range of motion
- **Answer:** B) To assess muscle strength through resistance after the patient holds a position

3. **What is one of the key factors affecting the reliability of manual muscle testing (MMT)?**
- A) The size of the muscle
- B) Proper positioning and stabilization
- C) The patient’s gender
- D) Muscle fiber type
- **Answer:** B) Proper positioning and stabilization

4. **Which of the following best describes a Grade 3 in MMT?**

- A) Full range of motion against gravity with minimal resistance
- B) Full range of motion with moderate resistance
- C) Partial range of motion against gravity
- D) No movement against gravity
- **Answer:** A) Full range of motion against gravity with minimal resistance

5. **Which factor does NOT directly affect the muscle strength measurement in MMT?**
- A) Age
- B) The type of contraction (e.g., isometric, isotonic)
- C) The testing surface used
- D) The type of muscle fibers in the tested muscle
- **Answer:** C) The testing surface used

6. **Which of the following is the most appropriate procedure for MMT when assessing the patient’s strength?**
- A) Test the patient with both hands at the same time
- B) Use maximum resistance regardless of patient condition
- C) Test the non-involved side first as a reference
- D) Ask the patient to perform the test without explaining the procedure
- **Answer:** C) Test the non-involved side first as a reference

7. **What is a limitation of MMT when testing muscle strength above grade 4?**
- A) It cannot test endurance
- B) It is not effective for lower grades of muscle strength
- C) It lacks accuracy for testing strength in grades ≥ 4
- D) It is not useful for muscle groups with greater cross-sectional areas
- **Answer:** C) It lacks accuracy for testing strength in grades ≥ 4

8. **What is the recommended break time between MMT trials to ensure accuracy and avoid fatigue?**
- A) 1 minute
- B) 30 seconds
- C) 5 minutes
- D) 10 minutes
- **Answer:** B) 30 seconds

9. **Which of the following would be an example of a method to prevent substitution during MMT?**
- A) Use a noisy environment to distract the patient
- B) Proper positioning and adequate stabilization of the body
- C) Allowing the patient to assist in the movement
- D) Rapidly increasing resistance during the test
- **Answer:** B) Proper positioning and adequate stabilization of the body
10. **Which of the following statements is true about the "ceiling effect" in MMT?**
- A) It applies to all grades of muscle strength
- B) It occurs when MMT can no longer accurately measure strength above a certain level
- C) It results in more precise measurements for strong individuals
- D) It does not affect the reliability of the test
- **Answer:** B) It occurs when MMT can no longer accurately measure strength above a certain level

---

### True/False Questions:

1. **Grade 2 in MMT represents full range of motion against gravity with no resistance.**
- **Answer:** False (Grade 2 indicates partial range of motion against gravity or full ROM in a gravity-minimized position.)

2. **Manual Muscle Testing (MMT) is suitable for all populations, including infants and individuals with severe upper motor neuron lesions.**
- **Answer:** False (MMT is not suitable for infants or severe UMNL cases.)

3. **Friction can be reduced in MMT by applying powder to the testing area.**

- **Answer:** True

4. **MMT relies solely on the therapist’s subjective judgment of the patient's strength and resistance.**
- **Answer:** True

5. **Grade 5 in MMT indicates that the patient’s muscle strength is normal and can resist maximal manual resistance.**
- **Answer:** True
Lec 3

### Multiple-Choice Questions (MCQs):

1. **Which muscle is primarily responsible for scapular abduction and upward rotation during a manual muscle test?**
- A) Serratus anterior
- B) Rhomboid major
- C) Trapezius
- D) Levator scapula
- **Answer:** A) Serratus anterior

2. **During the manual muscle test for scapular elevation, which muscles are primarily involved?**
- A) Levator scapula and upper trapezius
- B) Rhomboids and lower trapezius
- C) Serratus anterior and pectoralis minor
- D) Rhomboid major and minor
- **Answer:** A) Levator scapula and upper trapezius

3. **In the test for scapular adduction (retraction), which position is the patient typically placed in?**
- A) Prone with shoulder abducted to 90°
- B) Sitting with arm flexed above 90°
- C) Supine with arm extended overhead
- D) Prone with arm internally rotated and adducted across the back
- **Answer:** A) Prone with shoulder abducted to 90°

4. **What is the main muscle responsible for scapular depression and adduction?**
- A) Latissimus dorsi
- B) Lower trapezius
- C) Rhomboid minor
 - D) Pectoralis major
- **Answer:** B) Lower trapezius

5. **Which muscle is most involved in scapular adduction and downward rotation during a manual muscle test?**
- A) Upper trapezius
- B) Rhomboids major and minor
- C) Serratus anterior
- D) Levator scapula
- **Answer:** B) Rhomboids major and minor

6. **During the manual muscle test for scapular upward rotation and abduction, what is the patient's arm position?**
- A) Shoulder flexed to 90°
- B) Shoulder flexed to 130° with elbow extended
- C) Arm abducted to 90°
- D) Arm adducted across the back
- **Answer:** B) Shoulder flexed to 130° with elbow extended

7. **What substitution might occur during scapular elevation testing?**

- A) Trapezius substitution
- B) Rhomboid substitution
- C) Pectoralis major substitution
- D) Trunk rotation
- **Answer:** D) Trunk rotation

8. **In the manual muscle test for scapular adduction (retraction), what muscle group is being tested?**
- A) Middle trapezius and rhomboids
- B) Serratus anterior and pectoralis minor
- C) Upper trapezius and levator scapula
- D) Latissimus dorsi and lower trapezius
- **Answer:** A) Middle trapezius and rhomboids

9. **Which test position is used for the manual muscle test of scapular depression and adduction?**
- A) Arm flexed to 90°
- B) Arm raised to 145° with forearm in mid-position
- C) Arm extended overhead with elbow straight
- D) Arm resting at the side
- **Answer:** B) Arm raised to 145° with forearm in mid-position

10. **Which of the following is true when testing scapular adduction and downward rotation?**
- A) The shoulder is externally rotated
- B) The test is performed with the patient supine
- C) The resistance is applied downward and outward on the humerus
- D) The arm is positioned overhead in full flexion
- **Answer:** C) The resistance is applied downward and outward on the humerus

---

### True/False Questions:

1. **During the test for scapular abduction and upward rotation, the scapula should maintain its abducted and rotated position without
winging.**
- **Answer:** True

2. **The levator scapulae is the primary muscle responsible for scapular depression and adduction.**
- **Answer:** False (The primary muscle is the lower trapezius.)
3. **In the test for scapular adduction and downward rotation, the patient’s arm should be internally rotated and adducted across the
back.**
- **Answer:** True

4. **When performing a manual muscle test for scapular elevation, the examiner should apply resistance downward while the patient
shrugs their shoulders.**
- **Answer:** True

5. **During scapular adduction (retraction) testing, the middle trapezius and rhomboids are the primary muscles involved.**
- **Answer:** True
Lec 4

Multiple Choice Questions (MCQs)

1. **Which muscle is a primary mover for shoulder flexion?**

- A. Posterior deltoid
- B. Middle deltoid
- C. Anterior deltoid
- D. Latissimus dorsi

**Answer: C. Anterior deltoid**

2. **What is the range of motion (ROM) for shoulder flexion?**

- A. 120° glenohumeral motion and 60° scapular motion
- B. 90° total motion
- C. 150° glenohumeral motion and 30° scapular motion
- D. 45° total motion

**Answer: A. 120° glenohumeral motion and 60° scapular motion**

3. **In shoulder extension, which muscle acts as the only hyperextensor?**

- A. Anterior deltoid
- B. Posterior deltoid
- C. Supraspinatus
- D. Coracobrachialis

**Answer: B. Posterior deltoid**

4. **Which primary muscles are involved in shoulder abduction?**

- A. Posterior deltoid and Infraspinatus
- B. Anterior deltoid and Pectoralis major
- C. Middle deltoid and Supraspinatus
- D. Latissimus dorsi and Teres major

**Answer: C. Middle deltoid and Supraspinatus**

5. **What position is the patient in for shoulder extension grades 5 & 4?**
- A. Sitting with arms at sides
- B. Prone with arms at sides and shoulder internally rotated
- C. Supine with shoulder abducted to 90°
- D. Standing with arms above the head

**Answer: B. Prone with arms at sides and shoulder internally rotated**

6. **During the shoulder horizontal adduction test for the clavicular head, what is the test position?**
- A. 90° of abduction
- B. 60° of abduction
- C. 120° of abduction
- D. Full extension

**Answer: B. 60° of abduction**

7. **Which accessory muscle is involved in shoulder flexion?**

- A. Posterior deltoid
- B. Clavicular portion of pectoralis major
- C. Teres minor
- D. Latissimus dorsi

**Answer: B. Clavicular portion of pectoralis major**

8. **What is the main substitution to watch for during shoulder flexion testing?**
- A. Leaning forward
- B. Leaning backward
- C. Lateral trunk flexion
- D. Knee flexion

**Answer: B. Leaning backward**

9. **Which muscle is primarily responsible for shoulder horizontal abduction?**

- A. Anterior deltoid
- B. Posterior deltoid
- C. Supraspinatus
- D. Pectoralis major

**Answer: B. Posterior deltoid**

10. **For shoulder abduction, where is resistance applied during testing?**

- A. Over the distal forearm
- B. Over the shoulder joint
- C. Over the arm just above the elbow
- D. Over the wrist

**Answer: C. Over the arm just above the elbow**

### True/False Questions

1. **The posterior deltoid is the primary muscle responsible for shoulder flexion.**
- **Answer: False**

2. **The middle deltoid and supraspinatus are the primary muscles involved in shoulder abduction.**
- **Answer: True**

3. **Shoulder extension requires the patient to be in a supine position for grades 5 & 4.**
- **Answer: False**

4. **A common substitution during shoulder flexion is leaning backward.**

- **Answer: True**

5. **The shoulder horizontal adduction test for the sternal head requires the patient to move from 120° of abduction.**
 - **Answer: True**
Lec 5

Multiple Choice Questions (MCQs)

1. **Which muscles are the primary movers for shoulder external rotation?**
- A. Subscapularis and Pectoralis major
- B. Infraspinatus and Teres minor
- C. Latissimus dorsi and Teres major
- D. Anterior deltoid and Supraspinatus

**Answer: B. Infraspinatus and Teres minor**

2. **What is the ROM for shoulder external rotation?**

- A. 0°: 60-80°
- B. 0°: 80-90°
- C. 0°: 120-150°
- D. 0°: 45-60°

**Answer: B. 0°: 80-90°**

3. **In the test position for shoulder external rotation grades 5, 4, and 3, what position is the patient in?**
- A. Sitting with arms at sides
- B. Prone, shoulder abducted to 90° with forearm hanging vertically over the edge of the table
- C. Supine with shoulder abducted to 90°
- D. Standing with arms at sides

**Answer: B. Prone, shoulder abducted to 90° with forearm hanging vertically over the edge of the table**

4. **Where should resistance be applied during shoulder external rotation testing?**

- A. On the shoulder joint
- B. On the wrist
- C. On the elbow
- D. On the forearm

**Answer: B. On the wrist**

5. **Which muscle is primarily responsible for shoulder internal rotation?**

- A. Infraspinatus
- B. Teres minor
- C. Subscapularis
- D. Posterior deltoid

**Answer: C. Subscapularis**

6. **What is the ROM for shoulder internal rotation?**

- A. 0°: 60-80°
- B. 0°: 80-90°
- C. 0°: 45-60°
- D. 0°: 120-150°

**Answer: A. 0°: 60-80°

7. **What is a common substitution to watch for during shoulder external rotation testing?**
- A. Pronation
 - B. Supination
- C. Trunk rotation
- D. Shoulder elevation

**Answer: B. Supination**

8. **What is a common substitution to watch for during shoulder internal rotation testing?**
- A. Pronation
- B. Supination
- C. Trunk flexion
- D. Shoulder elevation

**Answer: A. Pronation**

9. **Where can you palpate the infraspinatus during shoulder external rotation testing?**
- A. Over the anterior deltoid
- B. Over the body of the scapula below the spine
- C. On the inferior margin of the axilla
- D. On the lateral side of the arm

**Answer: B. Over the body of the scapula below the spine**

10. **Where can you palpate the subscapularis during shoulder internal rotation testing?**
- A. On the anterior surface of the deltoid
- B. Deep in the central area of the axilla
- C. On the lateral border of the scapula
- D. Over the supraspinatus

**Answer: B. Deep in the central area of the axilla**

### True/False Questions

1. **The posterior deltoid is an accessory muscle for shoulder internal rotation.**

- **Answer: False**

2. **Shoulder external rotation can be tested with the patient in a prone position.**
- **Answer: True**

3. **The subscapularis is a primary muscle responsible for shoulder internal rotation.**

- **Answer: True**

4. **A folded towel is used under the arm for shoulder internal rotation testing to ensure comfort.**
- **Answer: True**

5. **Supination is a common substitution during shoulder internal rotation testing.**

- **Answer: False**
Lec 5 part 2

Multiple Choice Questions (MCQs)

1. **Which muscles are the primary movers for elbow flexion?**

- A. Biceps, Brachialis, and Brachioradialis
- B. Triceps brachii and Anconeus
- C. Pronator teres and Pronator quadratus
- D. Supinator and Biceps brachii
 **Answer: A. Biceps, Brachialis, and Brachioradialis**

2. **What is the range of motion (ROM) for elbow flexion?**

- A. 0° - 150°
- B. 0° - 80°
- C. 0° - 90°
- D. 0° - 120°

**Answer: A. 0° - 150°**

3. **Which muscle is the primary mover for elbow extension?**

- A. Biceps brachii
- B. Triceps brachii
- C. Pronator teres
- D. Brachialis

**Answer: B. Triceps brachii**

4. **What is the position of the patient for testing elbow extension in grades 5 and 4 from the prone position?**
- A. Sitting with arm at side
- B. Prone on table with the arm in 90° of abduction and the forearm flexed
- C. Standing with arm at side
- D. Supine with arm at 90° of flexion

**Answer: B. Prone on table with the arm in 90° of abduction and the forearm flexed**

5. **Which muscles are the primary movers for forearm supination?**

- A. Pronator teres and Pronator quadratus
- B. Biceps brachii and Supinator
- C. Triceps brachii and Anconeus
- D. Flexor carpi radialis and Brachioradialis

**Answer: B. Biceps brachii and Supinator**

6. **What is the ROM for forearm supination?**

- A. 0° - 150°
- B. 0° - 80°
- C. 0° - 90°
- D. 0° - 120°

**Answer: B. 0° - 80°**

7. **Which muscle is primarily responsible for forearm pronation?**

- A. Supinator
- B. Pronator quadratus
- C. Biceps brachii
- D. Triceps brachii

**Answer: B. Pronator quadratus**

8. **Where is resistance applied during forearm supination testing for grades 5 and 4?**
- A. On the anterior surface of the forearm
- B. On the dorsal surface of the wrist
- C. On the lateral border of the radius
 - D. On the medial condyle of the humerus

**Answer: B. On the dorsal surface of the wrist**

9. **In which position should the forearm be for testing elbow flexion (grade 2) with the biceps brachii?**
- A. Prone with arm at side
- B. Sitting with arm 90° flexion or abduction rested on a smooth surface
- C. Supine with arm extended
- D. Standing with arm at side

**Answer: B. Sitting with arm 90° flexion or abduction rested on a smooth surface**

10. **What is a common substitution to watch for during forearm pronation testing?**
- A. Elbow extension
- B. Shoulder abduction and internal rotation
- C. Shoulder external rotation
- D. Wrist flexion

**Answer: B. Shoulder abduction and internal rotation**

### True/False Questions

1. **The triceps brachii is the primary muscle responsible for elbow flexion.**
- **Answer: False**

2. **Forearm supination involves the primary muscles biceps brachii and supinator.**
- **Answer: True**

3. **Elbow flexion can be tested with the patient in a side-lying position for grades 2, 1, and 0.**
- **Answer: True**

4. **A common substitution during elbow extension testing is by the shoulder external rotation.**
- **Answer: True**

5. **The ROM for forearm pronation is 0° - 150°.**

- **Answer: False**