Tendinitis is a condition caused by the tearing of tendon fibers and subsequent inflammation in the tendon. (17)           When a muscle contracts, it pulls on the tendon, which is composed of tissue that cannot stretch. The tendon then transmits that pulling force to the bone and moves the bone, producing movement. Tendinitis usually results from excessive repeated (18)demands placed on the tendon by the muscle. Tendinitis is not usually caused by a sudden injury; it is more commonly a result of a long period of overuse. Tendinitis occurs frequently with active individuals and those whose occupational tasks require (19)repetitive motion. Tendons that commonly become inflamed include: tendons of the hand, tendons of the upper arm that affect the shoulder, tendons of the forearm at the elbow, the tendon of the quadriceps muscle group at the knee, and the Achilles tendon at the ankle.

Repeated overuse of the tendon will cause small tears to develop in the tendon fibers. (20) $\fbox{a}$             As a result, the body will initiate the injury repair process in the area and lay down scar tissue. $\fbox{b}$             Inflammation increases the blood supply, bringing nutrients to the damaged tissues along with infection-fighting agents. $\fbox{c}$             The result is swelling, tenderness, pain, and heat. Redness may occur if the injury is close to the skin $\fbox{d}$             Since many cases of tendinitis result from chronic inflammatory conditions that develop from long periods of overuse, the inflammatory process is not as exaggerated as with an acute injury. (21)Therefore, swelling, heat, and redness are not always visible in a tendinitis complaint because the inflammation is really at a low level.

Recent research has found that tendinitis sometimes develops as a (22)side effect of treatment with quinolones, which are a group of antibiotics frequently used to treat bacterial infections. (23)            , and the tendinitis usually develops within the first few weeks of antibiotic treatment. Tendinitis is most often diagnosed by evaluating factors in the patient's history that indicate muscular overuse. Tendinitis will often develop when an individual suddenly increases his or her level of activity without adequate training or conditioning. This occurs frequently in occupational and recreational settings.

In addition to evaluating (24)factors in the patient's history that are likely to lead to tendinitis, the clinician may use several physical examination procedures. Most tendons are near the surface of the skin and therefore can be easily palpated (touched or pressed in order to make a diagnosis), especially by practitioners of manual therapy who have highly developed palpation skills. Pressure placed directly on these tendons is likely to cause discomfort. (25)In addition, the practitioner may ask the patient to contract the muscle attached to the tendon, usually against resistance, to see if this maneuver causes pain.

• 16. The word “subsequent'' in line 2 is closest in meaning to
  • a. alternative
  • b. preliminary
  • c. resulting
  • d. posterior
• 17. Which of the following is most appropriate for underlined part (17)?
  • a. The strong bone that muscle connect to tendons are connective tissues.
  • b. Tissues are the strong connective that connect bone muscle to tendons.
  • c. Tendons are the strong connective tissues that connect muscle to bone.
  • d. Muscle connective tissues are the strong tendons that connect to bone.
• 18. The word “demands” in line 6 is closest in meaning to
  • a. loads
  • b. desires
  • c. actions
  • d. concessions
• 19. The word “repetitive” in line 9 is closest in meaning to
  • a. restrictive
  • b. recurring
  • c. replaceable
  • d. redundant
• 20. Look at the blanks $\fbox{a}$, $\fbox{b}$, $\fbox{c}$, and $\fbox{d}$ in the passage. Insert the following sentence in the correct blank. Inflammation will develop in the area as part of the injury repair process.
  • a. $\fbox{a}$
  • b. $\fbox{b}$
  • c. $\fbox{c}$
  • d. $\fbox{d}$
• 21. Which of the following sentences is the closest in meaning to underlined part (21)?
  • a. Therefore, the main complaint of tendinitis is that the swelling, heat, and redness may not be visible unless the inflammation is at a low level.
  • b. Even though the tendinitis is at a low level, it produces very noticeable swelling, heat, and redness that often cause the patient to complain.
  • c. The main complaint about tendinitis is that it produces swelling, heat, and redness without visible signs, which cause a low level of inflammation.
  • d. The inflammation in tendinitis may not be severe and, as a result, the redness, heat, and swelling usually associated with inflammation sometimes are not noticeable.
• 22. The phrase “side effect” in line 25/26 is closest in meaning to
  • a. cause
  • b. substitution
  • c. consequence
  • d. precursor
• 23. Which of the following should go in underlined part (23)?
  • a. The tendon most likely to be affected by these drugs is the Achilles tendon
  • b. The tendon drugs to be likely most affected by these is the Achilles tendon
  • c. The most likely to be affected by these drugs tendon is the Achilles tendon
  • d. The tendon most likely affected by these drugs to be is the Achilles tendon
• 24. The word “factors” in line 34 is closest in meaning to
  • a. appearances
  • b. adjustments
  • c. calculations
  • d. elements
• 25. Which of the following sentences is the closest in meaning to underlined part (25)?
  • a. The practitioner will check to see if the patient experiences pain when flexing the affected muscle, especially when pushing or pulling against something.
  • b. The patient will try to contract the muscle attached to the tendon when the practitioner asks him or her, but may not be able to if there is too much resistance.
  • c. The practitioner will check to see whether or not the patient can contract the muscle, and sometimes the patient will want to resist because of the pain.
  • d. The practitioner will ask the patient if he or she feels resistance when the muscle attached to the affected tendon is contracted painfully.
• 26. According to the text, tendinitis most commonly develops
  • a. as a result of a sudden injury.
  • b. when people stop training or conditioning suddenly.
  • c. if people are not active enough.
  • d. when people use the same muscles too much.
• 27. Which tendons are not mentioned as being commonly affected by tendinitis?
  • a. tendons of the hand
  • b. tendons of the forearm
  • c. tendons of the neck
  • d. tendons of the upper arm that affect the shoulder
• 28. According to the text, why is the inflammatory process of tendinitis not as exaggerated as it is with an acute injury?
  • a. Because tendinitis happens close to the skin.
  • b. Because the factors that cause tendinitis develop over time.
  • c. Because the inflammation in tendinitis increases the blood supply.
  • d. Because the inflammation in tendinitis causes swelling, redness, and heat.
• 29. According to the text, how is tendinitis usually diagnosed?
  • a. Tendinitis is usually diagnosed by looking at the patient's history and by physical examination.
  • b. Tendinitis is usually diagnosed by examining the patient's level of activity and training.
  • c. Tendinitis is usually diagnosed by checking for areas of inflammation.
  • d. Tendinitis is usually diagnosed by contracting the muscles with the most resistance.
• 30. According to the text, palpation is sometimes used to check for tendinitis because
  • a. most practitioners have highly developed palpation skills.
  • b. the patient may have difficulty contracting his or her muscles.
  • c. other forms of diagnosis cause too much discomfort to the patient.
  • d. tendinitis is easy to evaluate by palpation.