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ABEM Sports Medicine study materials
ABEM Sports Medicine study resources

ABEM Sports Medicine practice questions

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Question 1Emergency Medicine and Sports Medicine Clinical Practice

A high school soccer player collapses during a match and is unresponsive with abnormal, gasping breathing. After activating emergency response and retrieving an AED, what is the most appropriate immediate action?

  1. Give two rescue breaths before compressions
  2. Perform a finger sweep of the airway
  3. Place the AED pads before starting compressions
  4. Begin chest compressions immediately Correct answer.

Explanation

Sudden cardiac arrest in an athlete is managed with immediate high-quality chest compressions as part of CPR; compressions should start without delay once unresponsiveness and abnormal breathing are recognized. Rescue breaths and AED application are integrated but do not precede the initiation of compressions.

Question 2Emergency Medicine and Sports Medicine Clinical Practice

Which finding most strongly suggests exertional heat stroke rather than heat exhaustion in a collapsed marathon runner?

  1. Heart rate above 100 beats per minute
  2. Core temperature above 40°C with altered mental status Correct answer.
  3. Profuse sweating with a normal mental status
  4. Muscle cramps and nausea after the race

Explanation

Exertional heat stroke is defined by hyperthermia (core temperature typically above 40°C) combined with central nervous system dysfunction such as confusion or altered mental status. Heat exhaustion lacks significant CNS dysfunction, and sweating may be present in either condition.

Question 3Emergency Medicine and Sports Medicine Clinical Practice

A football player sustains a blow to the side of the head and briefly loses consciousness, then reports a headache and is confused about the play. Which action is most appropriate?

  1. Return to play after symptoms resolve in 10 minutes
  2. Allow return to play if balance testing is normal
  3. Remove from play and evaluate for concussion Correct answer.
  4. Clear the athlete after a normal pupillary exam

Explanation

Any athlete with suspected concussion, especially after loss of consciousness or persistent confusion, must be removed from play and assessed; same-day return to play is not permitted. Resolution of a single symptom or a normal focused exam does not authorize return.

Question 4Emergency Medicine and Sports Medicine Clinical Practice

Which immunization is specifically recommended for athletes engaged in contact sports because of the risk of splenic rupture from abdominal trauma?

  1. Influenza vaccine
  2. Hepatitis B vaccine
  3. Meningococcal vaccine
  4. Pneumococcal vaccine Correct answer.

Explanation

Athletes in contact sports who sustain abdominal trauma are at risk for splenic injury, and pneumococcal vaccination is recommended for those at risk of overwhelming sepsis after splenectomy or in certain high-risk contexts. Routine influenza, hepatitis B, and meningococcal vaccines are not specifically tied to splenic trauma risk.

Question 5Emergency Medicine and Sports Medicine Clinical Practice

A wrestler is found with a deformed, painful elbow after a fall and has absent radial pulse with pale, cool distal tissue. What is the most appropriate next step?

  1. Perform immediate reduction of the dislocation Correct answer.
  2. Apply a splint and arrange next-day follow-up
  3. Obtain an MRI before any intervention
  4. Give analgesics and observe for one hour

Explanation

A dislocated joint with absent distal pulse indicates vascular compromise and requires urgent reduction to restore perfusion. Delaying reduction for imaging or observation risks limb ischemia.

Question 6Emergency Medicine and Sports Medicine Clinical Practice

A 16-year-old basketball player has anterior knee pain that worsens with jumping and a palpable tender bump at the tibial tubercle. What is the most likely diagnosis?

  1. Sinding-Larsen-Johansson syndrome
  2. Patellar tendon rupture
  3. Meniscal tear
  4. Osgood-Schlatter disease Correct answer.

Explanation

Osgood-Schlatter disease is traction apophysitis at the tibial tubercle, common in adolescents during growth spurts, causing activity-related anterior knee pain and a tender bony prominence. Patellar tendon rupture and meniscal tears present differently, and Sinding-Larsen-Johansson affects the inferior pole of the patella.

Question 7Emergency Medicine and Sports Medicine Clinical Practice

A runner develops lateral knee pain that worsens with downhill running and is reproduced by palpation over the lateral femoral epicondyle. What is the most likely diagnosis?

  1. Medial collateral ligament sprain
  2. Patellofemoral pain syndrome
  3. Pes anserine bursitis
  4. Iliotibial band syndrome Correct answer.

Explanation

Iliotibial band syndrome causes lateral knee pain, often worsened by downhill running, with point tenderness at the lateral femoral epicondyle. Patellofemoral pain is anterior, pes anserine bursitis is medial, and MCL sprains follow valgus stress.

Question 8Emergency Medicine and Sports Medicine Clinical Practice

An athlete sustains an inversion ankle injury with tenderness over the lateral malleolus and inability to bear weight. Which imaging decision is most appropriate?

  1. Obtain ankle radiographs using the Ottawa Ankle Rules Correct answer.
  2. Order an MRI of the ankle immediately
  3. Reassure and discharge without imaging
  4. Obtain a CT scan of the ankle

Explanation

The Ottawa Ankle Rules guide radiography: tenderness over the posterior edge or tip of the lateral or medial malleolus, or inability to bear weight for four steps, indicates need for plain films. MRI and CT are not first-line for acute ankle trauma.

Question 9Emergency Medicine and Sports Medicine Clinical Practice

An athlete with sickle cell trait develops severe muscle pain, dark urine, and weakness during intense conditioning in the heat. What is the most likely diagnosis?

  1. Heat cramps
  2. Simple muscle strain
  3. Exertional rhabdomyolysis Correct answer.
  4. Delayed-onset muscle soreness

Explanation

Sickle cell trait predisposes to exertional sickling, which can cause rhabdomyolysis with severe muscle pain, dark urine, and weakness during intense exertion, especially in heat. DOMS, simple strain, and heat cramps do not cause dark urine or systemic weakness.

Question 10Emergency Medicine and Sports Medicine Clinical Practice

A boxer is knocked out and on waking has a headache, vomiting, and progressive drowsiness. What is the most concerning diagnosis?

  1. Migraine headache
  2. Intracranial hemorrhage Correct answer.
  3. Post-concussion syndrome
  4. Cervical strain

Explanation

Headache, vomiting, and progressive decline in consciousness after head trauma raise concern for intracranial hemorrhage and warrant urgent imaging and neurosurgical evaluation. Post-concussion syndrome is a chronic diagnosis, and migraine or strain do not explain progressive drowsiness.

Question 11Emergency Medicine and Sports Medicine Clinical Practice

A swimmer reports shoulder pain with overhead activity and positive Neer and Hawkins tests. What is the most likely diagnosis?

  1. Acromioclavicular joint separation
  2. Labral tear
  3. Subacromial impingement Correct answer.
  4. Glenohumeral dislocation

Explanation

Subacromial impingement causes pain with overhead motion and positive Neer and Hawkins tests. AC separation follows direct trauma, dislocation causes deformity and instability, and labral tears present with instability or clicking.

Question 12Emergency Medicine and Sports Medicine Clinical Practice

A gymnast has wrist pain with tenderness in the distal radial physis and repetitive loading. What condition should be suspected?

  1. Gymnast wrist (distal radial physeal stress injury) Correct answer.
  2. Carpal tunnel syndrome
  3. De Quervain tenosynovitis
  4. Scaphoid fracture

Explanation

Repetitive wrist loading in young gymnasts can cause distal radial physeal stress injury, known as gymnast wrist. Scaphoid fracture follows a fall, De Quervain affects the thumb tendons, and carpal tunnel causes median nerve symptoms.

Question 13Emergency Medicine and Sports Medicine Clinical Practice

A soccer player is struck in the thigh and develops a tense, swollen, painful thigh with rapidly increasing compartment pressure. What is the most appropriate management?

  1. NSAIDs and return to play
  2. Compression wrapping and observation
  3. Elevation and ice only
  4. Urgent fasciotomy Correct answer.

Explanation

Acute compartment syndrome is a surgical emergency; tense swelling, pain out of proportion, and rising compartment pressures require urgent fasciotomy. Conservative measures and observation risk muscle and nerve necrosis.

Question 14Emergency Medicine and Sports Medicine Clinical Practice

A cross-country runner has a stress fracture of the femoral neck with a complete fracture line on imaging. What is the most appropriate management?

  1. Physical therapy alone with weight-bearing as tolerated
  2. Continue running with pain monitoring
  3. Non-weight-bearing and urgent orthopedic consultation Correct answer.
  4. Gradual return to running after one week

Explanation

Complete femoral neck stress fractures are high-risk and require non-weight-bearing status and urgent orthopedic evaluation, often surgical, because of the risk of displacement and avascular necrosis. Continued loading risks catastrophic displacement.

Question 15Emergency Medicine and Sports Medicine Clinical Practice

A football player has a transient episode of burning, stinging pain and numbness in one arm after a tackle, resolving within minutes. What is the most likely diagnosis?

  1. Cervical fracture
  2. Burner (stinger) syndrome Correct answer.
  3. Radial nerve palsy
  4. Shoulder dislocation

Explanation

Burner syndrome results from traction or compression of the brachial plexus or cervical roots, causing transient burning pain and numbness in one arm that resolves quickly. Fracture, dislocation, and radial nerve palsy have different mechanisms and persistent findings.

Question 16Emergency Medicine and Sports Medicine Clinical Practice

A diver surfaces rapidly and develops chest pain, confusion, and joint pain. What is the most appropriate initial management?

  1. NSAIDs and return to diving
  2. Oral fluids and observation
  3. High-flow oxygen and urgent hyperbaric evaluation Correct answer.
  4. Chest radiograph and discharge if normal

Explanation

Decompression sickness after rapid ascent presents with joint pain, chest symptoms, and neurologic findings; high-flow oxygen and urgent hyperbaric oxygen therapy are indicated. Delaying treatment risks worsening neurologic injury.

Question 17Emergency Medicine and Sports Medicine Clinical Practice

A young athlete presents with a swollen, painful knee and a large effusion within hours of a twisting injury. What is the most likely diagnosis?

  1. Osgood-Schlatter disease
  2. Anterior cruciate ligament tear Correct answer.
  3. Patellofemoral pain syndrome
  4. Pes anserine bursitis

Explanation

A rapid hemarthrosis after a twisting injury suggests an ACL tear or other intra-articular injury. Patellofemoral pain, pes anserine bursitis, and Osgood-Schlatter are overuse conditions without acute hemarthrosis.

Question 18Emergency Medicine and Sports Medicine Clinical Practice

Which preparticipation screening element most strongly identifies athletes at risk for sudden cardiac death?

  1. Personal and family history of cardiac disease plus physical exam Correct answer.
  2. Routine resting electrocardiogram for all athletes
  3. Routine echocardiography for all athletes
  4. Routine exercise stress testing for all athletes

Explanation

The American Heart Association recommends cardiovascular screening with focused personal and family history and physical examination, which identifies many at-risk athletes. Routine ECG, echocardiography, and stress testing for all athletes are not universally recommended and have cost and false-positive concerns.

Question 19Emergency Medicine and Sports Medicine Clinical Practice

An athlete with type 1 diabetes is about to exercise. Which strategy best reduces hypoglycemia risk?

  1. Exercise only when glucose is below 70 mg/dL
  2. Skip meals before exercise
  3. Take extra insulin before exercise
  4. Check glucose before exercise and adjust insulin or carbohydrate intake Correct answer.

Explanation

Checking glucose before exercise and adjusting insulin or carbohydrate intake reduces hypoglycemia risk during activity. Skipping meals, extra insulin, and exercising with low glucose all increase hypoglycemia risk.

Question 20Emergency Medicine and Sports Medicine Clinical Practice

A female athlete reports fatigue, stress fractures, and amenorrhea. Which condition should be suspected?

  1. Hypothyroidism
  2. Female athlete triad Correct answer.
  3. Polycystic ovary syndrome
  4. Anemia

Explanation

The female athlete triad consists of low energy availability, menstrual dysfunction, and low bone mineral density, presenting with amenorrhea and stress fractures. PCOS, hypothyroidism, and anemia do not account for the combined triad.

Question 21Emergency Medicine and Sports Medicine Clinical Practice

A young athlete has a Colles-type deformity after a fall onto an outstretched hand. What is the most appropriate initial step?

  1. Immobilize and obtain radiographs Correct answer.
  2. Discharge with a sling
  3. Immediate closed reduction without imaging
  4. Apply traction to the wrist

Explanation

Suspected distal radius fracture should be immobilized and imaged before reduction to define the injury. Reduction without imaging or discharge without evaluation risks missed fracture and neurovascular compromise.

Question 22Emergency Medicine and Sports Medicine Clinical Practice

A hockey player develops severe eye pain and decreased vision after a stick injury. What is the most appropriate next step?

  1. Urgent ophthalmologic evaluation Correct answer.
  2. Ice and observation
  3. Irrigation and discharge
  4. Topical antibiotics and follow-up in one week

Explanation

Penetrating or blunt eye trauma with vision loss requires urgent ophthalmologic evaluation to assess for globe injury, hyphema, or retinal damage. Delay risks permanent vision loss.

Question 23Emergency Medicine and Sports Medicine Clinical Practice

A wrestler has a cauliflower ear with a fluctuant hematoma. What is the most appropriate management?

  1. Observation only
  2. Warm compresses and return to wrestling
  3. Topical antibiotics alone
  4. Aspiration or incision and drainage with compression Correct answer.

Explanation

Auricular hematoma requires drainage and compression to prevent cartilage necrosis and cauliflower ear deformity. Observation or topical treatment alone leads to deformity.

Question 24Emergency Medicine and Sports Medicine Clinical Practice

A runner has medial tibial pain with diffuse tenderness along the posteromedial tibia and no focal fracture line on imaging. What is the most likely diagnosis?

  1. Tibial stress fracture
  2. Chronic exertional compartment syndrome
  3. Medial tibial stress syndrome Correct answer.
  4. Achilles tendinopathy

Explanation

Medial tibial stress syndrome causes diffuse posteromedial tibial tenderness without a focal fracture line. Stress fracture shows focal tenderness and imaging findings, compartment syndrome causes exertional pain with pressure, and Achilles tendinopathy affects the posterior heel.

Question 25Emergency Medicine and Sports Medicine Clinical Practice

An athlete with an acute ankle sprain is being managed in the emergency department. Which measure is most appropriate initially?

  1. Strict immobilization for six weeks
  2. Early protected weight-bearing with functional support Correct answer.
  3. Immediate return to sport
  4. Corticosteroid injection into the joint

Explanation

Acute ankle sprains are managed with early protected weight-bearing, functional support, and rehabilitation rather than prolonged immobilization. Immediate return to sport and routine steroid injection are not recommended.

Question 26Emergency Medicine and Sports Medicine Clinical Practice

An athlete collapses during a game and is unresponsive, apneic, and pulseless. After calling for help and starting chest compressions, what is the most appropriate next step in management?

  1. Place the athlete in the recovery position
  2. Elevate the legs to improve venous return
  3. Begin rescue breathing before compressions
  4. Apply an automated external defibrillator as soon as it is available Correct answer.

Explanation

Sudden cardiac arrest in athletes is most often due to a shockable ventricular arrhythmia, so early defibrillation is the single most time-critical intervention after high-quality compressions and activation of emergency response. CPR should be continued with minimal interruptions while the AED is applied.

Question 27Emergency Medicine and Sports Medicine Clinical Practice

An athlete is removed from play after a helmet-to-helmet collision and is suspected of having a cervical spine injury. Which maneuver is preferred for opening the airway while maintaining spinal alignment?

  1. Turning the head to the side
  2. Hyperextension of the neck
  3. Head-tilt chin-lift
  4. Jaw-thrust maneuver Correct answer.

Explanation

The jaw-thrust maneuver opens the airway without extending the cervical spine, making it the preferred technique when a cervical injury is suspected. Head-tilt chin-lift and neck hyperextension can displace an unstable cervical segment.

Question 28Emergency Medicine and Sports Medicine Clinical Practice

A marathon runner collapses near the finish line on a hot day with core temperature of 41 degrees C, confusion, and hot dry skin. Which cooling method provides the most rapid reduction in core temperature?

  1. Cold-water immersion Correct answer.
  2. Application of ice packs to the groin only
  3. Fanning with misting alone
  4. Oral rehydration with ice water

Explanation

Exertional heat stroke is a time-critical emergency, and cold-water immersion produces the fastest cooling rate and is the preferred field treatment. Ice packs and fanning are adjuncts but cool far more slowly.

Question 29Emergency Medicine and Sports Medicine Clinical Practice

A high school wrestler cuts weight rapidly and presents with weakness, palpitations, and muscle cramping. Which electrolyte disturbance is most likely to produce these symptoms in this setting?

  1. Hypokalemia from diuretic use and poor intake Correct answer.
  2. Hyperkalemia from potassium supplementation
  3. Hypercalcemia from dehydration
  4. Hypernatremia from water restriction

Explanation

Rapid weight cutting with fluid restriction, diuretics, and poor intake commonly causes hypokalemia, which produces weakness, cramping, and palpitations. The clinical picture should prompt an ECG and electrolyte measurement.

Question 30Emergency Medicine and Sports Medicine Clinical Practice

An athlete is stung by a bee and within minutes develops urticaria, wheezing, and hypotension. What is the most appropriate first-line medication?

  1. Inhaled albuterol
  2. Intravenous corticosteroids
  3. Oral diphenhydramine
  4. Intramuscular epinephrine Correct answer.

Explanation

Anaphylaxis is treated first with intramuscular epinephrine, which reverses bronchospasm and vascular collapse. Antihistamines, steroids, and bronchodilators are adjuncts and do not treat the life-threatening airway and hemodynamic components.

Question 31Emergency Medicine and Sports Medicine Clinical Practice

An athlete sustains a direct blow to the eye and is found to have a fixed, dilated pupil, decreased vision, and a tense globe. Which action is most appropriate?

  1. Measurement of intraocular pressure with a tonometer
  2. Instillation of topical anesthetic and discharge
  3. Immediate ophthalmologic consultation for a suspected globe rupture Correct answer.
  4. Application of a pressure patch

Explanation

A tense globe with a fixed dilated pupil and vision loss after trauma raises concern for an acute compartment syndrome of the eye or globe rupture, which requires emergent ophthalmologic evaluation and protection of the eye. Pressure on the globe and tonometry must be avoided.

Question 32Emergency Medicine and Sports Medicine Clinical Practice

A basketball player dislocates the shoulder and the shoulder remains dislocated on arrival. Which finding would most strongly suggest an associated nerve injury requiring urgent attention?

  1. Swelling over the anterior shoulder
  2. Guarding with voluntary restriction of motion
  3. Mild diffuse soreness around the shoulder
  4. Loss of sensation over the lateral deltoid with weak shoulder abduction Correct answer.

Explanation

The axillary nerve runs close to the shoulder joint and is the most commonly injured nerve with anterior dislocation; loss of deltoid sensation and weak abduction suggest axillary nerve injury. The neurovascular status should be documented before and after reduction.

Question 33Emergency Medicine and Sports Medicine Clinical Practice

An athlete reports a 'dead arm' after a tackle with transient weakness and burning but full recovery of strength within minutes. Which condition best fits this presentation?

  1. Axillary nerve laceration
  2. Rotator cuff tear
  3. Acute compartment syndrome of the arm
  4. Cervical cord neurapraxia Correct answer.

Explanation

Transient bilateral or unilateral burning, numbness, and weakness after axial loading of the cervical spine that resolves within minutes to hours is characteristic of cervical cord neurapraxia. Persistent deficits or symptoms in multiple extremities warrant immobilization and imaging.

Question 34Emergency Medicine and Sports Medicine Clinical Practice

An athlete develops sudden pleuritic chest pain and dyspnea during a contact sport and is found to have decreased breath sounds on one side with tracheal deviation away from the affected side. What is the most appropriate immediate management?

  1. Applying supplemental oxygen and arranging outpatient follow-up
  2. Administering a bronchodilator and observing
  3. Obtaining a chest radiograph before any intervention
  4. Needle decompression followed by tube thoracostomy Correct answer.

Explanation

Tracheal deviation with unilateral absent breath sounds and hemodynamic compromise indicates tension pneumothorax, a clinical diagnosis requiring immediate needle decompression followed by tube thoracostomy. Imaging should not delay decompression in an unstable patient.

Question 35Emergency Medicine and Sports Medicine Clinical Practice

A hockey player is struck in the mouth and a permanent tooth is avulsed and recovered dry from the ice. What is the most appropriate immediate action for the tooth?

  1. Scrub it vigorously with a brush and soap
  2. Reimplant it into the socket or store it in a physiologic medium such as milk Correct answer.
  3. Wrap it in dry gauze and refer the next day
  4. Soak it in hydrogen peroxide

Explanation

Avulsed permanent teeth have the best survival when reimplanted promptly or stored in a physiologic medium such as milk or saline while dental care is arranged. The root surface should be handled minimally and not scrubbed.

Question 36Emergency Medicine and Sports Medicine Clinical Practice

A soccer player is kicked in the flank and has gross hematuria with stable vital signs. Which initial imaging study is most appropriate in the emergency department?

  1. Immediate exploratory laparotomy
  2. Plain radiograph of the abdomen
  3. Diagnostic peritoneal lavage
  4. CT of the abdomen and pelvis with intravenous contrast Correct answer.

Explanation

A stable patient with suspected renal injury from blunt trauma is best evaluated with contrast-enhanced CT, which identifies the grade of renal injury and other abdominal injuries. Unstable patients require operative management rather than imaging.

Question 37Emergency Medicine and Sports Medicine Clinical Practice

A cyclist falls and presents with a swollen, painful elbow and an inability to fully extend the arm after reduction of a dislocation. Which finding most suggests a vascular injury requiring urgent evaluation?

  1. Decreased grip strength alone
  2. A small joint effusion
  3. Absent radial pulse with pallor and coolness of the hand Correct answer.
  4. Pain localized to the lateral epicondyle

Explanation

Absent distal pulse with pallor and coolness after elbow trauma suggests brachial artery injury, a limb-threatening emergency requiring urgent vascular assessment. Compartment pressures and neurovascular status should be documented frequently.

Question 38Emergency Medicine and Sports Medicine Clinical Practice

An athlete with a known seizure disorder has a seizure during practice and remains unresponsive for several minutes. Which step is most important in the immediate management of a prolonged seizure?

  1. Give oral fluids once the movements stop
  2. Place an object in the mouth to prevent tongue biting
  3. Administer a benzodiazepine and support the airway Correct answer.
  4. Restrain the limbs to prevent injury

Explanation

A seizure lasting more than five minutes or recurrent seizures without recovery is status epilepticus and requires prompt benzodiazepine administration with airway and breathing support. Objects should never be placed in the mouth, and restraints should be avoided.

Question 39Emergency Medicine and Sports Medicine Clinical Practice

A young athlete has sudden onset of severe scrotal pain during sports with a high-riding testicle and absent cremasteric reflex. What is the most appropriate next step?

  1. Emergent urologic consultation for surgical exploration Correct answer.
  2. Scrotal ultrasound before any consultation
  3. Empiric antibiotics for epididymitis
  4. Application of a warm compress and observation

Explanation

Testicular torsion is a surgical emergency, and salvage depends on the time to detorsion. When the presentation is classic, urologic consultation for exploration should not be delayed by imaging.

Question 40Emergency Medicine and Sports Medicine Clinical Practice

An athlete is found unresponsive but breathing after a fall from height and is suspected of having a spinal injury. Which action is most appropriate during transport?

  1. Remove the helmet and pads immediately regardless of fit
  2. Log-roll the athlete repeatedly to check the back
  3. Sit the athlete upright and monitor
  4. Immobilize the spine with manual stabilization and a rigid collar Correct answer.

Explanation

Suspected spinal injury requires manual in-line stabilization with immobilization during transport to prevent secondary cord injury. Equipment such as helmets and pads should be removed only when necessary and with attention to maintaining alignment.

Question 41Musculoskeletal Injury Evaluation and Management

A 22-year-old basketball player lands on an inverted foot and reports immediate lateral ankle pain and swelling. Which physical exam maneuver best assesses the integrity of the anterior talofibular ligament?

  1. Squeeze test of the distal tibiofibular joint
  2. External rotation stress test with the knee flexed
  3. Talar tilt with the foot in maximal dorsiflexion
  4. Anterior drawer test with the foot in slight plantarflexion Correct answer.

Explanation

The anterior drawer test isolates the anterior talofibular ligament, which is the most commonly injured lateral ankle ligament, and is performed with the ankle slightly plantarflexed to reduce bony congruency. The talar tilt primarily stresses the calcaneofibular ligament.

Question 42Musculoskeletal Injury Evaluation and Management

A 30-year-old runner has focal tenderness 2 to 3 cm proximal to the medial malleolus with pain reproduced by resisted foot inversion and toe raises. Which structure is most likely involved?

  1. Achilles tendon
  2. Tibialis posterior tendon Correct answer.
  3. Peroneus brevis tendon
  4. Plantar fascia

Explanation

Tibialis posterior tendinopathy produces pain posterior and inferior to the medial malleolus, aggravated by resisted inversion and single-leg heel raises. The tendon is a primary dynamic stabilizer of the medial longitudinal arch.

Question 43Musculoskeletal Injury Evaluation and Management

Which physical examination finding is most specific for a complete anterior cruciate ligament tear?

  1. Joint line tenderness medially
  2. Positive Lachman test with a soft endpoint Correct answer.
  3. Positive McMurray test
  4. Popliteal fossa fullness

Explanation

A Lachman test with a soft or absent endpoint indicates loss of ligamentous restraint and is highly sensitive and specific for ACL disruption. An intact endpoint suggests either no tear or a partial injury.

Question 44Musculoskeletal Injury Evaluation and Management

A 45-year-old recreational tennis player develops lateral elbow pain worsened by gripping and by resisted wrist extension. Which diagnosis is most consistent with these findings?

  1. Medial epicondylalgia
  2. Olecranon bursitis
  3. Cubital tunnel syndrome
  4. Lateral epicondylalgia Correct answer.

Explanation

Lateral epicondylalgia involves the common extensor origin, producing pain with resisted wrist extension and gripping. Medial epicondylalgia affects the common flexor origin and is provoked by resisted wrist flexion.

Question 45Musculoskeletal Injury Evaluation and Management

A 19-year-old soccer player has anterior knee pain that worsens with descending stairs and prolonged sitting, with tenderness at the inferior pole of the patella and pain on resisted knee extension. Which condition is most likely?

  1. Patellar tendinopathy Correct answer.
  2. Iliotibial band syndrome
  3. Pes anserine bursitis
  4. Patellofemoral osteoarthritis

Explanation

Patellar tendinopathy produces focal pain at the inferior patellar pole with loading activities such as jumping and stair descent, and is provoked by resisted knee extension. It reflects degenerative changes at the tendon-bone junction rather than acute inflammation.

Question 46Musculoskeletal Injury Evaluation and Management

Which finding on shoulder examination best distinguishes a full-thickness rotator cuff tear from subacromial impingement?

  1. Painful arc between 60 and 120 degrees of abduction
  2. Pain with overhead activity relieved by rest
  3. Positive Neer impingement sign
  4. Marked weakness in a specific cuff muscle with a positive drop arm test Correct answer.

Explanation

A true full-thickness tear produces focal weakness and a positive drop arm sign, whereas impingement typically produces pain with preserved strength. Painful arc and impingement signs are sensitive but not specific for a tear.

Question 47Musculoskeletal Injury Evaluation and Management

A 25-year-old football player sustains a shoulder injury with the arm forced into abduction and external rotation. He reports a sensation of the shoulder slipping and has apprehension when the arm is placed in that position. Which structure is most likely injured?

  1. Posterior glenoid labrum
  2. Acromioclavicular joint capsule
  3. Anterior glenohumeral labrum and capsule Correct answer.
  4. Subscapularis tendon alone

Explanation

Forceful abduction and external rotation drives the humeral head anteriorly, injuring the anterior labrum and capsule and producing anterior apprehension. This is the typical mechanism for anterior shoulder instability.

Question 48Musculoskeletal Injury Evaluation and Management

A 40-year-old cyclist falls onto the point of the shoulder. There is tenderness over the distal clavicle with a step-off, and pain is reproduced by cross-body adduction. Which injury is most likely?

  1. Glenohumeral dislocation
  2. Clavicle shaft fracture
  3. Rotator cuff tear
  4. Acromioclavicular joint sprain Correct answer.

Explanation

A direct blow to the superior shoulder stresses the acromioclavicular ligaments, producing focal AC tenderness, a palpable step-off, and pain with cross-body adduction. The cross-body adduction test stresses the AC joint specifically.

Question 49Musculoskeletal Injury Evaluation and Management

A 55-year-old presents with lateral hip pain that worsens when lying on the affected side and with single-leg stance. Tenderness is present over the greater trochanter. Which diagnosis is most likely?

  1. Femoral neck stress fracture
  2. Lumbar radiculopathy
  3. Hip osteoarthritis
  4. Gluteus medius tendinopathy Correct answer.

Explanation

Gluteus medius tendinopathy produces lateral hip pain over the greater trochanter, aggravated by side-lying and single-leg stance. The pain is extra-articular and localized to the trochanteric region.

Question 50Musculoskeletal Injury Evaluation and Management

Which maneuver is most useful for detecting a posterior cruciate ligament injury?

  1. Posterior drawer test with the knee flexed to 90 degrees Correct answer.
  2. Valgus stress test at 30 degrees
  3. Lachman test
  4. McMurray test

Explanation

The posterior drawer test directly assesses posterior tibial translation with the knee flexed to 90 degrees, the position in which the PCL is most taut. A posterior sag sign may also be present.