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ABFM Sports Medicine study materials
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ABFM Sports Medicine practice questions

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Question 1Musculoskeletal Injuries and Conditions

A 24-year-old soccer player sustains an inversion injury to the ankle. On examination there is tenderness over the lateral malleolus and the anterior talofibular ligament. Which physical examination maneuver is most specific for an anterior talofibular ligament injury?

  1. Anterior drawer test of the ankle Correct answer.
  2. Squeeze test of the mid-calf
  3. External rotation stress test
  4. Talar tilt with the ankle in dorsiflexion

Explanation

The anterior drawer test assesses the integrity of the anterior talofibular ligament, the most commonly injured ligament in inversion ankle sprains. Increased anterior translation of the talus relative to the tibia indicates ATFL insufficiency. The talar tilt primarily assesses the calcaneofibular ligament, and the squeeze and external rotation tests assess syndesmotic injury.

Question 2Musculoskeletal Injuries and Conditions

A 45-year-old runner reports lateral knee pain that worsens with downhill running. There is point tenderness over the lateral femoral epicondyle, and pain is reproduced by flexing and extending the knee while the leg is internally rotated. What is the most likely diagnosis?

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

Explanation

Iliotibial band syndrome produces lateral knee pain with tenderness over the lateral femoral epicondyle, exacerbated by repetitive flexion-extension such as downhill running. The Noble compression test, reproducing pain at about 30 degrees of flexion over the lateral epicondyle, supports the diagnosis. Pes anserine bursitis causes medial pain, and MCL sprain follows valgus stress.

Question 3Musculoskeletal Injuries and Conditions

A 30-year-old basketball player lands awkwardly and cannot fully extend the knee. The patella sits high, and the patient cannot perform a straight-leg raise. Which structure is most likely ruptured?

  1. Anterior cruciate ligament
  2. Patellar tendon Correct answer.
  3. Quadriceps tendon
  4. Medial meniscus

Explanation

Patellar tendon rupture leaves the extensor mechanism disrupted, producing patella alta, loss of active knee extension, and an inability to perform a straight-leg raise. Quadriceps tendon rupture also disrupts extension but produces patella baja or a low-riding patella and a palpable suprapatellar defect. ACL and meniscal injuries do not abolish the extensor mechanism.

Question 4Musculoskeletal Injuries and Conditions

A 19-year-old football player has a positive Lachman test and a hemarthrosis after a noncontact pivot injury. Which structure is most directly assessed by the Lachman test?

  1. Lateral collateral ligament
  2. Posterior cruciate ligament
  3. Medial collateral ligament
  4. Anterior cruciate ligament Correct answer.

Explanation

The Lachman test evaluates anterior tibial translation with the knee flexed about 20 to 30 degrees, which isolates the anterior cruciate ligament. A soft or absent endpoint indicates ACL disruption. The posterior drawer assesses the PCL, and varus and valgus stress tests assess the collaterals.

Question 5Musculoskeletal Injuries and Conditions

A 52-year-old recreational tennis player develops lateral elbow pain. Which finding on examination most supports lateral epicondylitis?

  1. Pain with resisted wrist extension Correct answer.
  2. Decreased sensation in the small finger
  3. Pain with resisted wrist flexion
  4. Tinel sign at the cubital tunnel

Explanation

Lateral epicondylitis involves the common extensor origin, so resisted wrist extension and passive wrist flexion reproduce pain at the lateral epicondyle. Medial epicondylitis would be provoked by resisted wrist flexion. Cubital tunnel findings suggest ulnar neuropathy rather than tendinopathy.

Question 6Musculoskeletal Injuries and Conditions

A 60-year-old presents with shoulder pain and inability to actively abduct the arm past 90 degrees, though passive range of motion is full. Which diagnosis is most likely?

  1. Cervical radiculopathy
  2. Rotator cuff tear Correct answer.
  3. Acromioclavicular joint arthritis
  4. Adhesive capsulitis

Explanation

Preserved passive motion with markedly limited active motion in a painful shoulder suggests a rotator cuff tear, because the tendon cannot generate active force. Adhesive capsulitis restricts both active and passive motion. AC arthritis causes localized pain, and cervical radiculopathy produces neurologic findings.

Question 7Musculoskeletal Injuries and Conditions

Which organism is the most common cause of septic arthritis in sexually active young adults?

  1. Escherichia coli
  2. Neisseria gonorrhoeae Correct answer.
  3. Staphylococcus aureus
  4. Streptococcus pneumoniae

Explanation

Neisseria gonorrhoeae is the most common cause of septic arthritis in sexually active young adults, though Staphylococcus aureus remains the overall most common cause across all age groups. Gonococcal arthritis often presents with migratory polyarthralgia, tenosynovitis, and dermatitis before localizing to a joint.

Question 8Musculoskeletal Injuries and Conditions

A patient with an acute ankle sprain has swelling and pain but can bear weight with minimal pain. Which initial management is most appropriate?

  1. Immediate immobilization in a cast for six weeks
  2. Immediate surgical ligament repair
  3. Early protected weight bearing with functional rehabilitation Correct answer.
  4. Complete bed rest for two weeks

Explanation

For grade I and II ankle sprains, early protected weight bearing with functional rehabilitation, including proprioceptive training, produces better outcomes than prolonged immobilization. Casting and surgery are reserved for severe or unstable injuries. Prolonged bed rest risks stiffness and deconditioning.

Question 9Musculoskeletal Injuries and Conditions

A 40-year-old distance runner has medial tibial pain worsened by running. There is diffuse tenderness over the posteromedial tibia without focal point tenderness or fracture line on radiographs. What is the most likely diagnosis?

  1. Medial tibial stress syndrome Correct answer.
  2. Tibial stress fracture
  3. Popliteal artery entrapment
  4. Chronic exertional compartment syndrome

Explanation

Medial tibial stress syndrome, or shin splints, causes diffuse posteromedial tibial tenderness worsened by activity, without a discrete fracture line. Stress fracture typically shows focal point tenderness and may require MRI to detect early changes. Compartment syndrome produces pain with exertion that resolves with rest and is associated with tightness and neurologic symptoms.

Question 10Musculoskeletal Injuries and Conditions

A 22-year-old presents with a locked knee that cannot fully extend after a twisting injury. Which structure is most likely injured?

  1. Posterior cruciate ligament
  2. Quadriceps tendon
  3. Anterior cruciate ligament
  4. Medial meniscus Correct answer.

Explanation

A displaced meniscal tear, often a bucket-handle tear, can mechanically block knee extension and produce a locked knee. This is a mechanical block rather than a ligamentous instability. ACL and PCL injuries cause instability, and quadriceps tendon rupture abolishes active extension.

Question 11Musculoskeletal Injuries and Conditions

A 16-year-old athlete reports anterior knee pain worsened by jumping. There is a prominent tibial tubercle with tenderness over the apophysis. Which condition is most likely?

  1. Osgood-Schlatter disease Correct answer.
  2. Patellar sleeve fracture
  3. Osteochondritis dissecans of the femoral condyle
  4. Sinding-Larsen-Johansson syndrome

Explanation

Osgood-Schlatter disease is traction apophysitis at the tibial tubercle, common in adolescents during growth spurts, and is characterized by a prominent painful tubercle worsened by jumping and running. Sinding-Larsen-Johansson syndrome involves the inferior patellar pole. A sleeve fracture is an acute injury with acute swelling and inability to extend the knee.

Question 12Musculoskeletal Injuries and Conditions

A 28-year-old presents with a painful, swollen joint after a penetrating injury from a rose thorn. Which organism should be specifically considered?

  1. Staphylococcus aureus
  2. Streptococcus pyogenes
  3. Sporothrix schenckii Correct answer.
  4. Neisseria gonorrhoeae

Explanation

Penetrating injuries from plants or thorns raise concern for Sporothrix schenckii, the causative agent of sporotrichosis, which can present as tenosynovitis or arthritis. Staphylococcus aureus remains the most common cause of septic arthritis overall, but the exposure history points to a specific fungal organism.

Question 13Musculoskeletal Injuries and Conditions

A patient with a suspected Achilles tendon rupture is evaluated. Which examination finding is most consistent with a complete rupture?

  1. Positive Thompson test Correct answer.
  2. Positive Finkelstein test
  3. Positive McMurray test
  4. Positive anterior drawer test

Explanation

The Thompson test squeezes the calf; in a complete Achilles rupture the foot does not plantarflex. A palpable gap may also be present. The anterior drawer assesses the ankle ligaments, McMurray the meniscus, and Finkelstein the first dorsal compartment.

Question 14Musculoskeletal Injuries and Conditions

A 35-year-old has atraumatic shoulder pain with marked loss of external rotation and global restriction of both active and passive motion. What is the most likely diagnosis?

  1. Adhesive capsulitis Correct answer.
  2. Rotator cuff tendinopathy
  3. Subacromial bursitis
  4. Acromioclavicular osteoarthritis

Explanation

Adhesive capsulitis produces global restriction of both active and passive motion, with external rotation being characteristically limited. Rotator cuff tendinopathy and subacromial bursitis cause painful active motion with relatively preserved passive motion. AC arthritis causes focal joint tenderness.

Question 15Musculoskeletal Injuries and Conditions

A 20-year-old has anterior knee pain and a positive apprehension test with the patella pushed laterally. What is the most likely diagnosis?

  1. Patellar tendinopathy
  2. Patellar instability Correct answer.
  3. Meniscal tear
  4. Plica syndrome

Explanation

A positive apprehension test with lateral patellar pressure indicates patellar instability, often associated with patellofemoral malalignment or prior dislocation. Patellar tendinopathy causes infrapatellar pole tenderness, and meniscal tears cause joint line pain and mechanical symptoms.

Question 16Musculoskeletal Injuries and Conditions

A 55-year-old with diabetes develops acute monoarthritis of the wrist. Joint aspiration shows a white blood cell count of 60,000/mm3 with 90% neutrophils and no crystals. What is the most appropriate next step?

  1. Observation for 48 hours
  2. Reassurance and NSAIDs alone
  3. Intra-articular corticosteroid injection
  4. Empiric antibiotics after cultures and urgent orthopedic evaluation Correct answer.

Explanation

A joint aspirate with a white blood cell count above 50,000/mm3 and a neutrophilic predominance is highly suspicious for septic arthritis, especially in a patient with diabetes. Empiric antibiotics after obtaining cultures and urgent orthopedic evaluation are indicated. Corticosteroids and observation could worsen infection.

Question 17Musculoskeletal Injuries and Conditions

A 30-year-old cyclist reports numbness and tingling in the ring and small fingers after prolonged riding. Which structure is most likely compressed?

  1. Ulnar nerve at Guyon canal Correct answer.
  2. Radial nerve at the spiral groove
  3. Median nerve at the carpal tunnel
  4. Posterior interosseous nerve

Explanation

Ulnar neuropathy at Guyon canal causes numbness in the ring and small fingers and is associated with prolonged pressure on the hypothenar eminence, as in cycling. Carpal tunnel syndrome affects median nerve distribution, and radial nerve compression causes wrist drop.

Question 18Musculoskeletal Injuries and Conditions

A 14-year-old with open growth plates has hip and knee pain and a limp. Examination shows limited internal rotation of the hip. Which condition is most likely?

  1. Iliotibial band syndrome
  2. Legg-Calve-Perthes disease
  3. Septic arthritis of the hip
  4. Slipped capital femoral epiphysis Correct answer.

Explanation

Slipped capital femoral epiphysis occurs in adolescents and presents with hip or referred knee pain, a limp, and limited internal rotation. Legg-Calve-Perthes disease affects younger children, typically ages 4 to 8. Septic arthritis presents acutely with fever and inability to bear weight.

Question 19Musculoskeletal Injuries and Conditions

A 42-year-old presents with plantar heel pain that is worst with the first steps in the morning. Which examination finding is most characteristic of plantar fasciitis?

  1. Tenderness over the lateral malleolus
  2. Positive Tinel sign at the ankle
  3. Tenderness at the medial calcaneal tuberosity Correct answer.
  4. Pain with resisted ankle dorsiflexion

Explanation

Plantar fasciitis classically causes tenderness at the medial calcaneal tuberosity with pain that is worst with the first steps after rest. Tenderness over the lateral malleolus suggests a lateral ankle injury, and a Tinel sign suggests nerve irritation.

Question 20Musculoskeletal Injuries and Conditions

A 25-year-old has a first-time anterior shoulder dislocation. Which structure is most commonly injured and predisposes to recurrent instability?

  1. Glenoid labrum (Bankart lesion) Correct answer.
  2. Supraspinatus tendon
  3. Long head of the biceps tendon
  4. Acromioclavicular ligament

Explanation

Anterior shoulder dislocation commonly causes a Bankart lesion, an avulsion of the anteroinferior glenoid labrum, which predisposes to recurrent instability. Rotator cuff tears occur more often in older patients, and AC ligament injury follows a direct blow to the shoulder.

Question 21Musculoskeletal Injuries and Conditions

A 65-year-old with chronic kidney disease develops acute monoarthritis of the knee. Aspiration reveals needle-shaped negatively birefringent crystals. Which condition is present?

  1. Reactive arthritis
  2. Pseudogout
  3. Gout Correct answer.
  4. Septic arthritis

Explanation

Needle-shaped, negatively birefringent crystals under polarized light are diagnostic of monosodium urate crystals, confirming gout. Pseudogout involves rhomboid, positively birefringent calcium pyrophosphate crystals. Septic arthritis shows a high white count without crystals.

Question 22Musculoskeletal Injuries and Conditions

A 50-year-old with a history of a prior ankle fracture develops progressive ankle pain and stiffness. Radiographs show joint space narrowing and subchondral sclerosis. What is the most likely diagnosis?

  1. Post-traumatic ankle osteoarthritis Correct answer.
  2. Osteochondral lesion of the talus
  3. Rheumatoid arthritis
  4. Ankle impingement syndrome

Explanation

Post-traumatic osteoarthritis is the most common cause of ankle arthritis and follows prior fractures or ligamentous injury, with radiographic joint space narrowing and sclerosis. Rheumatoid arthritis is typically polyarticular and symmetric, and osteochondral lesions produce focal defects rather than global joint space loss.

Question 23Musculoskeletal Injuries and Conditions

A 30-year-old has chronic lateral ankle instability with recurrent sprains despite rehabilitation. Which finding on examination best indicates mechanical instability?

  1. Positive squeeze test
  2. Pain with resisted ankle eversion
  3. Diffuse swelling over the medial malleolus
  4. Increased talar tilt and anterior drawer on stress testing Correct answer.

Explanation

Mechanical instability is demonstrated by increased talar tilt and anterior drawer laxity on stress testing, reflecting insufficiency of the lateral ligaments. Medial swelling suggests deltoid injury, and a positive squeeze test indicates syndesmotic injury.

Question 24Musculoskeletal Injuries and Conditions

A 35-year-old presents with shoulder pain and weakness in external rotation after a fall. Examination shows a positive drop arm test and a positive external rotation lag sign. Which structure is most likely injured?

  1. Subscapularis tendon
  2. Long head of the biceps tendon
  3. Infraspinatus tendon Correct answer.
  4. Supraspinatus tendon

Explanation

The external rotation lag sign assesses the infraspinatus, and weakness in external rotation points to a posterior cuff tear. The drop arm test is more sensitive for large supraspinatus tears. Subscapularis weakness is assessed with the lift-off or belly-press test.

Question 25Musculoskeletal Injuries and Conditions

A 28-year-old has a suspected femoral stress fracture with normal radiographs. Which imaging modality is most appropriate for early detection?

  1. Computed tomography
  2. Ultrasound
  3. Bone scan with technetium
  4. Magnetic resonance imaging Correct answer.

Explanation

MRI is the most sensitive modality for early stress fractures, detecting bone marrow edema and fracture lines before radiographic changes appear. CT is less sensitive for early marrow changes, and ultrasound does not assess bone marrow. Bone scan is sensitive but less specific and involves radiation.

Question 26Musculoskeletal Injuries and Conditions

A 45-year-old recreational tennis player develops gradual lateral elbow pain that worsens with resisted wrist extension. Which diagnosis is most likely?

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

Explanation

Pain over the lateral epicondyle reproduced by resisted wrist extension reflects an angiofibroblastic tendinopathy of the common extensor origin. Medial epicondylitis involves the flexor-pronator origin and is provoked by resisted wrist flexion. Bursitis and ulnar neuropathy produce swelling or sensory symptoms rather than load-dependent lateral elbow pain.

Question 27Musculoskeletal Injuries and Conditions

A 62-year-old man reports shoulder stiffness and pain that has progressed over months, with loss of both active and passive external rotation. Which diagnosis best fits this presentation?

  1. Acromioclavicular joint arthritis
  2. Subacromial bursitis
  3. Adhesive capsulitis Correct answer.
  4. Rotator cuff tear

Explanation

Global loss of both active and passive motion, especially external rotation, is the hallmark of adhesive capsulitis. Rotator cuff tears and bursitis impair active motion while passive motion is relatively preserved. AC joint arthritis produces focal pain at the joint rather than global restriction.

Question 28Musculoskeletal Injuries and Conditions

Which structure is the primary static restraint preventing anterior translation of the humeral head in the abducted, externally rotated shoulder?

  1. Long head of the biceps tendon
  2. Coracohumeral ligament
  3. Inferior glenohumeral ligament Correct answer.
  4. Supraspinatus tendon

Explanation

The inferior glenohumeral ligament complex is the principal static stabilizer against anterior dislocation in abduction and external rotation. The coracohumeral ligament restrains inferior and posterior translation. The biceps and supraspinatus contribute dynamically but are not the primary static restraint.

Question 29Musculoskeletal Injuries and Conditions

A 24-year-old sprinter has sudden posterior thigh pain while accelerating. Which muscle group is most commonly involved?

  1. Gluteus medius
  2. Hamstrings Correct answer.
  3. Hip adductors
  4. Quadriceps

Explanation

Acceleration injuries typically strain the hamstrings, especially the biceps femoris, because of eccentric loading during terminal swing. Quadriceps strains occur more with deceleration or kicking. Adductor and gluteus medius injuries produce medial groin or lateral hip pain rather than posterior thigh pain.

Question 30Musculoskeletal Injuries and Conditions

A 19-year-old basketball player lands awkwardly and sustains an anterior cruciate ligament tear. Which associated finding on examination is most consistent with this injury?

  1. Positive Thompson test
  2. Positive Finkelstein test
  3. Positive McMurray test
  4. Positive Lachman test Correct answer.

Explanation

The Lachman test assesses anterior tibial translation with the knee flexed about 20 to 30 degrees and is the most sensitive examination for an ACL tear. McMurray tests meniscal pathology, Thompson tests the Achilles tendon, and Finkelstein tests for de Quervain tenosynovitis.

Question 31Musculoskeletal Injuries and Conditions

A 30-year-old presents with a painful swelling over the radial styloid that worsens with ulnar deviation of the wrist. Which diagnosis is most likely?

  1. Carpal tunnel syndrome
  2. Ganglion cyst of the wrist
  3. de Quervain tenosynovitis Correct answer.
  4. Scaphoid fracture

Explanation

Pain over the first dorsal compartment of the wrist reproduced by ulnar deviation with the thumb flexed is characteristic of de Quervain tenosynovitis. Carpal tunnel syndrome produces median nerve symptoms, and a scaphoid fracture follows trauma with anatomic snuffbox tenderness.

Question 32Musculoskeletal Injuries and Conditions

A 26-year-old soccer player has a direct blow to the anterior thigh and develops a tense, swollen, painful thigh with limited knee flexion. Which condition should be considered?

  1. Quadriceps contusion with hematoma Correct answer.
  2. Hamstring strain
  3. Femoral shaft fracture
  4. Deep vein thrombosis

Explanation

A direct blow to the thigh causes a quadriceps contusion with intramuscular bleeding and swelling that limits knee flexion. Hamstring strain follows sprinting rather than direct trauma. Femoral fracture and DVT have distinct mechanisms and findings.

Question 33Musculoskeletal Injuries and Conditions

Which imaging study is the preferred initial test for a suspected acute meniscal tear in a stable knee?

  1. Bone scan
  2. Diagnostic ultrasound
  3. Magnetic resonance imaging Correct answer.
  4. Computed tomography

Explanation

MRI is the modality of choice for evaluating meniscal and ligamentous injuries because of its high soft-tissue contrast and accuracy. CT and bone scan are better suited to osseous pathology, and ultrasound has limited ability to visualize the menisci.

Question 34Musculoskeletal Injuries and Conditions

A 34-year-old runner reports lateral knee pain that worsens with downhill running. There is focal tenderness over the lateral femoral epicondyle, and the pain is reproduced by repetitive knee flexion and extension. Which diagnosis is most likely?

  1. Patellofemoral pain syndrome
  2. Popliteus tendinopathy
  3. Iliotibial band syndrome Correct answer.
  4. Medial collateral ligament sprain

Explanation

Iliotibial band syndrome produces lateral knee pain near the lateral femoral epicondyle, typically aggravated by downhill running and repetitive flexion-extension. Patellofemoral pain is anterior, and MCL sprains follow valgus stress with medial tenderness.

Question 35Musculoskeletal Injuries and Conditions

A 40-year-old presents with a swollen, painful knee and a history of a remote meniscectomy. Arthrocentesis yields cloudy fluid with a cell count of 60,000/mm3 and a predominance of neutrophils. What is the most appropriate next step?

  1. Inject intra-articular corticosteroids
  2. Recommend arthroscopic lavage without cultures
  3. Start empiric intravenous antibiotics and obtain synovial cultures Correct answer.
  4. Prescribe oral NSAIDs and observe

Explanation

A synovial white blood cell count above 50,000/mm3 with neutrophilic predominance suggests septic arthritis and warrants empiric antibiotics after cultures are obtained. Corticosteroid injection or observation risks rapid joint destruction.

Question 36Musculoskeletal Injuries and Conditions

A 28-year-old has a first-time lateral ankle sprain with significant swelling and a positive anterior drawer but no tenderness over the posterior malleolus or medial malleolus. Which ligament is most likely injured?

  1. Anterior inferior tibiofibular ligament
  2. Calcaneofibular ligament
  3. Deltoid ligament
  4. Anterior talofibular ligament Correct answer.

Explanation

The anterior talofibular ligament is the most commonly injured structure in inversion ankle sprains and is assessed by the anterior drawer test. The deltoid ligament is injured with eversion, and the syndesmosis is injured with external rotation or high-energy mechanisms.

Question 37Musculoskeletal Injuries and Conditions

A 16-year-old baseball pitcher reports medial elbow pain during throwing. There is tenderness over the medial epicondyle and pain with valgus stress. Which structure is most likely affected?

  1. Ulnar collateral ligament Correct answer.
  2. Extensor carpi radialis brevis origin
  3. Lateral ulnar collateral ligament
  4. Annular ligament

Explanation

Valgus stress during throwing loads the ulnar collateral ligament, and injury causes medial elbow pain in overhead athletes. The lateral collateral complex is on the lateral side, the annular ligament stabilizes the radial head, and the ECRB origin relates to lateral epicondylitis.

Question 38Musculoskeletal Injuries and Conditions

A 22-year-old gymnast has chronic wrist pain with tenderness in the anatomic snuffbox after a fall on an outstretched hand. Radiographs are normal. What is the most appropriate management?

  1. Refer for immediate open reduction
  2. Immobilize the wrist and repeat imaging or obtain MRI Correct answer.
  3. Reassure and allow full activity
  4. Inject the radiocarpal joint with corticosteroid

Explanation

Occult scaphoid fractures can be missed on initial radiographs and risk nonunion and avascular necrosis, so immobilization with repeat imaging or early MRI is indicated. Allowing activity or injecting steroids risks displacement and poor healing.

Question 39Musculoskeletal Injuries and Conditions

A 58-year-old with diabetes has a swollen, warm knee and a history of recent intra-articular injection. Synovial fluid analysis shows a white blood cell count of 12,000/mm3 with 70% neutrophils and negatively birefringent needle-shaped crystals. What is the most likely diagnosis?

  1. Gout Correct answer.
  2. Reactive arthritis
  3. Septic arthritis
  4. Pseudogout

Explanation

Negatively birefringent needle-shaped crystals identify monosodium urate, confirming gout. Although the cell count is elevated, it is lower than typically seen in septic arthritis, and the crystals establish the diagnosis. Pseudogout involves positively birefringent rhomboid crystals.

Question 40Musculoskeletal Injuries and Conditions

A 45-year-old has chronic lateral hip pain that worsens when lying on the affected side. Examination shows pain with resisted hip abduction and tenderness over the greater trochanter. Which diagnosis is most likely?

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

Explanation

Lateral hip pain with greater trochanter tenderness and pain on resisted abduction is characteristic of gluteus medius tendinopathy. Hip osteoarthritis causes groin pain with limited rotation, and stress fractures cause activity-related pain with weight bearing.

Question 41Musculoskeletal Injuries and Conditions

A 30-year-old has pain at the posterior heel with a palpable gap in the Achilles tendon and a positive Thompson test. Which management is most appropriate?

  1. Surgical repair or functional bracing with early rehabilitation Correct answer.
  2. Corticosteroid injection into the tendon
  3. Activity modification and observation
  4. Eccentric heel-drop exercises alone

Explanation

A complete Achilles rupture with a positive Thompson test requires surgical repair or functional bracing with early controlled rehabilitation. Corticosteroid injection is contraindicated because it weakens the tendon, and eccentric exercise alone is inadequate for a complete rupture.

Question 42Musculoskeletal Injuries and Conditions

A 25-year-old has anterior knee pain and a positive patellar grind test. Which intervention is the best initial management?

  1. Arthroscopic lateral retinacular release
  2. Patellar tendon debridement
  3. Physical therapy targeting quadriceps and hip strengthening Correct answer.
  4. Intra-articular hyaluronic acid injection

Explanation

Patellofemoral pain syndrome is managed initially with physical therapy emphasizing quadriceps and hip abductor strengthening. Surgical options and injections are reserved for refractory cases and are not first-line.

Question 43Musculoskeletal Injuries and Conditions

A 24-year-old has a posterior shoulder dislocation after a seizure. Which radiographic finding is most characteristic?

  1. Positive drop arm test
  2. Light bulb sign Correct answer.
  3. Bankart lesion of the anterior glenoid
  4. Hill-Sachs lesion on the anterior humeral head

Explanation

Posterior dislocation produces the light bulb sign from fixed internal rotation of the humeral head. Hill-Sachs and Bankart lesions are associated with anterior instability, and the drop arm test assesses the rotator cuff.

Question 44Musculoskeletal Injuries and Conditions

A 38-year-old has chronic medial knee pain after a valgus injury. Examination shows laxity with valgus stress at 30 degrees of flexion and point tenderness at the medial femoral condyle. Which structure is most likely injured?

  1. Lateral collateral ligament
  2. Anterior cruciate ligament
  3. Posterior cruciate ligament
  4. Medial collateral ligament Correct answer.

Explanation

Valgus stress opens the medial compartment and tests the medial collateral ligament, which is injured by valgus forces. The lateral collateral ligament is tested with varus stress, and cruciate injuries produce sagittal plane laxity.

Question 45Musculoskeletal Injuries and Conditions

A 50-year-old has chronic shoulder pain with weakness in forward elevation and a positive drop arm test. Which structure is most likely torn?

  1. Long head of the biceps tendon
  2. Supraspinatus tendon Correct answer.
  3. Subscapularis tendon
  4. Teres minor tendon

Explanation

The supraspinatus initiates abduction and is the most commonly torn rotator cuff tendon, producing weakness in elevation and a positive drop arm test. Subscapularis weakness shows on the lift-off test, and biceps pathology causes anterior pain rather than elevation weakness.

Question 46Musculoskeletal Injuries and Conditions

A 65-year-old with knee osteoarthritis has persistent pain despite NSAIDs and physical therapy. Which intervention has the strongest evidence for providing symptomatic relief in knee osteoarthritis?

  1. Arthroscopic lavage
  2. Oral opioid therapy
  3. Intra-articular corticosteroid injection Correct answer.
  4. Intra-articular saline injection

Explanation

Intra-articular corticosteroid injections provide short-term symptomatic relief in knee osteoarthritis and are supported by clinical evidence. Saline has minimal benefit, opioids carry substantial risk, and arthroscopic lavage has not shown meaningful benefit.

Question 47Musculoskeletal Injuries and Conditions

A 20-year-old soccer player sustains a syndesmotic ankle injury. Which examination finding best supports this diagnosis?

  1. Tenderness over the medial malleolus with valgus stress
  2. Pain with external rotation stress and squeeze test at the mid-calf Correct answer.
  3. Tenderness over the lateral malleolus with a positive anterior drawer
  4. Pain with passive great toe dorsiflexion

Explanation

Syndesmotic injuries produce pain with external rotation stress and the squeeze test because the distal tibiofibular ligaments are stressed. Lateral malleolar tenderness with a positive anterior drawer indicates a lateral ligament sprain, and great toe pain suggests plantar plate or sesamoid pathology.

Question 48Musculoskeletal Injuries and Conditions

A 32-year-old has chronic Achilles pain without rupture. Which management strategy is best supported for midportion Achilles tendinopathy?

  1. Progressive eccentric heel-drop loading program Correct answer.
  2. Immediate surgical tenotomy
  3. Complete immobilization for six weeks
  4. Repeated corticosteroid injections

Explanation

Progressive eccentric loading is the cornerstone of nonsurgical management for midportion Achilles tendinopathy and stimulates tendon remodeling. Prolonged immobilization causes atrophy, and corticosteroid injections risk tendon rupture.

Question 49Musculoskeletal Injuries and Conditions

A 28-year-old has chronic groin pain with tenderness at the pubic symphysis and pain with resisted hip adduction. Which diagnosis is most likely?

  1. Hip labral tear
  2. Athletic pubalgia Correct answer.
  3. Inguinal hernia
  4. Femoral acetabular impingement

Explanation

Athletic pubalgia involves the pubic symphysis and adductor or abdominal wall insertions, producing groin pain with resisted adduction. Labral tears and femoroacetabular impingement cause pain with hip rotation and flexion, while a hernia produces a palpable bulge with Valsalva.

Question 50Musculoskeletal Injuries and Conditions

A 22-year-old has recurrent lateral patellar instability with a positive apprehension test. Which anatomic factor most commonly predisposes to this condition?

  1. Genu varum
  2. Tibial external torsion
  3. Increased femoral anteversion
  4. Patella alta Correct answer.

Explanation

Patella alta places the patella proximal to the trochlear groove during early flexion, reducing bony constraint and predisposing to lateral instability. Genu varum and rotational malalignment alter load distribution but are less directly linked to lateral patellar dislocation.