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ABP Sports Medicine study materials
ABP Sports Medicine study resources

ABP Sports Medicine practice questions

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Question 1General Principles and Preparticipation Evaluation

According to AAP recommendations, when should the preparticipation physical evaluation be performed?

  1. Annually, 6 weeks before season Correct answer.
  2. Only at high school entry
  3. Every 2 years
  4. Only when symptoms occur

Explanation

The PPE is best completed annually and at least 6 weeks before the sport season so that any needed evaluation or rehabilitation can occur before play. A single exam at school entry or only for symptoms misses interval health changes.

Question 2General Principles and Preparticipation Evaluation

Which item is part of the AHA 14-point personal history for cardiovascular screening?

  1. History of asthma
  2. Heart murmur or hypertension Correct answer.
  3. History of acne
  4. History of ankle sprain

Explanation

The AHA personal history asks about heart murmur, high blood pressure, and other cardiac symptoms or diagnoses. Asthma, ankle sprains, and acne are important but are not part of the cardiovascular screening set.

Question 3General Principles and Preparticipation Evaluation

A systolic murmur is heard during PPE. Which maneuver most reliably augments a murmur caused by hypertrophic cardiomyopathy?

  1. Deep inspiration
  2. Squatting
  3. Valsalva Correct answer.
  4. Handgrip

Explanation

Valsalva reduces venous return and left ventricular preload, which worsens dynamic left ventricular outflow tract obstruction and intensifies the HCM murmur. Handgrip and squatting increase preload and typically soften that murmur.

Question 4General Principles and Preparticipation Evaluation

Which physical finding most supports a diagnosis of Marfan syndrome during PPE?

  1. Positive thumb sign Correct answer.
  2. Positive Lachman test
  3. Positive Phalen test
  4. Positive McMurray test

Explanation

The thumb sign and wrist sign reflect arachnodactyly and are classic skeletal features of Marfan syndrome. McMurray, Lachman, and Phalen tests assess the knee meniscus, ACL, and carpal tunnel, respectively.

Question 5General Principles and Preparticipation Evaluation

An athlete with sickle cell trait should be counseled about increased risk of which complication during intense exercise?

  1. Iron-deficiency anemia
  2. Heat illness and rhabdomyolysis Correct answer.
  3. Exercise-induced bronchospasm
  4. Anterior cruciate ligament tear

Explanation

Sickle cell trait is associated with exertional sickling, which can cause heat illness, rhabdomyolysis, and even sudden collapse during extreme conditioning. Hydration, pacing, and early recognition of symptoms are key preventive measures.

Question 6General Principles and Preparticipation Evaluation

Which statement about baseline neurocognitive testing in the PPE is most appropriate?

  1. Replaces sideline assessment
  2. Optional, not required for clearance Correct answer.
  3. Diagnostic of concussion
  4. Mandatory for all athletes annually

Explanation

Baseline testing may be considered for some athletes, but it is not required for sports clearance and does not replace clinical or sideline evaluation. A baseline score cannot diagnose a concussion by itself.

Question 7General Principles and Preparticipation Evaluation

What is the safest approach for youth football players beginning summer practice in hot weather?

  1. Two-a-day practices from day one
  2. Restrict fluids to prevent cramps
  3. Full gear in afternoon heat
  4. Gradual increase in intensity and equipment Correct answer.

Explanation

Heat acclimatization should be gradual, with progressive increases in practice intensity and protective equipment over 1 to 2 weeks. This reduces the risk of exertional heat illness during early-season practices.

Question 8General Principles and Preparticipation Evaluation

Which is the preferred pretreatment for an athlete with exercise-induced bronchoconstriction?

  1. Oral corticosteroid
  2. Montelukast daily
  3. Albuterol before exercise Correct answer.
  4. Long-acting beta agonist alone

Explanation

A short-acting beta agonist such as albuterol, taken 15 to 20 minutes before exercise, is first-line prevention for exercise-induced bronchoconstriction. Daily controller therapy is added when underlying asthma is present.

Question 9General Principles and Preparticipation Evaluation

How should an athlete with type 1 diabetes monitor blood glucose around exercise?

  1. Only at bedtime
  2. Only before exercise
  3. Only when symptomatic
  4. Before, during, after Correct answer.

Explanation

Exercise can cause both hypoglycemia and hyperglycemia, so glucose should be checked before, during, and after activity as needed. Carbohydrate and insulin plans are adjusted based on these readings.

Question 10General Principles and Preparticipation Evaluation

Which sport is generally contraindicated for an athlete with uncontrolled epilepsy?

  1. Basketball
  2. Cycling
  3. Cross-country running
  4. SCUBA diving Correct answer.

Explanation

SCUBA diving is generally contraindicated when seizures are uncontrolled because a seizure underwater can be fatal. Most land-based sports can be considered with appropriate supervision and seizure precautions.

Question 11General Principles and Preparticipation Evaluation

A wrestler has herpes gladiatorum. What is the minimum return criterion?

  1. Afebrile for 12 hours
  2. 48 hours without new lesions Correct answer.
  3. No new lesions for 24 hours
  4. Lesions covered with a bandage

Explanation

Return-to-wrestling criteria generally require no new lesions for 48 hours and all lesions dried or crusted, often with a minimum course of antiviral therapy. Covering active lesions alone is not sufficient.

Question 12General Principles and Preparticipation Evaluation

Which vaccine is most important for preventing annual team outbreaks of a respiratory illness?

  1. Meningococcal conjugate
  2. Influenza Correct answer.
  3. Hepatitis A
  4. Human papillomavirus

Explanation

Influenza spreads readily in team settings and is preventable with annual vaccination. Hepatitis A, HPV, and meningococcal vaccines protect against other diseases but are not the main seasonal respiratory outbreak vaccine.

Question 13General Principles and Preparticipation Evaluation

Which substance is prohibited by WADA and used illicitly for anabolic effects?

  1. Creatine monohydrate
  2. Vitamin D
  3. Anabolic-androgenic steroids Correct answer.
  4. Caffeine

Explanation

Anabolic-androgenic steroids are prohibited in sport and carry serious cardiovascular, hepatic, and endocrine risks. Creatine, caffeine, and vitamin D are not prohibited, although caffeine has a monitoring threshold.

Question 14General Principles and Preparticipation Evaluation

Which finding is a key component of the female athlete triad?

  1. Hyperthyroidism
  2. Hypertension
  3. Obesity
  4. Menstrual dysfunction Correct answer.

Explanation

The female athlete triad includes low energy availability, menstrual dysfunction, and low bone mineral density. Hypertension, obesity, and hyperthyroidism are not components of the triad.

Question 15General Principles and Preparticipation Evaluation

Which is a warning sign of overtraining in a young athlete?

  1. Improved sleep
  2. Persistent fatigue Correct answer.
  3. Elevated mood
  4. Increased appetite

Explanation

Persistent fatigue, declining performance, sleep disturbance, and mood changes suggest overtraining or burnout. Improved sleep, appetite, and mood are not warning signs.

Question 16General Principles and Preparticipation Evaluation

An athlete has a fever of 38.5°C and myalgias. What is the best clearance decision?

  1. Allow practice with acetaminophen
  2. Withhold until afebrile and improved Correct answer.
  3. Return when fever resolves with antibiotics
  4. Clear for competition if no rash

Explanation

Exercise with fever and systemic symptoms raises concern for viral myocarditis and should be avoided until the athlete is afebrile and clinically improved. Antipyretics do not make exercise safe.

Question 17General Principles and Preparticipation Evaluation

An adolescent has repeated blood pressure readings of 150/95 mm Hg. What is the appropriate sports clearance?

  1. Clear for all sports
  2. Only non-contact sports
  3. Recheck in 6 months
  4. No sports until evaluated Correct answer.

Explanation

Readings at this level suggest stage 2 hypertension, which requires prompt evaluation and control before competitive sports. Clearance can be reconsidered once secondary causes and end-organ effects are assessed.

Question 18General Principles and Preparticipation Evaluation

What is the most common cardiovascular cause of sudden cardiac death in young US athletes?

  1. Hypertrophic cardiomyopathy Correct answer.
  2. Marfan syndrome
  3. Coronary artery anomaly
  4. Arrhythmogenic right ventricular cardiomyopathy

Explanation

Hypertrophic cardiomyopathy is the most commonly identified cardiovascular cause of sudden cardiac death in young US athletes. Other causes include coronary anomalies, arrhythmogenic cardiomyopathy, and ion channel disorders.

Question 19General Principles and Preparticipation Evaluation

An asymptomatic athlete has confirmed hypertrophic cardiomyopathy. What is the usual sports eligibility recommendation?

  1. Cleared for low-intensity only
  2. Cleared after beta-blocker therapy
  3. Cleared for all sports if asymptomatic
  4. Restricted from high-intensity competitive sports Correct answer.

Explanation

Athletes with confirmed HCM are generally restricted from high-intensity competitive sports because of arrhythmia risk. Beta-blocker therapy does not routinely reverse that restriction, and clearance requires individualized expert evaluation.

Question 20General Principles and Preparticipation Evaluation

Absent femoral pulses on PPE should prompt evaluation for which condition?

  1. Deep vein thrombosis
  2. Hypertrophic cardiomyopathy
  3. Aortic coarctation Correct answer.
  4. Marfan syndrome

Explanation

Diminished or absent femoral pulses suggest aortic coarctation, especially when upper-extremity blood pressure exceeds lower-extremity pressure. This finding warrants prompt cardiovascular evaluation.

Question 21General Principles and Preparticipation Evaluation

An athlete fails vision screening in one eye. What is the next best step?

  1. Refer for eye examination Correct answer.
  2. Prescribe corrective lenses
  3. Restrict from contact sports
  4. Clear for all sports

Explanation

A failed vision screen should be confirmed with a formal eye examination to identify refractive error or ocular disease. Clearance and protective eyewear decisions follow that evaluation.

Question 22General Principles and Preparticipation Evaluation

The Adam forward bend test is used to screen for which condition?

  1. Scoliosis Correct answer.
  2. Kyphosis
  3. Hamstring tightness
  4. Leg-length discrepancy

Explanation

The Adam forward bend test looks for trunk asymmetry and rib hump, which suggest scoliosis. It is not a specific test for kyphosis, leg-length discrepancy, or hamstring tightness.

Question 23General Principles and Preparticipation Evaluation

Which measure best assesses biologic maturity in an adolescent athlete?

  1. Height alone
  2. Chronologic age
  3. Tanner staging Correct answer.
  4. Weight

Explanation

Tanner staging evaluates pubic hair and genital or breast development and is a practical marker of biologic maturation. Chronologic age, height, and weight alone do not capture the wide variation in pubertal timing.

Question 24General Principles and Preparticipation Evaluation

A 16-year-old athlete discloses marijuana use during the PPE. What is the best initial approach?

  1. Report to police
  2. Tell the entire team
  3. Ignore the disclosure
  4. Maintain confidentiality and counsel Correct answer.

Explanation

Adolescent health information should be handled confidentially, and the clinician should counsel the athlete and assess for risky use or co-occurring problems. Reporting to police or the team is not appropriate absent a specific legal duty or imminent danger.

Question 25General Principles and Preparticipation Evaluation

What is the current status of routine ECG screening for asymptomatic young athletes in the United States?

  1. Not universally recommended Correct answer.
  2. Recommended only for females
  3. Mandatory by the AHA
  4. Replaces history and physical

Explanation

The AHA does not recommend universal ECG screening for all asymptomatic athletes because of false positives, cost, and variable interpretation. History and physical remain the standard, with ECG used selectively.

Question 26Exercise Physiology, Training, and Nutrition

During a maximal sprint lasting about 6 seconds, which energy system supplies the majority of ATP?

  1. Phosphagen system Correct answer.
  2. Oxidative phosphorylation
  3. Fatty acid oxidation
  4. Anaerobic glycolysis

Explanation

The phosphagen system uses stored ATP and phosphocreatine to supply energy for very brief, maximal efforts, typically up to about 10 seconds. Anaerobic glycolysis contributes more as the effort extends toward 30 seconds, while oxidative pathways dominate longer work.

Question 27Exercise Physiology, Training, and Nutrition

Which muscle fiber type has high myosin ATPase activity, low oxidative capacity, and rapid fatigue?

  1. Type IIa
  2. Cardiac muscle
  3. Type I
  4. Type IIx Correct answer.

Explanation

Type IIx fibers are fast-twitch, glycolytic fibers with high ATPase activity and low mitochondrial density, so they produce rapid force but fatigue quickly. Type I fibers are slow and highly oxidative, while type IIa fibers are intermediate.

Question 28Exercise Physiology, Training, and Nutrition

In which muscle action does a muscle generate force while lengthening?

  1. Isokinetic
  2. Isometric
  3. Eccentric Correct answer.
  4. Concentric

Explanation

An eccentric action occurs when external resistance exceeds the force produced and the muscle lengthens under tension. Concentric actions shorten the muscle, and isometric actions hold length constant.

Question 29Exercise Physiology, Training, and Nutrition

The principle that training loads must increase over time to continue producing adaptation is called:

  1. Progressive overload Correct answer.
  2. Specificity
  3. Individuality
  4. Reversibility

Explanation

Progressive overload states that the body adapts to a given stimulus and requires gradually increasing stress to keep improving. Without overload, gains plateau.

Question 30Exercise Physiology, Training, and Nutrition

Which supplement has the strongest evidence for improving short-duration, high-intensity performance by increasing phosphocreatine availability?

  1. Glucosamine
  2. Creatine monohydrate Correct answer.
  3. Vitamin C
  4. Branched-chain amino acids

Explanation

Creatine monohydrate raises intramuscular creatine and phosphocreatine, supporting ATP resynthesis during brief maximal efforts. It is among the most studied ergogenic supplements.

Question 31Exercise Physiology, Training, and Nutrition

How long before exercise is it generally recommended to drink about 500 mL of fluid to allow excess to be excreted?

  1. 2-4 hours before Correct answer.
  2. 8-12 hours before
  3. 24 hours before
  4. Immediately before

Explanation

Drinking roughly 5-7 mL/kg about 2-4 hours before exercise allows time for urine output to regulate fluid balance while promoting euhydration at the start. Drinking immediately before may cause discomfort, and very early intake does not ensure continued hydration.

Question 32Exercise Physiology, Training, and Nutrition

A cyclist trains specifically on hills to improve climbing performance. This best illustrates which training principle?

  1. Periodization
  2. Reversibility
  3. Specificity Correct answer.
  4. Overtraining

Explanation

The principle of specificity, often summarized as SAID (specific adaptation to imposed demands), holds that training adaptations are specific to the mode, intensity, and movement patterns used. Hill training therefore produces adaptations relevant to climbing.

Question 33Exercise Physiology, Training, and Nutrition

Periodization in training refers to:

  1. Planned training variation Correct answer.
  2. Random daily workout selection
  3. Training a single energy system
  4. Daily increases in training volume

Explanation

Periodization is the systematic planning of training variables such as volume, intensity, and exercise selection across cycles to peak at the right time and reduce stagnation. It is deliberate, not random.

Question 34Exercise Physiology, Training, and Nutrition

Lactate threshold is best described as the exercise intensity at which:

  1. Fat oxidation stops completely
  2. Lactate production stops completely
  3. Lactate rises above baseline Correct answer.
  4. Lactate reaches maximal concentration

Explanation

Lactate threshold is the intensity at which blood lactate begins to accumulate above resting values because production exceeds clearance. It is not the maximal lactate value and does not mean lactate production has ceased.

Question 35Exercise Physiology, Training, and Nutrition

According to the Fick equation, VO2max equals cardiac output multiplied by:

  1. Heart rate
  2. Arteriovenous oxygen difference Correct answer.
  3. Minute ventilation
  4. Stroke volume

Explanation

The Fick equation states that oxygen consumption equals cardiac output times the arteriovenous oxygen difference. Cardiac output itself is heart rate times stroke volume, but neither alone is the multiplier in the Fick equation.

Question 36Exercise Physiology, Training, and Nutrition

Delayed-onset muscle soreness 24-72 hours after unaccustomed exercise is primarily attributed to:

  1. Electrolyte depletion
  2. Microscopic muscle damage and inflammation
  3. Acute muscle strain Correct answer.
  4. Lactic acid accumulation

Explanation

DOMS is associated with mechanical damage to muscle fibers and the subsequent inflammatory response, especially after eccentric exercise. Lactic acid clears within hours and does not explain soreness days later.

Question 37Exercise Physiology, Training, and Nutrition

Which daily protein intake is recommended for most strength-training athletes?

  1. 1.6-2.2 g/kg Correct answer.
  2. 2.5-3.5 g/kg
  3. 0.8 g/kg
  4. 1.0-1.2 g/kg

Explanation

Position stands generally recommend 1.6-2.2 g/kg per day for resistance-training athletes to support muscle protein synthesis and repair. The 0.8 g/kg RDA is intended for sedentary adults.

Question 38Exercise Physiology, Training, and Nutrition

Classic carbohydrate loading before an endurance event is intended to:

  1. Deplete glycogen permanently
  2. Maximize muscle glycogen stores Correct answer.
  3. Increase body fat stores
  4. Reduce plasma volume

Explanation

Carbohydrate loading increases muscle glycogen above normal concentrations before prolonged endurance events, delaying glycogen depletion. It does not permanently deplete glycogen or target fat stores.

Question 39Exercise Physiology, Training, and Nutrition

Which change is a hallmark of heat acclimatization?

  1. Increased sweat sodium concentration
  2. Increased plasma volume and earlier sweating Correct answer.
  3. Decreased sweat rate
  4. Increased core temperature at a given workload

Explanation

Heat acclimatization expands plasma volume, lowers the core temperature threshold for sweating, and increases sweat rate while reducing sweat sodium loss. These changes improve thermoregulation and cardiovascular stability.

Question 40Exercise Physiology, Training, and Nutrition

A marathon runner who drinks large volumes of plain water over several hours is at greatest risk of:

  1. Exercise-associated hyponatremia Correct answer.
  2. Dehydration
  3. Hyperkalemia
  4. Hypernatremia

Explanation

Excessive plain water intake without sodium replacement can dilute serum sodium, causing exercise-associated hyponatremia. This can lead to cerebral edema and is a medical emergency.

Question 41Exercise Physiology, Training, and Nutrition

Relative energy deficiency in sport (RED-S) is characterized by:

  1. Improved menstrual function
  2. Normal bone density
  3. Excess energy intake
  4. Low energy availability Correct answer.

Explanation

RED-S describes impaired physiological function caused by low energy availability, where energy intake is insufficient to cover exercise and basic body functions. It can affect bone health, menstrual function, immunity, and performance.

Question 42Exercise Physiology, Training, and Nutrition

The primary purpose of a taper before competition is to:

  1. Increase training volume sharply
  2. Detrain the athlete
  3. Eliminate carbohydrate intake
  4. Reduce fatigue while retaining fitness Correct answer.

Explanation

A taper reduces training volume while maintaining some intensity, allowing fatigue to dissipate without losing fitness gains. This typically improves competition performance.

Question 43Exercise Physiology, Training, and Nutrition

The ergogenic effect of caffeine in endurance exercise is mainly mediated by:

  1. Adenosine receptor antagonism Correct answer.
  2. Increased sweat rate
  3. Plasma volume expansion
  4. Increased glycogen storage

Explanation

Caffeine blocks adenosine receptors, reducing perceived exertion and increasing arousal and neuromuscular function. It does not primarily act by increasing glycogen stores or plasma volume.

Question 44Exercise Physiology, Training, and Nutrition

After 2-4 weeks of complete bed rest, which adaptation is expected?

  1. Increased capillary density
  2. Increased VO2max
  3. Decreased mitochondrial enzyme activity Correct answer.
  4. Increased plasma volume

Explanation

Detraining from bed rest reduces mitochondrial enzyme activity and oxidative capacity, lowering endurance performance. Plasma volume and VO2max typically decrease rather than increase.

Question 45Exercise Physiology, Training, and Nutrition

Plyometric training primarily improves power through:

  1. Increased muscle glycogen
  2. Slow eccentric loading
  3. Prolonged isometric contractions
  4. Stretch-shortening cycle utilization Correct answer.

Explanation

Plyometrics use the stretch-shortening cycle, in which a rapid eccentric stretch potentiates a stronger concentric contraction. This enhances explosive power and neuromuscular efficiency.

Question 46Exercise Physiology, Training, and Nutrition

At high altitude, initial exercise performance declines mainly because:

  1. Atmospheric oxygen percentage falls
  2. Reduced oxygen partial pressure lowers saturation Correct answer.
  3. Carbon dioxide levels fall
  4. Hemoglobin concentration drops immediately

Explanation

The fraction of oxygen in air remains about 20.9%, but at altitude the barometric pressure and therefore the partial pressure of oxygen are lower, reducing alveolar and arterial oxygenation. Hemoglobin concentration does not fall immediately; it later rises with acclimatization.

Question 47Exercise Physiology, Training, and Nutrition

The interference effect in concurrent training is most likely when:

  1. Resistance training is prioritized off-season
  2. Endurance work immediately precedes resistance work Correct answer.
  3. Sessions are separated by 24 hours
  4. Endurance training is low intensity

Explanation

The interference effect occurs when endurance training, especially high-volume work performed immediately before resistance training, blunts strength and hypertrophy adaptations through residual fatigue and competing signaling. Separating sessions and managing volume reduce interference.

Question 48Exercise Physiology, Training, and Nutrition

Which finding most suggests nonfunctional overtraining rather than normal training fatigue?

  1. Elevated heart rate variability
  2. Transient soreness after a new workout
  3. Performance improves after a rest day
  4. Persistent performance decline despite adequate recovery Correct answer.

Explanation

Nonfunctional overtraining is characterized by a prolonged performance decline that persists despite rest and adequate recovery, often with mood and sleep disturbances. Normal fatigue resolves within days.

Question 49Exercise Physiology, Training, and Nutrition

Autologous blood transfusion improves endurance performance primarily by increasing:

  1. Cardiac output at rest
  2. Arterial oxygen content Correct answer.
  3. Muscle buffering capacity
  4. Plasma volume

Explanation

Reinfusing stored red blood cells raises hemoglobin and hematocrit, increasing the oxygen-carrying capacity of arterial blood. This raises arterial oxygen content and can improve VO2max and endurance performance.

Question 50Exercise Physiology, Training, and Nutrition

Polarized endurance training typically distributes training intensity as:

  1. 20% low, 80% high intensity
  2. 50% low, 50% high intensity
  3. 80% low, 20% high intensity Correct answer.
  4. Entirely moderate intensity

Explanation

Polarized training emphasizes a large volume of low-intensity work with a smaller amount of high-intensity work, often around an 80/20 split. This approach seeks to build aerobic base while preserving high-intensity quality.