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ABPMR PM&R practice questions

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Question 1Neurologic Disorders

A 63-year-old man develops sudden vertigo, hiccups, dysphagia, and left facial numbness with right-sided loss of pain and temperature sensation. Which artery is most commonly responsible?

  1. SCA
  2. PICA Correct answer.
  3. Basilar artery
  4. AICA

Explanation

This is lateral medullary (Wallenberg) syndrome, classically caused by occlusion of the posterior inferior cerebellar artery or the vertebral artery that supplies it. The lesion involves the lateral medulla and spinothalamic tract, producing crossed pain and temperature loss with bulbar signs.

Question 2Neurologic Disorders

Which finding is most characteristic of myasthenia gravis rather than Lambert-Eaton myasthenic syndrome?

  1. Fatigable weakness Correct answer.
  2. Autonomic dysfunction
  3. Proximal leg weakness
  4. Reduced deep tendon reflexes

Explanation

Myasthenia gravis produces fatigable weakness that worsens with repeated use and improves with rest, often beginning with ocular or bulbar muscles. Lambert-Eaton syndrome instead causes proximal leg weakness, hyporeflexia, and autonomic symptoms.

Question 3Neurologic Disorders

A spinal cord hemisection at T8 produces which sensory pattern below the lesion?

  1. Contralateral vibration loss and ipsilateral pain loss
  2. Bilateral loss of pain and temperature
  3. Ipsilateral vibration loss and contralateral pain loss Correct answer.
  4. Ipsilateral loss of pain and temperature

Explanation

Brown-Séquard syndrome damages the dorsal columns and corticospinal tract ipsilaterally and the spinothalamic tract contralaterally. This yields ipsilateral loss of vibration and position sense with contralateral loss of pain and temperature.

Question 4Neurologic Disorders

Which nerve is compressed in carpal tunnel syndrome?

  1. Ulnar nerve
  2. Posterior interosseous nerve
  3. Radial nerve
  4. Median nerve Correct answer.

Explanation

The median nerve passes through the carpal tunnel beneath the flexor retinaculum, where compression produces numbness in the thumb, index, and middle fingers. Thenar weakness and nocturnal symptoms are common.

Question 5Neurologic Disorders

Which medication is first-line for convulsive status epilepticus in the emergency setting?

  1. Intramuscular haloperidol
  2. Oral phenytoin
  3. Oral valproate
  4. Intravenous lorazepam Correct answer.

Explanation

A benzodiazepine such as intravenous lorazepam is the first-line agent for terminating convulsive status epilepticus. If seizures persist, a second-line intravenous antiseizure medication is then added.

Question 6Neurologic Disorders

Which type of cerebral palsy is most common?

  1. Athetoid
  2. Mixed
  3. Ataxic
  4. Spastic Correct answer.

Explanation

Spastic cerebral palsy is the most common subtype, resulting from damage to the corticospinal tract. It is characterized by increased muscle tone, hyperreflexia, and velocity-dependent resistance to passive movement.

Question 7Neurologic Disorders

Which medication is a first-line treatment for painful diabetic peripheral neuropathy?

  1. Oxycodone
  2. Gabapentin Correct answer.
  3. Ibuprofen
  4. Tramadol

Explanation

Gabapentin is a first-line agent for neuropathic pain, along with pregabalin, duloxetine, and tricyclic antidepressants. Nonsteroidal anti-inflammatory drugs and opioids are not preferred first-line treatments for neuropathic pain.

Question 8Neurologic Disorders

Which bedside maneuver is used to diagnose posterior canal benign paroxysmal positional vertigo?

  1. Epley maneuver
  2. Dix-Hallpike Correct answer.
  3. Romberg test
  4. Head impulse test

Explanation

The Dix-Hallpike maneuver positions the posterior semicircular canal to provoke characteristic torsional nystagmus and vertigo in posterior canal benign paroxysmal positional vertigo. The Epley maneuver is a treatment rather than a diagnostic test.

Question 9Neurologic Disorders

A patient with multiple sclerosis reports transient blurring of vision and weakness when overheated or after exercise. Which phenomenon is this?

  1. Uhthoff phenomenon Correct answer.
  2. Lhermitte sign
  3. Infection-related pseudoexacerbation
  4. Optic neuritis

Explanation

Uhthoff phenomenon is a transient worsening of neurologic symptoms with increased body temperature, such as heat or exercise. It reflects temperature-sensitive conduction block in demyelinated axons rather than new inflammation.

Question 10Neurologic Disorders

A patient with Parkinson disease taking carbidopa-levodopa develops predictable end-of-dose deterioration with re-emergence of symptoms before the next dose. Which initial adjustment is most appropriate?

  1. Add a COMT inhibitor Correct answer.
  2. Increase carbidopa dose
  3. Start an anticholinergic
  4. Discontinue levodopa

Explanation

Predictable wearing-off reflects a shortened duration of levodopa response, and adding a catechol-O-methyltransferase inhibitor extends levodopa availability. Other options include a dopamine agonist or monoamine oxidase type B inhibitor.

Question 11Neurologic Disorders

Duration of post-traumatic amnesia after traumatic brain injury is most useful for predicting which outcome?

  1. Seizure recurrence
  2. Intracranial pressure
  3. Functional outcome Correct answer.
  4. Skull fracture risk

Explanation

Post-traumatic amnesia duration correlates with injury severity and is a strong predictor of long-term functional and cognitive outcome after traumatic brain injury. It is more informative than loss of consciousness alone for rehabilitation prognosis.

Question 12Neurologic Disorders

A patient with Guillain-Barré syndrome develops labile blood pressure and heart rate variability. Which management step is most appropriate?

  1. Beta-blocker therapy
  2. Immediate tracheostomy
  3. High-dose steroids
  4. Cardiac monitoring Correct answer.

Explanation

Autonomic instability in Guillain-Barré syndrome can cause dangerous arrhythmias and blood pressure swings, so continuous cardiac monitoring is essential. Treatments such as intravenous immunoglobulin or plasma exchange address the underlying disease.

Question 13Neurologic Disorders

Which medication has been shown to modestly prolong survival in amyotrophic lateral sclerosis?

  1. Pyridostigmine
  2. Interferon beta
  3. Levodopa
  4. Riluzole Correct answer.

Explanation

Riluzole reduces glutamatergic transmission and has a modest survival benefit in amyotrophic lateral sclerosis. Noninvasive ventilation and multidisciplinary care also improve outcomes.

Question 14Neurologic Disorders

Which examination finding most suggests an L5 radiculopathy?

  1. Weakness of plantar flexion
  2. Reduced ankle jerk
  3. Sensory loss over the medial calf
  4. Weakness of great toe extension Correct answer.

Explanation

The L5 nerve root supplies the extensor hallucis longus, so great toe extension weakness is a classic localizing sign. Sensation over the dorsum of the foot and the lateral calf may also be affected.

Question 15Neurologic Disorders

Which triad is classic for normal pressure hydrocephalus?

  1. Chorea, dementia, seizures
  2. Gait apraxia, incontinence, dementia Correct answer.
  3. Headache, vomiting, papilledema
  4. Resting tremor, rigidity, bradykinesia

Explanation

Normal pressure hydrocephalus classically presents with gait apraxia, urinary incontinence, and cognitive decline, often with ventriculomegaly out of proportion to sulcal enlargement. Gait disturbance is usually the earliest and most treatable feature.

Question 16Neurologic Disorders

A patient presents within 72 hours of onset of idiopathic facial nerve palsy with incomplete eye closure. Which treatment is most appropriate?

  1. Acyclovir alone
  2. Antibiotics
  3. Corticosteroids Correct answer.
  4. Observation only

Explanation

Oral corticosteroids started within 72 hours improve recovery in Bell palsy. Eye protection is also important to prevent corneal injury from incomplete eyelid closure.

Question 17Neurologic Disorders

Which oral medication reduces spasticity through GABA-B receptor agonism?

  1. Dantrolene
  2. Baclofen Correct answer.
  3. Diazepam
  4. Tizanidine

Explanation

Baclofen is a GABA-B receptor agonist that reduces spasticity by inhibiting mono- and polysynaptic spinal reflexes. It can be given orally or intrathecally for severe spasticity.

Question 18Neurologic Disorders

Autonomic dysreflexia occurs most commonly after spinal cord injury above which neurologic level?

  1. T10
  2. T6 Correct answer.
  3. L2
  4. S1

Explanation

Autonomic dysreflexia typically occurs with injuries above the T6 level because splanchnic sympathetic outflow is disconnected from supraspinal control. Noxious stimuli below the lesion trigger unopposed parasympathetic responses and dangerous hypertension.

Question 19Neurologic Disorders

Which presentation most suggests cauda equina syndrome?

  1. Isolated low back pain
  2. Urinary retention with saddle numbness Correct answer.
  3. Unilateral foot drop
  4. Radicular pain that is relieved by lying down

Explanation

Cauda equina syndrome classically causes saddle anesthesia, bladder or bowel dysfunction, and bilateral lower extremity weakness or sensory loss. It is a surgical emergency requiring urgent imaging and decompression.

Question 20Neurologic Disorders

Which clinical feature is most characteristic of Huntington disease?

  1. Asymmetric lead-pipe rigidity
  2. Resting tremor
  3. Chorea with dementia Correct answer.
  4. Prominent cervical dystonia

Explanation

Huntington disease is an autosomal dominant neurodegenerative disorder characterized by chorea, psychiatric symptoms, and progressive cognitive decline. It results from CAG repeat expansion in the HTT gene.

Question 21Neurologic Disorders

Locked-in syndrome from a basilar artery occlusion localizes to which structure?

  1. Bilateral internal capsule
  2. Cervical spinal cord
  3. Medial medulla
  4. Ventral pons Correct answer.

Explanation

Infarction of the ventral pons interrupts corticospinal and corticobulbar tracts while sparing the reticular activating system. The patient remains conscious but has quadriplegia and anarthria, often communicating with vertical eye movements.

Question 22Neurologic Disorders

During the apnea test for brain death, which finding supports the diagnosis?

  1. Absent cough with suctioning
  2. Pupils fixed at 3 mm
  3. No motor response to pain
  4. Apnea with PaCO2 >60 mmHg Correct answer.

Explanation

The apnea test confirms absence of respiratory drive despite adequate hypercarbia. Brain death criteria require no respiratory effort when the PaCO2 rises above 60 mmHg or by 20 mmHg above baseline.

Question 23Neurologic Disorders

A patient reports a sudden severe headache described as the worst of life. Noncontrast head CT at 6 hours is normal. Which is the next best step?

  1. Lumbar puncture Correct answer.
  2. Start antibiotics
  3. Reassurance and discharge
  4. MRI brain in 1 week

Explanation

Subarachnoid hemorrhage can be missed by CT, especially as time passes. When CT is negative and suspicion remains high, lumbar puncture for xanthochromia is indicated, ideally after 12 hours from onset.

Question 24Neurologic Disorders

Which antibody is most specifically associated with neuromyelitis optica spectrum disorder?

  1. Anti-Hu
  2. Anti-MOG
  3. Anti-acetylcholine receptor
  4. Anti-aquaporin-4 Correct answer.

Explanation

Neuromyelitis optica spectrum disorder is strongly associated with antibodies against aquaporin-4, the water channel on astrocyte foot processes. Anti-aquaporin-4 positivity supports the diagnosis and predicts a relapsing course.

Question 25Neurologic Disorders

Which finding is the earliest sign of transtentorial herniation?

  1. Respiratory arrest
  2. Decerebrate posturing
  3. Contralateral hemiparesis of the arm
  4. Ipsilateral pupil dilation Correct answer.

Explanation

Transtentorial herniation compresses the oculomotor nerve, producing ipsilateral pupillary dilation as the earliest sign. Contralateral hemiparesis and posturing develop as compression progresses.

Question 26Neurologic Disorders

Which antibody is most commonly detected in adults with generalized myasthenia gravis?

  1. Anti-MAG antibody
  2. Voltage-gated calcium channel antibody
  3. Anti-GQ1b antibody
  4. Acetylcholine receptor antibody Correct answer.

Explanation

Roughly 80-85% of patients with generalized myasthenia gravis harbor antibodies directed against the postsynaptic muscle acetylcholine receptor; seronegative cases may instead show MuSK or LRP4 antibodies. Anti-MAG and anti-GQ1b antibodies belong to peripheral demyelinating and Miller Fisher syndromes respectively, and VGCC antibodies define Lambert-Eaton myasthenic syndrome.

Question 27Neurologic Disorders

Which medication is the preferred first-line monotherapy for a child with newly diagnosed absence epilepsy and no other seizure types?

  1. Carbamazepine
  2. Valproate
  3. Ethosuximide Correct answer.
  4. Phenytoin

Explanation

Ethosuximide is first-line for childhood absence epilepsy because it controls absence seizures as well as valproate does while causing fewer adverse effects on attention and cognition. Valproate is reserved for children who also have generalized tonic-clonic seizures, and sodium channel blockers can aggravate absence seizures.

Question 28Neurologic Disorders

A patient sustains a midshaft humeral fracture and afterward is unable to extend the wrist or fingers. Which nerve was injured?

  1. Musculocutaneous nerve
  2. Ulnar nerve
  3. Median nerve
  4. Radial nerve Correct answer.

Explanation

The radial nerve runs in the spiral groove against the humeral shaft, so a midshaft fracture stretches or lacerates it, producing wrist and finger drop with sensory loss over the dorsal first web space. Median, ulnar, and musculocutaneous injuries do not produce wrist extension weakness.

Question 29Neurologic Disorders

A patient develops sudden vertigo, hiccups, hoarseness, ipsilateral facial numbness, and ipsilateral limb ataxia, together with loss of pain and temperature sensation on the contralateral body. Which structure is infarcted?

  1. Medial medulla
  2. Lateral medulla Correct answer.
  3. Basis pontis
  4. Cerebral peduncle

Explanation

This is lateral medullary (Wallenberg) syndrome, caused by occlusion of the intracranial vertebral artery or the posterior inferior cerebellar artery. The crossed sensory pattern reflects damage to the spinal trigeminal nucleus and spinothalamic tract, with hoarseness and dysphagia from the nucleus ambiguus.

Question 30Neurologic Disorders

Which feature is a core clinical criterion for dementia with Lewy bodies?

  1. Stepwise cognitive decline
  2. Isolated memory loss
  3. Prominent early aphasia
  4. Visual hallucinations Correct answer.

Explanation

Recurrent, well-formed visual hallucinations are one of the core features of dementia with Lewy bodies, along with fluctuating cognition, spontaneous parkinsonism, and REM sleep behavior disorder. Stepwise decline and prominent early aphasia point instead to vascular and frontotemporal dementias.

Question 31Neurologic Disorders

Twelve hours after aortic aneurysm repair, a patient has flaccid paraplegia with loss of pain and temperature sensation below the level, but vibration and position sense remain intact. Which diagnosis best fits this pattern?

  1. Anterior cord syndrome Correct answer.
  2. Central cord syndrome
  3. Posterior cord syndrome
  4. Brown-Séquard syndrome

Explanation

Anterior cord syndrome results from infarction of the anterior spinal artery or of the artery of Adamkiewicz, which supplies the corticospinal and spinothalamic tracts while sparing the dorsally located posterior columns. This yields motor paralysis and loss of pain and temperature below the lesion with preserved vibration and proprioception.

Question 32Neurologic Disorders

A woman 10 days postpartum develops a progressive throbbing headache, papilledema, and a focal seizure; noncontrast head CT is unremarkable. Which study is most appropriate to confirm the suspected diagnosis?

  1. Lumbar puncture
  2. Routine EEG
  3. CT venography Correct answer.
  4. Carotid duplex ultrasound

Explanation

The puerperal state is a classic risk factor for cerebral venous sinus thrombosis, which requires venous-phase imaging with CT venography or MR venography because noncontrast CT is frequently normal. Delayed diagnosis is dangerous because untreated thrombosis can progress to venous infarction and hemorrhage.

Question 33Neurologic Disorders

A 62-year-old smoker with small cell lung cancer reports proximal leg weakness that briefly improves after repeated contractions, along with dry mouth and absent reflexes. Which antibody is most likely responsible?

  1. Acetylcholine receptor antibody
  2. Voltage-gated potassium channel antibody
  3. GQ1b ganglioside antibody
  4. P/Q-type calcium channel antibody Correct answer.

Explanation

Antibodies against presynaptic P/Q-type voltage-gated calcium channels cause Lambert-Eaton myasthenic syndrome, which classically accompanies small cell lung cancer and produces proximal weakness that improves with sustained effort plus autonomic symptoms such as xerostomia. Repetitive nerve stimulation shows an incremental response, the opposite of the decrement seen in myasthenia gravis.

Question 34Neurologic Disorders

A 22-year-old woman is admitted with new psychosis, seizures, and prominent orofacial dyskinesias; CSF shows lymphocytic pleocytosis and EEG is diffusely slow. Which diagnosis should be pursued first?

  1. Anti-NMDA encephalitis Correct answer.
  2. Herpes simplex encephalitis
  3. Acute disseminated encephalomyelitis
  4. Neurosyphilis

Explanation

The sequence of psychiatric symptoms followed by seizures, movement disorder, and autonomic instability in a young woman is the classic presentation of anti-NMDA receptor encephalitis, which is frequently associated with an ovarian teratoma. Early immunotherapy and tumor removal substantially improve outcome, so antibody testing and pelvic imaging should follow promptly.

Question 35Musculoskeletal Disorders and Sports Medicine

A 22-year-old soccer player sustains a noncontact pivoting injury with an audible pop and rapid knee swelling within 2 hours. Which structure is most likely injured?

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

Explanation

A noncontact pivot with a pop and a tense effusion within a few hours is the classic presentation of an ACL tear. Rapid swelling reflects hemarthrosis from an intra-articular ligament tear rather than a reactive effusion.

Question 36Musculoskeletal Disorders and Sports Medicine

Which rotator cuff muscle initiates the first 15 degrees of shoulder abduction?

  1. Subscapularis
  2. Supraspinatus Correct answer.
  3. Infraspinatus
  4. Teres minor

Explanation

The supraspinatus initiates abduction and shares the first 15 to 30 degrees with the deltoid. The remaining cuff muscles act mainly as humeral rotators and depressors of the head.

Question 37Musculoskeletal Disorders and Sports Medicine

A 45-year-old recreational tennis player reports lateral elbow pain worsened by resisted wrist extension. Which structure is the likely source?

  1. Common extensor origin at the lateral epicondyle Correct answer.
  2. Triceps insertion at the olecranon
  3. Common flexor origin at the medial epicondyle
  4. Biceps brachii insertion at the radial tuberosity

Explanation

Lateral epicondylitis is a tendinopathy of the common extensor origin, chiefly the extensor carpi radialis brevis. Pain is reproduced by resisted wrist extension and by gripping.

Question 38Musculoskeletal Disorders and Sports Medicine

According to the Ottawa ankle rules, which finding alone justifies obtaining ankle radiographs after an ankle injury?

  1. Pain on active dorsiflexion of the ankle
  2. Diffuse swelling around the lateral malleolus
  3. Point tenderness at the posterior edge of the lateral malleolus Correct answer.
  4. Inability to bear weight for 10 steps only at the time of injury

Explanation

The Ottawa ankle rules require imaging when there is bone tenderness at the posterior edge or tip of either malleolus or at the navicular or fifth metatarsal base, or inability to bear weight for four steps both immediately and at evaluation.

Question 39Musculoskeletal Disorders and Sports Medicine

A 50-year-old runner has sharp heel pain with the first steps in the morning that eases with continued activity. What is the most likely diagnosis?

  1. Achilles tendinopathy
  2. Plantar fasciitis Correct answer.
  3. Tarsal tunnel syndrome
  4. Calcaneal stress fracture

Explanation

First-step pain at the medial calcaneal tuberosity that improves with activity is characteristic of plantar fasciitis. Tenderness is maximal at the medial calcaneal tubercle and along the proximal fascia.

Question 40Musculoskeletal Disorders and Sports Medicine

A 40-year-old man feels a sudden snap in the calf while playing basketball and cannot push off. Which examination finding best confirms an Achilles tendon rupture?

  1. Positive anterior drawer of the ankle
  2. Absent plantarflexion when the calf is squeezed Correct answer.
  3. Pain with resisted ankle dorsiflexion
  4. Increased dorsiflexion range with the knee extended

Explanation

The Thompson test squeezes the calf; in a complete Achilles rupture the foot fails to plantarflex. A palpable gap and weak push-off support the diagnosis.

Question 41Musculoskeletal Disorders and Sports Medicine

A young athlete sustains an anterior shoulder dislocation and afterward has numbness over the lateral deltoid. Which nerve is most likely injured?

  1. Axillary nerve Correct answer.
  2. Musculocutaneous nerve
  3. Radial nerve
  4. Median nerve

Explanation

The axillary nerve passes around the surgical neck of the humerus and is the nerve most often injured in anterior shoulder dislocation. It supplies the deltoid and the skin over the lateral shoulder.

Question 42Musculoskeletal Disorders and Sports Medicine

A football player takes a blow to the lateral knee, and valgus stress at 30 degrees of flexion reproduces medial pain and laxity. Which ligament is 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 testing at 30 degrees of flexion isolates the MCL from the ACL and posterior capsule. The MCL is the primary restraint to valgus force.

Question 43Musculoskeletal Disorders and Sports Medicine

A 24-year-old volleyball player has deep anterosuperior shoulder pain and pain in the cocked throwing position. Which test is most specific for a superior labral tear?

  1. O'Brien active compression test Correct answer.
  2. Drop arm test
  3. Speed test
  4. Lift-off test

Explanation

The O'Brien active compression test loads the superior labrum and is used for SLAP lesions, with pain in internal rotation that lessens with supination. It is more specific for labral pathology than the other maneuvers listed.

Question 44Musculoskeletal Disorders and Sports Medicine

A 25-year-old hockey player has groin pain with deep hip flexion and internal rotation. Radiographs show a decreased femoral head-neck offset. Which diagnosis is most likely?

  1. Pincer-type femoroacetabular impingement
  2. Proximal hamstring tendinopathy
  3. Cam-type femoroacetabular impingement Correct answer.
  4. Developmental dysplasia of the hip

Explanation

A reduced femoral head-neck offset creates cam morphology that abuts the acetabular rim during flexion and internal rotation. Pincer impingement instead results from acetabular overcoverage.

Question 45Musculoskeletal Disorders and Sports Medicine

A 16-year-old runner has anterior knee pain aggravated by stairs and squatting, with no effusion and no ligamentous laxity. Which intervention has the strongest evidence for patellofemoral pain?

  1. Hip and quadriceps strengthening with activity modification Correct answer.
  2. Prolonged immobilization in a cylinder cast
  3. Immediate corticosteroid injection
  4. Arthroscopic lateral retinacular release

Explanation

Patellofemoral pain is managed with exercise-based therapy targeting hip abductors and the quadriceps, combined with load modification. Surgery and injections are not first-line care.

Question 46Musculoskeletal Disorders and Sports Medicine

A cross-country runner has reproducible lateral leg pain that begins after 10 minutes of running and resolves with rest. Examination between episodes is normal. What is the most likely diagnosis?

  1. Deep vein thrombosis
  2. Tibial stress fracture
  3. Chronic exertional compartment syndrome Correct answer.
  4. Popliteal artery entrapment syndrome

Explanation

Exercise-induced pain that resolves predictably with rest, together with a normal resting examination, suggests chronic exertional compartment syndrome. Compartment pressure measurement after exercise confirms the diagnosis.

Question 47Musculoskeletal Disorders and Sports Medicine

A 52-year-old woman with diabetes has gradual shoulder pain and cannot reach behind her back or overhead, with global loss of passive motion. Which diagnosis is most likely?

  1. Adhesive capsulitis Correct answer.
  2. Calcific tendinitis of the supraspinatus
  3. Acute rotator cuff tear
  4. Glenohumeral osteoarthritis

Explanation

Adhesive capsulitis causes global restriction of both active and passive motion, especially external rotation, and is associated with diabetes. Loss of passive motion distinguishes it from rotator cuff disease.

Question 48Musculoskeletal Disorders and Sports Medicine

A 15-year-old gymnast has low back pain worsened by extension. What is the most appropriate initial imaging study for suspected spondylolysis?

  1. Posteroanterior and lateral lumbar radiographs Correct answer.
  2. Lumbar MRI with contrast
  3. Whole-body bone scan
  4. Computed tomography of the lumbar spine

Explanation

Plain radiographs, often including oblique views, are the initial study for suspected spondylolysis and may show a pars defect. Advanced imaging is reserved for cases with negative radiographs and persistent suspicion.

Question 49Musculoskeletal Disorders and Sports Medicine

A high school soccer player is symptom-free at rest 3 days after a concussion. According to consensus return-to-sport guidance, what is the next step?

  1. Return to full contact practice immediately
  2. Begin a graduated stepwise exercise progression Correct answer.
  3. Remain in complete rest until 2 weeks have passed
  4. Undergo provocative vestibular testing before any activity

Explanation

Current consensus recommends a brief period of relative rest followed by a stepwise aerobic and sport-specific progression, with roughly 24 hours at each step if symptoms do not recur. Contact activity is the final stage of that progression.

Question 50Musculoskeletal Disorders and Sports Medicine

A 13-year-old pitcher has lateral shoulder pain with throwing and radiographic widening of the proximal humeral physis. What is the diagnosis?

  1. Acromioclavicular joint sprain
  2. Posterior shoulder instability
  3. Osteochondritis dissecans of the humeral head
  4. Proximal humeral epiphysiolysis Correct answer.

Explanation

Little League shoulder is a Salter-Harris I stress injury of the proximal humeral physis caused by repetitive throwing. Treatment is rest from throwing followed by a graduated return.