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DACBSP practice questions

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Question 1Unverified domain (source unavailable)

A competitive surfer sustains a board fin laceration to the lateral malleolus with a 4 cm flap. In the emergency department, which wound characteristic most strongly determines whether primary closure can be performed immediately?

  1. The presence of mild surrounding erythema
  2. The wound's location over a bony prominence
  3. The time elapsed since injury and degree of contamination Correct answer.
  4. The patient's history of prior surfboard injuries

Explanation

The decision to close a traumatic wound primarily depends on the interval since injury and the degree of bacterial contamination, since these determine infection risk if the wound is sealed. Highly contaminated or old wounds are generally left to heal by secondary intention or delayed closure.

Question 2Unverified domain (source unavailable)

Which imaging study is the first-line choice for a surfer with suspected acute rotator cuff tear after a forceful wipeout?

  1. Computed tomography arthrogram
  2. Magnetic resonance imaging of the shoulder Correct answer.
  3. Plain radiographs of the shoulder
  4. Diagnostic musculoskeletal ultrasound

Explanation

Magnetic resonance imaging is the reference standard for detecting full-thickness rotator cuff tears and associated soft-tissue injury. Plain films are useful to exclude fracture but cannot visualize the cuff tendon directly.

Question 3Unverified domain (source unavailable)

A 24-year-old competitive swimmer reports lateral elbow pain worsened by resisted wrist extension. Which finding is most consistent with lateral epicondylalgia?

  1. Pain reproduced by resisted wrist extension and gripping Correct answer.
  2. Positive Tinel sign at the cubital tunnel
  3. Pain with passive elbow extension
  4. Pain reproduced by resisted wrist flexion

Explanation

Lateral epicondylalgia involves the common extensor origin, so pain is provoked by resisted wrist extension and gripping. This is the hallmark clinical test for the condition.

Question 4Unverified domain (source unavailable)

Which supplement has the strongest evidence for reducing the risk of recurrent muscle cramps in endurance athletes?

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

Explanation

Sodium replacement is supported for athletes who are heavy salt losers and develop cramps with prolonged sweating, as sodium losses contribute to cramping. There is no comparable evidence for the other supplements listed.

Question 5Unverified domain (source unavailable)

A downhill mountain biker presents with an open tibial fracture after a crash. Which action should be performed first in the field?

  1. Apply a traction splint before assessing distal pulses
  2. Attempt to reduce the fracture to improve alignment
  3. Irrigate the wound with bottled water and apply a sterile dressing
  4. Cover the wound with a clean dressing and immobilize the limb Correct answer.

Explanation

Field management of an open fracture prioritizes covering the wound with a clean dressing and immobilizing the limb to limit contamination and further injury. Reduction and irrigation are not performed in the field.

Question 6Unverified domain (source unavailable)

Which finding best distinguishes a grade II lateral ankle sprain from a grade I sprain?

  1. Mild swelling at the lateral malleolus
  2. Point tenderness over the anterior talofibular ligament
  3. Presence of a joint effusion
  4. Inability to bear weight with moderate ligamentous laxity Correct answer.

Explanation

A grade II sprain involves partial ligament tearing with moderate laxity and difficulty bearing weight, whereas grade I is a stretch injury with minimal laxity. Weight-bearing status and degree of laxity separate the grades.

Question 7Unverified domain (source unavailable)

Which condition is a recognized cause of exercise-associated collapse in an Ironman triathlete who finishes with normal core temperature?

  1. Malignant hyperthermia
  2. Postural hypotension from venous pooling Correct answer.
  3. Hyponatremic encephalopathy from overhydration
  4. Serotonin syndrome

Explanation

Exercise-associated postural hypotension results from peripheral vasodilation and venous pooling after exercise cessation, causing collapse despite normal temperature. Hyponatremia is a separate cause and would typically show altered mental status and low sodium.

Question 8Unverified domain (source unavailable)

Which physical examination maneuver is most specific for detecting a meniscal tear in a surfer with knee pain after a twisting injury?

  1. McMurray test Correct answer.
  2. Valgus stress test
  3. Lachman test
  4. Patellar apprehension test

Explanation

The McMurray test loads the meniscus during knee flexion and rotation and is used to detect meniscal tears. The Lachman test assesses the ACL and the valgus stress test assesses the MCL.

Question 9Unverified domain (source unavailable)

A surfer with chronic shoulder pain is diagnosed with multidirectional instability. Which rehabilitation principle is most appropriate initially?

  1. Aggressive stretching to increase capsular mobility
  2. Progressive strengthening of the dynamic stabilizers with activity modification Correct answer.
  3. Immediate surgical capsular shift
  4. Immobilization in a sling for six weeks

Explanation

Multidirectional instability is initially managed with a structured rehabilitation program that strengthens the rotator cuff and scapular stabilizers while modifying provocative activities. Surgery is reserved for failure of conservative care.

Question 10Unverified domain (source unavailable)

Which statement best describes the mechanism of injury for a classic anterior shoulder dislocation during a surfing wipeout?

  1. Forced hyperextension of the elbow
  2. Direct blow to the posterior shoulder
  3. Axial loading of the adducted arm
  4. Forced abduction and external rotation of the arm Correct answer.

Explanation

Anterior dislocation most often results from forced abduction and external rotation, which levers the humeral head anteriorly out of the glenoid. This is the common mechanism in falls with the arm outstretched.

Question 11Unverified domain (source unavailable)

A 30-year-old marathon runner has medial tibial stress syndrome. Which recommendation is most appropriate for return to running?

  1. Complete immobilization in a walking boot for eight weeks
  2. Immediate corticosteroid injection to the medial tibia
  3. Continue running at reduced mileage with no other change
  4. Relative rest with a graded return guided by pain and cross-training Correct answer.

Explanation

Medial tibial stress syndrome is managed with relative rest, cross-training, and a gradual return to running guided by symptoms. This allows tissue adaptation while maintaining fitness.

Question 12Unverified domain (source unavailable)

Which finding on the Ottawa Ankle Rules would justify obtaining radiographs in a surfer after an ankle inversion injury?

  1. A history of prior ankle sprain
  2. Pain near the lateral malleolus with inability to bear weight four steps Correct answer.
  3. Mild swelling without tenderness
  4. Pain only with passive dorsiflexion

Explanation

The Ottawa Ankle Rules recommend imaging when there is bone tenderness at the posterior edge or tip of the lateral or medial malleolus or an inability to bear weight for four steps. This combination meets the criteria.

Question 13Unverified domain (source unavailable)

A windsurfer develops forearm pain and swelling after prolonged gripping. Which diagnosis is most consistent with exertional compartment syndrome of the forearm?

  1. Constant pain at rest unrelated to activity
  2. Pain that resolves with rest and recurs with the same level of exertion Correct answer.
  3. Pain reproduced only by passive wrist flexion
  4. Immediate pain with light touch

Explanation

Chronic exertional compartment syndrome produces pain and tightness that appear with a specific level of exertion and resolve with rest. Compartment pressure measurement before and after exercise confirms the diagnosis.

Question 14Unverified domain (source unavailable)

Which statement about the use of NSAIDs in acute muscle strain is most accurate?

  1. They are contraindicated in all athletes under 40
  2. They may reduce pain and allow earlier mobilization but do not accelerate tissue healing Correct answer.
  3. They should be avoided entirely because they impair all healing
  4. They reliably prevent re-injury when taken prophylactically

Explanation

NSAIDs provide analgesia and may facilitate early mobilization, but evidence does not show that they speed tissue repair. They are used judiciously and briefly in acute strain management.

Question 15Unverified domain (source unavailable)

Which of the following best describes the role of a pre-participation evaluation in a competitive surfing athlete?

  1. To disqualify athletes with any prior injury
  2. To identify conditions that increase risk of injury or sudden cardiac death and guide management Correct answer.
  3. To replace the annual physical examination
  4. To determine sponsorship eligibility

Explanation

The pre-participation evaluation screens for cardiovascular and musculoskeletal conditions that could increase risk during sport and informs individualized management. It is not used to disqualify athletes wholesale or to determine sponsorship.

Question 16Unverified domain (source unavailable)

A kitesurfer has a suspected Achilles tendon rupture. Which clinical finding is most consistent with a complete rupture?

  1. Positive Thompson test Correct answer.
  2. Ability to perform a single-leg heel raise without difficulty
  3. Pain localized to the lateral heel
  4. Increased ankle dorsiflexion strength

Explanation

The Thompson test is positive when squeezing the calf fails to produce plantar flexion, indicating loss of Achilles continuity. This is the classic bedside sign of a complete rupture.

Question 17Unverified domain (source unavailable)

Which condition should be considered in a young endurance athlete with exertional syncope and a normal resting electrocardiogram?

  1. Hypertrophic cardiomyopathy Correct answer.
  2. Aortic dissection
  3. Pulmonary embolism
  4. Vasovagal syncope during heat exposure

Explanation

Hypertrophic cardiomyopathy can cause exertional syncope and may have a normal resting ECG in some cases, so further evaluation such as echocardiography is warranted. Exertional syncope in a young athlete should always prompt cardiac investigation.

Question 18Unverified domain (source unavailable)

A surfer reports chronic lateral hip pain and a positive Ober test. Which diagnosis is most likely?

  1. Adductor strain
  2. Piriformis syndrome
  3. Iliotibial band syndrome Correct answer.
  4. Femoroacetabular impingement

Explanation

A positive Ober test indicates tightness of the iliotibial band and is associated with iliotibial band syndrome, which causes lateral hip and knee pain. The history of chronic lateral hip pain supports this diagnosis.

Question 19Unverified domain (source unavailable)

Which is the most appropriate initial management for a suspected scaphoid fracture in a surfer with snuffbox tenderness and normal radiographs?

  1. Reassurance and return to surfing
  2. Immobilization and repeat imaging or MRI Correct answer.
  3. Immediate surgical fixation
  4. Corticosteroid injection into the snuffbox

Explanation

Scaphoid fractures can be occult on initial radiographs, so the wrist should be immobilized and imaging repeated or MRI obtained to avoid missed fractures and nonunion. Early recognition is important because of the tenuous blood supply.

Question 20Unverified domain (source unavailable)

Which finding is most consistent with a concussion in a surfer who struck the reef and has a normal head CT?

  1. Persistent vomiting with papilledema
  2. Headache, confusion, and imbalance that resolve over days Correct answer.
  3. Focal neurological deficit that persists for weeks
  4. Immediate loss of consciousness lasting 30 minutes

Explanation

Concussion is a functional disturbance with symptoms such as headache, confusion, and imbalance that typically resolve over days, and neuroimaging is normal. Focal deficits or prolonged unconsciousness suggest more severe injury.

Question 21Unverified domain (source unavailable)

A competitive swimmer develops shoulder pain and is diagnosed with subacromial impingement. Which rehabilitation component is most important initially?

  1. Complete rest with no activity for six months
  2. Aggressive overhead stretching
  3. Immediate subacromial decompression
  4. Scapular stabilization and rotator cuff strengthening Correct answer.

Explanation

Subacromial impingement is initially managed with scapular stabilization and rotator cuff strengthening to restore normal mechanics. Surgery is considered only after failure of conservative care.

Question 22Unverified domain (source unavailable)

Which statement about the use of hyperbaric oxygen for sports injuries is most accurate?

  1. It is proven to accelerate return to play in all athletes
  2. It is routinely indicated for all muscle strains
  3. It has no role in sports medicine
  4. Evidence for routine use in sports injuries is limited and it is not standard care Correct answer.

Explanation

Evidence supporting hyperbaric oxygen for common sports injuries is limited, and it is not part of standard management. It is used for specific indications such as non-healing wounds or decompression illness.

Question 23Unverified domain (source unavailable)

A surfer has a suspected exertional heat stroke with altered mental status and a core temperature of 41°C. Which action is the immediate priority?

  1. Administration of antipyretics
  2. Rapid cooling with cold-water immersion Correct answer.
  3. Oral rehydration with electrolyte solution
  4. Transfer to hospital without cooling en route

Explanation

Exertional heat stroke is a medical emergency requiring immediate rapid cooling, ideally cold-water immersion, to reduce core temperature. Antipyretics are ineffective because the hypothalamic set point is normal.

Question 24Unverified domain (source unavailable)

Which statement best describes the role of return-to-play criteria after a sport-related concussion?

  1. Return is permitted after 24 hours regardless of symptoms
  2. A normal CT scan allows immediate return
  3. Athletes may return once symptoms resolve at rest
  4. A graduated stepwise protocol with symptom monitoring is required before full return Correct answer.

Explanation

Return to play follows a graduated stepwise protocol that advances only if symptoms do not recur, with each step separated by appropriate intervals. Symptom resolution at rest alone is insufficient.

Question 25Unverified domain (source unavailable)

A surfer with chronic low back pain and imaging showing a pars defect is diagnosed with spondylolysis. Which management approach is most appropriate initially?

  1. Activity modification with a graded rehabilitation program Correct answer.
  2. Prolonged bed rest for six weeks
  3. Immediate spinal fusion
  4. Corticosteroid injection into the pars defect

Explanation

Symptomatic spondylolysis is initially managed with activity modification and a graded rehabilitation program emphasizing core stabilization. Surgery is reserved for failure of conservative care or progressive instability.

Question 26Unverified domain (source unavailable)

A competitive surfer sustains a blow to the lateral thigh from a board rail, developing a tense, swollen, painful thigh with limited knee flexion. Which diagnosis is most likely?

  1. Femoral shaft stress fracture
  2. Hamstring strain
  3. Adductor strain
  4. Quadriceps contusion Correct answer.

Explanation

Direct blunt trauma to the anterior thigh causing tense swelling and restricted knee flexion is the classic presentation of a quadriceps contusion, with bleeding contained within the fascial envelope. Hamstring and adductor injuries arise from stretch or sprinting mechanisms rather than direct impact.

Question 27Unverified domain (source unavailable)

During a surf contest a competitor collapses after a heat in hot humid conditions. Rectal temperature is 40.5°C with confusion and hot dry skin. Which is the most appropriate immediate priority?

  1. Passive stretch of cramping muscles
  2. Rapid cold-water immersion with concurrent cooling Correct answer.
  3. Intramuscular analgesic injection
  4. Oral rehydration and observation in shade

Explanation

Exertional heat stroke with core temperature above 40°C and central nervous system dysfunction requires immediate aggressive cooling, with cold-water immersion being the most effective field method. Delay in cooling increases the risk of multiorgan failure and death.

Question 28Unverified domain (source unavailable)

Which finding on physical examination best supports a diagnosis of Achilles tendinopathy rather than a partial tendon tear in a surfer with posterior heel pain?

  1. Inability to perform a single-leg heel raise
  2. Positive Thompson test
  3. A palpable gap in the tendon with weak plantarflexion
  4. Pain with palpation of a thickened tendon 2–6 cm above the insertion Correct answer.

Explanation

Midportion Achilles tendinopathy produces localized tenderness and fusiform thickening in the relatively avascular zone 2–6 cm proximal to the insertion, with pain on loading. A palpable gap, abnormal Thompson test, and inability to heel raise point toward rupture.

Question 29Unverified domain (source unavailable)

A windsurfer develops dorsal wrist pain after repetitive forceful gripping. Examination shows tenderness over the second and third carpometacarpal joints with pain on axial loading of the index metacarpal. Which diagnosis is most likely?

  1. De Quervain tenosynovitis
  2. Carpometacarpal bossing with associated synovitis Correct answer.
  3. Scapholunate ligament tear
  4. Guyon canal syndrome

Explanation

Carpometacarpal bossing of the second or third ray produces a dorsal prominence with activity-related pain and tenderness reproduced by axial loading of the involved metacarpal. It is common in athletes who repeatedly load the wrist in extension.

Question 30Unverified domain (source unavailable)

Which statement best describes the recommended first-line management of an acute lateral ankle sprain sustained during a beach volleyball landing?

  1. Immediate corticosteroid injection into the lateral ligaments
  2. Prolonged bed rest until swelling fully resolves
  3. Early protected weight bearing with functional rehabilitation and progressive strengthening Correct answer.
  4. Immobilization in a non-weight-bearing cast for six weeks

Explanation

Current evidence supports early protected weight bearing, functional bracing, and progressive proprioceptive and strengthening exercise, which improve outcomes compared with prolonged immobilization. Early mobilization reduces stiffness and supports return to sport.

Question 31Unverified domain (source unavailable)

A stand-up paddleboarder reports chronic anterior knee pain worsened by descending stairs and prolonged sitting. Examination shows tenderness at the inferior pole of the patella with pain on resisted knee extension. Which diagnosis is most likely?

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

Explanation

Load-dependent anterior knee pain localized to the inferior patellar pole with pain on resisted extension is characteristic of patellar tendinopathy, common in athletes who repeatedly load the extensor mechanism. Symptoms typically worsen with jumping, descending stairs, and prolonged sitting.

Question 32Unverified domain (source unavailable)

A surfer sustains a direct blow to the lateral chest wall and develops focal rib pain with a negative initial radiograph. Which statement about management is most accurate?

  1. Clinical diagnosis of rib contusion or occult fracture with analgesia and incentive spirometry is appropriate Correct answer.
  2. Immediate return to full surfing without restriction is advised
  3. Routine prophylactic antibiotics are indicated
  4. Chest tube placement is indicated in the absence of pneumothorax

Explanation

Most rib injuries after blunt trauma without pneumothorax or respiratory compromise are managed supportively with analgesia and incentive spirometry to prevent atelectasis. Radiographs may miss nondisplaced fractures, so clinical management guides care.

Question 33Unverified domain (source unavailable)

Which factor most strongly increases the risk of an overuse injury in a competitive surfer increasing weekly training volume?

  1. Consistent sleep duration
  2. Use of a foam surfboard
  3. Rapid increases in training load without adequate recovery Correct answer.
  4. Regular stretching before paddling

Explanation

Abrupt spikes in training load relative to recent chronic load are a well-established risk factor for overuse injury, as tissue adaptation lags behind demand. Gradual progression with adequate recovery reduces this risk.

Question 34Unverified domain (source unavailable)

A competitive surfer develops insidious anterior hip and groin pain with a positive FADIR test and restricted internal rotation. Which diagnosis should be highest on the differential?

  1. Proximal hamstring tendinopathy
  2. Sacroiliac joint dysfunction
  3. Adductor longus strain
  4. Femoroacetabular impingement syndrome Correct answer.

Explanation

Anterior hip pain with restricted internal rotation and a positive flexion-adduction-internal rotation test suggests femoroacetabular impingement syndrome, especially in young athletic patients. Imaging may show cam or pincer morphology.

Question 35Unverified domain (source unavailable)

A surfer with a suspected acromioclavicular joint injury has point tenderness over the AC joint and pain when the arm is adducted across the chest. Which test is being described?

  1. Speed test
  2. Cross-body adduction test Correct answer.
  3. Lift-off test
  4. Empty can test

Explanation

The cross-body adduction test stresses the acromioclavicular joint by bringing the arm across the chest, reproducing pain in AC joint pathology. It is a simple provocative maneuver for AC joint arthritis or sprain.

Question 36Unverified domain (source unavailable)

A 16-year-old surfer reports anterior knee pain during a growth spurt with tenderness over the tibial tuberosity and pain on resisted knee extension. Which diagnosis is most likely?

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

Explanation

Traction apophysitis at the tibial tuberosity during adolescent growth is Osgood-Schlatter disease, presenting with localized tenderness and pain on resisted extension. It is typically self-limited with activity modification.

Question 37Unverified domain (source unavailable)

Which statement best describes the role of imaging in a surfer with acute low back pain and no red flags?

  1. MRI should be obtained in all patients before any treatment
  2. CT is the first-line test for all acute back pain
  3. Routine imaging is not indicated initially because most cases are self-limited and imaging findings correlate poorly with symptoms Correct answer.
  4. Radiographs are required to exclude malignancy in every case

Explanation

In the absence of red flags such as trauma, fever, neurologic deficit, or cancer history, routine imaging for acute low back pain is not recommended because it does not improve outcomes and may reveal incidental findings. Imaging is reserved for persistent symptoms or concerning features.

Question 38Unverified domain (source unavailable)

A surfer sustains a fall onto the point of the shoulder with severe pain and an inability to actively abduct the shoulder, but passive abduction is preserved and there is no shoulder step-off. Which injury is most likely?

  1. Axillary nerve neurapraxia with deltoid weakness Correct answer.
  2. Clavicle fracture
  3. Anterior shoulder dislocation
  4. Complete rotator cuff tear

Explanation

Falls onto the shoulder can stretch the axillary nerve, producing deltoid weakness with preserved passive motion and no dislocation. Sensation over the lateral deltoid should be tested, and the nerve is monitored for recovery.

Question 39Unverified domain (source unavailable)

Which return-to-surf criterion is most appropriate after a grade II acromioclavicular joint sprain?

  1. Immediate return once sling is removed
  2. Pain-free full overhead motion and restored scapular strength before progressive paddling Correct answer.
  3. Complete absence of tenderness on palpation
  4. Radiographic normalization of the joint

Explanation

Return after AC joint sprain should be guided by pain-free functional motion, restored scapular and rotator cuff strength, and graded exposure to paddling loads. Imaging normalization and complete absence of tenderness are not required and may lag behind function.

Question 40Unverified domain (source unavailable)

A surfer reports numbness and tingling in the thumb, index, and middle fingers that worsens at night and with prolonged wrist extension. Which test is most likely to reproduce symptoms?

  1. Finkelstein test
  2. Phalen test Correct answer.
  3. Tinel test at the elbow
  4. Watson test

Explanation

Nocturnal paresthesias in the median nerve distribution with symptom reproduction on sustained wrist flexion (Phalen test) suggest carpal tunnel syndrome. Nerve conduction studies may confirm the diagnosis.

Question 41Unverified domain (source unavailable)

A surfer with chronic lateral elbow pain has tenderness over the lateral epicondyle and pain with resisted wrist extension. Which diagnosis is most consistent?

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

Explanation

Pain over the lateral epicondyle with resisted wrist extension indicates lateral epicondylalgia, an overuse tendinopathy of the common extensor origin. It is common in athletes with repetitive gripping and wrist extension.

Question 42Unverified domain (source unavailable)

A surfer develops sudden severe calf pain while pushing off during a wave, with a palpable defect and a positive Thompson test. Which management is most appropriate?

  1. Immobilization and urgent orthopedic referral for possible surgical repair Correct answer.
  2. Corticosteroid injection into the calf
  3. Immediate return to surfing with stretching
  4. Massage and heat application

Explanation

A positive Thompson test with a palpable defect indicates Achilles tendon rupture, which requires immobilization and urgent orthopedic evaluation for repair or functional bracing. Delay increases morbidity and impairs outcomes.

Question 43Unverified domain (source unavailable)

Which statement about the use of platelet-rich plasma in chronic tendinopathy is most accurate?

  1. It is contraindicated in all athletes
  2. It reliably restores tendon architecture on imaging
  3. It is proven superior to exercise in all tendinopathies
  4. Evidence is mixed and it is generally considered an adjunct rather than a proven primary treatment Correct answer.

Explanation

Evidence for platelet-rich plasma in tendinopathy is heterogeneous and inconsistent, and it is best considered an adjunct to loading-based rehabilitation rather than a definitive primary therapy. It is not universally contraindicated nor proven superior to exercise.

Question 44Unverified domain (source unavailable)

A surfer with a history of recurrent shoulder instability reports a sudden sensation of the shoulder slipping while paddling, followed by pain. Which finding on examination most directly supports recurrent anterior instability?

  1. Positive Neer impingement sign
  2. Positive Hawkins-Kennedy test
  3. Positive apprehension and relocation test Correct answer.
  4. Positive drop arm test

Explanation

The apprehension and relocation test reproduces the sensation of instability and relieves it with posterior force, supporting anterior instability. Impingement tests and the drop arm test assess different pathology.

Question 45Unverified domain (source unavailable)

A surfer sustains a facial laceration from a fin and has an associated orbital floor fracture. Which finding most specifically indicates orbital floor involvement?

  1. Subconjunctival hemorrhage alone
  2. Restricted upward gaze with diplopia and infraorbital numbness Correct answer.
  3. Mild periorbital swelling
  4. Periorbital ecchymosis alone

Explanation

Restricted upward gaze with diplopia suggests entrapment of the inferior rectus, and infraorbital numbness indicates involvement of the infraorbital nerve, both supporting orbital floor fracture. Ecchymosis and swelling alone are nonspecific.

Question 46Unverified domain (source unavailable)

A competitive surfer reports exertional anterior thigh pain and numbness that resolves with rest, with normal radiographs and a normal MRI of the thigh. Which diagnosis should be considered?

  1. Meralgia paresthetica
  2. Femoral stress fracture
  3. Quadriceps strain
  4. Exertional compartment syndrome Correct answer.

Explanation

Exertional compartment syndrome causes activity-related pain and neurologic symptoms that resolve with rest, often with normal resting imaging; compartment pressure testing after exercise confirms it. Stress fractures and strains produce different patterns and imaging findings.

Question 47Unverified domain (source unavailable)

A surfer with chronic shoulder pain has imaging showing a partial-thickness rotator cuff tear. Which factor most strongly influences the decision for surgical versus nonoperative management?

  1. Functional impairment and response to a structured rehabilitation trial Correct answer.
  2. Presence of mild pain at rest
  3. Patient age alone
  4. Tear size on MRI alone

Explanation

The decision for surgery in partial-thickness cuff tears is driven primarily by functional limitation and failure of a structured nonoperative program, not by imaging size or age in isolation. Many partial tears improve with rehabilitation.

Question 48Unverified domain (source unavailable)

A surfer develops acute shoulder pain after a fall with inability to actively raise the arm and a positive drop arm test, plus a normal radiograph. Which structure is most likely injured?

  1. Acromioclavicular ligament
  2. Rotator cuff tendon Correct answer.
  3. Biceps long head tendon
  4. Glenoid labrum

Explanation

Inability to actively raise the arm with a positive drop arm test after trauma suggests a rotator cuff tear, which may not appear on plain radiographs. Ultrasound or MRI is used to confirm the diagnosis.

Question 49Unverified domain (source unavailable)

A surfer with chronic low back pain is found to have a lumbar spondylolisthesis on imaging. Which finding on examination most specifically supports an associated neurologic deficit requiring further evaluation?

  1. Dermatomal sensory loss with diminished reflexes and weakness Correct answer.
  2. Paraspinal muscle tenderness
  3. Restricted lumbar flexion
  4. Positive straight leg raise without neurologic findings

Explanation

Dermatomal sensory loss, diminished reflexes, and weakness indicate radiculopathy or cauda equina involvement and warrant urgent further evaluation. Paraspinal tenderness and restricted motion are nonspecific findings.

Question 50Unverified domain (source unavailable)

A surfer sustains a fin laceration to the dorsum of the foot. Which structure must be specifically assessed because its injury would impair active extension of the great toe?

  1. Extensor hallucis longus tendon Correct answer.
  2. Tibialis anterior tendon
  3. Flexor hallucis longus tendon
  4. Peroneus longus tendon

Explanation

The extensor hallucis longus crosses the dorsum of the foot and is the primary active extensor of the great toe, so a dorsal laceration deep to the skin can divide it. Testing great-toe extension against resistance confirms integrity before wound closure.