Domain II: Examination, Assessment, and Diagnosis (Part 2)

A football player walks off the field toward you, and you observe his right arm being held against his torso and his head looking away from the injured shoulder. What pathology is most associated with this observation? A. Acromioclavicular joint sprain B. Anterior glenohumeral joint dislocation C. Posterior glenohumeral joint dislocation D. Brachial plexus injury

A. Acromioclavicular joint sprain

You elect to perform the Spurling test in an effort to confirm your differential diagnosis of cervical nerve root compression. With your hands interlocked over the crown of the patient ' s head, you first passively extend the patient ' s head. As no symptoms are produced, you then add lateral flexion. Again no symptoms are produced. What is your next step? A. Add axial compression to see if pain radiates down the patient ' s arm. B. Grade the test as negative and proceed with your evaluation. C. Add rotation of the head toward the ceiling to see if pain diminishes or centralizes. D. Ask the athlete to take a deep breath and hold it to see if pain radiates down the patient ' s arm.

A. Add axial compression to see if pain radiates down the patient ' s arm.

Which of the following athletes is most at risk for developing Sever ' s disease? A. An 11-year-old competitive male soccer player B. A 12-year-old female freestyle swimmer C. A 14-year-old elite female gymnast D. A 16-year-old male interior lineman E. A 13-year-old female track athlete

A. An 11-year-old competitive male soccer player

You suspect that an athlete has sustained a spontaneous pneumothorax. While palpating tactile fremitus, which of the following findings would confirm your suspicions? A. Decreased fremitus is palpable unilaterally. B. Decreased fremitus is palpable bilaterally. C. Increased fremitus is palpable unilaterally. D. Increased fremitus is palpable bilaterally. E. Fremitus is absent bilaterally.

A. Decreased fremitus is palpable unilaterally.

You are evaluating a recreational tennis player who sustained an acute knee injury. You are assessing the athlete ' s active knee flexion and knee extension using a goniometer. Based on the photo, approximately how many degrees of active knee flexion does the athlete have at this time? A. 120° B. 60° C. 145° D. 35°

A. 120°

A female lacrosse player is exhibiting signs of disordered eating. The physician to whom the athlete was referred has concluded the athlete is suffering from anorexia athletica. How does this condition differ from anorexia nervosa? A. Absence of self-starvation practices B. Maintenance of regular menstrual cycle C. Absence of distorted body image D. Absence of mood shifts and fear of becoming obese E. Willingness to discuss eating practices

A. Absence of self-starvation practices

To encourage patient treatment compliance and patient self-motivation, clinicians should clearly and objectively define what is meant by program adherence and articulate this definition to their patients. Which of the following communications from the clinician to the patient can achieve this goal? A. "Bring a positive attitude with you to each appointment." B. "We ' ll need to meet three times a week for the next 4 weeks." C. "Try to avoid doing too much physical activity when you are home." D. "Let me know what exercises you like completing and which ones you don ' t like." 268. Goal setting, particularly setting short-term goals,

A. "Bring a positive attitude with you to each appointment."

A sailor presents for evaluation of a right finger injury. The athlete notes significant stiffness and pain in his right index finger distal interphalangeal (DIP) joint. The athlete reports an old dislocation of the joint, which occurred over a year ago. Evaluation reveals that the joint is basically fused. How would you grade the mobility present at the joint? A. 0 = ankylosed B. 1 = hard C. 2 = firm D. 4 = pathological

A. 0 = ankylosed

A baseball coach who is 6 weeks status post rotator cuff repair is rehabilitating in your athletic training room. You assess the range of motion of the coach ' s glenohumeral joint. What is the normal range of motion for shoulder flexion without scapular elevation? A. 0°-120° B. 0°-180° C. 0°-90° D. 0°-135° E. 0°-160°

A. 0°-120°

You refer an 8-year-old camper who has tenderness over the base of the fifth metatarsal to the emergency department for evaluation. The camper returns to camp the next day on crutches with paperwork indicating he should follow up with an orthopedist in 1 week for a repeat x-ray to rule out an occult fracture. The camper ' s mother inquires about the diagnosis. How should you best respond? A. An occult fracture means a hidden fracture, which is common in young athletes. B. An occult fracture is a rapidly healing fracture, which is common in young athletes because of their constant growth. C. An occult fracture is a fracture of the fifth metatarsal that is often confused with a Jones fracture. D. An occult fracture is an avulsion fracture; repeat x-ray is required to determine fragment displacement. E. An occult fracture is a growth plate injury common to young athletes participating in lower extremity sports.

A. An occult fracture means a hidden fracture, which is common in young athletes.

An athlete presents with flu-like symptoms and a cluster of cutaneous vesicles on an erythematous base. The vesicles are tightly clustered and appear to have developed into pustules and ulcers. Several of the vesicles have ruptured, releasing a serous material that has formed a yellowish crust. How is this condition best treated pharmacologically? A. An oral antiviral medication such as acyclovir B. An oral antiviral medication such as erythromycin C. An antibiotic medication such as amoxicillin D. An antifungal medication such as terbinafine hydrochloride (Lamisil) E. An antifungal medication such as zanamivir (Relenza)

A. An oral antiviral medication such as acyclovir

Which bony landmark should be palpated in order to palpate the proximal attachment of the rectus femoris muscle? A. Anterior inferior iliac spine B. Anterior superior iliac spine C. Greater trochanter of femur D. Linea aspera of the femur E. Iliac tubercle

A. Anterior inferior iliac spine

A senior on your intercollegiate sailing team is escorted to the athletic training room by her coach after having been hit in the head by the boat ' s boom. You have chosen to use a Standardized Assessment of Concussion (SAC) test to gather objective data on this injured athlete. To assess the concentration component of the test, you ask the athlete to state the months of the year in reverse order. The athlete responds by saying, "December, October, September, August, July, June, May, April, March, February, January." How do you score this response? A. Assign zero points. B. Assign one point. C. Immediately ask the athlete to try again and then score. D. Repeat this component at the end of the assessment before scoring.

A. Assign zero points.

You have chosen to assess an athlete ' s cervical myotomes. Based on the photo, which cervical myotome is being assessed? A. C5 B. C6 C. C7 D. C8 E. T1

A. C5

You suspect a recreational tennis player complaining of elbow pain with activities of daily living (e.g., driving and household chores such as painting) may have lateral epicondylalgia. What type of brace may help confirm your diagnosis if wearing it results in a decrease in pain with activity? A. Counterforce brace B. Medial/lateral hinge brace C. Functional derotation brace D. Neoprene sleeve

A. Counterforce brace

An athlete with repeated herpes simplex eruptions should be counseled to avoid which of the following potential outbreak triggers? A. Fatigue, psychological stress, and sunlight exposure B. Overexposure to the sun, decreased body fat percentage, and sharing water bottles C. Sexual activity, contact with others, and dehydration D. Contact with others, fatigue, and a highcarbohydrate diet

A. Fatigue, psychological stress, and sunlight exposure

Which two bones make up the roof of the orbit? A. Frontal and sphenoid B. Ethmoid and maxillary C. Zygomatic and palatine D. Lacrimal and sphenoid E. Palatine and frontal

A. Frontal and sphenoid

An athlete on your soccer team is nearing the end of her anterior cruciate ligament (ACL) reconstruction rehabilitation protocol. As the time to return to play grows shorter, the athlete ' s apprehension about returning is growing. What strategy might the athletic trainer use to minimize this emotional reaction? A. Help the athlete focus on facts, such as range of motion measurements, isokinetic strength testing, and functional progressions, rather than emotions to determine readiness to return. B. Reassure the athlete that she is ready and she is simply overreacting. C. Have the coach give the athlete a motivational speech about how much the team needs her. D. Encourage the athlete to go to the counseling center to talk about her feelings.

A. Help the athlete focus on facts, such as range of motion measurements, isokinetic strength testing, and functional progressions, rather than emotions to determine readiness to return.

During your on-field evaluation of a soccer player with a lower leg injury, you determine that the athlete has a markedly decreased posterior tibial pulse. What should be your next steps? A. Immediate transport to a medical facility for further evaluation B. Complete the on-field evaluation and then move the athlete to the sideline for a more thorough evaluation C. Assist the athlete in walking to the sideline and then refer for radiographs to rule out fracture D. Assess for neurologic deficits and then have three to four people carry athlete to the athletic training room for fluoroscopic evaluation.

A. Immediate transport to a medical facility for further evaluation

While carrying the football in a run for the goal line, a football player is tackled and lands on the ball. On the sideline the player complains of palpable pain where the rib meets the cartilage and sharp pain with any trunk movements. He is having difficulty breathing and feels the rib may be making a crepitus noise each time he takes a breath. How is this condition best managed? A. Immobilization using a sling for the shoulder complex on the affected side and avoid strenuous activity for 1 to 2 months B. Immobilization using a sling for the shoulder complex on the affected side and avoid strenuous activity until symptoms eliminated C. Immobilization using a rib brace and avoid strenuous activity until symptoms eliminated D. Immobilization using a rib brace, avoid strenuous activity for 7 to 10 days, and then progress back to activity over the next 5 to 7 days

A. Immobilization using a sling for the shoulder complex on the affected side and avoid strenuous activity for 1 to 2 months

You are reviewing dictation from a physician ' s clinic and hear the following information: HEENT: EOMI, PERRLA. Which of the following best illustrates how you would transcribe this information into a SOAP note? A. In the objective section: Head, ears, eyes, nose, and throat—extraocular muscles intact; pupils equal, regular, react to light, accommodation B. In the assessment section: Head, ears, eyes, nose, and throat—extraocular muscles intact; pupils equal, regular, react to light, accommodation C. In the objective section: Head, ears, eyes, nose, and throat—equal occlusion of mandible intact; patient excited, reactive, resistant to Likert assessment D. In the assessment section: Head, ears, eyes, nose, and throat—equal occlusion of mandible intact; patient excited, reactive, resistant to Likert assessment E. In the assessment section: Head, ears, eyes, nose, and throat—early onset myopic insufficiency; patient educated

A. In the objective section: Head, ears, eyes, nose, and throat—extraocular muscles intact; pupils equal, regular, react to light, accommodation

Why is horizontal adduction limited when an athlete has sustained an acromioclavicular separation? A. It approximates the joint surfaces, creating pressure and pain. B. It distracts the joint surfaces, stretching damaged tissue and creating pain. C. Horizontal adduction is not limited. D. It causes impingement of the rotator cuff in the subacromial space, creating pain. E. It causes the biceps tendon to create a traction force at the joint, creating pain.

A. It approximates the joint surfaces, creating pressure and pain.

You are treating a dancer for sesamoiditis that has not resolved with conservative treatment measures. A radiograph was originally obtained to rule out acute fracture. What additional diagnostic testing is indicated to provide a more definitive diagnosis and direct treatment moving forward? A. Magnetic resonance imaging (MRI) to rule out stress reaction, bipartite sesamoid, or soft tissue inflammation B. Repeat radiograph to determine if a previously unidentifiable fracture is present C. Bone scan to identify metabolic activity in the bone D. Diagnostic ultrasound to visualize soft tissue versus bony pathology

A. Magnetic resonance imaging (MRI) to rule out stress reaction, bipartite sesamoid, or soft tissue inflammation

When using a Balance Error Scoring System (BESS) test to assess an athlete following a concussion, for which of the following criteria would the athlete be assigned 0 points? A. Moving hip into greater than 10° of abduction B. Lifting hands off iliac crests C. Opening eyes D. Remaining out of test position more than 5 seconds E. Lifting forefoot or heel

A. Moving hip into greater than 10° of abduction

An athlete reports on her preparticipation medical history form having taken Toradol (ketorolac), for which she has a prescription, intermittently over the past 3 months. In which drug category is this medication? A. Nonsteroidal anti-inflammatory drug B. Steroidal anti-inflammatory drug C. Narcotic analgesic D. Antibiotic

A. Nonsteroidal anti-inflammatory drug

When evaluating an athlete ' s facial injury, you observe that the athlete is unable to look upward toward the ceiling. Which of the following conditions would you suspect? A. Orbital blow-out fracture with entrapment of the inferior rectus muscle B. Orbital blow-out fracture with entrapment of the superior rectus muscle C. Ruptured globe with spontaneous rupture of the inferior rectus muscle D. Ruptured globe with spontaneous rupture of the buccinator muscle E. Orbital blow-out fracture with entrapment of the infraorbital nerve

A. Orbital blow-out fracture with entrapment of the inferior rectus muscle

When evaluating a visibly upset child with an acute ankle injury, which of the following palpation schemes would be most appropriate? A. Palpate the contralateral side first, and then palpate the injured ankle with light pressure beginning away from the injury. B. Palpate the contralateral side first, and then palpate the injured ankle beginning at the injury site and working away using light pressure. C. Palpate the injured side first, beginning away from the injury with light pressure, working toward the injured site; then palpate the contralateral side only as needed for comparison. D. Palpate the injured side first, beginning at the injury site with light pressure, working away from the injury; then palpate the contralateral side only as needed for comparison. E. Palpate only the structures on the involved limb necessary to gather information.

A. Palpate the contralateral side first, and then palpate the injured ankle with light pressure beginning away from the injury.

A soccer player gets tripped while going for a ball and lands on her shoulder. Your evaluation reveals point tenderness and palpable deformity over the middle and distal third of the clavicle. What action should you take to manage this injury? A. Place the athlete in a sling and refer to the emergency department for evaluation. B. Place the athlete in a figure-8 brace and refer to campus health services for evaluation. C. Place the athlete in a sling and swath brace until she can be seen by the team physician in the morning. D. Place the athlete in a shoulder spica and refer for an x-ray.

A. Place the athlete in a sling and refer to the emergency department for evaluation.

While auscultating an athlete ' s lungs, an athletic trainer hears a low-pitched sound during inspiration and expiration that resembles the sound made when two balloons rub together. What is the name of this type of sound, and what does it indicate? A. Pleural rub; indicative of conditions of the pleura, such as pleurisy B. Stridor; indicative of conditions of the central airway, such as croup C. Crackle; indicative of conditions of the smaller airways, usually fluid D. Wheeze; indicative of airway obstruction from mucus, spasm, or foreign body E. Bronchophony; indicative of obstruction of the respiratory tree such as pneumonia

A. Pleural rub; indicative of conditions of the pleura, such as pleurisy

A member of the women ' s swim team presents with suprapubic discomfort she has been feeling for the past 2 days. She also reports pain and burning when urinating, increased frequency of urination, and foulsmelling urine. What urinalysis result would indicate need for referral? A. Positive for hematuria B. Positive for ketones C. Negative for leukocyte esterase D. Specific gravity reading greater than 1.00

A. Positive for hematuria

You are treating a patient with chronic tendinopathy that is not responding to typical conservative treatment. In discussions with your team physician, you determine that it may be effective to increase the inflammatory reaction to enhance the healing process. Which of the following therapeutic interventions would meet this goal? A. Prolotherapy B. Corticosteroid injection C. Electrical stimulation D. Immobilization

A. Prolotherapy

While conducting a physical examination of an athlete with a brachial plexus injury you have chosen to assess the athlete ' s cervical myotomes. To assess the C6 myotome, what action should you have the athlete perform? A. Resisted elbow flexion B. Resisted elbow extension C. Resisted wrist flexion D. Resisted shoulder abduction E. Resisted finger abduction

A. Resisted elbow flexion

An athlete with medial tibial stress syndrome reports pain along the medial tibia traversing behind the medial malleolus and medial longitudinal arch. To assess the muscle most likely associated with this pain, which motions should you assess? A. Resisted plantar flexion and inversion B. Passive plantar flexion and inversion C. Resisted dorsiflexion and inversion D. Active dorsiflexion and inversion E. Resisted plantar flexion and eversion

A. Resisted plantar flexion and inversion

An athlete with systemic lupus erythematosus needs to be referred to a specialist. Which of the following specializations would be most appropriate? A. Rheumatology B. Pathology C. Endocrinology D. Dermatology E. Neurology

A. Rheumatology

When inspecting the tympanic membrane with an otoscope, which of the following statements best describes a normal tympanic membrane? A. Shiny, translucent, and smooth without perforations B. Shiny, translucent, and distended C. Convex, pink or red in color, and slightly bulging D. Dull, bluish or dark in color, with a small

A. Shiny, translucent, and smooth without perforations

When communicating with a patient whose primary language is not English, which of the following is an effective communication strategy? A. Speak more slowly, not more loudly. B. Ask several questions at one time so the athlete has time to think through his responses. C. Use pictures, models, and medical terminology when explaining medical conditions. D. Use slang terminology, which may be more recognizable than standard English.

A. Speak more slowly, not more loudly.

An adolescent softball pitcher with a history of neurological symptoms in her throwing shoulder and elbow has been diagnosed with neurapraxia of her radial nerve. What is neurapraxia? A. Stretching of the nerve, epineurium, and myelin sheath B. Complete disruption of the nerve C. Disruption of the axon and myelin sheath of the nerve D. Disruption of blood flow to the nerve

A. Stretching of the nerve, epineurium, and myelin sheath

You are conducting a physical examination of a patient with a history of diffuse pain, burning, and numbness along the medial and plantar aspects of the foot. You passively evert the heel and dorsiflex the foot and toes as shown in the photo. After you have held the foot in this position for about 10 seconds, the patient reports paresthesia radiating into her foot. Based on this outcome, what condition should you include in your differential diagnosis? A. Tarsal tunnel syndrome secondary to posterior tibial nerve entrapment B. Tarsal tunnel syndrome secondary to peroneal nerve entrapment C. Peroneal neuropathy secondary to peroneal nerve entrapment D. Peroneal neuropathy secondary to posterior tibial nerve entrapment

A. Tarsal tunnel syndrome secondary to posterior tibial nerve entrapment

To palpate the rotator cuff muscle responsible for initiating shoulder abduction, how should the patient be positioned? A. With the glenohumeral joint in maximal internal rotation B. With the glenohumeral joint in maximal external rotation C. With the glenohumeral joint in 90° of abduction D. With the glenohumeral joint in 30° of forward flexion E. With the glenohumeral joint in 30° of extension

A. With the glenohumeral joint in maximal internal rotation

An adolescent athlete has been told she has chondromalacia patellae. Which of the following best describes this condition? A. An inflammation and bony outgrowth from the attachment of the thigh muscles to the lower leg B. An abnormal softening of the cartilage on the underside of the patella or kneecap C. Pain and swelling of the tendon between the kneecap and the lower leg D. Abnormal movement of the kneecap in its groove when you bend and straighten your leg E. Tearing of the cartilage cushions inside the knee joint

B. An abnormal softening of the cartilage on the underside of the patella or kneecap

A student athlete who has been sick with an upper respiratory tract infection for the past 2 weeks is seen in the emergency department of the local hospital and is diagnosed with Guillain-Barré syndrome (GBS). What is GBS? A. A chronic neurodegenerative disease characterized by the gradual accumulation of focal plaques of demyelination in the brain B. An acute autoimmune disorder that causes diffuse demyelination of the spinal roots and peripheral nerves C. A neurological condition that affects the facial cranial nerve resulting in unilateral or bilateral facial weakness or paralysis D. A condition characterized by overactivity of the sympathetic nervous system resulting in pain that is disproportionate to the severity of the initial injury

B. An acute autoimmune disorder that causes diffuse demyelination of the spinal roots and peripheral nerves

Which of the following elements must be included in order for a Health Insurance Portability and Accountability Act (HIPAA) authorization to be considered valid? A. Detailed description of the injury or illness for which the patient is giving permission to release information B. An expiration date C. List of specific persons by name who are authorized to release information D. Itemized list of the specific documents that are allowed to be released

B. An expiration date

During observation of an athlete ' s hip and pelvis, you note that while the athlete is standing erect, her left anterior superior iliac spine (ASIS) is slightly inferior to her right ASIS. What condition might be associated with this observation? A. Normal pelvic alignment B. Anteriorly rotated left ilium C. Anteriorly rotated right ilium D. Posteriorly rotated left sacrum E. Posteriorly rotated right sacrum

B. Anteriorly rotated left ilium

To determine accuracy, clinical results are measured against a predetermined diagnostic gold standard, which is also known as the reference standard. For the diagnosis of anterior cruciate ligament (ACL) tears, what is considered to be the gold standard? A. Lachman ' s test B. Arthroscopy C. Magnetic resonance imaging (MRI) D. Slocum test

B. Arthroscopy

The parent of a 17-year-old student athlete who graduated from your high school last year calls your athletic training room requesting that her daughter ' s immunization records be forwarded to the athletic training staff of the college where her daughter is now a freshman. How will you respond to the parent? A. Ask for the e-mail address of the athletic trainer so you can scan and send the information. B. Ask the mother to come by the school office and sign a release to share the records. C. Tell the mother that the records have already been shredded and are not available. D. Tell the mother that the student must request the records because she now attends a school beyond the high school level.

B. Ask the mother to come by the school office and sign a release to share the records.

What postconcussion metabolic changes, which may assist in the diagnosis of a concussion, can put a patient with a concussion at risk of further brain trauma if he is allowed to return to activity and suffers another head injury? A. Brain cells have a suppressed metabolism despite enhanced blood flow to the cells. B. Brain cells have an increased demand for glucose, but blood flow decreases. C. Brain cells have an increased demand for glucose and an associated enhanced blood flow to the cells. D. Brain cells have a suppressed metabolism and an associated blood flow decrease.

B. Brain cells have an increased demand for glucose, but blood flow decreases.

Which of the following demonstrates the order of bony palpation from proximal to distal? A. Peroneal tubercle, cuboid, third cuneiform, styloid process at base of the fifth metatarsal B. Calcaneus, sustentaculum tali, talar head, navicular tuberosity, first cuneiform C. Sinus tarsi, dome of the talus, second cuneiform, navicular, third metatarsal D. Medial calcaneal tubercle, first cuneiform, navicular tubercle, first metatarsal, medial sesamoid of the great toe E. Calcaneus, talar head, navicular, sustentaculum tali, sinus tarsi, first cuneiform

B. Calcaneus, sustentaculum tali, talar head, navicular tuberosity, first cuneiform

How many degrees of freedom are allowed by the glenohumeral joint? A. 1 B. 2 C. 3 D. 4

C. 3

You are working a road race when an older man is brought into the medical tent with a large lower leg abrasion that is bleeding profusely and is difficult to control. The patient shares a list of the medications he is currently taking. Which of the following medications is likely contributing to the extensive bleeding? A. Ibuprofen B. Coumadin C. Lopressor D. Claritin

B. Coumadin

An athlete diagnosed with chronic daily headache 18 months earlier returns from a follow-up appointment with his neurologist carrying a prescription for propranolol (Inderal). What effect can this medication potentially have on sports participation and any musculoskeletal injuries? A. Inhibition of soft tissue and bone healing B. Decreased exercise tolerance C. Elevated perceived exertion during exercise D. Prolonged healing times

B. Decreased exercise tolerance

After gathering a comprehensive medical history and conducting a physical examination, a physician has diagnosed a senior collegiate gymnast with chronic sacroiliac joint pain and dysfunction. In addition to a treatment and rehabilitation program the physician feels this athlete can benefit from learning a pain management technique to increase her ability to cope with her chronic pain. Which statement regarding pain management techniques is correct? A. The goal of the association technique is to create a calming image that evokes positive, delightful images. B. Dissociation, the process of directing attention away from the pain sensation by listening to music, watching television, or reading, has been shown to be the most effective pain management technique. C. Examples of dissociation techniques include diaphragmatic breathing, meditation, and muscle relaxation. D. When practicing soothing imagery, patients choose a setting, such as the beach, and acknowledge and reinterpret their pain by viewing it as a challenge rather than a threat.

B. Dissociation, the process of directing attention away from the pain sensation by listening to music, watching television, or reading, has been shown to be the most effective pain management technique.

While not wearing a helmet, a baseball player is hit in the head with a baseball. The player is stunned but walks off the field without assistance. After getting to the dugout, the player experiences a severe headache and deterioration to unconsciousness. What condition is this athlete most likely experiencing? A. Subarachnoid hematoma B. Epidural hematoma C. Postconcussive symptom D. Subdural hematoma E. Chronic brain injuries

B. Epidural hematoma

On Monday afternoon, an athlete arrives at your athletic training facility complaining of a suddenonset rash. The athlete tells you her legs began itching this morning and she took an antihistamine, but it does not appear to be helping. She also tells you she crashed on a friend ' s couch last night because they were up late studying for a test. On examination you note a number of small red, raised vesicles in a random pattern on both lower legs. Overall the skin appears inflamed and irritated. To which health-care provider should you refer this patient? A. Internist B. Family medicine physician C. Rheumatologist D. Dermatologist

B. Family medicine physician

You are assessing shoulder flexion range of motion using a goniometer with the patient in a supine position. Which of the following indicates appropriate positioning of the goniometer? A. Fulcrum: lateral to the acromion process; stationary arm: parallel to the length of the torso; moving arm: midline of the anterior humerus B. Fulcrum: lateral to the acromion process; stationary arm: parallel to the thorax; moving arm: midline of the lateral humerus C. Fulcrum: lateral to the olecranon process; stationary arm: parallel to the tabletop; moving arm: centered on the long axis of the ulna D. Fulcrum: anterior to the acromion process; stationary arm: parallel to the long axis of the thorax; moving arm: centered over the midline of the anterior humerus

B. Fulcrum: lateral to the acromion process; stationary arm: parallel to the thorax; moving arm: midline of the lateral humerus

A patient reports for evaluation of foot pain that is centralized to the medial calcaneal tubercle but spreads out toward the toes. The pain increases with weight-bearing and is heightened with weightbearing after prolonged sitting or first steps in the morning. Pain is increased with active and passive dorsiflexion and toe extension. Based on this information, which of the following would be your differential diagnosis? A. Tarsal fracture, Sever ' s disease, posterior tibialis tendinopathy, calcaneal stress fracture B. Heel spur, calcaneal stress fracture, fat pad syndrome, plantar fasciitis C. Tarsal coalition, metatarsal fracture, interdigital neuroma D. Tarsal tunnel syndrome, Achilles tendinopathy, sesamoiditis

B. Heel spur, calcaneal stress fracture, fat pad syndrome, plantar fasciitis

While reviewing an athlete ' s injury report, you note his diagnosis is an anterior dislocation of the glenohumeral joint. How should the mechanism for this injury be documented in the injury report? A. In the objective section, document that the athlete stated that his arm was cocked to throw the football when he was hit. B. In the subjective section, document that the athlete reports a mechanism of shoulder abduction and external rotation. C. In the subjective section, document that the athlete states he fell on an outstretched arm. D. In the objective section, document that you determined that he has pain when the arm is forced into horizontal adduction and external rotation. E. In the subjective section, document that you determine he has limited internal rotation and abduction.

B. In the subjective section, document that the athlete reports a mechanism of shoulder abduction and external rotation.

In athletes, which of the following is considered the primary cause of iron-deficiency anemia? A. Elevated hemoglobin level B. Insufficient dietary iron intake C. Loss of iron due to chronic heel strike D. Chronic vegetarian diet

B. Insufficient dietary iron intake

Which of the following statements best describes the way in which a manual muscle test differs from a break test? A. Manual muscle tests are used to provide objective measures of the strength of muscle groups, whereas break tests grade an isolated muscle. B. Manual muscle tests are used to isolate muscles within their functional planes of motion, whereas break tests assess strength of muscle groups within the cardinal planes. C. Manual muscle tests are performed in the horizontal plane, whereas break tests are performed in the frontal plane. D. Manual muscle tests provide more accurate information when the patient is unable to perform active range of motion, whereas break tests are used when the patient is pain-free through the full range of motion. E. Manual muscle tests are used more commonly to assess muscular strength, whereas break tests are used more commonly to make return-to-play decisions.

B. Manual muscle tests are used to isolate muscles within their functional planes of motion, whereas break tests assess strength of muscle groups within the cardinal planes.

An athlete with an anterior tibiofibular ligament injury asks why this ankle sprain is taking much longer to heal than previous lateral ankle sprains he has sustained. What is the best response to this athlete? A. Tibiofibular ligament injuries are almost always associated with avulsion fractures, which increase healing time. B. Normal gait pattern repetitively spreads the mortise, which results in decreased approximation of healing ligament fibers. C. More tendons around the ankle are involved in the mechanism for a tibiofibular ligament injury. D. Tibiofibular ligament injuries usually result in significantly more joint effusion, limiting motion and delaying return. E. Research shows that the mechanism associated with tibiofibular ligament injuries results in the most complete ligament ruptures of all types of ankle sprains.

B. Normal gait pattern repetitively spreads the mortise, which results in decreased approximation of healing ligament fibers.

An 18-year-old diver reports low back pain exacerbated with lumbar extension and relieved with lumbar flexion. Pain is described as localized and primarily dull and achy. She denies radiating or radicular pain. Based on this athlete ' s sport and history, what injury would you suspect? A. Disc herniation B. Spondylolysis C. Scoliosis D. Sacroiliac joint dysfunction E. Lumbar facet joint lock

B. Spondylolysis

The Star Excursion Balance Test (SEBT) assesses postural control and can be used in identifying persons at risk for lower extremity injury as well as a means of assessing postinjury rehabilitation progress. Which of the following statements is correct regarding this functional assessment? A. The goal of the SEBT is to determine reach of the involved limb as the patient maintains single leg stance on the uninvolved limb while reaching as far as possible with the involved leg. B. The anterior, posteromedial, and posterolateral directions appear to be important to identify individuals with chronic ankle instability and athletes at greatest risk of lower extremity injury. C. Loss of dynamic postural control is noted when the person demonstrates a significantly decreased reach while standing on the healthy limb compared with standing on the injured limb. D. A SEBT reach trial is not scored if the patient returns to bilateral stance after a reach instead of maintaining single leg stance.

B. The anterior, posteromedial, and posterolateral directions appear to be important to identify individuals with chronic ankle instability and athletes at greatest risk of lower extremity injury.

An athlete who recently sustained a concussion and remains symptomatic is anxious to return for tomorrow ' s game. As his athletic trainer you are receiving pressure from the athlete, his parents, and the coaching staff to clear him for full participation. Which of the following is the best reason for withholding this athlete from participation? A. The athlete is at increased risk for cerebral blood clots. B. The athlete is at increased risk for sustaining second-impact syndrome. C. The athlete is at increased risk for sustaining a stroke. D. The athlete is at increased risk for sustaining a brain aneurysm. E. The athlete is at increased risk for postconcussive syndrome.

B. The athlete is at increased risk for sustaining second-impact syndrome.

If a normal eye is shaped like a basketball, which of the following best describes the presentation of astigmatism? A. The eye is shaped more like a boomerang. B. The eye is shaped more like a football. C. The eye is shaped more like a teardrop. D. The eye is shaped more like a hockey puck. E. The eye is shaped more like a flying disc.

B. The eye is shaped more like a football.

A patient sustained an ankle injury and was seen in the emergency department, where he was provided with a nonfunctional stirrup brace and crutches, which he has been using for the past 2 weeks. During your evaluation you assess his ankle joint play as 1 = considerably decreased. What conclusions can you draw from this finding? A. The patient ' s joint is hypermobile secondary to ligamentous injury. B. The patient ' s joint is hypomobile secondary to the immobilization. C. The patient ' s joint play is normal, and the brace and crutches can be discontinued. D. The patient ' s joint play should be assessed compared with the uninjured ankle in a close packed position.

B. The patient ' s joint is hypomobile secondary to the immobilization.

When auscultating the heart, the first sound or "lub" is heard coinciding with ventricular systole. What physiological action occurs during ventricular systole? A. The aortic and pulmonary valves close. B. The semilunar valves open. C. The atrioventricular valves open. D. The ventricles finish pushing out the blood and begin to relax. E. The mitral and tricuspid valves open.

B. The semilunar valves open.

A swimmer with a history of posterior shoulder pain was examined by her team physician yesterday and diagnosed with posterosuperior internal glenohumeral joint impingement. The athletic training student shadowing you today tells you he has never heard of posterosuperior internal glenohumeral joint impingement. What is the best explanation of this condition? A. The tendons of the infraspinatus, supraspinatus, and long head of the biceps along with the subacromial bursa and glenohumeral (GH) joint capsule are compressed in the space between the humeral head and the acromion process. B. The tendons of the infraspinatus and supraspinatus muscles are being compressed against the glenoid during shoulder abduction and external rotation. C. An irregularly shaped acromion, or other structural imperfection, decreases the subacromial space creating irritation and inflammation of soft tissue located within the subacromial space. D. Poor strength or fatigue of rotator cuff muscles allows the humeral head to translate superiorly during overhead motions, causing impingement of subacromial space structures.

B. The tendons of the infraspinatus and supraspinatus muscles are being compressed against the glenoid during shoulder abduction and external rotation.

An offensive lineman exhibits lumbar hyperlordosis. Which of the following is the typical anatomic profile for an athlete with excessive hyperlordosis? A. Weakened back extensor muscles with tightened or shortened hip extensors and abdominals B. Tightened or shortened hip flexor muscles or back extensors with weakened or elongated hip extensors or abdominals C. Tightened or shortened hip extensor muscles with weakened hip flexor muscles D. Weakened hip flexors with weakened back extensors and shortened hip extensors E. Tightened or shortened abdominals with tightened or shortened hip extensors and weak back extensors

B. Tightened or shortened hip flexor muscles or back extensors with weakened or elongated hip extensors or abdominals

A high school freshman athlete presents with polydipsia, polyuria, and polyphagia, along with a recent loss in body weight. What condition do you suspect, and what tests can your physician order to assist in confirming your initial impression? A. Type 2 diabetes mellitus; complete blood count and thyroid-stimulating hormone B. Type 1 diabetes mellitus; fasting blood glucose level C. Kidney stones; urinalysis D. Urinary tract infection; urinalysis

B. Type 1 diabetes mellitus; fasting blood glucose level

Your sister calls you and tells you that her daughter was kicked in the lower leg during soccer practice and is experiencing localized anterior tibial pain with moderate swelling, discoloration, and point tenderness. You are concerned that your niece may have sustained trauma to the epiphyseal plate of the tibia. Which type of Salter-Harris fracture is illustrated in the diagram? A. Type I B. Type II C. Type III D. Type IV E. Type V

B. Type II

It is often helpful to have patients quantify their pain in an objective manner. Which of the following pain scales is most useful when conducting serial measurements, as it is more difficult for the patient to intentionally skew the measurement? A. Numeric rating scale B. Visual analog scale C. McGill Pain Questionnaire D. Referred pain outcome measure

B. Visual analog scale

Which vitamin deficiency usually occurs only in neonates, persons taking certain drugs, or individuals with faulty fat absorption? A. Vitamin D B. Vitamin K C. Vitamin B 12 D. Folic acid E. Vitamin A

B. Vitamin K

When conducting a medical history, which question can best assist you in ascertaining information regarding the patient ' s chief complaint? A. Have you or anyone in your family been diagnosed with asthma? B. When did your symptoms first start? C. Have you recently changed work or living conditions? D. How would you characterize your tobacco use and alcohol consumption?

B. When did your symptoms first start?

In which anatomic position are the rotator cuff muscles in their optimal length-tension relationship? A. With the humeral head in 90° of abduction and maximal external rotation B. With the glenoid fossa angled 30° from the frontal plane C. With the humeral head in 90° of abduction D. With the glenoid fossa perpendicular to the sagittal plane E. With the glenoid fossa angled 10° from the frontal plane and the humeral head abducted 10°

B. With the glenoid fossa angled 30° from the frontal plane

A plant worker falls from the top of a 12-ft ladder, landing on his right foot before falling to the ground. The worker is transported to the facility ' s medical clinic, and plain film x-rays are obtained of his foot, ankle, and lower leg. He is diagnosed with a comminuted fracture of his right calcaneus. What is a comminuted fracture? A. A fracture with an "S" shape B. A fracture in which the bone splits along its length C. A fracture consisting of three or more fragments at the fracture site D. A fracture that occurs at right angles to the bone shaft

C. A fracture consisting of three or more fragments at the fracture site

An athlete has been diagnosed with stenosing tenosynovitis of the first dorsal carpal tunnel. What is another name for this condition? A. Guyon ' s disease B. Gamekeeper ' s thumb C. de Quervain ' s disease D. Swan-neck deformity E. Johnson ' s disease

C. de Quervain ' s disease

Vital signs should be assessed and repeated at regular intervals during the physical examination of an athlete who has sustained head trauma. What measurement of blood pressure (BP) may be a sign of intracranial bleeding? A. Pulse pressure less than 40 mm Hg B. BP that decreases after a high postexercise measurement C. BP that continues to increase over time D. Negative pulse pressure

C. BP that continues to increase over time

During a football practice a player sustains a brachial plexus injury. As part of your sideline evaluation of the injured athlete, you assess the athlete ' s reflexes. Based on the photo, which reflex is being assessed? A. C5 B. C6 C. C7 D. C8 E. T1

C. C7

Which of the following calcaneal alignments is most commonly observed in patients with pes planus? A. Calcaneal varus B. Calcaneal inversion C. Calcaneal valgus D. Calcaneal pronation E. Calcaneal supination

C. Calcaneal valgus

A women ' s basketball player is elbowed in the jaw during a practice session. Observation reveals a portion of her tooth is broken, some bleeding is present, and the pulp chamber is exposed, producing a great deal of pain. With which type of tooth fracture are these signs most closely associated? A. Uncomplicated crown fracture B. Root fracture C. Complicated crown fracture D. Complicated pulp fracture E. Uncomplicated periodontal fracture

C. Complicated crown fracture

Which of the following terms is consistent with an increased carrying angle of greater than 14° in a male subject? A. Cubitus varus B. Genu recurvatum C. Cubitus valgus D. Genu varum

C. Cubitus valgus

12. During a match a water polo player sustains an aggressive tackle, forcing his neck into lateral right side flexion and depressing his left shoulder. The player immediately retreats to the side of the pool complaining of radiating and "burning" pain. Based on the mechanism of injury and initial complaint, what other sign or symptom is this athlete likely to report? A. Severe neck pain B. Bilateral paresthesia C. Decreased strength of left shoulder and arm muscles that are innervated by the involved nerves D. Diminished sensory ability of right side dermatomes of the involved cervical nerves

C. Decreased strength of left shoulder and arm muscles that are innervated by the involved nerves

The pediatrician who assists you in providing medical coverage to your high school athletes is evaluating a football player ' s ankle injury. The athlete had forcefully rotated on a planted foot and sustained excessive external rotation of the talus and dorsiflexion forces. The physician has determined the athlete has sprained his deltoid ligament but is unsure of the reason the athlete is reporting anterior ankle pain. As an athletic trainer, how should you appropriately respond to this physician? A. When the ankle is forcefully dorsiflexed and the talus excessively externally rotated, the peroneal tendons can be stretched or torn. B. An ankle joint forcefully dorsiflexed with the talus excessively externally rotated places pressure on the tibia, stretching the tibialis anterior muscle. C. During excessive external rotation of the talus or forced dorsiflexion, the distal syndesmosis can be spread and the anterior tibiofibular ligament can be sprained. D. The mechanism of excessive external rotation of the talus and forceful dorsiflexion can cause an avulsion of the medial malleolus or bimalleolar fracture.

C. During excessive external rotation of the talus or forced dorsiflexion, the distal syndesmosis can be spread and the anterior tibiofibular ligament can be sprained.

Which of the following is classified as a saddle joint and is capable of 2 degrees of freedom? A. Fourth carpometacarpal joint B. First metacarpophalangeal joint C. First carpometacarpal joint D. Fifth carpometacarpal joint E. Fifth metacarpophalangeal joint

C. First carpometacarpal joint

With the patient seated and cervical spine laterally flexed to his left side, the examiner places one hand on the right side of the patient ' s head and the other over the patient ' s ipsilateral acromioclavicular (AC) joint. The examiner applies force to laterally bend the head while depressing the shoulder. The patient reports paresthesia symptoms throughout his right upper extremity. What are the clinical implications of this test outcome? A. Outcome is consistent with stretching of the brachial plexus. B. Outcome is consistent with left side thoracic outlet syndrome. C. Outcome is consistent with compression of the cervical nerve roots between two vertebrae. D. Outcome is consistent with right side thoracic outlet syndrome.

C. Outcome is consistent with compression of the cervical nerve roots between two vertebrae.

Which of the following functional areas of the cerebral cortex manages complex problems and abstract thought? A. Parietal lobe B. Temporal lobe C. Frontal lobe D. Occipital lobe E. Medulla

C. Frontal lobe

The stress-strain curve is a representation of the relative relationship of tissue properties. Which of the following is an example of tissue creep? A. Avulsion fracture of the fibula subsequent to ankle joint inversion forces instead of a ligament tear B. Bilateral subacromial impingement syndrome in a butterfly swimmer C. Greater glenohumeral joint external rotation in the throwing arm of a baseball player compared with the nonthrowing limb D. Lateral epicondylalgia in the dominant elbow of a tennis player

C. Greater glenohumeral joint external rotation in the throwing arm of a baseball player compared with the nonthrowing limb

A 17-year-old female volleyball player reports experiencing a forceful inversion and plantar flexion of her right ankle when she landed on her teammate ' s foot following a block. After gathering a medical history, observing and palpating the injured tissues, and assessing this athlete ' s ankle joint range of motion, you suspect she has sustained a sprain of the anterior talofibular ligament. To verify your initial differential diagnosis, you conduct an anterior drawer test. This test has a positive likelihood ratio of 4.5 and a negative likelihood ratio of 0.35. How do these likelihood ratios contribute to your evaluation findings? A. If the anterior drawer test is positive, the high positive likelihood ratio of 4.5 enhances the probability a tear of the anterior talofibular ligament is present. B. If the anterior drawer test is positive, the low negative likelihood ratio of 0.35 decreases the chance of a false-positive test. C. If the anterior drawer test is negative, a tear of the anterior talofibular ligament could not be ruled out because the negative likelihood ratio is 0.35, which is small and indicates only a small shift in pretest probability. D. If the anterior drawer test is negative, the high positive likelihood ratio of 4.5 decreases the chance of a false-negative test.

C. If the anterior drawer test is negative, a tear of the anterior talofibular ligament could not be ruled out because the negative likelihood ratio is 0.35, which is small and indicates only a small shift in pretest probability.

Two days after sustaining a knee hyperextension injury running to first base, a baseball player presents with mild joint swelling, pain with joint movement, inability to bear weight, and limited joint motion. Which of the following is a well-structured and appropriate short-term treatment goal for this patient? A. Instruct patient on partial weight-bearing gait. B. Work on increasing strength within pain-free range of motion. C. Increase knee joint flexion from 90° to 120°. D. Use therapeutic modalities two times daily to decrease pain and swelling.

C. Increase knee joint flexion from 90° to 120°.

Which statement best describes the pressures present during inhalation? A. Atmospheric pressure is lower than intrapleural pressure. B. Intra-alveolar pressure is lower than intrapleural pressure. C. Intra-alveolar pressure is lower than atmospheric pressure. D. Intra-alveolar pressure is higher than atmospheric pressure. E. Intrapleural pressure is higher than atmospheric pressure.

C. Intra-alveolar pressure is lower than atmospheric pressure.

Which of the following best describes the location of the sinus tarsi? A. Just posterior to the lateral malleolus B. Just posterior to the medial malleolus C. Just anterior to the lateral malleolus D. Just anterior to the medial malleolus E. Just inferior to the lateral malleolus

C. Just anterior to the lateral malleolus

A 13-year-old adolescent athlete presents for evaluation of pain, stiffness, and swelling in multiple joints that have been present in varying degrees of intensity for more than 6 months without any mechanism of injury. Joint stability tests are within normal limits. Which of the following conditions would be in your differential diagnosis? A. Apophysitis B. Raynaud disease C. Juvenile idiopathic arthritis D. Multiple sclerosis

C. Juvenile idiopathic arthritis

Winging of the scapula could result from injury to which nerve? A. Median B. Axillary C. Long thoracic D. Suprascapular E. Spinal accessory

C. Long thoracic

Although clinical tests for thoracic outlet syndrome may be effective at reproducing symptoms, they are ineffective in determining causative factors. Which assessment is required to identify causative factors so that those can be addressed? A. Angiography B. Ultrasonography C. Magnetic resonance imaging (MRI) D. Electromyography (EMG) conduction testing

C. Magnetic resonance imaging (MRI)

A patient reports to the athletic training room for reevaluation of an acute knee injury sustained in a game the previous evening. Goniometric evaluation reveals an increase in flexion range of motion of 15° and improvement on a lower extremity functional scale. Whereas the clinician may think this is a significant improvement, what measure is most important to the patient? A. Minimum detectable change (MDC) B. Global rating of change (GRC) C. Minimum clinically important difference (MCID) D. Predictor variable (PV)

C. Minimum clinically important difference (MCID)

A soccer player sustained a deep contusion to his quadriceps from an opponent ' s knee approximately 4 weeks ago. The athlete was treated conservatively with modalities and flexibility exercises and has returned to practice but continues to note pain and decreased function. Radiographic evaluation reveals a calcification in the quadriceps muscle. What is your clinical diagnosis? A. Myositis ossificans progressiva B. Myositis ossificans circumscripta C. Myositis ossificans traumatica D. Myositis ossificans imperfecta

C. Myositis ossificans traumatica

You are evaluating an adolescent athlete complaining of anterior knee pain at the insertion of the patellar tendon on the tibial tuberosity. You observe a bony deformity at the tibial tuberosity. Pain is exacerbated with eccentric loading of the tendon when landing from jumping and descending stairs. What condition do you suspect? A. Sinding-Larsen-Johansson disease B. Synovial plica C. Osgood-Schlatter disease D. Patellofemoral pain syndrom

C. Osgood-Schlatter disease

An 18-year-old basketball player fell on his outstretched hand during a practice session. Examination by his physician and subsequent radiographic evaluations resulted in the diagnosis of a scaphoid fracture. Based on the location of the fracture, the physician is worried about impaired circulation and the potential for development of Preiser ' s disease. What is Preiser ' s disease? A. Chronic instability of the scaphoid B. A deformity that results when the fracture fragment displaces C. Osteoporosis of the scaphoid D. Exostosis of the scaphoid

C. Osteoporosis of the scaphoid

Which four palpable bony prominences define the carpal tunnel? A. Radial styloid, navicular, ulnar styloid, and hook of the hamate B. Radial styloid, base of the first metacarpal, base of the fifth metacarpal, and ulnar styloid C. Pisiform, tubercle of the navicular, hook of the hamate, and tubercle of the trapezium D. Tubercle of the navicular, lunate, pisiform, and ulnar styloid E. Lister ' s tubercle, tubercle of the trapezium, capitate, and base of the fifth metacarpal

C. Pisiform, tubercle of the navicular, hook of the hamate, and tubercle of the trapezium

A 20-year-old male cheerleader presents with a history of chronic dominant shoulder pain attributed to sports participation. On examination you note the following: atrophy of the deltoid muscle compared bilaterally, decreased active and passive glenohumeral joint internal rotation in the presence of normal external rotation, pain and weakness when assessing resisted internal rotation motion of glenohumeral joint, negative relocation test, and positive jerk test. Based on these examination findings, what condition should be included in your differential diagnosis? A. Multidirectional glenohumeral instability B. Subacromial impingement syndrome C. Posterior glenohumeral instability D. Anterior glenohumeral instability

C. Posterior glenohumeral instability

A factory worker presents with signs and symptoms consistent with unilateral carpal tunnel syndrome, which is likely due to the repetitiveness of his work tasks. What is the most effective means of quantifying the degree of this patient ' s median nerve compression? A. Refer the patient to a neurologist for an electroencephalogram. B. Refer the patient to an occupational therapist for manual muscle testing. C. Refer the patient to a physiatrist for a nerve conduction study and electromyography. D. Refer the patient to a radiologist for a computed tomography scan with contrast dye.

C. Refer the patient to a physiatrist for a nerve conduction study and electromyography.

In the initial phase of throwing a ball, as the shoulder girdle and arm move from a posterior retracted position to a forward, internally rotated position, what are the primary muscles responsible for moving the scapula and the arm forward? A. Subscapularis, anterior deltoid, coracobrachialis, and serratus anterior B. Supraspinatus, teres major, rhomboids, and pectoralis major C. Serratus anterior, subscapularis, anterior deltoid, and pectoralis major D. Serratus anterior, upper trapezius, latissimus dorsi, and pectoralis major E. Subscapularis, upper trapezius, latissimus dorsi, and triceps

C. Serratus anterior, subscapularis, anterior deltoid, and pectoralis major

You are approached by an athlete who recently learned she has a family history of Wolff-ParkinsonWhite syndrome. She is asymptomatic but is confused and has questions regarding this cardiac arrhythmia condition. You decide to begin your explanation of this condition by explaining normal cardiac activity. Which of the following paths constitutes the normal route for conduction of electrical activity through the heart? A. Sinoatrial node to atrioventricular node to atrioventricular bundle to Purkinje ' s fibers to ventricular musculature B. Sinoatrial node to atrial musculature to atrioventricular node to atrioventricular bundle to bundle branches to ventricular musculature C. Sinoatrial node to atrial musculature to atrioventricular node to atrioventricular bundle to bundle branches to Purkinje ' s fibers to ventricular musculature D. Sinoatrial node to atrioventricular node to atrioventricular bundle to bundle branches to Purkinje ' s fibers E. Sinoatrial node to atrioventricular bundle to atrial musculature to atrioventricular node to bundle branches to ventricular musculature to Purkinje ' s fibers

C. Sinoatrial node to atrial musculature to atrioventricular node to atrioventricular bundle to bundle branches to Purkinje ' s fibers to ventricular musculature

What foot position allows for the maximum amount of rigidity at initial contact during the stance phase of the gait cycle to allow the limb to accept the impact of body weight loading? A. Foot flat and knee in 20° of flexion B. Foot supinates toward neutral, weight shifts over metatarsal heads, and heel begins to rise into plantar flexion C. Subtalar joint is in supination, and tibia is externally rotated D. 20° of plantar flexion combined with up to 40° of knee flexion

C. Subtalar joint is in supination, and tibia is externally rotated

When completing a manual muscle test for the middle deltoid muscle, in what position should the athlete be placed if he is unable to hold the test position against gravity? A. Semirecumbent, with examiner standing anterior to the athlete B. Seated, with the examiner standing at the side of the athlete C. Supine, with the examiner standing caudally D. Seated, with the examiner standing behind the athlete E. Semirecumbent, with the examiner standing behind the athlete

C. Supine, with the examiner standing caudally

Which of the following tests assesses cranial nerve II? A. Lateral and vertical gaze B. Double simultaneous stimulation of the trigeminal nerve C. Symmetric smile D. Visual acuity E. Pupil reaction to light

C. Symmetric smile

A beach volleyball player complains of blurred vision, light sensitivity, and the sensation of "having something in her eye" after diving in the sand. Evaluation reveals no visible foreign objects, but similar sensations remain after flushing the eye with sterile saline solution. Examination utilizing a fluorescein strip reveals a possible corneal abrasion. How should this condition be managed? A. The eye should be patched, and the athlete should be instructed to return in 24 hours for reevaluation. B. The athlete should be provided with nonprescription contact lenses to protect the healing area. C. The athlete should be referred to an ophthalmologist for topical antibiotic and anesthetic treatment as needed. D. The eye should be patched, and the athlete should be referred to the emergency department for evaluation.

C. The athlete should be referred to an ophthalmologist for topical antibiotic and anesthetic treatment as needed.

You receive a call from your team physician alerting you that the female equestrian athlete you had referred to him has been diagnosed with type 1 diabetes mellitus. The athlete reports to the athletic training facility and tells you she ate lunch approximately 2 hours ago. She just checked her blood glucose level, and the glucometer reading was 203 mg/dL. How would you interpret these results? A. The blood glucose level indicates impaired glucose tolerance. B. The blood glucose level indicates normal physiological glucose management. C. The blood glucose level indicates uncontrolled diabetes. D. The blood glucose level indicates the athlete is hypoglycemic.

C. The blood glucose level indicates uncontrolled diabetes.

An athlete asks you to look at a mole on her back that she has had her whole life but that she thinks has changed over the past several months. To rule out melanoma, you screen for the ABCD characteristics. Which of the following characteristics would necessitate referral for evaluation by a dermatologist? A. The mole is symmetrical all the way around. B. The mole is bordered by skin that is red and scaly. C. The mole varies in color in different areas. D. The mole ' s diameter is smaller than a dime.

C. The mole varies in color in different areas.

A member of the rifle team reports to your athletic training facility complaining of posterior scapular and thoracic muscle pain. On review of his medical records, you note he has been treated for muscular trigger points in the postural muscles where he is reporting pain. What is the potential cause of his trigger point development? A. The postural muscles become inhibited in response to stress or strain. B. The postural muscles become weakened in response to stress or strain. C. The postural muscles become overactivated and tightened or shortened in response to stress or strain. D. The postural muscles become actively insufficient in response to stress or strain.

C. The postural muscles become overactivated and tightened or shortened in response to stress or strain.

A 14-year-old skateboarder falls while performing a trick and externally rotates his foot. The anterior tibiofibular ligament is intact, but you suspect he may have sustained a fracture. Which fracture is most likely based on this information? A. Salter-Harris V fracture of the distal tibia B. Talar dome fracture C. Tillaux ' s fracture D. Fibular avulsion fracture E. Jones' fracture

C. Tillaux ' s fracture

Based on return-to-play recommendations for patients with a surgically or nonsurgically managed superior labral anterior posterior (SLAP) lesion in the National Athletic Trainers' Association (NATA) position statement on evaluation, management, and outcomes of and return-to-play criteria for overhead athletes with SLAP injuries, what percentage of range of motion needs to be regained in order to return to full activities? A. 65% B. 75% C. 80% D. 90%

D. 90%

Pulse oximetry provides a rapid and noninvasive technique to estimate peripheral oxygen saturation (Sp O 2) of hemoglobin. What Sp O2 measure falls within the "normal" range? A. 45% B. 75% C. 85% D. 95%

D. 95%

A skier reports to your athletic training facility following a hard fall during a giant slalom race. He is complaining of pain around the area of the hypothenar eminence, so after observing this area you begin palpating the soft tissue. What muscles comprise the hypothenar eminence? A. Flexor digitorum superficialis, flexor digitorum profundus, and lumbricals B. Abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis C. Abductor pollicis longus, abductor pollicis brevis, and tendon of the flexor pollicis longus D. Abductor digiti minimi, opponens digiti minimi, and flexor digiti minimi brevis E. Extensor digiti minimi, adductor digiti minimi, and dorsal interossei

D. Abductor digiti minimi, opponens digiti minimi, and flexor digiti minimi brevis

The ability of a muscle to develop tension is dependent on the length of the muscle, which impacts the positioning of the actin and myosin cross-bridges. What impact will a shortened muscle have on its ability to provide mobility and stability? A. Passive insufficiency will occur, and the muscle will provide efficient mobility and inefficient stability. B. Reciprocal inhibition will occur, and the muscle will provide efficient mobility and efficient stability. C. Muscular imbalance will occur, and the muscle will provide inefficient mobility and inefficient stability. D. Active insufficiency will occur, and the muscle will provide inefficient mobility and efficient stability.

D. Active insufficiency will occur, and the muscle will provide inefficient mobility and efficient stability.

Irritability, aphasia, concentration difficulty, fatigue, and unilateral visual disturbances are five potential migraine prodrome symptoms. When should a patient expect to experience these prodrome symptoms? A. During peak headache pain intensity B. In the beginning of the migraine attack as pain intensity is increasing C. Toward the end of the migraine attack as pain intensity is abating D. Before the onset of the migraine attack

D. Before the onset of the migraine attack

During a doubles tennis match, the player nearest the net fails to quickly react to an opponent ' s shot and is struck in the eye by the hard hit tennis ball. During inspection of the player ' s traumatized eye, noting which of the following would indicate immediate referral to an ophthalmologist? A. Blood in the sclera of the eye B. Periorbital hematoma C. Laceration of the eyelid D. Blood in the anterior chamber of the eye

D. Blood in the anterior chamber of the eye

An equestrian rider reports for evaluation of a head injury after being thrown from her horse. The athlete is having difficulty talking, swallowing, and sticking out her tongue. Which cranial nerve is most likely impaired? A. Cranial nerve VII B. Cranial nerve V C. Cranial nerve VIII D. Cranial nerve XII E. Cranial nerve I

D. Cranial nerve XII

When evaluating a patient with low back pain, which of the following conditions should be screened for, as it may exacerbate the condition and result in poor outcomes? A. Incontinence B. Celiac disease C. Gastritis D. Depression

D. Depression

John surgery. In addition to providing the patient with an overview of the various phases of the rehabilitation process, what other important piece of information should be communicated to the patient to improve compliance with the rehabilitation program? A. Examples of other patients who have had excellent rehabilitation outcomes B. Detailed schedule of the first month of rehabilitation, including appointment dates, exercises, sets, and repetitions C. Prognosis and date when the athlete will be able to return to activity D. Detailed consequences of not following rehabilitation protocol

D. Detailed consequences of not following rehabilitation protocol

An athlete recovering from an ankle ligament reconstruction is suspected to have a deep vein thrombosis. Which of the following imaging techniques would be most helpful in diagnosing this condition? A. Electromyography B. Echocardiogram C. Electrocardiogram D. Doppler ultrasonography E. Dual-energy x-ray absorptiometry scan

D. Doppler ultrasonography

Which of the following adaptations might occur as a result of hyperlordotic posture? A. Adaptive shortening of anterior chest musculature B. Increased compressive forces on posterior hip ligaments C. Soft tissue shortening and increased compressive forces in posterior upper thoracic and cervical regions D. Elongation of the anterior lumbar spine ligaments and posterior hip ligaments

D. Elongation of the anterior lumbar spine ligaments and posterior hip ligaments

A postoperative patient reports to your clinic for rehabilitation. You note that her knee appears more swollen and is warm to the touch. You encourage the patient to schedule an immediate follow-up appointment with her surgeon to rule out an infection in the surgical site. What implications might infection have on the healing process? A. Fibroplasia and collagen synthesis may be inhibited. B. Nutrition to the healing structures may be inhibited. C. Tissue separation may occur. D. Excessive production of granulation tissue and excess scar tissue may occur.

D. Excessive production of granulation tissue and excess scar tissue may occur.

A female basketball player reports to the high school ' s athletic training room complaining of bilateral nonspecific anterior knee pain and a medical history significant for patellar subluxation. You are assessing patellar glide. Based on the photo, how would you characterize the patient ' s patellar mobility? A. Hypomobile medial patellar glide B. Hypermobile medial patellar glide C. Hypomobile lateral patellar glide D. Hypermobile lateral patellar glide E. Normal medial patellar glide F. Normal lateral patellar glide

D. Hypermobile lateral patellar glide

You are evaluating a swimmer who is experiencing low back pain. The pain is least in the morning and worsens as the day goes on. Movement is guarded, as most motion exacerbates the pain. The patient also notes a tingling sensation across the anterolateral thigh and down the medial aspect of the knee into the medial lower leg. Some weakness is noted with resisted dorsiflexion and reduced patellar tendon reflex. The femoral nerve stretch test is positive for pain in the anterolateral thigh, and Milgram ' s test is positive as well. Based on these findings, what injury do you suspect? A. Spondylolysis B. Sciatica C. Lumbar disc involvement at the L5-S1 level D. Lumbar disc involvement at the L4 level E. Facet joint dysfunction

D. Lumbar disc involvement at the L4 level

Which of the following terms is correctly defined? A. Neurapraxia: axon undergoes wallerian degeneration B. Axonotmesis: mildest form of peripheral nerve injury C. Paresthesia: abnormal sensation D. Neurotmesis: complete disruption of the nerve E. Neurodynia: degeneration of nerve cells

D. Neurotmesis: complete disruption of the nerve

Which of the following patients with knee pain is most likely to respond positively to patellar taping? A. Patient with a Q angle <10° B. Patient with a structural, but not a functional, leglength difference C. Patient with notable supination with weight bearing D. Patient with a positive patellar tilt test

D. Patient with a positive patellar tilt test

A patient ' s medical record indicated he has been provided a written prescription for Percocet, an oxycodone combination drug, to assist in pain management. In which Drug Enforcement Administration category or schedule of controlled substances is this drug? A. Schedule V B. Schedule IV C. Schedule III D. Schedule II E. Schedule I

D. Schedule II

A pole vaulter misses the pit and makes contact with his head against the base of the support pole. On initial observation, you note bleeding from a small head laceration and blood and cerebrospinal drainage from the nose and ears. What condition do you suspect? A. Subdural hematoma B. Epidural hematoma C. Concussion D. Skull fracture E. Ruptured tympanic membrane

D. Skull fracture

You are evaluating a patient who complains of a "squeaky" sensation along the back of the lower leg into the foot. A palpable nodule can be felt along the distal tendon. Plantar flexion is painful and weak, and passive dorsiflexion is limited by pain at the end range. Which of the following is the most appropriate differential diagnosis for this patient? A. Heel spur, calcaneal stress fracture, fat pad syndrome, plantar fasciitis B. Os peroneum syndrome, lateral ankle, syndesmotic ankle sprain C. Osteochondritis dissecans, medial tibial stress syndrome, deep vein thrombosis D. Subcutaneous calcaneal bursitis, insertional Achilles tendonitis, Sever ' s disease

D. Subcutaneous calcaneal bursitis, insertional Achilles tendonitis, Sever ' s disease

Which structure returns deoxygenated blood to the heart? A. Aortic arch B. Pulmonary artery C. Pulmonary vein D. Superior and inferior vena cava E. Left ascending coronary artery

D. Superior and inferior vena cava

Blood pressure is assessed using a stethoscope and correctly sized sphygmomanometer. With the sphygmomanometer snugly secured around the patient ' s arm and the diaphragm of the stethoscope placed over the brachial artery, the cuff is inflated to greater than 200 mm Hg and then gradually deflated. During deflation the examiner listens for the Korotkoff sounds while watching the aneroid dial. Which of the following Korotkoff phase descriptions is accurate? A. The first two consecutive beats heard as the cuff deflates are phase I and indicate diastolic pressure. B. The knocking, crisp, high-pitched sounds are phase II and indicate systolic pressure. C. The swooshing sound is phase IV and results from the turbulent blood flow through the partially occluded artery. D. The disappearance of the last audible sound is phase V, also known as the fifth Korotkoff sound, and defines diastolic pressure.

D. The disappearance of the last audible sound is phase V, also known as the fifth Korotkoff sound, and defines diastolic pressure.

You are evaluating an athlete who has sustained a significant inversion and plantar flexion injurious force to his ankle approximately 24 hours prior. To determine if this patient should be referred for ankle radiographs, you employ the Ottawa Ankle Rules. According to the Ottawa Ankle Rules, what is a criterion for ankle joint radiographic referral? A. The patient presents with palpable pain over the proximal one third of the fibula. B. The patient is unable to walk without pain both immediately following the injury and at the time of the examination. C. The patient presents with palpable pain over the base of the fifth metatarsal or the navicular. D. The patient presents with palpable pain over the posterior edge, tip, or midline of the medial malleolus.

D. The patient presents with palpable pain over the posterior edge, tip, or midline of the medial malleolus.

A soccer player has sustained a traumatic blow to the lower leg in the absence of a shin guard. He is unable to dorsiflex and invert the ankle. Which of the following conclusions would you make? A. The player has sustained an injury to the lateral compartment; integrity of the peroneal artery should be assessed. B. The player has sustained an injury to the anterior compartment; integrity of the peroneal artery should be assessed. C. The player has sustained an injury to the superficial posterior compartment; integrity of the posterior tibial artery should be assessed. D. The player has sustained an injury to the anterior compartment; integrity of the anterior tibial artery should be assessed. E. The player has sustained an injury to the superficial posterior compartment; integrity of the dorsalis pedis artery should be assessed.

D. The player has sustained an injury to the anterior compartment; integrity of the anterior tibial artery should be assessed

You are observing a swimmer complete forward shoulder flexion during a physical examination. How should the scapula be moving after the first 60° of forward flexion of the glenohumeral joint? A. The scapula should be upwardly rotating, moving 2° for every 1° of glenohumeral motion. B. The scapula should be elevating, moving 1° for every 2° of glenohumeral motion. C. The scapula should be elevating, moving 2° for every 1° of glenohumeral motion. D. The scapula should be upwardly rotating, moving 1° for every 2° of glenohumeral motion. E. The scapula should be abducting, moving 1° for every 2° of glenohumeral motion.

D. The scapula should be upwardly rotating, moving 1° for every 2° of glenohumeral motion.

A patient with a history of bilateral heel and arch pain reports a daily pattern of pain that is worse in the morning, especially with the first few steps, but decreases with activity throughout the day. To what is this pain pattern attributed? A. Muscular fatigue B. Referred pain C. Acute inflammatory response D. Tissue creep

D. Tissue creep

You observe a patient with an altered gait characterized by the thorax listing toward the involved limb during the stance phase of gait. What type of gait are you observing, and what is the most common cause of this gait pattern? A. Steppage gait; weakness of the dorsiflexors B. Calcaneal gait; pain with forefoot weight-bearing or plantar flexor weakness C. Gluteus maximus gait; gluteus maximus muscle weakness D. Trendelenburg gait; gluteus medius weakness

D. Trendelenburg gait; gluteus medius weakness

Which of the following pain patterns is radicular pain? A. Right shoulder, right upper quadrant, and bilateral inner thigh pain attributed to gallbladder pathology B. Left shoulder, left upper quadrant, and left side low back pain attributed to spleen pathology C. Neck, left chest, left scapula, and left forearm pain attributed to cardiac pathology D. Unilateral sciatic nerve pain attributed to L5 nerve root pathology

D. Unilateral sciatic nerve pain attributed to L5 nerve root pathology

Which of the following findings would prompt referral to a physician for further evaluation because it may be indicative of an underlying cancer? A. Unexplained pain radiating down the left arm B. Unexplained swelling in the ankle or legs C. Inability to produce an active muscle contraction in the absence of an injury D. Unremitting night pain

D. Unremitting night pain

What information provides the basis for establishing clinical decision rules? A. Comparison of test results to a reference standard known as the diagnostic gold standard B. Measures of how positive and negative findings on a particular diagnostic test indicate the usefulness of the test C. Measures of the smallest amount of change that is functionally beneficial to the patient D. Validated and reliable items that have been tested across various groups that correctly predict a specific outcome

D. Validated and reliable items that have been tested across various groups that correctly predict a specific outcome

Which of the following tests assesses cranial nerve II? A. Lateral and vertical gaze B. Double simultaneous stimulation of the trigeminal nerve C. Symmetric smile D. Visual acuity E. Pupil reaction to light

D. Visual acuity

6. Which ligaments comprise the lateral ligaments of the elbow? A. Radial collateral ligament, lateral ulnar collateral ligament, anterior oblique band, posterior oblique band B. Transverse oblique band, annular ligament, accessory collateral ligament, radial collateral ligament C. Radial collateral ligament, lateral ulnar collateral ligament, accessory collateral ligament, anterior oblique band D. Anterior oblique band, posterior oblique band, transverse oblique band, annular ligament E. Annular ligament, accessory collateral ligament, radial collateral ligament, lateral ulnar collateral ligament

E. Annular ligament, accessory collateral ligament, radial collateral ligament, lateral ulnar collateral ligament

During evaluation of an athlete with abdominal pain, rebound tenderness is noted in the right lower quadrant halfway between the umbilicus and the anterior superior iliac spine. Inflammation of which organ is most associated with this symptom? A. Liver B. Spleen C. Bladder D. Gallbladder E. Appendix

E. Appendix

Your junior varsity softball coach calls you from a road trip to report that his starting pitcher sustained a blow to the anterior aspect of her lower leg when she was unable to field a batted ball. The player is experiencing localized anterior tibial pain with moderate swelling, discoloration, and point tenderness. Two days later, you receive a call from the athlete ' s mother who is concerned about her daughter ' s injury. She states that her daughter ' s leg is now very red and warm, and the skin appears tight. Which of the following conditions has this athlete most likely developed? A. Contusion that is entering the repair phase B. Anterior compartment syndrome C. Osteochondral defect D. Synovitis E. Cellulitis

E. Cellulitis

From which secondary injury should a wrestler who has sustained repetitive severe anterior thigh trauma be protected during subsequent practices and matches? A. Osteomyelitis B. Osteochondritis dissecans C. Rhabdomyolysis D. Myokymia E. Heterotopic ossification

E. Heterotopic ossification

Weakness or reflex inhibition of the psoas major muscle causes this compensatory gait whereby, during the swing phase, lateral rotation and flexion of the trunk occur with hip adduction. The trunk and pelvic movements are exaggerated. To what is this compensatory gait attributed? A. Leg-length discrepancy B. Severe weakness or paralysis of the gluteus maximus C. L4-L5 nerve root compression D. Weakness of the gluteus medius muscle E. Legg-Calvé-Perthes disease

E. Legg-Calvé-Perthes disease

An athlete reports falling directly on his knee and presents with a golf ball-sized lump just below the skin over the patella. Which bursa is most associated with this presentation? A. Deep infrapatellar B. Suprapatellar C. Superficial infrapatellar D. Pes anserine E. Prepatellar

E. Prepatellar

The physician is presenting a staff in-service on head injuries. The physician states that when the brain loses autoregulation of its blood supply, vascular engorgement within the cranium results. This engorgement leads to herniation either of the medial surface of the temporal lobe or lobes below the tentorium or of the cerebellar tonsils through the foramen magnum. This condition leads to rapid brainstem failure within 2 to 5 minutes. What injury is being discussed? A. Antegrade amnesia B. Transient ischemic attack C. Skull fracture D. Cerebral concussion E. Second impact syndrome

E. Second impact syndrome

As a high school athletic trainer, you receive a phone call from a local physician ' s office requesting copies of your preparticipation physical and evaluation notes from a 16-year-old football player ' s recent knee injury. How should you best respond to this request? A. A release of records must be signed by the athlete, and then they can be faxed to the requesting physician. B. The requested records may be faxed or mailed to the requesting physician ' s office. C. The athlete ' s mother may call and request the records be sent, and then the records can be faxed to the requesting physician. D. The coach requests the records be sent on behalf of the athlete, and then the records can be faxed to the requesting physician. E. The athlete and a parent may come by the athletic training clinic and pick up copies of his records to take to the physician

E. The athlete and a parent may come by the athletic training clinic and pick up copies of his records to take to the physician

In performing Renne ' s test, an athlete squats, flexing the knee to 30°. As the athlete returns to the start position of the knees in full extension, how does the function of the iliotibial band change? A. The iliotibial band is now able to assist in hip abduction. B. The iliotibial band acts to internally rotate the tibia. C. The iliotibial band creates posterior tibial translation. D. The iliotibial band assists in superior patellar glide. E. The iliotibial band goes from being a knee flexor to being a knee extensor.

E. The iliotibial band goes from being a knee flexor to being a knee extensor.

Which bones will you encounter when palpating the distal row of carpal bones from the radius to the ulna? A. Scaphoid, lunate, triquetral, pisiform B. Trapezoid, trapezium, lunate, scaphoid C. Scaphoid, capitate, trapezoid, hamate D. Trapezium, trapezoid, triquetral, pisiform E. Trapezium, trapezoid, capitate, hamate

E. Trapezium, trapezoid, capitate, hamate