AT BOC Prep Domain II - Examination, Assessment and Diagnosis

While gathering a medical history, your patient reports a previous diagnosis of kyphosis. Which of the following best defines kyphosis? A. A convex curve of the upper thorax B. A concave curve of the lumbar area C. A lateral curve often combined with rotation D. A concave curve of the cervical area E. A lateral curve of the cervical area

A: Kyphosis can be classified as or observed by an anterior shoulder posture and an anterior curvature of the thoracic spine. Patients who present with this posture may also display forward shoulder and head postures

Which of the following questions could you ask while talking to a patient that will allow you to demonstrate concern for the patient and establish rapport that may improve the quality of the information you receive? A. "How is your pain impacting your daily life and the things you enjoy doing?" B. "Can you point to the place where it hurts the most?" C. "How many times have you been evaluated for this injury and by whom? D. "Is the condition getting better?"

A: Open-ended questions that encourage patients to describe the complaint and questions that allow patients to share impacts of the injury facilitate patient/clinician communication.

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: The patient would be awarded zero points for moving his or her hip into greater than 10° of abduction. If the athlete was to move into 30° or more of hip abduction, he or she would be given a point for moving out of position

A volleyball player has inverted and plantar-flexed her ankle. She complains of lateral ankle pain. On inspection, you note the presence of two tendons posterior to the lateral malleolus. What anatomic structures maintain these tendons in this position? A. Superior and inferior peroneal retinacula B. Superior and inferior tibial retinacula C. Lateral and posterior fibular retinacula D. Superior and inferior extensor retinacula E. Lateral and inferior calcaneal retinacula

A: The peroneal tendons are primarily held in position by the superior retinaculum and the inferior peroneal retinaculum, with the inferior peroneal retinaculum playing a lesser role

A volleyball player reports to your athletic training facility complaining of chronic medial longitudinal arch and lower leg pain. You choose to perform a static postural assessment. Based on the photo, what do you conclude? A. The athlete has genu valgum and hyperpronation and most likely also has hip muscle weakness. B. The athlete has genu varum and excessive supination. C. The athlete has normal lower extremity alignment. D. The athlete has a kypholordotic posture. E. The athlete has genu recurvatum and thus has an anterior cruciate ligament sprain.

A: Genu valgum, sometimes referred to as knockknee, manifests with muscular weaknesses occurring at the hip or secondary to excessively pronated feet

A n 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 high carbohydrate diet E. Poor nutrition, overexposure to the sun, and sexual activity

A: Herpes simplex eruptions can be triggered by illness, external stresses, internal stresses, fatigue, overexposure to sunlight, menstruation, and physical trauma.

An athlete reports anterior knee pain. On inspection you note the athlete has squinting patellae. Which of the following is most likely the potential cause of this patellar malalignment? A. Hip anteversion B. External femoral rotation C. External tibial rotation D. Abnormally short patellar tendon E. Abnormally long patellar tendon

A: Hip anteversion is characterized by femoral internal rotation, which in turn results in tibial internal rotation. The patellae appear to be "squinting," or pointing medially, due to the femoral positioning.

Which of the following statements best describes how normal running gait differs from normal walking gait? A. Running gait has a greater stride length and less stride width. B. Running gait requires less range of motion and strength. C. The running gait cycle contains the dual phases of double limb support. D. Preswing is absent from the running gait cycle. E. The running gait cycle has less total upward and downward motion of the body.

A: During running the length of the stride is increased to accommodate for the increased leg turnover, and the stride width is streamlined in order to improve efficiency and reduce unnecessary muscle fatigue

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: Shoulder mechanics require the elevation of the scapula to accommodate for the motion of the more mobile humerus

-

-

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: "Tennis elbow straps" or counterforce braces can minimize pain or other symptoms associated with lateral epicondylalgia. If effective, this can confi rm the diagnosis.

You refer an athlete to the team physician for evaluation of jumper ' s knee. She returns with a diagnosis of bipartite patella. What does this diagnosis imply? A. The athlete has a congenital abnormality in which the patella has developed from two centers rather than one, resulting in two parts that are connected by fibrocartilage. B. The athlete has an avulsion fracture of the inferior pole of the patella by the patellar tendon. C. The athlete has a stress fracture of the patella due to the pull of the quadriceps musculature. D. The athlete has progressive degeneration of the patella that has developed from excessive maltracking and chronic tendonitis. E. The athlete has early onset of osteoarthritis of the patella that has developed from excessive maltracking and chronic tendonitis.

A: A bipartite patella results from failure of a complete ossifi cation that joins the multiple centers that formed the patella. This is a congenital defect and decreases the effi ciency of the extensor mechanism of the knee, causing pain

What type of approach is recommended for managing psychological concerns at the secondary school level? A. Interdisciplinary team to include the athletic trainer, team physician, school nurse, school counselor, and local mental health professionals. B. As high school athletes are minors, parents must be called first and allowed to manage the care of the athlete. C. Team physician must be consulted on every situation that involves a secondary school athlete. D. An athletic trainer should be well versed on the state laws and direct the care of the athlete

A: A team approach is recommended by the Interassociation Consensus Statement to provide the most comprehensive recognition and referral process

An athlete presents with fl u-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 terbinafi ne hydrochloride (Lamisil) E. An antifungal medication such as zanamivir (Relenza)

A: Acyclovir is an antiviral medication that is commonly used to treat herpes simplex virus. These symptoms are indicative of herpes simplex virus, which can manifest as the fl u, so an oral medication of acyclovir is an appropriate option

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: An ankylosed joint is fused as a result of decreased motion after injury or surgical intervention.

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 is one that is not seen on an x-ray. Although it is rare, it is more common in children. However, because of the tenderness on the base of the fi fth metatarsal, a fracture is suspected

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: Anorexia athletica is similar to anorexia nervosa but specifi c to athletes. It has most of the same characteristics, but without the self-starvation practice, as anorexia nervosa, including disturbances in body image, menstrual dysfunction, bingeing and purging, gastrointestinal complaints, weight loss, and excessive fear of becoming obese.

Twenty minutes into a soccer practice a player reports watery, itchy eyes; itchy throat and tongue; and red, raised areas of skin. You suspect this athlete is experiencing an environmental allergic reaction. What type of drug can best address this athlete ' s symptoms? A. Antihistamine B. Antiemetic C. Decongestant D. Expectorant

A: Antihistamines oppose histamine reactions that manifest with allergy symptoms, such as runny nose, itchy and watery eyes, itchy throat, hives, and cough.

One of your gymnasts calls you to tell you that she is very worried about her roommate, who is also on the team. She shares that her roommate sleeps a lot, does not want to leave the room or do anything with friends, and has increased her use of alcohol. She notes that she always talks about being a burden to her family, and tonight she posted a concerning message on social media saying goodbye to friends. What action should you take? A. Ask to speak to the athlete, screen for suicidal ideation, and ask for campus emergency medical services (EMS) to conduct a welfare check. B. Encourage the athlete who called you not to leave her roommate alone and to bring her to the athletic training room in the morning. C. Call the gymnastics coach and inform her that you will be asking for the athlete to be transported to the emergency department for a psychiatric evaluation. D. Call the athlete ' s parents and ask them to come get their daughter so she can be evaluated by a mental health provider.

A: Any athlete who is exhibiting warning signs of suicide should be treated seriously and screened for suicidal ideation. The athlete should not be left alone until the condition can be evaluated.

A softball player with epilepsy reports experiencing heightened senses of smell and hearing during a game. Which stage of an epileptic seizure is this athlete currently experiencing? A. Aura B. Clonic C. Postictal D. Tonic-clonic

A: Aura is usually the precursor stage to an epileptic seizure marked by perceptual disturbances, such as altered vision, hearing, or smell

During discussions with an athlete who is contemplating undergoing lateral ankle reconstruction for chronic ankle instability, which of the following is the most important long-term consequence that should be brought to the athlete ' s attention if surgery is not chosen? A. Osteoarthritis B. Talar fracture C. Joint contracture D. Tendinosis E. Subluxing peroneal tendon

A: Chronic ankle instability increases mobility and laxity of the ankle. This increases bone-on-bone contact, which increases the risk of osteoarthritis

A cheerleader who has been casted for a few days for an ulnar fracture reports to the athletic training room complaining of redness, increased pain, swelling, and extreme sensitivity to touch in the hand of her involved limb. Based on these symptoms, what condition should the athletic trainer include in an initial differential diagnosis? A. Complex regional pain syndrome B. Deep vein thrombosis C. Neurapraxia D. Amyotrophic lateral sclerosis E. Cellulitis

A: Complex regional pain syndrome (CRPS) is characterized by chronic pain that is disproportionate to the injury and can develop following a period of immobilization, such when a limb is casted. Common signs and symptoms include regional pain, vasomotor disturbances, edema, decreased motor function, and trophic changes

Which of the following should be noted during the observation portion of the injury evaluation? A. Demeanor, posture, and deformity B. Movement, swelling, and mechanism of injury C. Abnormal end-feels, crepitus, and asymmetry D. Posture, sensation, and swelling E. Movement, asymmetry, and reflexes

A: Demeanor, posture, and deformity are the areas of the observation portion that should be noted due to the fact that the athletic trainer must account for all physical abnormalities that may be visualized fi rst. After the observation portion, the athletic trainer may palpate and interrogate

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: Due to the area where pain is felt, the clinician should suspect involvement of the posterior tibialis muscle. The actions of this muscle at the ankle include plantar fl exion and inversion

Differences between patients and clinicians can lead to miscommunications or misunderstandings during the examination process. What action should a clinician take to avoid miscommunications or misunderstandings resulting in incorrect diagnoses or improper care? A. Convey respect by addressing adult patients formally, using appropriate prefixes such as Miss, Mrs., and Mr. B. Maintain professionalism by referring to the patient strictly by the injured or involved body part, saying "my ankle injury patient." C. Avoid making patients of different cultures feel unique; speak to them and treat them the same as everyone else without acknowledging their cultural difference. D. Refrain from burdening a patient and his family members with health-care decisions they most likely will not understand.

A: Examining patients with professionalism and respect for differences helps clinicians gather accurate information while establishing a positive patient rapport

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: Fremitus would not be felt unilaterally if someone is suffering from spontaneous pneumothorax. This sensation is not felt due to the lung being collapsed; air is unable to enter the lung, which decreases the vibrations felt during talking because there is no air movement on the side of the collapsed lung

Goal setting, particularly setting short-term goals, has been shown to be an effective strategy in helping patients motivate themselves to comply with a potentially extensive treatment and/or rehabilitation program. Which of the following short-term goals demonstrates effective goal setting? A. Increase active knee flexion from 20° to 30° in 10 days. B. For the next three treatment sessions, maintain focus during 90% of the session. C. Increase exercise intensity by applying 100% effort for at least three quarters of the exercises completed in the next 5 days. D. Decrease episodes of negative and doubting selftalk by 50% in 7 days.

A: Goals should be specifi c, measurable, and moderately diffi cult but realistic

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: Horizontal adduction is the action of moving the arm toward the midline, compressing the acromion and the clavicle, which causes pain, ultimately resulting in guarding and limited range of motion

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: If a clavicle fracture is suspected, the arm should be immobilized, and the athlete should be referred for immediate evaluation. Displaced fractures in the middle third of the clavicle may require surgical intervention

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: If the pain is not reproduced or radiates as a result of the two previous positions, axial compression should be provided and symptoms should be evaluated

You are evaluating a lacrosse player for a possible kidney contusion after he sustained a blunt trauma from a stick to his upper lumbar/lower thoracic region on the left side. Based on this mechanism of injury, what other abdominal organs should be screened for involvement? A. Liver B. Spleen C. Appendix D. Colon

A: Magnetic resonance imaging (MRI) is most effective in addressing the variety of pathologies that could be occurring, minimizing the need for multiple diagnostic tests

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) is most effective in addressing the variety of pathologies that could be occurring, minimizing the need for multiple diagnostic tests

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: Nerve injuries can be broadly grouped into three types: neurapraxia, axonotmesis, and neurotmesis, with neurapraxia being the least severe

The mother of one of your high school athletes calls the athletic training room to ask your advice. She shared that her son is sick and she believes that he has strep throat and may need an antibiotic. Her son ' s pediatrician is out of the office for the next 2 days, but the office offered to have the athlete seen by one of the physician assistants on staff. How would you respond to the mother? A. Encourage her to take the athlete to see the physician ' s assistant because that provider can conduct a strep test and prescribe an antibiotic if needed. B. Encourage her to treat her child with acetaminophen (Tylenol) and wait until the physician returns. C. Encourage her to take her son to a local urgent care facility to be seen. D. Encourage her to bring the athlete to the athletic training room so you can provide the athlete with a 2-day dose of antibiotics until the physician returns.

A: Physician ' s assistants are trained to evaluate patients, order diagnostic tests, and prescribe medications

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 involves injection of an irritant solution to increase infl ammation or injection of the patient ' s own blood plasma enhanced with platelets to stimulate healing

A football player sustained a mild head injury. Two days later the athlete reports feeling no symptoms and recalls everything that happened. You conduct a follow-up Standardized Assessment of Concussion (SAC) and Balance Error Scoring System (BESS), and he scores within 90% of his baseline scores. The team physician has cleared the player for activity; therefore, you decide to begin a supervised returnto-play progression protocol. During the fi rst stage the player completes a variety of light exercises at an intensity of less than 70% age-predicted maximal heart rate. While exercising the player experiences a mild headache and dizziness. How should you manage this player? A. Halt activity and have the athlete repeat this stage after 24 hours of rest. B. Permit the athlete to complete the activities at this stage, and progress to the next stage if symptoms subside within 24 hours. C. Permit the athlete to complete the activities at this stage, and repeat this stage after 24 hours of rest. D. Permit the athlete to complete the activities of this stage, and refer to the physician for reevaluation.

A: Return to play for an athlete who has sustained a concussion should follow a staged progression with each stage separated by 24 hours. If activity at any stage causes a return in symptoms or a decline in test performance, the activity should be halted and restarted after 24 hours

An athlete on your soccer team sustains two seizures of unknown etiology within a span of 1 week. Which of the following is the most appropriate health-care provider to evaluate this athlete? A. Neurologist B. Rheumatologist C. Endocrinologist D. Hematologist

A: Seizures are associated with disruption of cerebral function and should be evaluated by a neurologist to identify the etiology and develop a treatment plan

While completing a ligamentous stress test, the examiner notes increased movement of the joint surfaces on one another and a sense of some joint opening compared with the contralateral side. How might the examiner describe the end-feel when documenting the evaluation? A. Soft end-feel B. Firm end-feel C. Empty end-feel D. Normal end-feel

A: Soft end-feel is associated with a grade II sprain, which includes partial tearing of the ligamentous fi bers

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: Some findings are so critical that the remainder of the evaluation should be suspended in an effort to get the athlete to medical care more quickly. Loss of or a significantly diminished pulse warrants immediate referral

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: Speaking slowly will allow the athlete time to translate into his own language. Other tips that will improve communication include using pictures or models in the athlete ' s primary language, asking questions one at a time, and avoiding slang terminology

A diver reports to the athletic training facility complaining of right shoulder pain during overhead weight training activities. During your physical examination, you conduct the special test shown in the photos. You determine that the test result is positive when the athlete reports experiencing pain along the long head of the biceps brachii tendon, especially in the bicipital groove. What is the common name for this test? A. Speed ' s test B. Ludington ' s test C. Yergason ' s test D. O'Brien ' s test E. Allen ' s test

A: Speed ' s test is performed by the examiner resisting shoulder fl exion with the elbow extended or shoulder fl exion with elbow fl exion while palpating the bicipital groove.

Following a football play, one of the linemen remains down on the fi eld. The athlete ' s thigh is slightly fl exed, internally rotated and adducted, and resting on the uninvolved knee. The athlete complains of intense pain in the hip and buttocks and is unwilling to move the joint. What is the role of the athletic trainer who has not been trained in the reduction of suspected hip joint dislocations in managing this condition? A. Activate emergency medical services (EMS), and check sensory and vascular status of the limb B. Splint the limb in the position in which it is found and remove the athlete from the field C. Activate EMS and then gently straighten the leg while supporting the limb D. Attempt to reduce the suspected dislocation and then transport for x-rays and evaluation

A: Suspected hip dislocations should be treated as a medical emergency. Immediate transport for x-rays to rule out fracture and closed or open reduction performed under anesthesia as quickly as possible are indicated

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: Systemic lupus erythematosus is an autoimmune disease in which the immune system creates autoantibodies that attack the body ' s own proteins. This can cause pain and swelling. Because this condition involves the immune system and can affect the musculoskeletal system, the athlete should be referred to a rheumatologist

The office manager for the outpatient sports medicine clinic where you are employed has requested you provide the CPT codes for your first patient of the day. What are CPT codes? A. 5-digit codes that identify procedures or services rendered B. 7-digit codes used for identifying diagnoses and tracking conditions C. 5-digit codes used to determine if a given treatment is working D. 7-digit codes used to track morbidity and mortality of medical conditions

A: The Current Procedural Terminology (CPT) manual is published annually by the American Medical Association (AMA). This manual contains fi ve-digit codes that identify procedures performed or services rendered

. 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: The glenohumeral joint allows for 120° of forward fl exion without scapular elevation. When the scapula is permitted to elevate, the normal range of glenohumeral fl exion increases to 180°.

An athlete at your institution shares that she has recently been diagnosed with HIV. In order to best care for this athlete, her teammates, and any other athlete who might be exposed, what steps should you take to manage this information? A. The athlete ' s identity must remain confidential unless she chooses to share. B. The coaching staff should be notified so they can assist you in caring for the athlete and the team. C. The athletics director should be notified. D. Campus legal affairs office should be notified.

A: The identity of any athlete who tests positive for HIV should be kept strictly confi dential. The athlete may choose to share his or her status with any persons of his or her choice.

An athlete sustains a direct blow to the ilium resulting in pain at the site of injury and also with trunk flexion away from the injured side. The patient also notes paresthesia over the anterolateral thigh. Which nerve do you suspect has also been impacted by the injury? A. Lateral femoral cutaneous nerve B. Obturator nerve C. Superior gluteal nerve D. Inferior gluteal nerve

A: The lateral femoral cutaneous nerve supplies sensation to the anterolateral thigh. This nerve is commonly injured by the same mechanism as an iliac crest contusion or hip pointer

During practice a wrestler experiences forced lateral fl exion of the cervical spine with a simultaneous inferior force to the contralateral shoulder. The athlete comes to the side of the mat holding the injured arm and complaining of an extreme burning sensation, numbness, and weakness of the arm. When should you allow this athlete to return to the game? A. The athlete must demonstrate normal sensation and strength bilaterally, be cleared for any associated injuries, and express confidence in returning to play. B. The athlete must demonstrate full shoulder and neck range of motion and be able to complete functional activities. C. The athlete must wait a minimum of 20 minutes and express confidence in returning to play. D. The athlete must ice for 20 minutes, demonstrate normal sensation and strength bilaterally, and score within 90% of baseline on neuropsychological testing.

A: The mechanism of injury and symptoms are consistent with an injury to the brachial plexus. Symptoms should subside, ruling out other injuries, such as a cervical spine injury or shoulder dislocation, and the athlete should be comfortable with returning to play before being cleared

A diver reports to the athletic training room complaining of right shoulder pain during overhead weight training activities. During your assessment of the athlete ' s shoulder, you conduct the special test shown in the photos and determine that the test result is positive because the athlete reports pain with motion, especially near the end range of motion. What does a positive test imply? A. Pathology is present in the rotator cuff group, especially the supraspinatus, or the long head of the biceps brachii tendon. B. The long head of the biceps brachii tendon is moving out of bicipital groove due to a tear or laxity of the transverse humeral ligament. C. Laxity of the superior glenohumeral ligament is present. D. Laxity of the posterior glenohumeral capsule is present, and there is a possible torn posterior labrum.

A: The motion of this test impinges the supraspinatus and long head of the biceps tendon between the greater tuberosity and the inferior side of the acromion process.

After completing a patient history and range of motion assessment, the athletic trainer is concerned that the athlete ' s pain may be related to vertebral disc damage. Which of the following groups of special tests would best assist the athletic trainer in ruling out this pathology? A. Well straight leg raise test, Kernig-Brudzinski test, and Valsalva ' s maneuver B. Hoover test, bowstring test, and Milgram ' s test C. Lasegue ' s test, quadrant test, and spring test D. Tension sign, stork standing test, and long sit test E. Gaenslen ' s test, bilateral straight leg raise test, and slump test

A: The well straight leg raise, Kernig-Brudzinski test, and Valsalva ' s maneuver place pressure on the disc or make changes to the internal pressure in the body, which places stress on the vertebral disc. If there is damage to the disc, patients will often report that these tests elicit pain

On the preseason medical history questionnaire a female diver indicates an abnormal menstrual cycle pattern. After gathering information about the athlete ' s menstrual cycle, you are concerned that she may be experiencing secondary amenorrhea. Which of the following is an accepted definition of secondary amenorrhea? A. Fewer than three menstrual cycles per year B. Absence of at least six consecutive menstrual cycles C. Menstrual periods lasting less than 2 days for at least 6 consecutive months D. Five menstrual cycles in 1 calendar year

A: There are various defi nitions of secondary amenorrhea, including (1) fewer than three menstrual cycles per year and (2) the absence of menses for 3, 4, 6, or 12 months in a previously menstruating woman

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: To palpate the proximal insertion point of the rectus femoris, the clinician should palpate the anterior inferior iliac spine. However, this muscle can be diffi cult to palpate due to the fact that both heads of the rectus femoris are covered by the sartorius muscle.

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: To palpate the supraspinatus, the patient should be positioned with the glenohumeral joint in maximal internal rotation so the tendon can be palpated at the greater tuberosity of the humerus

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. Specifi c gravity reading greater than 1.00

A: Urinary tract infection symptoms include painful urination, burning sensations, increased urination, frequent urge to urinate, abdominal pain, and foulsmelling urine. Patients presenting with a low-grade fever, abnormal vaginal bleeding, or hematuria should be referred for further evaluation and treatment

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: When emotions are clouding an athlete ' s ability to make decisions, it is often helpful to provide measurable data or facts on which to base the decision

When palpating soft tissue on the medial aspect of the ankle, in which order are the flexor tendons palpated moving from anterior to posterior? A. Tibialis posterior, fl exor digitorum longus, and fl exor hallucis longus B. Tibialis anterior, flexor hallucis longus, and flexor hallucis brevis C. Peroneus brevis, fl exor digitorum longus, and flexor hallucis brevis D. Plantaris, lumbricals, and tibialis posterior E. Flexor digiti minimi, flexor digitorum longus, and flexor hallucis longus

A: When palpating the medial aspect of the ankle, an examiner can palpate the tibialis posterior, fl exor digitorum longus, and fl exor hallucis longus moving from anterior to posterior

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: When the inferior rectus muscle is entrapped as a result of an orbital blowout fracture, the muscle is unable to complete its normal function of superior eye motion, so the eye will become locked in a downward gaze.

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: With an acromioclavicular (AC) sprain the step deformity will cause discomfort causing the athlete to turn away from the injured shoulder. The arm is observed at the side due to the fact that with the congruency of the joint lost, motion at the shoulder will cause extreme pain

A 19-year-old male collegiate athlete with a history of chronic groin pain that is exacerbated with physical activity and prolonged sitting has been diagnosed with a Cam lesion, a type of femoral acetabular impingement. Which of the following statements regarding Cam lesions is accurate? A. Cam lesions are the most common hip disorder in adolescents and are more common in females than males. B. Cam lesions result from an abnormally shaped femoral head repetitively contacting the acetabulum and labrum. C. Patients with a Cam lesion present with limited hip external rotation when the hip is in 90 degrees of fl exion. D. Cam lesions are bony outgrowths of the acetabulum that compress the femoral head during hip motions.

B. Femoral acetabular impingement (FAI) results from altered morphology of the femoral head and/or acetabulum. FAI can be caused by (1) a Cam lesion, a bony outgrowth on the femoral head, (2) a Pincer lesion, a bony outgrowth of the acetabulum, or (3) the concurrent formation of both lesions.

An athlete with a 3-week history of knee pain and mild joint effusion develops a Baker ' s cyst. After discussions with the team physician, which test would best reveal the cause of the cyst? A. X-ray B. Magnetic resonance imaging C. Bone scan D. Diagnostic ultrasound E. Complete blood count

B: A baker ' s cyst involves only bursae of the semimembranosus and medial head of the gastrocnemius tendon. As the pathology involves soft tissues, magnetic resonance imaging (MRI) would be the best diagnostic test

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: An epiphyseal fracture is classifi ed as a type II Salter-Harris fracture when the fracture starts through the physis and ends on the shaft

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: A hyperlordotic posture is marked by increased lumbar lordosis, anterior pelvic tilt, and a slightly fl exed hip position. This posture occurs due to an anterior-posterior muscular imbalance, specifi cally, a weakening of the abdominals and/or hip extensors and a tightening or shortening of the hip fl exors and back extensors.

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: A joint play grade of 3 is considered to be normal. Grades of 1 and 2 indicate levels of hypomobility. Grades of 4 to 6 indicate levels of hypermobility with grade 6 indicating pathologic mobility. A grade of 0 indicates the joint is ankylosed

When assessing passive joint range of motion of a symptomatic elbow, you note the patient ' s extension range ends sooner than usual and earlier than in the contralateral limb. This abnormal end of the patient ' s passive extension feels boggy. How is this abnormal end-feel defined? A. Empty B. Soft C. Firm D. Hard

B: A soft end-feel occurs sooner or later in the normal range of motion and is often described as a "boggy" feeling. Soft end-feels occur in joints that normally have a fi rm or hard end-feel, as occurs with elbow extension

For which passive joint motion is the physiological end-feel for most persons soft? A. Hip extension with the knee extended B. Knee flexion C. First metatarsophalangeal joint extension D. Elbow extension

B: A soft end-feel results from soft tissue approximation

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: A visual analog scale requires the patient to mark the intensity of his or her pain level on a straight 10-cm line. The clinician then measures the distance to determine an objective pain value. Other scales, such as the numeric rating scale, can be manipulated by the patient, who will likely remember the score from the previous day

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."

B: Adherence should be objectively defi ned so that the clinician and patient are in agreement. Patients should be provided with the number of sessions to attend, the number of home sessions, compliance with rest time, achievement of weekly progress goals, and similar information

In the process of bone healing following injury, what immediately follows the phase in which a fi brocartilage soft callus forms? A. A fracture hematoma forms. B. A bony callus made of spongy bone is formed. C. Osteoclasts remove excess tissue. D. Blood vessels grow into the fracture site.

B: After bone injury, the bone reacts by forming a hematoma, then blood vessels grow into the fractured bone, and a fi brocartilage callus is formed. This soft callus becomes a bony callus made of spongy bone. Eventually osteoclasts remove excess tissue from the bony callus, and the bone resembles the original bone.

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 fl ow to the cells. B. Brain cells have an increased demand for glucose, but blood fl ow decreases. C. Brain cells have an increased demand for glucose and an associated enhanced blood fl ow to the cells. D. Brain cells have a suppressed metabolism and an associated blood fl ow decrease.

B: After trauma, brain cells have an increased need for glucose, which is not met because of decreased blood fl ow to the cells

An athlete reports experiencing a minor seizure over the weekend. The team physician orders an electroencephalogram to assist in ruling out the presence of epilepsy and asks you to explain the purpose of the test to the athlete. How would you best explain the purpose of this test? A. The purpose of this test is to record electrical activity of your heart. B. The purpose of this test is to assess electrical activity in the brain. C. The purpose of this test is to measure electrical activity in peripheral nerve tissue. D. The purpose of this test is to measure electrical activity in contracting muscle tissue.

B: An electroencephalogram records electrical activity in the brain and notes any abnormalities that occur

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: An epidural hematoma occurs from a blow to the head, resulting in bleeding between the outermost layer of the dura mater and the skull. Symptoms appear minutes to hours after injury and can include unconsciousness, irritability, a unilaterally dilated pupil, and other symptoms similar to a concussion.

An athlete sustains an uncomplicated crown fracture. There is obvious tooth deformity and bleeding, but no pain. How would you explain the absence of pain to the athlete? A. The dentin is not affected by this fracture, and it is the primary site of nerve endings in the tooth. B. The fracture affects only the enamel portion of the tooth, and the enamel contains no nerve endings. C. This type of fracture exposes the pulp cavity; after the pulp cavity is exposed to air, the nerve endings cease to fire. D. The fracture is through the gum, which causes bleeding but no pain. E. The fracture line is through the root, which results in significant bleeding but no pain because the area is not innervated.

B: An uncomplicated crown fracture of the tooth involves only the enamel. The enamel is the outermost and hardest layer of a tooth that covers the dentin. The dentin covers the pulp chamber, which houses the blood vessels and the nerves for each tooth. Because the pulp chamber was not exposed in the uncomplicated fracture, nerve roots were not stimulated, causing no pain

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: Astigmatism is an abnormal shape of either the lens or the cornea. With astigmatism, the shape of the eye would be that of a football, and images are focused either before or after the light reaches the retina, resulting in blurred vision.

Based on outcome data, which of the following statements regarding knee special tests is the most accurate? A. The anterior drawer test is the best indicator of an isolated anterior cruciate ligament tear. B. Lachman ' s test is the best indicator of anterior cruciate ligament injury, especially the posterolateral band. C. The active drawer test is a better indicator of anterior cruciate insuffi ciency than of posterior cruciate insuffi ciency. D. The pivot shift test may be the most sensitive and accurate test for assessing posterior tibiofemoral instability. E. The jerk test is more sensitive and accurate than the pivot shift test.

B: Based on outcome data, Lachman ' s test is the best indicator of an anterior cruciate ligament injury, especially when testing the integrity of the posterolateral band.

An adolescent athlete sustains a fall on an outstretched hand and is seen by his pediatrician. He returns the next day and reports that the x-ray in the pediatrician ' s offi ce was negative, and he can play as tolerated; however, he still presents with exquisite pain in the anatomical snuff box. You are hesitant to allow him to return to play because you feel he may have a fracture. How would you best communicate to the athlete ' s parents your concern that yesterday ' s x-ray may be a false-negative? A. The navicular bone is too dense for x-rays to pass through. B. A fracture line may not show on x-rays for several weeks. C. The wrist cannot be stabilized because of a chronic or acute irritation of the proximal radial condyle. D. It may take several months for a fracture line to show on x-rays. E. The navicular bone is too small to be seen by x-ray.

B: Because of the nature of a young athlete ' s bones, fracture lines do not always appear right away. If a fracture is suspected, it is important to follow up with an additional x-ray and stabilize the suspected fracture

One of your butterfly swimmers is complaining of bilateral posterior shoulder and upper back pain and tightness. Your evaluation reveals a series of myofascial trigger points and fascial adhesions. Which provider might you collaborate with to provide the best care for this athlete? A. Occupational therapist B. Certified massage therapist C. Chiropractor D. Osteopath

B: Certifi ed massage therapists licensed by the individual state focus on using massage as a modality to restore tissues to their normal function

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: Chondromalacia patella is the deterioration and/or softening of the articular cartilage that covers the deep side of the patella and reduces friction on the femur during range of motion

A high school junior varsity basketball player sustained a grade II lateral ankle sprain in the game you are covering. Which of the following strategies might ensure the best compliance with the overnight treatment plan you have outlined for the athlete? A. Have the athlete repeat the treatment plan back to you until she can say it verbatim. B. Ask the athlete ' s parents to meet you in the athletic trainer clinic after the game and explain the treatment to them and answer any questions they have. C. Call the athlete at home to make sure she is doing her treatment as instructed. D. Ask the athlete to write down everything she does and turn it in tomorrow when she comes in for reevaluation

B: Communicating with family members can improve understanding of the injury and compliance with treatment regimens, especially if the patient is a minor or an older adult.

Which of the following correctly identifies the most appropriate intervention strategy for a medial collateral ligament (MCL) injury that occurs concurrently with an anterior cruciate ligament (ACL) injury? A. The MCL should be surgically repaired when the ACL is reconstructed, as its blood supply is inadequate for healing. B. The MCL can be managed nonoperatively with a functional rehabilitation plan, as it has adequate blood supply for healing. C. The patient should be fitted with a derotation brace that will allow the MCL and ACL to heal nonoperatively. D. The MCL should be surgically repaired if there is associated patellar lateral instability, as the joint is unable to maintain enough inherent stability to allow healing to occur

B: Due to its location inside the soft tissue of the medial knee joint, the medial collateral ligament (MCL) has a blood supply that is adequate for healing when combined with a sound functional rehabilitation program.

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: Each of the conditions listed in this differential diagnosis is in close proximity to the location of the injury and therefore should be evaluated

Your team physician has decided to use fluoroscopy instead of an x-ray-based radiograph to view an athlete ' s painful ankle. The athlete is unfamiliar with fluoroscopy and apprehensive about this testing method. How would you explain the advantage of using fluoroscopy instead of x-ray-based radiographs? A. Fluoroscopy is more detailed than x-ray-based radiographs. B. Fluoroscopy images can be taken with the patient in weight-bearing positions. C. Fluoroscopy can be used on women who are pregnant. D. Fluoroscopy does not use radiation in creating images.

B: Fluoroscopy permits the examiner to see the "live" images showing size, shape, and movement of tissues; to determine if a fracture has occurred; to see if a joint is disarticulated; and to look at blood fl ow, tumors, foreign bodies, and some soft tissues.

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: GBS is a severe and rapidly progressing nervous system disorder. This condition can occur in individuals of either gender; about two thirds of patients with GBS report having experienced symptoms of respiratory or gastrointestinal infection 1 to 3 weeks before onset of GBS symptoms

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: Gold standards have outstanding diagnostic accuracy but tend to be more invasive and expensive and so are not utilized routinely for diagnostic purposes.

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: Health Insurance Portability and Accountability Act (HIPAA) authorizations should include a brief description of the information to be disclosed, persons or class of people authorized to use the information, identifi cation of persons or class of people authorized to release the information, purpose of the disclosure, expiration date or event, signature of the patient, and date completed.

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 infl ammation 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: Internal glenohumeral (GH) joint impingement is impingement of structures between the humeral head and the glenoid, within the joint. Posterosuperior impingement is the most common type of internal impingement and is strongly associated with glenohumeral internal rotation defi cit (GIRD) and anterior GH joint instability

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 comm

B: Manual muscle tests are conducted to grade the strength of individual muscles. Patients are positioned so as to isolate a muscle or muscle group and instructed to create a maximal contraction against the clinician ' s resistance. The degree of muscle action is graded on a 5- or 10-point scale. A break test requires a patient to maintain a specifi c joint position against an examiner ' s resistance as the examiner attempts to "break" the patient ' s muscular hold

Why should an athletic trainer promptly refer any athlete suspected of having Marfan ' s syndrome to the appropriate specialists? A. Marfan ' s syndrome may cause myopia so the athlete will need corrective lenses. B. Marfan ' s syndrome commonly results in major cardiovascular system abnormalities that can lead to sudden death. C. Marfan ' s syndrome often leads to joint hypermobility and increased risk for osteoarthritis. D. Marfan ' s syndrome is associated with a high arched oral palate leading to dental crowding requiring corrective oral devices

B: More than 95% of patients with Marfan ' s syndrome have cardiovascular abnormalities that can cause sudden cardiac death.

An athlete reports to the athletic training room complaining of burning, numbness, and shooting pain between the third and fourth metatarsal heads. He reports that the pain increases when he wears cleats and lessens when he is sitting or wearing sandals. Which of the following conditions is most closely associated with these symptoms? A. Peroneal nerve palsy B. Morton ' s neuroma C. Tarsal tunnel syndrome D. Medial plantar nerve compression syndrome E. March fracture

B: Morton ' s neuroma is caused by the entrapment of a nerve between two metatarsal heads. The signs and symptoms of this pathology include paresthesia and alteration of sensation in the digits with pain in the transverse arch radiating to the toes, plantar aspect of the foot, and occasionally the lower leg

A pitcher on your baseball team recently underwent surgery to repair a tendon laceration in his throwing hand. The athlete is having difficulty regaining dexterity and fine motor skills, which are inhibiting his activities of daily living. Which of the following providers might best assist you in the rehabilitation of this athlete? A. Orthotist B. Occupational therapist C. Massage therapist D. Osteopath

B: Occupational therapists focus on assisting patients in regaining strength and skills necessary for activities of daily living and in the work environment.

A 12-year-old basketball camper reports anterior knee pain focused at the inferior insertion of the patellar tendon. What apophyseal injury should you suspect? A. Sever ' s disease B. Osgood-Schlatter disease C. Salter-Harris II fracture D. Larsen-Johansson disease E. Legg-Calvé-Perthes disease

B: Osgood-Schlatter disease is a common knee condition in adolescents. This condition is an apophysitis characterized by pain at the tibial tuberosity, the distal attachment of the patella tendon

When would a patient ' s seizures be considered a paroxysmal disorder? A. When the symptoms are severe, affecting multiple body systems B. When the symptoms come and go, and are episodic in nature C. When the symptoms negatively impact the patient ' s quality of life D. When the symptoms can be attributed to another preexisting condition

B: Paroxysmal disorders, such as seizures and headaches, tend to go away on their own but will also return without warning

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: Patients employing dissociation techniques to manage their chronic pain direct their attention away from the pain through internal or external methods of distraction

A high school basketball player who has been receiving treatment for a lateral ankle sprain suddenly stops attending scheduled treatment sessions. When contacted by phone the athlete states he does not want to attend treatment sessions because he does not like being different from his teammates who are not injured. How can you best respond to this athlete to encourage him to accept responsibility for his recovery? A. Inform this athlete that attending therapy is a privilege he will lose if he does not attend his next scheduled session. B. Inform this athlete that it is his choice to come to therapy, but if he does not, he may not continue to improve at the same pace as if he had been attending therapy. C. Inform this athlete that members of the basketball team are required to attend all scheduled treatment sessions and he will be reported if he misses one more scheduled treatment session. D. Inform this athlete that if he returns to attending treatment sessions you will provide a positive report to the coach.

B: Patients have choices, including the choice to attend and participate in therapy sessions. Clinicians can help patients accept responsibility for their injuries by providing them with their choices and the potential consequences of their choices so that they make the right decision based on what is best for their overall well-being

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: Polydipsia, polyuria, polyphagia, and weight loss all are symptoms of type 1 diabetes. Evaluating fasting blood glucose levels can help confirm if the patient is effectively managing blood glucose levels.

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: Propranolol is a beta blocker. These medications may be prescribed in the treatment of chronic headaches, but not typically in athletes because they decrease exercise tolerance and reduce perceived exertion

You have determined that an athlete who has been demonstrating symptoms of depression should be referred to a mental health professional. Which of the following disciplines takes a medical approach to assessing and treating mental health conditions, including prescribing medications to address the underlying physiological or chemical components of the problem? A. Professional counselor B. Psychiatrist C. Psychologist D. Pastoral counselor

B: Psychiatrists are licensed medical doctors who have completed psychiatric training. In addition to diagnosing conditions and prescribing medications, these physicians may provide therapy

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: Second impact syndrome occurs when an athlete receives a concussive blow after already having a concussion that is not resolved. Second impact syndrome is a rapid swelling of the brain and is very serious and can lead to death

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: Shoulder fl exion range of motion can be assessed in a prone or supine position. In addition to appropriate goniometer position, the scapula should be stabilized at the lateral border

A patient presents with a medical history and mechanism of injury consistent with ankle joint ligamentous trauma. To formulate a clinical diagnosis, you conduct a physical examination. According to the National Athletic Trainers' Association (NATA) position statement on conservative management and prevention of ankle sprains in athletes, what should clinicians consider when formulating a clinical diagnosis for an ankle joint injury? A. The diagnostic accuracy of special tests to assess injury to the lateral ankle ligaments has been shown to be unaffected by joint effusion. B. Lateral ankle ligament special tests, such as the anterior drawer and inversion talar tilt, have more diagnostic accuracy 5 days after injury compared with 2 days postinjury. C. Stress radiography has been shown to be a reliable tool in detecting acute ligamentous disruption when physical examination findings are inconsistent. D. The Cotton test, external-rotation test, and other tests for high ankle sprains are unreliable in detecting injury to the anterior inferior tibiofibular ligament.

B: Special tests for lateral ankle ligaments have better diagnostic accuracy when conducted before the accumulation of joint effusion and when conducted 5 days after injury compared with 2 days

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 is marked by pain in extension, relieved by trunk fl exion. This pathology is common in activities that require repetitive trunk extension.

A 55-year-old active adult, who coaches his son ' s soccer team, plays recreational tennis and golf, and enjoys renovating his historic home, has been diagnosed with a rotator cuff tear. While counseling him on his treatment options, you ask him to complete the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. What is the purpose of this self-reported patient assessment? A. Determines patients who will have the best outcome following upper extremity surgery B. Assists in describing the disability experienced by people with upper extremity disorders C. Determines which upper extremity joint has the greatest impact on overall function D. Assists in setting the maximum number of postoperative treatment and rehabilitation sessions

B: The Disability of the Arm, Shoulder, and Hand (DASH) is a 30-item, self-report questionnaire designed to measure symptoms and physical function in patients with any or several upper extremity musculoskeletal disorders.

You are evaluating a recreational tennis player who experienced knee pain when he stepped, pivoted, and rotated on his fixed leg. To assess the static stability of the athlete ' s knee joint, you perform the special test shown in the photo. This test assesses the integrity of which knee joint structure? A. Posterior cruciate ligament (PCL) B. Anteromedial portion of anterior cruciate ligament (ACL) C. Posteromedial portion of ACL D. Anterolateral portion of ACL E. Anteroposterior portion of ACL

B: The Lachman test is performed with the patient supine with the hip extended and the knee joint in 20° to 30° of fl exion. An anterior force is applied to the tibia assessing the anterior cruciate ligament (ACL) when both the anteromedial and the posterolateral portions of the ACL are taut

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: The anterior tibiofi bular ligament originates superior to the lateral malleolus and attaches on the anterolateral portion of the distal tibia. Each time a step is taken the position of the talus in the mortise slightly separates the distal tibiofi bular joint, stressing the ligament. Repetitive microstress of the healing tissues can extend healing time

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: Ventricular systole is caused by ventricular depolarization. The contraction of the ventricles during this phase causes an increase in pressure, forcing the atrioventricular (AV) valves shut and forcing the aortic and pulmonary semilunar valves open.

While running back for a lob shot, a collegiate freshman tennis player trips and falls, landing hard on her hand that is holding her racquet and fracturing her fifth metacarpal. Two weeks after her fracture diagnosis, she tells you she is considering dropping out of school and moving back home. She tells you, "My life is totally ruined. I ' m never going to get better or be able to play tennis again." How can you encourage this patient to use positive selftalk to influence her healing and recovery process? A. Sympathize with the athlete and help her by introducing her to other athletes whose careers have ended as a result of injury. B. Allow the athlete to express her frustration, but encourage her to concentrate on things that are controllable, such as her overall fitness and her academic pursuits. C. Be patient while the athlete expresses her frustrations and then let her know you are available to listen and help. D. Remind the athlete that many athletes get injured during their college years, and she needs to accept her situation, as bad as it may be, and move forward.

B: When athletes are faced with injuries and potentially extended healing and recovery timelines, clinicians need to encourage them to practice positive self-talk. Athletes need to be reminded of the power of positive thinking; to be reminded to be optimistic, to remain realistic and objective, to focus on the present, to view their problems as challenges, and to concentrate on things they can control.

A lacrosse player has been diagnosed with a concussion based on his medical history and physical examination findings. To incorporate best-practice guidelines into your management of this athlete ' s condition, you have consulted the National Athletic Trainers' Association (NATA) position statement on concussion management. Each clinical practice recommendation in this document is followed by a Strength Of Recommendation Taxonomy (SORT) letter, A, B, or C. Which of the following is correct regarding this lettering system? A. The letter B indicates the recommendation is based on published case series or studies of diagnosis, treatment, prevention, or screening. B. The letter A indicates the recommendation is based on inconsistent or limited-quality experimental evidence. C. The letter C indicates the recommendation is based on consensus, usual practice, or opinion. D. The letter C indicates the recommendation is based on consistent and good-quality experimental evidence.

C: A Strength Of Recommendation Taxonomy (SORT) letter of A indicates the recommendation is based on consistent and good quality experimental evidence. In contrast, recommendations with a SORT letter of C are based on usual practice; opinion; consensus; case series or studies of diagnosis, treatment, prevention, or screening; or extrapolations from quasiexperimental research. Clinicians should consider the SORT of each recommendation.

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

C: A costochondral separation or dislocation can result from a fall on an object that compresses the ribs. This condition manifests with many of the same signs as a rib fracture except the pain will be localized to the junction of the rib and the rib cartilage. Management is similar to a rib fracture, and healing may take 1 to 2 months.

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: A negative likelihood ratio expresses the probability that the pathology is still present even though the test was negative. The closer the LR − is to 1, the less signifi cant is the change in pretest probability, so LR − of 0.35 is small, whereas LR − of 0.1 or less is large and often conclusive

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: Corneal abrasions are very painful secondary to the large number of nerves in the area. Referral is necessary for evaluation of vision and possible medication management through antibiotics, anesthetics, and wetting agents as needed

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 dorsifl exion 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: A syndesmosis sprain, also referred to as a high ankle sprain, results from mechanisms that cause spreading of the distal syndesmosis. The forces causing this spreading can result in a sprain of the anterior tibiofi bular ligament, posterior tibiofi bular ligament, interosseous membrane, and crural interosseous ligament. Syndesmotic and deltoid ligament sprains can occur concurrently

Active listening is a key component in clinicians developing positive patient rapport while gathering a medical history and conducting a physical examination. Which of the following illustrates active listening? A. Avoiding direct eye contact with patient unless required for examination components B. Asking primarily questions that can be answered with "yes" or "no" to avoid confusing the patient C. Following up a patient ' s statements by paraphrasing and repeating what was said and asking for clarification as needed D. Refraining from allowing patients' nonverbal cues to affect initial or follow-up medical history questions or examination components

C: Active listening involves listening to the patient ' s entire message and acknowledging both verbal information and nonverbal cues. Patients who feel they are being heard will continue to provide information, resulting in a more accurate medical examination

Just as the football leaves the foot of the punter he is rushed by opposing players, and with his hip in 90° of forward flexion he sustains an axial load along the femur. The athlete has fallen to the ground and is expressing extreme pain. On inspection of this injured athlete, you note his involved leg is slightly flexed, adducted, and internally rotated at the hip joint. What condition should be included in your initial differential diagnosis? A. Hip pointer B. Athletic pubalgia C. Hip joint dislocation D. Trochanteric bursitis

C: Although rare in sports, hip dislocations can result from traumatic force directed along the long axis of the femur. Most commonly the femur displaces posteriorly to the acetabulum, resulting in the patient presenting with a fl exed, adducted, and internally rotated thigh

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: Asymmetry, irregular borders, color that varies across the mole, and diameter larger than a pencil eraser all are characteristics that would indicate referral, especially if the mole has been changing

Which statement correctly describes the relationship that the athletic trainer should have with the strength and conditioning coach? A. The strength and conditioning coach should be exclusively responsible for maintaining the fitness levels of all athletes, and the athletic trainer should be responsible for prevention and treatment of all injuries. B. The strength and conditioning coach should provide all workout plans to the athletic trainer in advance so they can be reviewed and approved. C. The athletic trainer should approach the strength and conditioning coach if there appears to be a commonly occurring injury or functional deficit so that the situation can be evaluated and strategies can be developed. D. The athletic trainer should assume responsibility for all conditioning for athletes who are undergoing a rehabilitation program.

C: Athletic trainers and strength and conditioning coaches should work collaboratively to ensure the highest levels of fi tness and function for their athletes. Whereas each may focus on a specifi c area, the roles are not mutually exclusive

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: Carrying angle is the angle formed by the long axis of the humerus and the ulna. Normal ranges are 13° to 16° in female subjects and 11° to 14° in male subjects

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: Classifi cations of myositis ossifi cans are determined by the cause of the calcifi cation. In athletes, an acute trauma, such as a deep contusion or a muscle strain, is a common cause.

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: Comminuted fractures can be caused by a hard blow or fall in an awkward position, as can occur when falling from a ladder. The multiple bone fragments can delay or make healing diffi cult. Sometimes these fractures require surgery

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: Evidence for most clinical tests for thoracic outlet syndrome are inconclusive, and so diagnosis is through multiple positive fi ndings and reproduction of symptoms. Actual tissue structure must be visualized to determine true causative factors.

On Monday afternoon, an athlete arrives at your athletic training facility complaining of a sudden onset 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

C: Family practice physicians provide medical care for a variety of medical conditions and injuries to all members of a family

. A patient you are seeing in your clinic has consistently complained of fatigue, chronic pain, and stiffness in various joints for the past 2 to 3 months. She notes pain to palpation of several joints, and some warmth and joint effusion are present as well. The patient has been doing her own research online and tells you that she is pretty confident that she has fibromyalgia. How would you respond? A. Encourage the patient to begin taking a magnesium and folic acid supplement to minimize the effects of the condition. B. Suggest that the patient see a psychiatrist for possible antidepressant therapy. C. Encourage the patient to share her concerns with her physician, but remind her that active evidence of joint inflammation such as heat and effusion is not present in patients with fibromyalgia. D. Suggest that the patient see her physician and ask to be screened for Lyme disease.

C: Fibromyalgia is characterized by a minimum 3-month history of fatigue, pain, and stiffness. The pain must be present to palpation at 11 of 18 identifi ed sites and must occur bilaterally above and below the waist without evidence of active joint infl ammation

When assessing your patient ' s anterior glenohumeral (GH) joint play using the load and shift technique, you note that the humeral head translates over the glenoid rim, but the head spontaneously reduces. Using the three-point grading scale for load and shift testing, how should you document your findings? A. Trace (0) B. Grade I C. Grade II D. Grade III

C: Glenohumeral (GH) joint play testing can be modifi ed using the load and shift techniques whereby an axial load is applied to the humerus compressing it into the glenoid while joint play is assessed. A three-point grading system where trace indicates no translation of the humeral head and grade 3 indicates dislocation of the humeral head without spontaneous reduction is one method of documenting test fi ndings.

A male athletic trainer working outreach at a high school is asked to evaluate a female gymnast who is complaining of right hip and groin pain. Which of the following actions can the athletic trainer take to make the student athlete feel as comfortable as possible during the evaluation? A. Share a little about his educational background and hobbies. B. Perform the evaluation in the middle of the athletic training room when lots of athletes are around. C. Ask the athlete ' s coach who is also a female to be present during the evaluation. D. Begin by taking a medical history that includes questions about mechanism of injury, current training plan, and menstrual history

C: If palpations must be conducted or evaluation needs to occur in a private examination room, it is always most appropriate to have another person of the same gender as the patient present

A high school freshman reports to the athletic training clinic complaining of first metatarsophalangeal (MTP) irritation, which he attributes to his new cleats. On examination you note bilateral hallux valgus along with pes planus. Also the first toe appears to slightly overlap the second toe. What condition tends to develop secondary to hallux valgus? A. Onychomycosis B. Onychocryptosis C. Bunion D. Subungual hematoma

C: In individuals with hallux valgus, bunions may form over the fi rst metatarsophalangeal (MTP) joint secondary to the valgus deformity or due to dislocation of the sesamoid bones of the fi rst MTP

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 fl at 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: Initial contact begins at the moment the foot touches the ground. Maximum rigidity is achieved by supination and tibia external rotation that allows contact on the lateral aspect of the heel that immediately moves toward pronation as weight moves forward along the lateral aspect of the foot

An athlete who was recently injured has fallen into a pattern of saying things such as, "I think this is the referee ' s fault; he let the game get out of hand" and "I ' m no good to anyone now." The athlete is dwelling on these thoughts, and it is hindering his progress, as he has lost motivation. Which type of psychological strategy would be most effective for this athlete? A. Reducing muscle tension through relaxation techniques B. Guided imagery C. Cognitive restructuring D. Meditation

C: Irrational and negative thought patterns that impede treatment are best addressed through cognitive restructuring techniques, such as returning irrational thoughts and thought stopping

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 (JIA) should be included in the differential diagnosis any time a child younger than 16 years of age presents with unexplained joint pain for which other diagnoses have been excluded

An athlete limps into the athletic training room complaining of acute pain in his right hamstring muscle. He states that he was completing sprinting drills as part of his conditioning program, and as he extended his stride and increased his speed, he felt immediate pain and a tearing sensation in his hamstring in the areas of the musculotendinous junction. Based on the athlete ' s subjective report, how would you classify the mechanism of injury? A. Microtrauma B. Biomechanical insufficiency C. Macrotrauma D. Muscular imbalance

C: Macrotrauma is characterized by a single force being placed on a tissue that results in tearing of the fi bers

An athlete has been diagnosed with mallet finger. Which tendon is involved in this condition? A. Flexor digitorum profundus B. Central extensor tendon C. Extensor digitorum longus D. Extensor pollicis brevis E. Extensor digitorum communis

C: Mallet fi nger occurs when the extensor digitorum longus tendon is disrupted or torn and the distal interphalangeal joint is stuck in fl exion.

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: Normally blood pressure (BP) is elevated after exercise and decreases over time. BP that does not decrease or continues to increase may indicate severe intracranial bleeding.

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 syndrome

C: Osgood-Schlatter disease is an apophysitis injury that occurs from repeated avulsion fractures at the insertion of the patellar tendon at the tibial tuberosity

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: Pathology in peripheral nerves, such as the median nerve, and the muscles they innervate can be detected and quantified using nerve conduction studies and electromyography. These tests are typically performed by neurologists or physiatrists.

You are providing medical coverage for a Little League baseball tournament when a mother escorts her 10-year-old son to the medical tent. She states that he cannot seem to get his asthma under control. If the child ' s asthma is not under control, what should you expect to hear when you auscultate his lungs? A. Crackles B. Rales C. Wheezing D. Stridor E. Pleural rubs F. Diminished lung sounds

C: Patients with asthma experience episodes of shortness of breath, wheezing, chest tightness, and a dry cough

A member of your school ' s gymnastics team informs you that her parents want her to see a physiatrist, who is a friend of the family, when she gets home for summer break. What type of health-care provider is a physiatrist? A. Exercise physiologist who can provide advice on training and conditioning techniques, nutrition, and sports performance B. Chiropractor who emphasizes musculoskeletal rehabilitation to complement spinal and extremity manipulation C. Physician who specializes in physical medicine and rehabilitation to diagnose and treat a variety of injuries and conditions D. Biomechanist who focuses on faulty gait patterns and improper movement mechanics

C: Physiatrists are physicians who specialize in physical medicine and rehabilitation (PM&R)

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 can be caused by repetitive microtrauma involving longitudinal forces along the length of the humerus when the glenohumeral joint is fl exed and internally rotated, as when a cheerleader supports a team member in his hands over his head

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: Preiser ' s disease is osteoporosis of the scaphoid that can result from initial or repeated scaphoid fractures

If an educational institution stores a student ' s medical records with the student ' s educational records, what protects the privacy of those records? A. HIPAA B. NCAA regulations C. FERPA D. NHSL regulations

C: The Family Educational Rights and Privacy Act (FERPA) protects the privacy of student educational records, and medical records stored with such educational records are protected by FERPA instead of the Health Insurance Portability and Accountability Act (HIPAA)

Which of the following outcome measures gives you information about the quality of the pain a patient is experiencing? A. Visual analog scale B. Numeric rating scale C. McGill Pain Questionnaire D. Referred pain pattern

C: The McGill Pain Questionnaire has two parts. The fi rst part asks the patient to identify the location of the pain and whether it is superfi cial or deep. The second part asks the patient to choose from a list of descriptive words to determine the nature of the pain.

While conducting a physical examination you ask your patient to single leg stand on his injured limb with his foot fl at on the ground and his knee flexed approximately 5°. Then you ask him to rotate his body to internally and externally rotate the femur on the tibia three times. Next you ask the patient to repeat this test with his knee in a position of 20° of flexion. What is the name of this test? A. McMurray ' s test B. Noble compression test C. Thessaly test D. Wilson ' s test

C: The Thessaly test is used to identify meniscal lesions, either the medial or the lateral meniscus depending on the source of the pain. The presence of an anterior cruciate ligament (ACL) injury decreases the diagnostic value of this test

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: The anatomy of the fi rst carpometacarpal joint allows for 2 degrees of freedom of movement (movement about two axes, in two planes) including (1) fl exion and extension and (2) abduction and adduction

Which of the following statements is most accurate regarding the apprehension test for anterior glenohumeral laxity? A. Patient is supine, sitting, or standing, and the glenohumeral joint is abducted to 90° and the elbow is flexed at 10°. B. While supporting the humerus at 90° of abduction the examiner passively internally rotates the glenohumeral joint by applying pressure to the forearm. C. The test should be considered positive if the subject displays apprehension that the shoulder may dislocate and resists further movement. D. Apprehension along with pain that is centered in the anterior capsule of the glenohumeral (GH) joint may be associated with internal impingement.

C: The anterior apprehension test is designed to elicit pain or apprehension during the test. If the patient shows facial apprehension or resistance to the clinician during an anterior apprehension test, the test can be considered positive.

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

C: The degrees of freedom of a joint indicates the number of planes within which a joint moves. Balland-socket joints, such as the glenohumeral joint, are triaxial (moving in three planes about three axes) and therefore have 3 degrees of freedom

You are performing a manual muscle test for the deltoid and supraspinatus. You stand to the side and just behind the athlete, who is seated on the end of a treatment table. You place one hand on the patient ' s shoulder and the other hand on the distal aspect of the patient ' s humerus just superior to the lateral epicondyle. What instructions should you give the patient? A. "I am going to move your arm to the start position, and then I want you to pull your arm down toward your body, and I am going to resist you." B. "I am going to move your arm to the start position, and then I want you to hold that position, pulling your forearm up toward the ceiling in front of your body while I try to push your arm down." C. "I am going to move your arm to the start position and then I want you to hold that position, not letting me push your arm down. You keep pushing up toward the ceiling with your elbow and upper arm." D. "I want you to extend your arm and raise it out to the side at shoulder level. Now pull your arm across your body, keeping your elbow straight, and I ' m going to resist you."

C: The deltoid and supraspinatus are tested with resisted abduction beginning from a start position of 30° of abduction

An athlete is seated with his leg hanging off the edge of the table and the knee flexed to 90° and the ankle in slight plantar flexion. The athletic trainer stabilizes the distal tibia and fibula with one hand and while holding the calcaneus with the other hand applies an externally rotated force on the calcaneus. A positive test indicates possible injury to which of the following structures? A. Anterior tibiofibular ligament B. Calcaneofibular ligament C. Deltoid ligament D. Posterior talofibular ligament

C: The described test is the external rotation test, also known as Kleiger test. An external rotation force on the calcaneus (subtalar joint) with the ankle in slight plantar fl exion applies a traction force to the deltoid ligament. Performing this test with the ankle joint in dorsifl exion stresses the syndesmosis.

During preseason training the senior captain of a boys' soccer team sustains an anterior cruciate ligament tear. When you meet with him 2 weeks after the injury for his presurgery evaluation, he states, "This is the worst thing that could have ever happened to me, everything is gone, my soccer career is over, I don ' t even care if my knee gets better." In what phase of Turnick, Etzel, Leard, and Lerner ' s phases of adjustment is this patient currently? A. Shock B. Realization C. Mourning D. Acknowledgment E. Coping and reformulation

C: The emotional response for an athlete who has an injury requiring more than 4 weeks of rehabilitation commonly includes phases or stages of adjustment. Each patient progresses through these phases on different timelines and to varying degrees. Some patients may skip a phase, whereas others may get stuck in a phase for an extended period of time. A patient enters the mourning phase when the fi nality of the injury enters his or her consciousness and is characterized by intense distress, reactive depression, internalized anger, and the belief that "everything has been lost."

While your patient performs active external rotation of the glenohumeral joint, he stops his movement before he reaches the end of this motion due to pain. You then ask him to relax while you apply overpressure in the direction of passive glenohumeral joint external rotation. The integrity of which of the following structures was being assessed during the patient ' s active motion, but not during the passive motion? A. Anterior glenohumeral ligament B. Subscapularis C. Infraspinatus D. Posterior glenohumeral ligament

C: The external rotators contract to externally rotate the glenohumeral joint but are not put in a stretched position or engaged during passive glenohumeral external rotation

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

C: The long thoracic nerve innervates the serratus anterior, which acts to upwardly rotate and protract the scapula. When innervation to this muscle is compromised, the serratus anterior is unable to act on the scapula, resulting in scapular winging

An athlete has recently undergone a splenectomy. Which of the following functions are most impacted by this surgical procedure? A. Ability to filter poisons out of the blood and produce mediators for blood clotting B. Ability to filter toxins from the blood and regulate the body ' s electrolyte level C. Ability to filter blood and remove ineffective or damaged red blood cells D. Ability to produce estrogen and progesterone E. Capacity to store vitamins A, E, and K and produce vitamin D

C: The primary function of the spleen is to protect the body against systemic infection and to remove old red blood cells (RBCs) and damaged platelets. It serves as a reservoir for RBCs, regulates the number of RBCs in circulation, produces antibodies, and produces lymphocytes. Platelets and white blood cells (WBCs) are stored in the spleen

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: Treatment goals should be clear, concise, and measurable. They should also be relative to the patient ' s condition and consistent with the patient ' s priorities, lifestyle, and participation expectations.

Which of the following medical history questions that would be appropriate in an acute, possibly catastrophic injury situation would not be as effective in a noncatastrophic off-field evaluation? A. What activities increase your shoulder pain? B. How does the pain you are feeling now compare with the worst pain you have ever experienced? C. Can you wiggle your fingers? D. How is the injury impacting your activities of daily living?

C: Typically open-ended questions should be used when taking a medical history, but in potentially catastrophic injury situations, closed-ended questions that allow you to gather key information quickly are acceptable

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: When using outcome measures that have been validated, minimum clinically important difference (MCID) indicates the smallest change that is considered benefi cial to the patient

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: With a complicated crown fracture the fracture line extends into the pulp. The pulp houses the nerves and vessels, thus explaining the excessive pain experienced by this athlete.

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: A prodrome is an early sign or symptom indicating the onset of a disease. Prodromal symptoms occur before the specifi c signs and symptoms of the condition

A student-athlete reports to the athletic training facility with a chief complaint of a chronic cough that is keeping her up all night and interfering with her ability to complete schoolwork. After completing a medical examination, you send this patient to the local drug store with instructions to purchase an over-the-counter (OTC) cough suppressant such as dextromethorphan (Delsym). In which drug category is this medication? A. Antihistamine B. Antibiotic C. Analgesic D. Antitussive

D: Antitussive agents suppress a cough, from either a central or a local mechanism.

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: Bacteria in a wound site resulting in infection can delay healing and result in excess tissue formation, which can lead to large scars

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, a traumatic hyphema, appears as a black half circle (meniscus) over the lens. The bleeding results from a tear in the ciliary bodies. Management includes patching, placing the patient in a semireclined position, and immediate referral

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: Clinical decision rules or clinical prediction rules are used to improve the effi ciency of clinical practice by identifying items that contribute to making an accurate clinical decision. Factors such as cost, patient satisfaction, and outcome data are included in the evaluation

You are meeting with a new patient who is coming to your clinic for rehabilitation following Tommy 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: Compliance with a rehabilitation plan can be improved by making sure the athlete understands the injury, the healing process, the rehabilitation plan, and the consequences of not following the assigned rehabilitation protocol.

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, or the hypoglossal nerve, allows tongue movement and is tested by having the athlete move the mouth and stick out the tongue

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 is a noninvasive procedure that uses high-frequency sound waves to assess the amount of blood fl ow moving through a vessel

You are treating a patient with an ice bag. How would you describe the expected sensations to the patient? A. "It ' s going to feel very cold and painful for the entire 20-minute treatment." B. "Many people note that they lose muscle function during the treatment and for 20 to 30 minutes after treatment due to a palsy of the motor nerves." C. "It will feel cold initially, but as the treatment progresses you will feel a surge of warmth as vasodilation occurs." D. "It will initially feel cold followed by burning, aching, and eventually numbness after about 5 minutes as nerve conduction velocity gradually slows."

D: Due to the impact of cold on cutaneous sensory nerves, most patients fi rst experience cold sensation for up to 3 minutes, followed by a burning and aching sensation from 2 to 7 minutes, and fi nally numbness after 5 to 12 minutes as the ice impacts the sensory receptors

. 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: Each of the conditions listed is consistent with Achilles tendinopathies, which must be screened to determine the specifi c injury.

An ice hockey defenseman is checked into the boards and receives an illegal blow to the left abdominothoracic area. After completing your initial and off-site assessment, you determine the athlete ' s condition does not warrant immediate referral. Therefore, the athlete returns with you to the ice to watch the last 30 minutes of practice. At the end of practice, you conduct a follow-up assessment. You assess the athlete ' s vital signs and record the following information: • Heart rate: 125 beats/min • Blood pressure: 90/64 mm Hg • Respirations: 20 breaths/min • Temperature (oral): 99°F • Diaphoretic appearance What condition do these findings indicate? A. Normal vital signs B. Septic shock C. Hyperventilation D. Hypovolemic shock

D: Hypovolemic shock results from a signifi cant reduction in blood volume (i.e., severe bleeding or dehydration). Patients experiencing hypovolemic shock may present with altered mental state due to lack of cerebral blood fl ow and oxygen; increased heart rate; nausea or vomiting; decreased blood pressure; thirst; and pale, cool, and clammy skin.

A youth ice hockey player receives a violent check into the boards by an overly aggressive opponent. He comes off the ice complaining of shortness of breath and right side chest pain. If this athlete has sustained a tension pneumothorax, what are other signs and symptoms that he could experience? A. Anoxia, dyspnea, coughing up of frothy blood, and a right tracheal shift B. Diffi cult and painful breathing, coughing up of frothy blood, signs of shock C. Purple discoloration of the upper trunk and head, bright red conjunctiva of eyes, cessation of breathing D. Cyanosis, absence of breath sounds, distention of neck veins, and a left tracheal shift

D: In sports, injuries to the lungs are rare but can occur. One of the most serious conditions is a tension pneumothorax that occurs when the pleural sac on one side fi lls with air. The additional air can force the lung and the heart toward the opposite side. A tracheal shift toward the uninjured side may demonstrate this movement of the lung and heart and resulting opposite lung compression

To effectively incorporate best practices into selecting special and diagnostic tests for patient examinations, clinicians need to obtain and be able to interpret published research. Which of the following clinical diagnostic tests is most useful in detecting a musculoskeletal pathology? A. A diagnostic test with a negative likelihood ratio (LR − ) of 0.50 B. A diagnostic test with an interrater reliability measure of 0.45 C. A diagnostic test with a positive likelihood ratio (LR + ) of 1.0 D. A diagnostic test with an intrarater reliability measure of 0.85

D: Intrarater reliability describes the extent to which the same examiner obtains the same results on the same patient when the test is repeated multiple times. The closer the measurement is to 1.0, the more reliable the test is.

Which of the following demonstrates a technique athletic trainers can use to build rapport with their patient while taking a medical history? A. Try to obtain the history as soon as possible after the injury occurs. B. Write down everything the patient says verbatim. C. Ask the athlete to point to the place of most intense pain. D. Maintain eye contact and attempt to see if you can determine what the patient is feeling.

D: Maintaining eye contact while listening carefully, asking open-ended questions, and presenting a calm and reassuring demeanor all will help develop the patient ' s trust

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: Normal values for Sp O 2 (estimate of arterial oxygen saturation) range from 95% to 100%

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.

D: Once an athlete turns 18 or attends a school beyond the high school level, Family Educational Rights and Privacy Act (FERPA) requirements state that rights to manage their personal records are now transferred solely to the student

As the athletic trainer for your school ' s baseball team you are reviewing the preparticipation examination reports for each player before the fall season begins. A referral is indicated for one of your pitchers based on the results of his visual acuity assessment. To what health-care professional should this athlete be referred? A. Family physician B. Occupational therapist C. Ophthalmologist D. Optometrist

D: Optometrists are not physicians but are health-care professionals who provide primary vision care. The care they provide includes vision testing, prescribing and dispensing corrective lenses, and prescribing medications for certain eye diseases.

An athlete requests a referral to a local physician for general routine preventive care. The athlete notes that she would prefer a provider who takes a holistic approach to patient care and is open to a variety of treatment techniques, including movement, rather than solely pharmacologic treatment. Based on professional training and philosophy, which of the following providers might be the best choice for this athlete? A. Physician ' s assistant B. Internist C. Pediatrician D. Osteopath

D: Osteopaths (DO) focus on the role that the musculoskeletal system plays in overall health and disease states. DOs bring a holistic approach using manual and physical treatment.

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: Ottawa Ankle Rules criteria for radiographic referral include the following: (1) patient is unable to walk four steps both immediately following the injury and at the time of examination, (2) palpable pain of zone A or B structures including midline of medial and lateral malleolus (ankle radiographs), (3) palpable pain of zone C or D structures (foot radiographs).

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: Pain that wakes from sleep and does not resolve, blood in the stool, skin wounds that heal slowly, moles or other skin growths, and unexplained weight loss are key findings that should prompt referral to rule out cancer

Your evaluation of the foot biomechanics of one of your cross country runners has led you to believe that the runner would benefit from custom orthotic intervention. To which of the following health-care providers would you refer this athlete? A. Occupational therapist B. Exercise physiologist C. Osteopath D.. Podiatrist

D: Podiatrists focus on the study and care of the foot and are well trained in foot biomechanics, orthotic intervention, and foot surgical procedures.

A group of student athletes from your volleyball team was involved in a motor vehicle accident while traveling during spring break. One of the athletes was killed in the accident. On returning from break, the athletics department has provided group counseling and access to counselors to all the athletes on the team. One of the players who was in the car when the accident occurred shares with you that she is having difficulty sleeping and difficulty concentrating in class due to bad dreams and flashbacks. She is also very anxious about getting into any car. How would you best manage this situation? A. Validate that the feelings the athlete is experiencing are normal and tell her these thoughts will likely diminish over the next several weeks. B. Recommend that the athlete take melatonin and perform some relaxation techniques. C. Encourage the athlete to come see you daily and begin cognitive behavioral therapy. D. Demonstrate empathetic listening skills to establish continued rapport with the athlete and refer her to the counseling center for an individual appointment.

D: Posttraumatic stress and acute stress disorders are often characterized by recurrent images, thoughts, dreams, and fl ashbacks about the event as well as sleep disturbances, irritability, diffi culty concentrating, and anxiousness

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: Radicular pain is attributed to nerve root or peripheral nerve compression or damage. This pain occurs along nerve distributions (dermatomes)

A freshman tennis player from Florida moves to Seattle, Washington, to attend college. The athlete comes to see you in February complaining of malaise, fatigue, difficulty paying attention in class, and feeling sleepy especially in the afternoon. She notes the symptoms have gotten worse as the school year has gone on, but have been particularly bad since December. What condition would you suspect? A. Adjustment disorder B. Clinical depression C. Anxiety D. Seasonal affective disorder

D: Seasonal affective disorder (SAD) typically occurs in the winter months due to decreased levels of sunlight. It is most common in adults and women. Treatment involves referral for light therapy, antidepressant medication, and stress management.

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 is marked by the presence of escaping cerebrospinal fl uid from the nose or ears.

An athletic trainer who is evaluating a patient ' s knee asks the patient to lie supine with the quadriceps relaxed. He then gently pushes the patella laterally as far as possible, taking care to not cause the joint to dislocate. What condition is the athletic trainer attempting to rule out of his differential diagnosis with this special test? A. Chondromalacia B. Jumper ' s knee C. Patellofemoral stress syndrome D. Patellar instability E. Patellarosteochondritis

D: The clinician is performing the apprehension test for patellar instability. A positive test is noted when the patient forcibly contracts the quadriceps to keep the patella from dislocating, verbally expresses apprehension, or displays apprehension through facial expressions

Which of the following injurious factors is the most significant determinant as to whether an athlete will sustain a first-degree or second-degree lateral ankle sprain? A. The amount of eversion at the subtalar joint B. The amount of inversion at the subtalar joint C. The amount of eversion combined with torsion at the subtalar joint D. The amount of inversion at the subtalar joint combined with plantar flexion at the talocrural joint E. The amount of plantar fl exion at the talocrural joint

D: The etiology of second-degree lateral sprains is moderate force placed on an ankle while in a position of inversion and plantar fl exion. The etiology for a fi rst-degree ankle sprain primarily is a moderate force placed on the ankle while in inversion position and a minimal plantar fl exed position

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: The fi ndings of the evaluation are consistent with nerve root impingement, but the lower quarter screening information isolates the injury to the L4 nerve root

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: The literature suggests restoration of bilateral symmetry in glenohumeral internal rotation, horizontal adduction, and total arc of motion is of prime importance for overhead athletes with superior labral anterior posterior (SLAP) lesions.

When conducting a knee evaluation, you suspect an athlete has injured his lateral meniscus. Due to its attachment to the lateral meniscus, what other structure should you suspect may be involved? A. Head of the fibula B. Biceps tendon C. Plantaris muscle D. Popliteal muscle E. Patella

D: The popliteal muscle reinforces the posterolateral corner of the knee; resists posterior tibial translation, static external tibial rotation, and dynamic internal tibial rotation; and helps to buffer varus forces. Because acute meniscal damage usually involves associated structures, it is highly likely that the popliteal muscle was also impacted

Through a comprehensive medical examination you determine your patient has rotational knee instability whereby his medial tibial plateau subluxes anteriorly. What is the term for this rotational knee instability? A. Medioanterior instability B. Anterolateral instability C. Posteromedial instability D. Anteromedial instability

D: The type of rotational instability is named based on the displacement of the tibial plateau relative to the femur. Anteromedial instability indicates the medial tibial plateau subluxates anteriorly relative to the femur

In a contusion of the medial epicondyle of the humerus, which nerve is most likely to sustain a compressive force? A. Median B. Radial C. Brachial D. Ulnar E. Musculocutaneous

D: The ulnar nerve enters the elbow through the arcade of Struthers and is located approximately 8 cm proximal to the medial epicondyle. It then passes superfi cially through the olecranon process and the medial epicondyle, making this nerve susceptible to compressive forces. This sensation is also known as hitting your funny bone.

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: Tight or shortened hip fl exors or back extensors combined with weakened or elongated hip extensors or abdominals result in anterior pelvic tilt, increased lumbar lordosis, and a slightly hip fl exed position. Over time this position results in adaptive changes to include increased compression on lumbar facet joints, shortening of posterior lumbar ligaments and anterior hip ligaments, and elongation of anterior lumbar ligaments and posterior hip ligaments

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: To assess patellar glide, the patella is viewed as having four quadrants. Normal lateral patella glide is 0.5 to 2.0 quadrants of glide, and glide of more than two quadrants is considered hypermobility

The potential response-injury severity relationship is founded in the understanding that a patient ' s response to an injury is more likely to be intense when the injury is more severe. Which of the following statements regarding the potential response-injury severity relationship within each of Hedgpeth and Gieck ' s four rehabilitation length categories is correct? A. Patients with a short-term injury (4 weeks or less) are likely to respond with fear and anger and experience several phases of adjustment. B. Patients with a long-term injury (more than 4 weeks) are typically optimistic following their injury and throughout the rehabilitation process, although they can become impatient and eager to return to preinjury activities. C. Patients with chronic injuries (recurring) routinely demonstrate a loss of vigor and irrational thoughts and feelings of alienation after the initial injury and throughout the rehabilitation process. D. Patients with an activity-terminating injury typically experience severe reactions, including isolation and all phases of adjustment, as they manage their identity loss.

D: To assist clinicians in understanding the potential response-injury severity relationship, Hedgpeth and Gieck grouped rehabilitation length into four categories in which clinicians can expect individuals to experience different progressive reactions to the injury, rehabilitation process, and act of returning to sport participation

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: Treatment for patellofemoral pain syndrome is multifaceted, so evaluation techniques that can predict effi cacy of intervention strategies are helpful. Taping seems to be most effective in patients with positive patellar tilt test or tibial varum greater than 5°.

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 dorsifl exors B. Calcaneal gait; pain with forefoot weight-bearing or plantar fl exor weakness C. Gluteus maximus gait; gluteus maximus muscle weakness D. Trendelenburg gait; gluteus medius weakness

D: Trendelenburg gait attempts to maintain center of gravity and prevent pelvic drop on the involved side by shifting the trunk toward the involved side

A diver who recently sustained a tympanic membrane rupture, which was treated with activity restriction and antibiotics, continues to complain of a sensation of air moving during a Valsalva maneuver. Visual evaluation reveals healing with a small fissure remaining in the membrane. What would be your next step? A. Continue with current treatment plan and reevaluate in 2 weeks to allow additional time for healing B. Allow the athlete to return to activity as long as the ear is covered to minimize water intrusion while healing continues C. Educate the athlete about strategies for minimizing water collection in the ear, signs and symptoms of possible infection, and prognosis of living with a permanent tympanic membrane fissure D. Refer the athlete to an otolaryngologist for evaluation and possible grafting

D: Tympanic membrane ruptures often heal without closing but may require a graft for permanent healing

A high school pitcher complains of medial elbow pain in the late cocking and early acceleration phase of throwing. He also notes a decrease in velocity and accuracy as well as a decrease in the total number of pitches he is able to throw before he gets tired. What condition is likely to result in this type of functional impairment? A. Supinator muscle strain B. Distal biceps tendon rupture C. Forearm compartment syndrome D. Ulnar nerve sprain

D: Ulnar nerve sprain may result in medial elbow instability. During the throwing motion, the highest amount of stress is placed on the ulnar collateral ligament (UCL) during late cocking and early acceleration

A wrestler sustains an auricular hematoma for the third time in the season. The athlete asks if there is anything he can do to minimize developing cauliflower ear? How would you respond? A. The athlete can wear ear plugs under his head gear to minimize long-term impacts. B. Once the injury has occurred, there is not much that can be done to minimize the impact. C. The athlete can be seen by the team physician, and antibiotics can be prescribed to minimize the chance of infection. D. The athlete can be seen by the team physician for aspiration of the hematoma and application of a gauze and flexible collodion cast.

D: Unaddressed auricular hematomas can result in increased scarring and a condition known as caulifl ower ear. Aspirating the hematoma will allow the cartilage to receive its nutrition and minimize scarring. 22 The condition develops or doesn ' t based on immediate treatment of the active hematoma, making answer option D correct. Using the word "getting" indicates a prevention strategy such as wearing headgear as opposed to managing the injury and preventing it from developing into "caulifl ower ear."

Before releasing an athlete who has sustained a cerebral concussion to the responsible adult who will be monitoring him overnight, which of the following signs and symptoms require immediate referral to the emergency department? A. Headache B. Lethargy C. Inability to concentrate D. Vomiting E. Irritability

D: Vomiting after a concussion can indicate a brain bleed or brain or nerve damage and can be a medical emergency

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, and hamate make up the distal row of carpal bones

. 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: Because the athlete is under age, a parent or legal guardian must be present to request medical documentation. This complies with Health Insurance Portability and Accountability Act (HIPAA) regulations

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 is an infectious infl ammation of deep cells and connective tissue. It is characterized by erythema (redness of skin), increased tissue temperature, swelling, and a tight, glossy, stretched appearance of the skin.

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 ossifi cation is the calcifi cation and formation of bone in muscle. This can occur from multiple blunt force traumas or a traumatic deep contusion.

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 often manifests with a positive Trendelenburg test, which is positive when the pelvis drops on the non-weight-bearing side. In Legg-Calvé-Perthes disease, an ischemic lesion forms on the femoral head; with permanent damage to this structure the hip will be limited by decreased abduction and internal rotation

A 19-year-old athlete presents with a 5-day history of only the following symptoms: acute pharyngitis, overwhelming fatigue, fever, and lymphadenopathy. Which of the following conditions should be included in your initial differential diagnosis? A. Encephalitis B. Mumps C. Herpes zoster D. Hepatitis A E. Infectious mononucleosis

E: Mononucleosis is a common occurrence in college-aged athletes. Although the chief initial presentation symptoms include fatigue, pharyngitis, fever, and lymphadenopathy, not all patients present with all these symptoms initially or at all. Other symptoms include tonsillitis, hepatomegaly, jaundice, and maculopapular rash

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 occurs when an athlete receives a concussive blow after already having a concussion that is not resolved. All the symptoms described can occur with second impact syndrome, which can ultimately lead to death

Your baseball coach who was a former catcher comes in for evaluation of his left knee. He notes that he does not have a mechanism of injury, but the knee has become increasingly painful with episodes of occasional "locking and catching." The joint often swells on and off but is usually most inflamed after locking episodes or after being on his feet for long periods of time. You perform a fluoroscopic evaluation, and it appears that there may be some bone fragments in the joint space. What is your clinical diagnosis? A. Patellofemoral pain syndrome B. Avascular necrosis of the femoral condyle C. Synovitis D. Osteochondritis dissecans

Osteochondritis dissecans is characterized by a bony fragment that is either stable or fl oating within the joint, which results in pain, decreased range of motion, and loss of function.

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: A pleural rub is a sound that is produced from outside of the lungs, from friction between infl amed visceral and parietal pleurae

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: According to the SCAT3 instructions, one point is earned for this test when the entire sequence is correct. No points are awarded if an error is made

After reviewing an adolescent athlete ' s medical history, you suspect that the athlete may have used anabolic steroids in an effort to increase muscle mass. What skeletal impact may result from anabolic steroid use? A. Premature epiphyseal plate closure B. Decreased bone density C. Exostosis development at apophyseal sites D. Increased incidence of stress fractures

A: Anabolic steroid abuse in adolescents can result in shortened stature due to premature epiphyseal plate closure as well as increased incidence of tendinopathies.

While inspecting an athlete ' s pupils, you note that one pupil is larger than the other. Before concluding that this is a symptom of this athlete ' s acute injury, you need to rule out which previously existing or congenital condition? A. Anisocoria B. Astigmatism C. Myopia D. Nystagmus E. Glaucoma

A: Anisocoria is a condition in which the pupils differ in size. It may be congenital or related to trauma. Congenital conditions must be ruled out to determine if the irregularity is due to the recent trauma

An athlete who recently completed a course of antibiotics and oral steroids complains of white, cheesy, curd-like patches on the tongue and buccal mucosa. What condition is most commonly associated with this presentation, and how is it best treated? A. Oral candidiasis; oral rinse of nystatin and oral antifungal medication B. Oral candidiasis; oral peroxide rinse and oral antibiotic medication C. Leukoplakia; oral rinse of nystatin and manual scraping D. Leukoplakia; oral peroxide rinse and oral antifungal medication E. Gingivitis; oral antibiotic rinse and fl uoride supplements

A: Oral candidiasis is a fungal infection common in infants and in patients with suppressed immune systems after taking antibiotics and after corticosteroid treatments. Symptoms include white to yellow lesions in the cheeks or on the tongue that look like milk curds. Treatment includes a nystatin oral rinse and an antifungal oral medication

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: Palpating the contralateral, uninvolved extremity before the injured extremity can assist in calming patients, while establishing a positive examiner/patient rapport. Palpation is typically performed in a specifi c sequence, beginning away from and then progressing toward the injury site

When evaluating an athlete 3 days after sustaining a mild head injury, which of the following symptoms would lead you to suspect the athlete is experiencing postconcussion syndrome? A. Persistent headache, lack of concentration, and fatigue B. Steady gait, visual disturbances, and insomnia C. Behavior changes, impaired memory, and tinnitus D. Fatigue, nystagmus, and anoxia E. Tinnitus, dyspnea, and depression

A: Postconcussion syndrome is characterized by decreased attention span, concentration difficulties, impaired memory, and irritability, which are most likely to appear at 3 days postinjury. If the condition persists, the symptoms intensify to include balance and coordination diff culties, emotional depression, and decreased cognitive function

A resisted range of motion evaluation reveals weakness in the absence of pain. What are the clinical indications of these findings? A. Neurological deficit or chronic contractile soft tissue injury B. Normal findings for contractile tissue C. Minor contractile soft tissue injury D. Significant contractile tissue injury or chronic noncontractile soft tissue injury E. Minor contractile soft tissue injury or chronic contractile soft tissue injury

A: Resisted range of motion (RROM) determines strength of a group of muscles throughout a specifi c range of motion. Weakness accompanied by pain during these ranges of motion can indicate a muscle strain or other pathology. Weakness by itself indicates a miscommunication between the nervous system and the muscle or an inability for the muscle to contract.

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: Sever ' s disease is a calcaneal apophysitis that develops due to repetitive tensile forces on the Achilles tendon insertion on the calcaneus. It commonly occurs in boys between ages 10 and 12 years and girls between ages 8 and 11 years. Occurrence rate is similar between genders

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 (TTS) is caused by entrapment of the posterior tibial nerve as it passes through the tarsal tunnel. The special test described is the dorsiflexion-eversion test for tarsal tunnel syndrome. The combined motions of dorsiflexion and eversion put the posterior tibial nerve on stretch and recreate the conditions and symptoms of TTS.

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: The C6 nerve root assesses the musculocutaneous nerve. The myotome is assessed by resisting the patient ' s ability to perform elbow fl exion.

In football players, what mechanism of injury most commonly causes an axial compression fracture of the cervical spine? A. Contact with the top of the helmet while the cervical spine is in a partially flexed position B. Contact with the face mask, forcing the cervical spine into hyperextension C. Contact with the helmet, pushing the cervical spine into lateral flexion and depressing the shoulder D. Contact with the chin strap, forcing the cervical spine into partial extension E. Contact with the side of the helmet, resulting in lateral rotation of the cervical spine

A: The etiology of an axial compression fraction stems from the head being loaded axially; in football, this means hitting with the top or crown of the helmet, also referred to as "spearing."

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: The orbit of the eye comprises many bones. The roof is formed by the frontal bone and the sphenoid bone

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 regarding referral for lens assessment

A: The physician ' s observations and measurements should be documented in the objective section of a SOAP note. HEENT is an abbreviation for head, ears, eyes, nose, and throat. EOMI is an abbreviation for extraocular muscles are intact. PERRLA is similar to PEARL, meaning pupils are equal, accommodating, and reactive to light

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 collection of fluid E. Concave, pearly gray, with a small opening in the center of the concavity

A: The tympanic membrane, otherwise known as the eardrum, can be seen separating the inner and outer ear. A normal tympanic membrane should appear as shiny, smooth, and translucent.

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: Toradol is a prescription nonsteroidal anti-inflammatory drug (NSAID) that can be taken by mouth or administered intravenously or intramuscularly

When gathering a medical history, which of the following actions can promote effective patient communication? A. Display a relaxed, but interested, open-body posture. B. Keep it simple by asking questions that can be answered with "yes" or "no." C. Demonstrate respect for the patient' s intelligence by using medical terminology. D. Follow up each patient response with a request for verifying evidence or examples.

A: When gathering a medical history, the patient needs to be comfortable and secure enough to provide honest and detailed information. Therefore, the clinician needs to create an atmosphere where the patient can openly answer questions. Creating such an environment includes maintaining an open and relaxed posture, keeping eye contact, repeating key words spoken by the patient, asking open-ended questions, and using simple phrases and words of encouragement

A peak fl ow meter can be used to obtain a quick assessment of a patient ' s pulmonary function. Which of the following statements reflects correct use of a peak fl ow meter? A. With the mouth sealed around the mouthpiece, the patient should blow out as hard and as fast as possible. B. The patient should be positioned supine or in semirecumbent position. C. Before giving the unit to the patient, slide the indicator tabs to the top of the meter. D. With the mouthpiece attached to the meter, instruct the patient to hold the meter just in front of his mouth as he exhales completely and then inhales as hard and fast as possible.

A: While standing or sitting up straight, the patient should exhale completely, take in a deep breath, and then with mouth sealed around mouthpiece, blow out as hard and fast as possible.

An athlete is seated with his lower legs hanging freely. Observation reveals the tibial tuberosity is more than 10° lateral to the inferior patellar pole. Based on this tubercle sulcus angle, to what condition may this athlete be predisposed? A. Lateral patellar tracking B. Medial compartment osteoarthritis C. Anterior cruciate ligament tear D. Iliotibial band syndrome E. Medial meniscus tear

A: With the tibia rotated 10° laterally, the patella will follow suit in order to remain within the trochlear notch. Lateral patella tracking is a condition that is primarily caused by an increased Q angle or lax medial restraints on the patella.

A female basketball player reports to your university's athletic training clinic complaining of right superior shoulder pain she has been experiencing for approximately 5 days. She reports no history of shoulder trauma or changes in training or conditioning load or intensity. Which of the following questions can best assist you in determining the potential cause of this patient's pain? A. "You look tired; have you been spending a lot of time on your laptop?" B. "That's a nice-looking and large new messenger style book bag; do you carry it on your right or left shoulder?" C. "I know you commute to campus; do you have a lumbar support roll in your car seat?" D. "When sitting in class, do you have difficulty seeing the projection screen or blackboard?"

B : A patient' s pain may be caused by activities of daily living that subject the body to repetitive stresses. Backpacks that are heavy and worn on one shoulder can overload the patient' s shoulders. Students should be instructed to use both shoulder straps while wearing backpacks, avoiding carrying weight over one shoulder.

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: The carpal tunnel is oriented within the carpal bones. The trapezium is the most medial bone in the carpal distal row, and its prominence can be palpated through the hypothenar eminence. The pisiform is also found and palpated on the medial portion of the wrist. The carpal tunnel is defi ned laterally by the tubercle of the navicular and the hook of the hamate

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 drugs have an accepted medical use in the United States, but they also have a high potential for abuse. They are tightly controlled, requiring a written prescription from a physician and not allowing refills without additional prescriptions

Which of the following joints and associated ligaments are involved in the injury commonly referred to as a shoulder separation? A. Sternoclavicular joint; anterior and posterior sternoclavicular ligaments, costoclavicular ligament, and interclavicular ligament B. Acromioclavicular joint; acromioclavicular ligament, and conoid and trapezoid ligaments C. Glenohumeral joint; superior, middle, and inferior glenohumeral ligaments and coracohumeral ligaments D. Acromioclavicular joint; costoclavicular, acromioclavicular, and coracoclavicular ligaments E. Glenohumeral joint; coracohumeral and superior and posterior glenohumeral ligaments

B: "Separated shoulder" is the common term for a sprain of the acromioclavicular (AC) joint. The structures that are affected in this pathology are the AC ligament and the coracoclavicular, conoid, and trapezoid ligaments

What causes the development of an exostosis? A. Tearing away of a ligament or tendon' s bony attachment B. Repetitive stress placed on a bone or bony insertion of a tendon C. Normal forces applied to weak bones D. Extensive joint and bone immobilization

B: An exostosis, growth of extraneous bone, can result from repetitive stress or from irregular forces to the bone

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: Anemia is defined as low blood hemoglobin count, and iron-deficiency anemia results from an insufficient dietary intake of iron

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, fi rst cuneiform

B: By envisioning the underlying anatomy, a clinician can palpate bones in a particular sequence while conducting a physical examination.

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 is a an anticoagulant that inhibits blood clotting.

A male athlete comes to the athletic trainer complaining of painful urination and pus discharge from the penis and confides that he had unprotected sexual contact approximately 1 week earlier. Based on his symptoms, what should the athletic trainer suspect is the athlete's immediate problem? A. Tinea cruris B. Gonorrhea C. Urethritis D. Syphilis E. Human papillomavirus

B: Gonorrhea is a sexually transmitted disease. It can cause dysuria, or painful urination, and discharge.

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 is a type III Salter-Harris fracture, typically caused by abduction and external rotation of the foot. This mechanism is also typical for an anterior tibiofi bular ligament tear. When the anterior tibiofi bular ligament does not tear, this typically results in an avulsion fracture of the anterior tibial tubercle.

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: Originally the Star Excursion Balance Test (SEBT) incorporated reaching in eight directions, set at 45° angles. However, researchers determined that the three directions of anterior, posteromedial, and posterolateral are most sensitive in identifying limb differences related to risk of lower extremity injury

You are reviewing medical records and note that an athlete has sustained an osteochondral fracture. In which joint does this injury most commonly occur? A. Glenohumeral B. Tibiofemoral C. Patellofemoral D. Distal tibiofibular

B: Osteochondral fractures of the articular cartilage and underlying bone of the weight-bearing surface of the femur, tibia, or under the patella typically result from either rotation or direct trauma that compresses the articular surface between the tibia and the femur

A collegiate freshman cross country athlete you are treating for Achilles tendinosis complains of loss of appetite, difficulty sleeping, fatigue, and a significant decrease in her performance compared with the previous season. What condition might you suspect? A. Homesickness and depression B. Staleness and over training C. Burnout D. Malingering

B: Overtraining occurs when the physical load exceeds the athlete ' s ability to manage the load and can manifest in injury and other medical and psychological symptoms

After gathering a history and developing a differential diagnosis, you need to evaluate the various clinical orthopedic tests available to determine which ones you will complete to confirm your diagnosis. You want to select the most reliable special tests. Which of the following special tests is considered to be the most reliable? A. Drop-arm test (interrater reliability measure: 0.57) B. Relocation test (interrater reliability measure: 0.71) C. Anterior release (interrater reliability measure: 0.63) D. Sulcus sign (interrater reliability measure: 0.60)

B: Reliability values greater than 0.75 are considered "good," and the closer the measure is to 1.0, the more reliable the test is considered to be.

Which of the following injuries result from a shearing force mechanism? A. Ligament tears, spiral fractures, and lacerations B. Ligament tears, blisters, and abrasions C. Blisters, comminuted fractures, and contusions D. Spiral fractures, ligament tears, and blisters E. Comminuted fractures, tendon injuries, and contusions

B: Shear forces create loads that are equal, but not directly opposite, resulting in forces parallel to each other. Once the forces exceed the tissue strength, pathologies such as abrasions, blisters, and ligament tears may result.

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: The anatomic position of the glenoid fossa of the scapula is 30° from the frontal plane. This is referred to as the plane of the scapula. This angle provides the most functional plane for motion and puts the rotator cuff muscles at their optimal length-tension relationship

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

B: The brachioradialis refl ex (pictured) is used to assess the integrity of the C6 nerve root

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: The patient ' s chief complaint, the reason a patient is seeking healthcare, can be described by gathering information regarding the location of the discomfort, quality or quantity of symptoms, frequency of symptoms, factors that aggravate or alleviate symptoms, and onset and duration of symptoms

An athlete who underwent surgical repair of the anterior cruciate ligament is unable to achieve the final degrees of extension, as she "locks out" her knee in the open kinetic chain position. What must occur for this athlete to complete the "screw home motion" and achieve full extension? A. The vastus medialis oblique must contract to internally rotate the tibia. B. The quadriceps must contract to externally rotate the tibia. C. The popliteus must contract to externally rotate the tibia. D. The iliotibial band must contract to internally rotate the tibia. E. The medial hamstrings must contract to internally rotate the tibia

B: The screw home mechanism occurs due to the fact that the femoral condyles are not of equal sizes. In order to reach terminal extension, the tibia must externally rotate while the femur rotates internally. The quadriceps causes anterior tibial translation, which creates tension in the anterior cruciate ligament, externally rotating the tibia.

To perform an anterior drawer test to assess the integrity of the anterior talofibular ligament, the patient should be sitting at the end of the examination table with the knee flexed. The examiner uses one hand to stabilize the lower leg and the other hand cups the calcaneus. In how many degrees of plantar flexion should the examiner place the ankle before drawing the calcaneus and talus anteriorly? A. 90° B. 45° C. 15° D. 0°

C: To permit anterior translation of the talus on the tibia and stress the anterior talofi bular ligament, the ankle joint needs to be in an open packed position of 10° to 20° of plantar fl exion

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: The subjective portion of the SOAP note is where statements and testimonials made by the patient are documented. The most common mechanism of an anterior glenohumeral dislocation is forced abduction and external rotation.

The bat swing in baseball (movement of the arms) takes place in which of the following planes? A. Frontal B. Transverse C. Sagittal D. Coronal

B: The transverse plane bisects the body into superior and inferior (proximal and distal) segments. Movement in this plane occurs around a vertical axis. So, swinging a bat, where the bat remains parallel to ground and does not drop below the midline of the body, occurs in the transverse plane about a vertical axis.

A cross country runner reports to your athletic training facility for a preparticipation physical examination. When assessing her vital signs, you determine her resting heart rate is 14 beats in 15 seconds. What should you conclude? A. The athlete is demonstrating bradycardia, which is a sign of physiological distress. B. The athlete is demonstrating bradycardia, which is common in well-trained athletes. C. The athlete is demonstrating a normal heart rate. D. The athlete is demonstrating tachycardia, which is common in well-trained athletes. E. The athlete is demonstrating tachycardia, which is a sign of physiological distress.

B: This athlete ' s heart rate is 56 beats/min. A heart rate at rest that is less than 60 beats/min is termed bradycardia and is common in well-conditioned athletes

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 is important in the clotting process, and deficiencies can occur. Infants lack the necessary intestinal bacteria to produce vitamin K their first week or so of life. Certain drugs, such as anticoagulants, can cause vitamin K deficiency, as can abusing drugs that can decrease intestinal bacterial function, which might lead to a vitamin K deficiency. Because vitamin K is a fat-soluble vitamin, when someone has a faulty fat absorption problem, that person might be vitamin K deficient due to lack of absorption of vitamin K

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: With the position of the left anterior superior iliac spine (ASIS) inferior to the right ASIS, it may be assumed that the bone itself is rotated anteriorly, causing the discrepancy in the levelness of the two

Immediately following tissue trauma the injured tissues should be briefly immobilized to facilitate the healing process by controlling inflammatory symptoms. Based on Wolff ' s law, what should follow this brief period of immobilization? A. Injured structures should be administered corticosteroids to promote tissue transition into the fibroblastic repair phase. B. Injured structures should be subjected to controlled, progressively increasing loads to encourage them to remodel or realign along lines of tensile force. C. Injured structures should continue to be immobilized and activity should be restricted until the patient no longer presents with any signs and symptoms of inflammation. D. Injured structures should be taxed with aggressive range of motion and strengthening exercises to encourage fibrosis development during the fibroblastic repair phase.

B: Wolff ' s law states that bone and soft tissue will respond to the physical demands placed on them, so the clinician ' s goal is to control infl ammation while providing progressively increasing loads on the tissues

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: Mental health conditions, such as depression and anxiety, are associated with increased severity and extended duration of symptoms

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 is the most severe form of peripheral nerve injury and is the complete disruption of the nerve

Which observation would lead you to believe an athlete has functional as opposed to structural scoliosis? A. Scoliosis is observed during erect posture and during forward trunk flexion. B. Scoliosis is observed during forward trunk flexion and disappears during erect posture. C. Scoliosis is observed during erect posture and disappears during forward trunk flexion. D. Scoliosis is observed during erect posture and disappears during trunk extension. E. Scoliosis is observed during trunk extension and disappears during erect posture

C: Scoliosis is observed during erect posture and disappears during forward trunk fl exion. Functional scoliosis is caused from a muscle imbalance or a leg-length discrepancy. Therefore, the curvature of the spine in the frontal plane would not be present during forward trunk fl exion due to the dynamic motion required and the lack of correlation with frontal plane abnormalities. The curve would be present in erect posture because the leg-length discrepancy or muscle imbalance would affect the symmetry of the spine

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' 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. The examiner is performing the brachial plexus traction test. A positive test, indicating brachial plexus neurapraxia, is indicated by reproduction of pain and/or paresthesia symptoms. Radiating pain on the side opposite lateral bending suggests stretching of the brachial plexus (tension mechanism of injury), whereas radiating pain toward the bending side suggests compression of the nerve roots between two vertebrae

An athlete is suspected of having sustained a corneal abrasion. Which of the following questions would give you the most information to confirm your evaluative conclusion? A. Are you experiencing double vision? B. Do you feel as though a curtain fell over your field of vision? C. When you close your eyelid, do you feel like you have something rubbing in your eye? D. Have you experienced any discharge coming from your eye?

C: A corneal abrasion will cause the patient to feel as though a foreign object is scratching the eye, whether or not something is still in the eye. The cornea is responsible for focusing light rays entering the eye; therefore, if the corneal abrasion is severe enough, the patient may experience blurred vision.

Your patient presents with a history of three right ankle sprains over the past 18 months. What patient-reported outcome measure is the best tool to objectively and reliably rate your patient ' s lower extremity function during activities of daily living and sports activities? A. Ottawa Ankle Rules B. Roland-Morris Disability Questionnaire C. Foot and Ankle Ability Measure D. Oswestry Disability Index

C: The Foot and Ankle Ability Measure (FAAM) is a lower extremity assessment tool for patients with leg, foot, or ankle conditions. The tool consists of 21 questions related to activities of daily living and an additional eight questions related to sports activities.

Which of the following descriptions is the best example of the coordination between dynamic and isometric contractions of opposing muscle groups to perform movement at a joint? A. Tibialis posterior pulling the talus toward the calcaneus while the tibialis anterior pulls the talus anteriorly during dorsiflexion of the talocrural joint B. Pectineus pulling the femur into internal rotation while the sartorius pulls the femur into external rotation during flexion of the hip joint C. Supraspinatus assisted by the other rotator cuff muscles pulling the head of the humerus toward the glenoid fossa while the deltoid pulls the head of the humerus superiorly during glenohumeral abduction D. Popliteus pulling the tibia posteriorly toward the femur while the quadriceps muscle group rotates the tibia externally during extension of the knee joint E. Biceps brachii supinating the forearm while the triceps muscle group pulls the ulna toward the humerus during elbow extension

C: A force couple is created at the glenohumeral joint when the supraspinatus and the other rotator cuff muscles pull the head of the humerus into the glenoid fossa and then glide the humerus inferiorly to prevent contact with the acromion process as the deltoid contracts to move the joint into full abduction

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: Creep is tissue deformation that occurs with a constant application of load over time.

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 syndrome is the thickening of the extensor pollicis brevis and the abductor pollicis longus tendons and tendon sheaths, both of which run through the first dorsal carpal tunnel and attach on the thumb, otherwise known as the first digit. The thickening of those structures cause a decrease in space in the dorsal carpal tunnel.

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: During inhalation the diaphragm contracts creating a vacuum that pulls air into the lungs across a pressure gradient from areas of high to low pressure

While making a save, a soccer goalie sustains a head-on collision with the goal post. While conducting a head assessment, you note the athlete is unable to follow your finger with his eyes as you move from midline laterally. Which cranial nerve is demonstrating a deficit? A. Trigeminal B. Vagus C. Abducens D. Olfactory E. Facial

C: If an athlete is unable to look laterally, the abducens is the cranial nerve demonstrating defi cits. The abducens is a motor nerve that innervates the lateral rectus muscle. The lateral rectus acts to move the eye laterally and can be compromised if the abducens is damaged.

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: If the patient is unable to hold the test position against gravity, he or she should be positioned to reduce the effects of gravity. In this case, by positioning the patient supine for a middle deltoid manual muscle, the patient is not working against gravity

A baseball pitcher presents with unilateral shoulder pain he describes as deep within the joint as well as intermittent bicipital groove and biceps tendon tenderness. The athlete also reports a history of his involved shoulder popping, clicking, and catching with certain motions. As he is a baseball pitcher, you are concerned he may have sustained a superior labral anterior-posterior (SLAP) lesion. To apply evidence based practice to the examination of this patient, what information from 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 should you consider? A. Bicipital groove or biceps tendon tenderness is diagnostic of a SLAP lesion. B. A history of popping, clicking, or catching is diagnostic of a SLAP lesion. C. Mechanisms of injury for a SLAP lesion can include repetitive overhead activities, especially activities requiring shoulder abduction and end-range external rotation, that impart tensile, eccentric, or torsional forces on the biceps-labral complex. D. Shoulder pain described as deep within the anterior superior glenohumeral joint is not diagnostic of a SLAP lesion.

C: In overhead athletes, the mechanisms of a superior labral anterior posterior (SLAP) lesion are associated with repetitive overhead activities. During overhead motions the tensile forces on the labrum from the biceps during the deceleration phase may result in a tear of the labrum

What is the term for the involuntary movement of the eyeballs that may be observed in a patient who has sustained a trauma to the head? A. Anisocoria B. Pupil accommodation C. Nystagmus D. Tinnitus E. Diplopia

C: Nystagmus is defi ned as involuntary shaking of the eyes. This involuntary motion of the eyes may follow a concussion due to the neurological effect of the traumatic damage to the frontal lobe

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: Pes planus is commonly known as fl at feet. When the medial longitudinal arch fl attens, calcaneal valgus occurs as the rearfoot everts or moves laterally

In most states, how long must paper medical records be maintained before they can be destroyed? A. 3 years B. 5 years C. 7 years D. 10 years

C: Record retention schedules differ by state, but most states require paper records to be maintained for 7 years and then destroyed

You are approached by an athlete who recently learned she has a family history of Wolff-Parkinson White 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: The correct pathway of electrical activity is sinoatrial node to atrial musculature to atrioventricular node to atrioventricular bundle to bundle branches to Purkinje ' s fibers to ventricular musculature. This is the best answer because it correctly traces the electrical transmission from the points within the heart and is the most inclusive and complete answer.

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: The four muscles acting on the shoulder girdle during the initial phase of throwing include the serratus anterior, which brings the scapula from retraction to protraction; the subscapularis, which internally rotates the humerus; the anterior deltoid, which forward fl exes and internally rotates the humerus; and the pectoralis major, which also forward fl exes and internally rotates the humerus.

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: The frontal lobe of the brain manages complex problems and abstract thought.

You are observing the gait cycle in an athlete who is status post anterior cruciate ligament repair. The athlete lacks the last 10° of extension. In which phase of the gait cycle would this deficit be most apparent? A. Midstance B. Preswing C. Initial contact D. Midswing E. Terminal stance

C: The initial contact phase of the gait cycle requires terminal extension for the heel to contact the ground. In the absence of full knee extension the patient ' s initial contact will be altered

After gathering a comprehensive medical history and conducting a physical examination, two conditions remain in your initial differential diagnosis. To rule out one condition and make a clinical diagnosis, you decide to use a special test with a reported specificity of 0.80. Based on this high specificity value, what do you know about this special test? A. A positive test finding rules out the condition. B. A negative test finding rules out the condition. C. A positive test finding rules in the condition. D. A negative test finding rules in the condition.

C: The mnemonic SpPin is helpful here as it reminds us that for a test with a high specifi city (Sp) a positive test fi nding (P) rules in (in) the condition.

An equestrian rider reports for evaluation of a head injury after being thrown from her horse. Which cranial nerve is being assessed by a balance test? A. Cranial nerve II B. Cranial nerve V C. Cranial nerve VIII D. Cranial nerve XI E. Cranial nerve I

C: The patient in the photo is performing a Romberg test to assess balance. Cranial nerve VIII, the vestibulocochlear nerve, is a sensory nerve responsible for equilibrium

Which of the following pieces of information should be gathered during the observation-inspection phase of the injury assessment process? A. Severity of pain B. Presence of crepitation C. Presence of swelling or ecchymosis D. Presence of paresthesia E. Type of activity that caused the pain

C: The purpose of the observation/physical inspection phase of injury assessment is to gather information by observing signs of injury that are visible to the naked eye.

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: The sinus tarsi is a landmark that is located just anterior to the lateral malleolus. This landmark appears as a depression and marks the site of the extensor digitorum brevis muscle

Which bone lies directly proximal to the first metacarpal? A. Trapezoid B. Pisiform C. Trapezium D. Navicular E. Lunate

C: The trapezium lies directly proximal to the fi rst metacarpal. The fi rst carpometacarpal (CMC) joint has a synovial cavity that is separate from the other four CMC joints and allows accessory rotational movement, which permits opposition

The classic mechanism of injury for a medial collateral ligament sprain of the knee is valgus stress with external tibial rotation. When this force occurs, what other injurious force may occur simultaneously? A. Medial meniscus sustains compressive forces. B. Iliotibial band sustains tensile forces. C. Lateral meniscus sustains compressive forces. D. Popliteus muscle sustains tensile forces. E. Posterior cruciate ligament sustains compressive forces.

C: The valgus loading and external rotation create compressive forces on the lateral meniscus. The medial meniscus is not loaded because the valgus load causes the joint line to open on the medial side, the extent of which is determined by the medial collateral ligament (MCL) and its strength.

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: This athlete has sustained a traction force to the brachial plexus, stretching the left side cervical nerve roots.

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: Trigger points are hypersensitive knots in muscle tissue that are painful and sensitive to touch. Trigger points develop when postural muscles, muscles that primarily function to support the body against gravity, are overactivated and shortened in response to stress and strain

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: Two to 3 hours after eating, a normal blood glucose level reading is between 100 mg/dL and 140 mg/dL. A reading of 203 mg/dL indicates hyperglycemia

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: Cranial nerve II is the optic nerve. Visual acuity is assessed testing vision with tools such as the Snellen eye chart

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: Due to the shortened position, the cross-bridges overlap and are unable to create maximum tension and mobility, whereas stability remains uncompromised.

A baseball player is struck in the face by the ball. Which of the following signs or symptoms would suggest a fracture of the maxilla? A. Depression of the cheekbone and blurring of vision B. Facial pain and epistaxis C. Inability to open the mouth fully and move the jaw laterally D. Malocclusion of the teeth and numbness of the cheek E. Hyphema and inability of the athlete to look upward

D: Injury to the maxilla may manifest as malocclusion of the teeth and numbness of the cheek if the facial nerve has been impinged on

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 athlete ' s inability to dorsifl ex and invert his ankle suggests trauma to the anterior tibialis muscle. This muscle is located in the anterior compartment. The integrity of the anterior tibial artery should be assessed

Following trauma, what is the initial response at the vascular level? A. Margination followed by vasoconstriction B. Transient vasodilation followed by vasoconstriction C. Continual vasoconstriction D. Transient vasoconstriction followed by vasodilation E. Margination followed by vasodilation

D: The body ' s initial response to trauma is vasoconstriction; however, once the chemical mediators are stimulated and delivered to the area, the vasoconstriction ends and vasodilation begins. One of the chemical mediators responsible for dilation is histamine

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 fl ow 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 first two consecutive beats are phase I and indicate systolic pressure, whereas the disappearance of the last sound indicates diastolic pressure

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: The inferior vena cava delivers deoxygenated blood from the lower portion of the body directly to the right atrium, while the superior vena cava delivers the blood from the upper body and cranium

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 superfi cialis, fl exor digitorum profundus, and lumbricals B. Abductor pollicis brevis, fl exor pollicis brevis, and opponens pollicis C. Abductor pollicis longus, abductor pollicis brevis, and tendon of the fl exor pollicis longus D. Abductor digiti minimi, opponens digiti minimi, and fl exor digiti minimi brevis E. Extensor digiti minimi, adductor digiti minimi, and dorsal interossei

D: The muscles that comprise the hypothenar eminence are the abductor digiti minimi, opponens digiti minimi, and fl exor digiti minimi brevis

A football running back sustained a compression mechanism to the brachial plexus. To assess the extent of this injury, you perform both sensory and motor testing of the nerves of the brachial plexus. From which of the following nerve roots are the nerves of the brachial plexus derived? A. C2-C6 B. C3-C7 C. C4-C8 D. C5-T1 E. C5-T3

D: The nerve roots of C5 through T1 comprise the brachial plexus. If these nerves are stretched, the result is transient paresthesia in the upper arm, commonly known as a stinger.

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 is the gradual and progressive deformation of tissues secondary to changes in pathomechanics or periods of immobilization. This pain pattern of worse pain in the morning is commonly experienced with conditions such as plantar fasciitis, when the affected tissues are permitted to shorten during the non-weight-bearing night hours

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. Superfi cial infrapatellar D. Pes anserine E. Prepatellar

E: Prepatellar bursa is located anterior to the patella, and its purpose is to protect the patella and to dissipate forces and reduce friction.

Which of the following groups of muscles insert into the medial aspect of the tibia just distal to the medial condyle? A. Vastus medialis, gracilis, and semimembranosus B. Semitendinosus, sartorius, and vastus medialis C. Biceps femoris, semitendinosus, and semimembranosus D. Sartorius, gracilis, and semitendinosus E. Sartorius, gracilis, and semimembranosus

E: Sartorius, gracilis, and semimembranosus muscles make up the pes anserine muscle group and insert on the medial aspect of the tibia through a common tendon

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: Tenderness in the area halfway between the umbilicus and the right side anterior superior iliac spine (ASIS), known as McBurney ' s point, generally indicates appendicitis when accompanied by fever and nausea

A female athlete presents complaining of left lower quadrant tenderness and pain and referred pain in the shoulders. The athlete reports absence of her menstrual cycle for the past 3 months, which she attributes to an increase in training intensity. Which of the following conditions should be ruled out? A. Diverticulitis, gallstones, and ovarian cyst B. Ectopic pregnancy, urinary tract infection, and hepatitis C. Cholecystitis, spleen injury, and irritable bowel syndrome D. Colitis, sexually transmitted disease, and pancreatitis E. Spleen injury, ovarian cyst, and ectopic pregnancy

E: The spleen is located on the left side of the body. The referred pain pattern for a spleen rupture is pain in the left shoulder, otherwise known as Kehr ' s sign. One of the ovaries is located in the lower left quadrant, so pain in these areas could indicate an ovarian cyst. Pregnancy should be ruled out in a patient presenting with absence of menstrual cycle for 3 months.

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: These ligaments assist in resisting varus stresses placed on the elbow as well as maintaining congruence between the articulating surfaces of the humerus and radius

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: When the knee fl exes past 30°, the iliotibial (IT) band slides posteriorly to the lateral femoral condyle, making the IT band a knee flexor. When fully extended, the IT band sits anteriorly to the lateral femoral condyle, making the IT band a knee extensor.