BOC practice test for athletic trainers

An athlete's pre-competition anxiety has spread to panic attacks in class and poor sleep for 3 weeks. What is the athletic trainer's MOST appropriate action?

1. Refer to a licensed mental-health provider
   Panic attacks spreading beyond sport and weeks of poor sleep call for referral to a licensed mental-health provider.
2. Ask the coach to reduce playing time
   Cutting playing time does not treat the anxiety and can add to the distress.
3. Teach box breathing and reassess in a month
   Box breathing alone, with a month's wait, delays care for symptoms that are already spreading and persistent.
4. Recommend an OTC sleep aid for the anxiety
   Recommending a sleep aid is outside the athletic trainer's role and does not treat the anxiety.

At what age is ACL-prevention neuromuscular training MOST effective in female athletes?

1. Early to mid-adolescence
   Neuromuscular ACL-prevention training has its largest effect in early to mid-adolescence, before risky movement patterns set in.
2. Only after skeletal maturity
   Waiting for skeletal maturity misses the age when training works best.
3. Mid-20s or older
   Effects are smallest in adults in their mid-20s and older.
4. Late teens, ages 18–22
   Training at 18–22 still helps, but the effect is smaller than in younger adolescents.

A wrestler exercises in a rubber suit in a heated room to make weight. Which condition poses the GREATEST immediate threat to this athlete?

1. Exertional heat stroke
   A rubber suit in a heated room blocks evaporative cooling, and exertional heat stroke is the most immediate threat.
2. Exertional sickling
   Exertional sickling needs sickle cell trait, which is not mentioned.
3. Exertional hyponatremia
   Exertional hyponatremia comes from overdrinking, the opposite of sweating to make weight.
4. Hypoglycemic seizure
   A hypoglycemic seizure is possible with fasting but is less immediate than heat stroke in a sealed suit.

Which measure reduces the risk of commotio cordis occurring in youth lacrosse and baseball players?

1. Echocardiogram for every player
   Echocardiograms find structural disease, but commotio cordis occurs in normal hearts.
2. Preseason 12-lead ECG screening
   An ECG does not detect commotio cordis risk, which happens in structurally normal hearts.
3. NOCSAE-certified chest protectors
   Chest protectors certified to the NOCSAE commotio cordis standard are designed to reduce the chance of a blow triggering an arrhythmia.
4. Regulation-hardness balls at every age
   Softer, age-appropriate balls lower risk; regulation-hardness balls for every age do the opposite.

A college soccer team wants to reduce adductor (groin) strains. Which exercise has the STRONGEST evidence?

1. Dumbbell lateral lunges
   Dumbbell lateral lunges build general strength but lack the evidence of the Copenhagen program.
2. Copenhagen adduction exercise
   The Copenhagen adduction program has the strongest evidence for reducing groin injuries in soccer.
3. Static adductor stretching
   Static stretching has not been shown to reduce adductor strains.
4. Seated hip-adduction machine
   Machine adduction trains less eccentric load than the Copenhagen exercise and lacks its injury-reduction evidence.

Which supplement combination has evidence for reducing stress fractures in young women during heavy military or athletic training?

1. Magnesium and zinc
   Magnesium and zinc have no comparable evidence for stress fracture prevention.
2. Glucosamine and chondroitin
   Glucosamine and chondroitin are marketed for joint cartilage and do not prevent stress fractures.
3. Iron and vitamin C
   Iron and vitamin C address iron status, not bone stress injury.
4. Calcium and vitamin D
   Calcium and vitamin D supplements reduced stress fractures in female military recruits.

During a high school softball game, the athletic trainer suspends play for lightning. Where should players and spectators go?

1. The school's field house
   A fully enclosed building with wiring and plumbing, such as the field house, is a safe lightning shelter.
2. The open-sided press box
   An open-sided press box is not a fully enclosed building.
3. The concrete dugouts
   Dugouts are not safe shelters, even when made of concrete.
4. A roofed picnic shelter
   Picnic shelters are open-sided and do not protect from lightning.

A high school athlete keeps missing physician follow-up visits for a knee injury. The family has no car, and the parent cannot leave work during clinic hours. What is the athletic trainer's MOST appropriate response?

1. Refer to the school counselor for motivation
   The missed visits come from access, not motivation, so counseling misses the cause.
2. Arrange transportation or a telehealth visit
   Arranging transportation or telehealth removes the access barrier that keeps the athlete from follow-up care.
3. Document noncompliance and discharge from care
   Discharging the athlete punishes an access problem and stops needed care.
4. Tell the family to find a weekend appointment
   Weekend appointments may not exist and do not solve the lack of a car.

A volleyball player who has sprained the same ankle twice asks how to reduce the risk of another sprain. Which recommendation is BEST supported by the NATA ankle sprain position statement?

1. Static peroneal stretching
   Static peroneal stretching does not prevent recurrent sprains.
2. High-top shoes alone
   High-top shoes alone have weak evidence compared with bracing and balance training.
3. Ankle range-of-motion exercises only
   Range-of-motion work alone does not restore the neuromuscular control that prevents sprains.
4. Balance training plus bracing
   After repeated sprains, balance training plus bracing (or taping) is what the evidence supports for preventing another.

During a lacrosse game, the athletic trainer's lightning-detection system shows a storm 8 miles (12.9 km) away and approaching. Under the NATA 2013 lightning statement, by when must all participants and spectators be inside a safe structure?

1. When lightning is within 3 miles (4.8 km)
   Three miles is too late, because strikes can occur well ahead of a storm.
2. At the next scheduled halftime break
   Waiting for halftime ignores how fast the storm is approaching.
3. Once rain begins to fall on the field
   Rain is not a reliable signal; lightning can strike before any rain falls.
4. Before it is within 6 miles (9.7 km)
   Everyone should already be in a safe structure before the storm comes within 6 miles (about 10 km).

Six weeks after ACL reconstruction, a patient avoids putting weight on the leg and says, "I'm afraid the graft will snap." Which instrument BEST quantifies this barrier to recovery?

1. Tampa Scale of Kinesiophobia
   The Tampa Scale of Kinesiophobia measures fear of movement and reinjury.
2. PHQ-9 depression screen
   The PHQ-9 screens for depression, not movement-related fear.
3. IKDC Subjective Knee Form
   The IKDC form measures knee function, not fear of movement.
4. Numeric Pain Rating Scale
   A numeric pain scale measures pain intensity, not fear.

A patient's Achilles reflex produces a very brisk response with sustained clonus. How should the athletic trainer grade and interpret it?

1. 1+, suggesting an upper motor neuron lesion
   1+ is a diminished reflex, which suggests a lower motor neuron problem, not an upper one.
2. 4+, an upper motor neuron sign
   A very brisk reflex with sustained clonus is graded 4+, which is an upper motor neuron sign.
3. 2+, which is a normal response
   2+ is normal, but this reflex has clonus.
4. 3+, suggesting a nerve root lesion
   A nerve root lesion dampens a reflex rather than exaggerating it, so this grade and interpretation do not fit the finding.

A patient with low back pain has numbness over the lateral foot, weakness during repeated single-leg heel raises, and a diminished Achilles reflex. Which nerve root is MOST likely involved?

1. L5
   L5 affects the dorsum of the foot and great-toe extension, not the Achilles reflex.
2. S1
   Lateral foot numbness, weak plantar flexion on repeated heel raises and a reduced Achilles reflex all fit S1.
3. L4
   L4 affects the medial leg and the patellar reflex.
4. L3
   L3 affects the anterior thigh and knee extension.

After an inversion ankle injury, which special test BEST assesses the integrity of the anterior talofibular ligament?

1. Kleiger test
   The Kleiger (external rotation) test stresses the syndesmosis and deltoid ligament.
2. Anterior drawer test
   The anterior drawer test pulls the talus forward and stresses the ATFL.
3. Inversion talar tilt test
   The inversion talar tilt test mainly stresses the calcaneofibular ligament.
4. Squeeze test
   The squeeze test checks for syndesmosis injury.

A baseball pitcher reports tingling in the ring and little fingers while throwing. Holding the elbow fully flexed with the wrist extended for 60 seconds reproduces the symptoms. Which condition is MOST likely?

1. Medial epicondyle tendinopathy
   Medial epicondyle tendinopathy causes local elbow pain, not finger tingling.
2. C8 radiculopathy
   A C8 radiculopathy is provoked from the neck rather than by elbow position.
3. Carpal tunnel syndrome
   Carpal tunnel affects the thumb, index and middle fingers.
4. Cubital tunnel syndrome
   Ring and little finger tingling reproduced by sustained elbow flexion with wrist extension is the elbow flexion test for cubital tunnel syndrome.

After punching a wall, a patient has pain and swelling over the fifth metacarpal neck and a depressed fifth knuckle. Which injury is MOST likely?

1. Rolando fracture
   A Rolando fracture is a comminuted fracture at the base of the thumb metacarpal.
2. Fifth MCP dislocation
   An MCP dislocation shows deformity at the joint, not tenderness at the metacarpal neck with a sunken knuckle.
3. Boxer's fracture
   A fifth metacarpal neck fracture after a punch is a boxer's fracture.
4. Bennett fracture
   A Bennett fracture involves the base of the first metacarpal.

A 20-year-old volleyball player reports deep shoulder pain and clicking with overhead hitting. With the shoulder flexed 90 degrees, horizontally adducted 10 degrees, and internally rotated (thumb down), resisted downward force produces deep pain that decreases when repeated with the palm up. Which special test has the athletic trainer performed?

1. Hawkins-Kennedy test
   Hawkins-Kennedy passively internally rotates the flexed arm to test impingement.
2. Yergason's test
   Yergason's test resists supination with the elbow flexed.
3. O'Brien test
   Pain with the arm flexed, adducted and thumb down that eases with the palm up is the O'Brien active compression test.
4. Speed's test
   Speed's test resists shoulder flexion with the elbow straight and palm up.

A 15-year-old lacrosse player reports a headache and feeling 'in a fog' after a collision. The sideline cognitive and balance scores equal the preseason baseline. What is the MOST appropriate decision?

1. Retest in 30 minutes and decide then
   A repeat test in 30 minutes cannot clear an athlete who had symptoms.
2. Return if symptoms clear within 15 minutes
   Symptoms clearing within 15 minutes still does not allow same-day return.
3. Return to play because scores match baseline
   Normal scores do not override symptoms; same-day return is not allowed.
4. Withhold from play for the rest of the day
   Any athlete with concussion symptoms is removed and does not return the same day, even if test scores match baseline.

A collegiate rower has pain over the radial styloid. Pain is reproduced when the patient makes a fist around the flexed thumb and the athletic trainer ulnarly deviates the wrist. What is the MOST likely condition?

1. Scaphoid fracture
   A scaphoid fracture follows a fall and is tender in the snuffbox, not on this tendon test.
2. Carpal tunnel syndrome
   Carpal tunnel causes numbness in the median nerve distribution.
3. De Quervain syndrome
   Pain at the radial styloid with the thumb tucked in a fist and the wrist deviated ulnarly points to De Quervain syndrome.
4. Intersection syndrome
   Intersection syndrome hurts proximal to the wrist on the back of the forearm, often with crepitus.

A 24-year-old volleyball player has gradual-onset anterior knee pain with jumping. There is tenderness at the inferior pole of the patella, and pain is reproduced during a single-leg decline squat. What is the MOST likely condition?

1. Patellofemoral pain
   Patellofemoral pain is diffuse around the patella, not focal at the inferior pole.
2. Patellar tendinopathy
   Gradual jumping pain, tenderness at the inferior pole and pain on a decline squat point to patellar tendinopathy.
3. Infrapatellar bursitis
   Infrapatellar bursitis swells in front of the tendon and hurts with kneeling.
4. Infrapatellar fat pad syndrome
   Fat pad irritation hurts beside the tendon and with knee hyperextension.

A wrestler sustains a posterior shoulder dislocation. The athletic trainer has physician standing orders to reduce anterior shoulder dislocations. What is the MOST appropriate action?

1. Reduce it with traction-countertraction
   Traction-countertraction is a reduction technique the athletic trainer is not authorized to use here.
2. Immobilize as found and refer to the ED
   The standing orders cover anterior dislocations only, so a posterior dislocation is immobilized as found and sent to the ED.
3. Attempt one gentle reduction
   A single gentle reduction attempt is still a reduction that the standing orders do not cover.
4. Reduce it after a phone call to the physician
   A phone call does not replace written orders for a procedure outside them, and posterior dislocations carry a high risk of associated fracture.

An athletic trainer is called to a wrestling room where an athlete lies motionless on the mat. A frayed power cord from a floor fan lies in a pool of water next to the athlete. What should the athletic trainer do FIRST?

1. Drag the athlete away from the cord
   Dragging the athlete risks contact with the energized water and cord.
2. Have the power shut off first
   Power must be shut off first; touching the athlete or the water near a live cord can electrocute the rescuer.
3. Check responsiveness right away
   Checking responsiveness means touching the athlete while the hazard is still live.
4. Begin chest compressions
   Compressions put the rescuer in contact with a possibly energized victim and water.

A cross-country skier has frostbite on the toes on a trail 2 hours from the lodge. What should the athletic trainer do?

1. Rub the toes vigorously to rewarm them
   Rubbing frostbitten tissue damages it further.
2. Rewarm in 115 °F (46 °C) water now
   Rewarming water should be about 98.6–102 °F (37–39 °C); 115 °F (46 °C) can burn numb tissue.
3. Protect the toes and delay rewarming
   If the toes could refreeze during a 2-hour trip, rewarming is delayed and the toes are protected, because thaw-refreeze causes more damage.
4. Rewarm now, then ski back to the lodge
   Skiing on rewarmed toes risks refreezing, which is worse than delaying rewarming.

A wrestler lies prone on the mat reporting neck pain and tingling in both arms after a takedown. What should the athletic trainer do FIRST?

1. Help the athlete sit up to assess
   Sitting the athlete up moves an unstable spine.
2. Log-roll the athlete to supine at once
   Log-rolling a conscious, breathing athlete is not urgent and comes after stabilization and enough trained help.
3. Ask the athlete to move the neck slowly
   Asking the athlete to move the neck risks worsening a spinal cord injury.
4. Manually stabilize the head and neck
   Neck pain with tingling in both arms means a possible cervical spine injury, so the first step is manual stabilization of the head and neck.

After a slide tackle, a soccer player has a tibial fracture with bone protruding through the skin. Distal pulse and sensation are present. What should the athletic trainer do?

1. Push the bone back under the skin
   Pushing the bone back drags contamination into the wound.
2. Irrigate the wound and close it with strips
   Wound irrigation and closure are hospital procedures; closing it in the field traps contamination.
3. Realign the leg before applying the splint
   Realigning a limb with intact pulse and sensation adds pain and tissue damage.
4. Dress the wound and splint as found
   An open fracture is covered with a sterile dressing and splinted in the position found.

During a cardiac arrest at a basketball game, the AED delivers a shock. What should the athletic trainer do immediately after the shock?

1. Resume chest compressions
   After a shock, compressions restart at once for 2 minutes before the next rhythm check.
2. Press the shock button again
   The AED decides when the next shock is needed after reanalysis.
3. Check for normal breathing
   Checking breathing right after the shock delays compressions; the AED reanalyzes after 2 minutes.
4. Check the carotid pulse
   Checking the pulse right after a shock delays compressions.

An athletic trainer is about to give an epinephrine auto-injector to a lacrosse player in anaphylaxis. Where should it be given?

1. Deltoid of the upper arm
   The deltoid is a smaller muscle and is not the auto-injector site.
2. Anterolateral thigh
   Epinephrine auto-injectors go into the anterolateral thigh, through clothing if needed.
3. Lower abdomen
   The abdomen is not a site for auto-injector epinephrine.
4. Upper outer buttock
   The buttock risks injection into fat or near the sciatic nerve.

Ten minutes after an epinephrine auto-injector, a tennis player's hives and wheezing from a food allergy have resolved. She feels fine and asks to skip the hospital. What should the athletic trainer do?

1. Release her to her parents
   Releasing her to her parents leaves her without medical observation for a second reaction.
2. Monitor on site for 1 hour, then release
   Monitoring on site for an hour is too short and lacks hospital care.
3. Arrange transport to the ED
   After epinephrine for anaphylaxis, the athlete goes to the emergency department because symptoms can return.
4. Let her return to practice in 30 minutes
   A return to practice ignores the risk of a second, biphasic reaction.

A hurdler falls onto a broken hurdle and has a deep wound in the groin crease with bright red blood spurting from it. Firm direct pressure with a dressing is not controlling the bleeding, and EMS has been called. What should the athletic trainer do NEXT?

1. Elevate the leg and add more dressings
   Elevating and adding dressings has failed to stop arterial bleeding and is not recommended.
2. Pack the wound with gauze and press
   A groin-crease wound is junctional, where a limb tourniquet cannot be placed, so it is packed with gauze and pressed firmly.
3. Apply a tourniquet above the wound
   A tourniquet needs room on the limb above the wound, and the groin crease leaves none.
4. Compress the femoral pressure point
   Pressure points are no longer recommended because they do not reliably control bleeding.

A cyclist has an isolated mid-shaft femur fracture with the thigh shortened and angulated. There is no hip, knee, ankle or pelvic injury, and distal pulses are present. Which splint is MOST appropriate?

1. Air splint
   An air splint does not counteract the thigh muscle spasm that shortens the femur.
2. Sling and swathe
   A sling and swathe is for upper-extremity injuries.
3. Short padded board
   A short board cannot span the hip and knee to immobilize a femur.
4. Traction splint
   An isolated midshaft femur fracture with shortening is splinted with a traction splint.

During a high school track meet, the National Weather Service issues a tornado warning for the area. The school building has a windowless interior hallway on its ground floor. Where should the athletic trainer direct athletes and spectators?

1. Open ground, away from buildings
   An open field exposes everyone to flying debris.
2. Their cars in the parking lot
   Cars offer little protection from tornado winds and debris.
3. The ground-floor interior hallway
   A windowless interior hallway on the lowest floor of a sturdy building is the safest place in a tornado.
4. Under the stadium bleachers
   Bleachers can collapse or become debris.

An athletic trainer is treating a grade II quadriceps strain with cold. Which finding BEST indicates that the inflammatory phase has settled enough to begin heat?

1. Ecchymosis has turned yellow-green
   Bruise color shows blood breakdown, not whether inflammation has settled.
2. Exactly 72 hours have passed
   A fixed 72 hours ignores how the tissue is responding; signs, not the clock, decide the switch.
3. Swelling and warmth no longer increasing
   Heat is safe once swelling and warmth stop increasing, which shows the acute inflammatory response has settled.
4. Pain-free full range has returned
   Full pain-free range is a much later goal and is not needed before heat is used.

A 52-year-old patient with adhesive capsulitis is in the stiffness-dominant (frozen) stage: pain is now low, and external rotation is limited with a firm capsular end-feel. Which mobilization should the athletic trainer use to gain external rotation?

1. Grade IV oscillations into tissue resistance
   Grade IV oscillations into tissue resistance stretch the stiff capsule once pain is low.
2. Grade I oscillations at the start of the range
   Grade I oscillations are small movements at the very start of the range; they never reach the stiff capsule, so they cannot gain external rotation.
3. Grade II oscillations short of tissue resistance
   Grade II oscillations stay short of tissue resistance, so the stiff capsule is never loaded and external rotation does not improve.
4. Grade V high-velocity thrust at end range
   A grade V thrust is not part of mobilization for adhesive capsulitis and can injure the capsule.

A 20-year-old basketball player has had fever, sore throat, fatigue, and swollen posterior cervical lymph nodes for a week, and a positive monospot test. Which complication is the PRIMARY reason to restrict contact activity?

1. Splenic rupture
   Mononucleosis enlarges the spleen, and splenic rupture is the main reason to restrict contact.
2. Liver failure
   Liver involvement is usually mild in mononucleosis, and failure is rare.
3. Dehydration from fever
   Fever-related dehydration is managed with fluids and does not drive the contact restriction.
4. Spread to teammates
   Spread to teammates is limited by not sharing water bottles; it is not the reason contact is restricted.

The athletic trainer usually heats a patient's patellar tendon with ultrasound and now needs to heat the piriformis, about 4 cm deep. Which parameter change is required?

1. Duty cycle from 50% to 100%
   Continuous output makes treatment thermal but does not change how deep the energy goes.
2. Treatment time from 5 to 10 minutes
   A longer treatment time does not change depth of penetration.
3. Frequency from 3 MHz to 1 MHz
   Depth is set by frequency, so 1 MHz reaches the piriformis at about 4 cm, while 3 MHz heats superficial tissue.
4. Intensity from 1.0 to 2.0 W/cm²
   Raising intensity at 3 MHz heats superficial tissue more without reaching 4 cm.

The athletic trainer needs to apply ultrasound over the bony, irregular surface of a patient's lateral malleolus. Which coupling technique is MOST appropriate?

1. Gel, soundhead held stationary
   A stationary soundhead concentrates energy and risks hot spots and periosteal pain.
2. Underwater, soundhead 10 cm away
   At 10 cm away, too much energy is lost in the water before it reaches the tissue.
3. Gel, with a larger 10 cm² soundhead
   A larger soundhead makes even less contact with a small, irregular bony surface.
4. Underwater, soundhead about 1 cm away
   Over a bony, uneven surface, the part is treated underwater with the soundhead held about 0.5–3 cm away, so water couples the sound to the whole surface.

An athletic trainer sets up iontophoresis to deliver a prescribed anti-inflammatory medication to a tendon. Which type of current must the unit deliver?

1. High-voltage pulsed current
   High-voltage pulsed current has pulses too short to move a meaningful drug dose.
2. Continuous direct current
   Iontophoresis needs continuous direct current to drive charged medication into the tissue.
3. Biphasic pulsed current
   Biphasic pulsed current alternates polarity and cannot push ions in one direction.
4. Interferential current
   Interferential current is alternating and does not move ions.

Eight weeks after a grade II lateral ankle sprain, the ligament is in the maturation-remodeling phase of healing. Which rehabilitation emphasis matches this phase?

1. Strict immobilization in a boot
   Strict immobilization at 8 weeks weakens the remodeling ligament.
2. Cryotherapy and elevation for swelling
   Cryotherapy and elevation target the acute inflammatory phase, not remodeling.
3. Progressive functional loading
   In the maturation-remodeling phase, progressive functional loading aligns and strengthens the new collagen.
4. Pain-free passive motion only
   Passive motion only is too little load for tissue that is remodeling.

A high school wrestler has honey-colored, crusted lesions around the nose. What should the athletic trainer do?

1. Apply antifungal cream and allow practice
   Impetigo is a bacterial infection, so antifungal cream does not treat it.
2. Refer and hold from contact until cleared
   Honey-crusted lesions suggest impetigo, so the wrestler is referred and held from contact until a physician clears return.
3. Cover the lesions and allow full practice
   Covering active lesions does not make a wrestler eligible; impetigo still spreads on the mat.
4. Apply hydrocortisone and allow practice
   Hydrocortisone does not treat the infection and can make it worse.

A patient with subacromial pain needs supraspinatus strengthening. Which exercise should the athletic trainer select?

1. Full-can raise in the scapular plane
   The full-can raise works the supraspinatus with the humerus externally rotated, which keeps the subacromial space open.
2. Upright row to shoulder height
   The upright row raises the arm in internal rotation and compresses the subacromial space.
3. Behind-the-neck overhead press
   The behind-the-neck press stresses the shoulder in abduction and external rotation and does not isolate the supraspinatus.
4. Empty-can raise in the scapular plane
   The empty-can position adds internal rotation, which narrows the subacromial space and provokes pain.

Seven months after ACL reconstruction, a patient hops 150 cm on the involved limb and 180 cm on the uninvolved limb. If the return-to-sport criterion is a limb symmetry index of 90% or more, how should the result be interpreted?

1. 17%; criterion is not yet met
   17% is the deficit (100% − 83%), not the symmetry index.
2. 30%; the criterion is not met
   30% is the difference in centimeters, not a symmetry index.
3. 120%; criterion is met
   120% comes from dividing the uninvolved limb by the involved limb.
4. 83%; criterion not yet met
   LSI = 150 ÷ 180 × 100 ≈ 83%, below the 90% criterion.

An athletic trainer vigorously heats the triceps surae with 1 MHz continuous ultrasound to improve ankle dorsiflexion. When should the stretch be performed?

1. During and right after heating
   Stretching during and right after heating uses the brief window before the tissue cools.
2. About 10 minutes after heating
   Ten minutes after heating, the tissue has largely cooled and the benefit is lost.
3. At the next day's session
   The next day's session is far outside the stretching window.
4. Before heating begins
   Stretching before heating misses the effect of the heat altogether.

Which set of findings indicates that a patient after ACL reconstruction is ready to begin a return-to-running program?

1. Pain-free walking for 30 minutes
   Pain-free walking is an earlier milestone and does not show readiness for running loads.
2. Twelve weeks post-op, regardless of findings
   Time since surgery alone ignores whether the knee is ready.
3. Quad LSI ≥ 70% with a moderate effusion
   A moderate effusion shows the knee is not tolerating its current load, even with quadriceps strength at 70%.
4. Full extension, trace effusion, quad LSI ≥ 70%
   Return to running is typically gated by full extension, no more than a trace effusion and quadriceps strength of about 70% of the other limb.

The athletic trainer wants to reduce a patient's acute ankle pain through the gate control mechanism with TENS. Which parameters are MOST appropriate?

1. 50 pps, 10 seconds on/50 seconds off
   50 pps with an on/off cycle is an NMES setting for muscle strengthening.
2. 80–150 pps at sensory level
   Gate control is activated by high-rate, sensory-level TENS, about 80–150 pps.
3. 2–4 pps at motor level
   2–4 pps at motor level is the low-rate TENS setting, which relies on endogenous opioid release rather than gate control.
4. 1–5 pps at noxious level
   1–5 pps at a noxious level is the noxious stimulation approach, not gate control.

A 20-year-old athlete with a suspected scaphoid fracture refuses referral for radiographs so he can play this weekend. Which documentation is MOST important?

1. The coach's agreement with his decision
   The coach's agreement has no bearing on the athlete's informed decision.
2. A general liability waiver signed by him
   A general liability waiver does not show that the specific risks of refusing referral were explained.
3. A note that he declined referral
   A note that he declined referral leaves out the explanation of risks that makes the refusal informed.
4. His informed refusal after risks explained
   Informed refusal records that the risks were explained and the athlete still declined, which best protects both parties.

A 17-year-old athlete who is married and legally emancipated under state law asks the athletic trainer to treat her ankle sprain. Who may consent to her treatment?

1. A guardian ad litem must consent
   A guardian ad litem is appointed by a court for a case and does not consent to routine care.
2. No one; only emergency care is allowed
   She can consent, so care is not limited to emergencies.
3. A parent must still consent
   Emancipation removes the need for parental consent.
4. She may consent for herself
   An emancipated minor may consent to her own medical care.

The next morning, an athletic trainer realizes that yesterday's treatment of an athlete's hamstring strain was never documented. How should the note be entered?

1. Enter it with yesterday's date and time
   Entering it with yesterday's date backdates the record and misrepresents when it was written.
2. Enter it now, labeled as a late entry
   A missed note is entered now and labeled as a late entry with the current date and time.
3. Skip it, since the treatment is already complete
   Skipping the note leaves the treatment undocumented and the record incomplete.
4. Add it to today's note as if done today
   Adding it to today's note as if done today misrepresents the record.

Before a home football game, an athletic trainer notices that a colleague is slurring words and smells of alcohol. What should the athletic trainer do?

1. Let the colleague handle only taping duties
   Taping duties are still patient care, so an impaired clinician should not do them.
2. Report it after the game to avoid disruption
   Reporting after the game leaves athletes in the care of an impaired clinician.
3. Relieve the colleague and report it
   An impaired clinician is relieved from patient care at once and reported through proper channels.
4. Cover the colleague's duties and say nothing
   Covering the duties in silence leaves an impaired provider and an unreported problem.

A 20-year-old female runner's DXA scan shows a lumbar spine Z-score of −1.4. How should the athletic trainer interpret this result?

1. Normal BMD for age
   Calling −1.4 normal applies the general-population cutoff of −2.0; weight-bearing sport should keep an athlete above average, not below it.
2. Osteoporosis by T-score criteria
   T-scores compare bone density with young-adult peak values and are used for postmenopausal women and older men, not a 20-year-old.
3. Low bone density for an athlete
   For athletes in weight-bearing sports, the Female Athlete Triad Coalition treats a Z-score below −1.0 as low bone density, so −1.4 needs follow-up.
4. Osteopenia by T-score criteria
   Osteopenia is a T-score category; a premenopausal athlete's DXA is read with the age-matched Z-score instead.

The athletic trainer is fitting a football helmet with the player's hair wet. Which finding indicates correct fit?

1. Front rim about 1 in (2.5 cm) above the eyebrows
   A correctly fitted helmet sits with the front rim about one inch, roughly two finger widths, above the eyebrows.
2. Front rim resting directly on the eyebrows
   A rim on the eyebrows sits too low, blocks upward vision and means the helmet is too large or tilted forward.
3. Front rim about 3 in (7.6 cm) above the eyebrows
   A rim 3 inches up leaves the forehead exposed, a sign the helmet is too small or tilted back.
4. Ear holes sitting just below the ear canals
   The ear holes should line up with the ear canals; sitting below them means the helmet rides too low.

A distance runner has lateral knee pain that begins at the same point in each run. With the patient supine, pressing over the lateral femoral condyle while extending the knee from 90 degrees reproduces pain at about 30 degrees of flexion. What is the MOST likely condition?

1. Iliotibial band syndrome
   Pain at about 30° of flexion while pressing over the lateral femoral condyle (Noble compression) points to iliotibial band syndrome.
2. Lateral meniscus tear
   A lateral meniscus tear causes joint-line pain and catching, not pain under the condyle at a set angle during runs.
3. Popliteus tendinopathy
   Popliteus tendinopathy hurts at the posterolateral corner, often on downhill running, and is not reproduced by this compression.
4. Biceps femoris tendinopathy
   Biceps femoris tendinopathy is tender at the fibular head and hurts with resisted knee flexion.

During a preparticipation screen, a 13-year-old gymnast has uneven shoulder heights. When the patient bends forward at the waist, a rib hump appears on the right side. What does this finding MOST suggest?

1. Structural scoliosis
   A rib hump on forward bending shows vertebral rotation, which marks a structural scoliosis.
2. Leg-length discrepancy
   A leg-length discrepancy causes a functional curve that disappears on forward bending.
3. Thoracic hyperkyphosis
   Hyperkyphosis is a sagittal-plane rounding, not a lateral curve with a one-sided rib hump.
4. Functional scoliosis
   A functional scoliosis straightens on forward bending and leaves no rib hump.

A marathon runner is confused and vomiting at the finish. The runner reports drinking water at every aid station and has gained weight during the race. Rectal temperature is 101 degrees F (38.3 degrees C), and an on-site sodium level is 126 mEq/L. What is the MOST appropriate action?

1. Give water or sports drink by mouth
   Water or sports drink adds fluid and lowers sodium further.
2. Start isotonic IV fluids and observe
   Isotonic IV fluids add volume that a water-retaining runner cannot clear and can lower sodium further; hyponatremia with neurological signs is treated with hypertonic saline in a hospital.
3. Restrict fluids and transport urgently
   Confusion and vomiting with weight gain and a sodium of 126 mEq/L point to exercise-associated hyponatremia with neurological signs, so fluids are restricted and the runner is transported.
4. Cold-water immersion to 102 degrees F
   Cold-water immersion treats heat stroke, and this runner's temperature is not elevated enough for that.

Six weeks after an ankle sprain, a patient lacks ankle dorsiflexion with a capsular end-feel at the talocrural joint. Which mobilization should the athletic trainer use?

1. Posterior glide of the talus
   By the convex-concave rule, the convex talus glides posteriorly during dorsiflexion, so posterior glide restores it.
2. Anterior glide of the talus
   Anterior talar glide accompanies plantar flexion and would not improve dorsiflexion.
3. Distal distraction of the fibula
   Distal fibular distraction is not the glide that restores talocrural dorsiflexion.
4. Lateral glide of the calcaneus
   Lateral calcaneal glide targets the subtalar joint, not talocrural dorsiflexion.

An athletic trainer wants to analyze 5 years of existing injury records from the clinic and publish the findings in a journal. What should the athletic trainer do FIRST?

1. Get approval from the athletic director
   The athletic director cannot approve research involving human subjects.
2. Submit the project for IRB review
   Publishing research using patient records needs IRB review before the work starts.
3. Proceed if the data are labeled as QI
   Calling it quality improvement does not avoid IRB review when the aim is publication.
4. Proceed, since the data already exist
   Existing data still contain protected health information, and publication makes this research.

A 24-year-old wrestler has neck pain radiating into the right forearm. Extending the neck, laterally flexing it to the right, and applying axial compression reproduces the arm pain. Which condition does this finding MOST suggest?

1. Brachial plexus traction injury
   A brachial plexus traction injury is provoked by stretching the neck away from the symptomatic side, not by compression toward it.
2. Thoracic outlet syndrome
   Thoracic outlet syndrome is provoked by arm and shoulder positions, not by foraminal compression.
3. Cervical facet joint irritation
   Facet irritation hurts with the same movement, but the pain stays in the neck rather than radiating into the forearm.
4. Cervical radiculopathy
   Extension, side bending toward the painful side and axial compression narrow the foramen; reproducing arm pain is a positive Spurling test for cervical radiculopathy.

After an eversion and external rotation ankle injury, a soccer player has tenderness over the deltoid ligament and at the proximal fibula just below the knee. Which injury MUST be suspected?

1. Maisonneuve fracture
   Deltoid tenderness after external rotation plus proximal fibula pain means a Maisonneuve fracture must be suspected and imaged.
2. Common fibular nerve contusion
   A common fibular nerve contusion follows a direct blow and gives sensory or motor signs rather than bone tenderness after an ankle twist.
3. Proximal tibiofibular joint sprain
   A proximal tibiofibular sprain comes from twisting at the knee, not from an external rotation ankle mechanism with a deltoid injury.
4. Isolated deltoid sprain
   An isolated deltoid sprain does not explain pain at the proximal fibula and misses an unstable injury.

A football player has a grade I sprain of the first metatarsophalangeal joint (turf toe) and is returning to practice. Which intervention should the athletic trainer use?

1. Tape limiting great-toe plantar flexion
   Limiting plantar flexion does not block the dorsiflexion that injured the joint.
2. A heel lift in both shoes
   A heel lift targets the Achilles and does nothing to limit toe dorsiflexion.
3. Tape limiting great-toe dorsiflexion
   Turf toe is a hyperextension injury of the first MTP joint, so tape limiting great-toe dorsiflexion protects it.
4. A flexible, soft-soled shoe
   A flexible shoe lets the great toe bend further into dorsiflexion.

A basketball player was elbowed in the jaw. Which finding MOST suggests a mandibular fracture?

1. Clicking of the TMJ on opening
   TMJ clicking reflects a displaced disc in the joint, not a broken mandible.
2. Tenderness over the masseter
   Masseter tenderness is expected with a simple contusion of the jaw muscles.
3. Pain biting on a tongue blade
   Pain when biting down on a tongue blade that is then twisted loads the mandible and points to a fracture.
4. Flattened cheek over the zygoma
   A flattened cheek points to a zygomatic fracture, not a mandibular one.