CCEP Clinical Decision Making 4 — Questions and Answers
Question 1: A patient with knee pain has a positive McMurray's test with a palpable click on external tibial rotation. Which meniscus is most likely torn?
- Lateral meniscus
- Medial meniscus (Correct answer)
- Both menisci equally
- Neither — this tests the PCL
Correct answer: Medial meniscus
McMurray's test with external tibial rotation stresses the medial meniscus; a click or pain at the medial joint line indicates a medial meniscal tear.
Question 2: During examination of the wrist, which provocative test is used to identify de Quervain's tenosynovitis?
- Phalen's test
- Tinel's sign at the wrist
- Finkelstein's test (Correct answer)
- Allen's test
Correct answer: Finkelstein's test
Finkelstein's test (thumb in fist with ulnar deviation) stretches the APL and EPB tendons through their sheath, reproducing pain in de Quervain's tenosynovitis.
Question 3: A CCEP practitioner is assessing gait and notes the patient's ipsilateral pelvis drops during the mid-stance phase. This Trendelenburg sign indicates weakness of which muscle?
- Ipsilateral adductors
- Contralateral gluteus medius
- Ipsilateral gluteus medius (Correct answer)
- Contralateral hip flexors
Correct answer: Ipsilateral gluteus medius
A positive Trendelenburg sign indicates weakness of the ipsilateral gluteus medius, which normally prevents pelvic drop during single-leg stance.
Question 4: Which imaging modality is most appropriate as a first-line study for evaluating a suspected rotator cuff tear in an acute setting?
- CT arthrogram
- Plain film X-ray
- Ultrasound
- MRI without contrast (Correct answer)
Correct answer: MRI without contrast
MRI without contrast is the gold standard for evaluating rotator cuff pathology, providing excellent soft tissue contrast for both partial and full-thickness tears.
Question 5: A runner presents with lateral knee pain that increases around the 2-km mark and resolves with rest. Noble compression test is positive. What is the most likely diagnosis?
- Lateral meniscus tear
- Biceps femoris tendinopathy
- Iliotibial band syndrome (Correct answer)
- Common peroneal nerve entrapment
Correct answer: Iliotibial band syndrome
IT band syndrome presents with predictable onset at a specific running distance and a positive Noble compression test at 30° knee flexion (2 cm proximal to the lateral epicondyle).
Question 6: When determining the need for orthotic intervention in a patient with plantar fasciitis, which biomechanical finding most strongly supports custom orthotic prescription?
- Mild forefoot supination
- Excessive rearfoot pronation with reduced subtalar joint motion (Correct answer)
- High-arched rigid foot (pes cavus)
- Leg length discrepancy less than 5 mm
Correct answer: Excessive rearfoot pronation with reduced subtalar joint motion
Excessive rearfoot pronation increases tension on the plantar fascia during midstance; custom orthotics that control rearfoot pronation reduce this pathological load.
Question 7: A 35-year-old female presents with shoulder pain and positive Speed's test (resisted shoulder flexion with elbow extended and forearm supinated). Which structure is most likely involved?
- Supraspinatus tendon
- Long head of the biceps tendon (Correct answer)
- Acromioclavicular joint
- Subscapularis tendon
Correct answer: Long head of the biceps tendon
Speed's test resists the long head of the biceps tendon as it courses through the bicipital groove; a positive test (pain in the groove) indicates bicipital tendinopathy.
CCEP Clinical Decision Making 4
A patient with knee pain has a positive McMurray's test with a palpable click on external tibial rotation.
Which meniscus is most likely torn?