NATA-BOC Clinical Evaluation and Diagnosis Questions and Answers 1 — Questions and Answers
Question 1: An athlete lands awkwardly from a jump and reports an audible 'pop' in the knee, followed by immediate effusion and a feeling of instability. During the on-field examination, the athletic trainer performs a Lachman's test, which reveals excessive anterior tibial translation with a soft end-feel. Which injury is most likely present?
- Medial Collateral Ligament (MCL) Sprain
- Meniscus Tear
- Anterior Cruciate Ligament (ACL) Tear (Correct answer)
- Patellar Dislocation
Correct answer: Anterior Cruciate Ligament (ACL) Tear
The mechanism of injury (awkward landing), audible 'pop', significant effusion, and feeling of instability are classic signs of an ACL tear. A positive Lachman's test, especially with a soft end-feel, is considered the most accurate clinical test for diagnosing an ACL rupture.
Question 2: Which of the following represents the subjective portion of a standard SOAP note?
- The athlete's description of the mechanism of injury and pain level. (Correct answer)
- Measurements of range of motion and results of special tests.
- The athletic trainer's clinical diagnosis of the injury.
- The plan for treatment, including short-term and long-term goals.
Correct answer: The athlete's description of the mechanism of injury and pain level.
The 'S' in SOAP stands for Subjective. This section includes all information reported by the athlete, such as their chief complaint, mechanism of injury, pain description, and feelings about the condition. The other options belong in the Objective (B), Assessment (C), and Plan (D) sections.
Question 3: A soccer player presents with a gradual onset of anterior knee pain that is worse when running downhill and after prolonged sitting. Palpation reveals point tenderness over the inferior pole of the patella, and resisted knee extension is painful. Which condition is most consistent with these findings?
- Iliotibial (IT) Band Syndrome
- Osgood-Schlatter Disease
- Patellofemoral Pain Syndrome (PFPS)
- Patellar Tendinopathy (Correct answer)
Correct answer: Patellar Tendinopathy
This presentation is classic for patellar tendinopathy (Jumper's Knee). Key features include localized pain at the inferior pole of the patella, aggravation with eccentric loading (running downhill), and pain with resisted knee extension. PFPS pain is typically more diffuse around the patella, IT band syndrome is lateral, and Osgood-Schlatter disease involves the tibial tuberosity.
Question 4: During a neurological screening of the upper extremity, an athletic trainer finds weakness during resisted shoulder abduction and diminished sensation over the deltoid patch area. Which nerve root is most likely implicated?
- C4
- C5 (Correct answer)
- C6
- C7
Correct answer: C5
The C5 nerve root provides motor innervation to the deltoid muscle (shoulder abduction) and sensory innervation to the lateral aspect of the upper arm, known as the deltoid patch area. Therefore, weakness and sensory loss in this specific pattern strongly suggest C5 nerve root involvement.
Question 5: Which of the following best describes the normal physiological end-feel an athletic trainer should expect when performing passive wrist flexion on a healthy individual?
- Bone to Bone
- Firm (Correct answer)
- Soft
- Empty
Correct answer: Firm
A firm end-feel is expected during passive wrist flexion due to the tension created by the stretching of the posterior radiocarpal ligament, dorsal joint capsule, and wrist extensor muscles. A soft end-feel is due to soft tissue approximation (e.g., knee flexion), a bone-to-bone end-feel is hard (e.g., elbow extension), and an empty end-feel is when the patient stops the movement due to pain.
Question 6: What is the primary purpose of performing a hip scour test during a clinical evaluation?
- To assess for a femoral stress fracture
- To measure the degree of femoral anteversion
- To detect intra-articular pathology such as a labral tear or osteoarthritis (Correct answer)
- To isolate and test for piriformis syndrome
Correct answer: To detect intra-articular pathology such as a labral tear or osteoarthritis
The hip scour test involves moving the hip through an arc of motion while applying a compressive force. This maneuver is designed to compress and shear the articular surfaces and labrum. Reproduction of the patient's symptoms (pain, clicking, or catching) suggests the presence of intra-articular pathology like a labral tear, chondral defect, or osteoarthritis.
