Shadow Health Musculoskeletal System -
Ezra Levy | Complete Focused Exam,
Right Ankle Injury, Subjective &
1. A patient reports an inversion ankle injury while stepping off a curb. Which
subjective finding is MOST critical to obtain first?
A. Whether the patient heard or felt a pop at the time of injury
B. The patient's usual shoe size and brand
C. The patient's dietary calcium intake
D. Whether the patient has ever had a foot X-ray
Answer: A. Whether the patient heard or felt a pop at the time of injury
Rationale: A pop or snap suggests ligamentous rupture or fracture, which directly changes
urgency and imaging decisions. Shoe size, calcium intake, and prior X-rays are less
immediately relevant to acute injury triage.
2. Which structure is MOST commonly injured in an inversion ankle sprain?
A. Anterior talofibular ligament
B. Deltoid ligament
C. Posterior tibiofibular ligament
D. Plantar fascia
Answer: A. Anterior talofibular ligament
Rationale: Inversion forces stress the lateral ligament complex, with the anterior
talofibular ligament being the most frequently injured. The deltoid ligament is injured with
eversion, and the plantar fascia is not a lateral ankle stabilizer.
Page 1 of 73
,3. According to the Ottawa Ankle Rules, which finding mandates radiographic
imaging?
A. Bone tenderness at the posterior edge of the distal 6 cm of the fibula
B. Swelling that resolves with elevation
C. Pain with active dorsiflexion only
D. A history of a previous sprain
Answer: A. Bone tenderness at the posterior edge of the distal 6 cm of the fibula
Rationale: The Ottawa Ankle Rules require imaging if there is tenderness at the posterior
edge or tip of the distal 6 cm of the fibula or tibia, or inability to bear weight. Swelling that
resolves, isolated dorsiflexion pain, and prior sprain do not meet imaging criteria.
4. When assessing neurovascular status of an injured ankle, which combination is
MOST appropriate?
A. Capillary refill, dorsalis pedis pulse, and sensation of the first web space
B. Radial pulse, pupil response, and grip strength
C. Temperature of the contralateral knee and thigh
D. Deep tendon reflexes at the patella
Answer: A. Capillary refill, dorsalis pedis pulse, and sensation of the first web space
Rationale: Neurovascular assessment of the ankle includes distal pulses (dorsalis pedis,
posterior tibial), capillary refill, and sensation, particularly the deep peroneal nerve
distribution in the first web space. The other options assess unrelated areas or systems.
Page 2 of 73
,5. A patient has swelling over the lateral malleolus and pain with weight-bearing.
Which documentation entry is MOST precise?
A. Right lateral ankle edema and tenderness noted; unable to bear weight without pain.
B. Ankle looks bad and hurts a lot.
C. Patient has a sprained ankle.
D. Some swelling and pain in the leg.
Answer: A. Right lateral ankle edema and tenderness noted; unable to bear weight
without pain.
Rationale: Objective documentation should specify location (right lateral), finding (edema,
tenderness), and functional limitation (unable to bear weight). The other entries are vague,
subjective, or lack laterality and specificity.
6. Which special test is used to assess for an anterior talofibular ligament injury?
A. Anterior drawer test
B. McMurray test
C. Lachman test
D. Phalen test
Answer: A. Anterior drawer test
Rationale: The anterior drawer test assesses the anterior talofibular ligament by
translating the talus forward. McMurray and Lachman assess the knee, and Phalen tests
for carpal tunnel syndrome.
Page 3 of 73
, 7. A patient with an acute ankle injury is prescribed RICE. Which instruction reflects
current best practice?
A. Apply ice for 20 minutes every 2 hours while awake.
B. Apply heat continuously for the first 48 hours.
C. Avoid all movement for 6 weeks.
D. Massage the area vigorously to reduce swelling.
Answer: A. Apply ice for 20 minutes every 2 hours while awake.
Rationale: Current RICE guidance recommends ice for approximately 20 minutes every 2
hours during the acute phase to reduce inflammation. Heat, prolonged immobilization, and
vigorous massage would worsen acute swelling and injury.
8. Which finding during the focused exam would MOST suggest a fracture rather than
a sprain?
A. Bony tenderness at the distal fibular tip with inability to bear weight
B. Mild swelling that improves with elevation
C. Pain reproduced only with inversion
D. Ecchymosis appearing after 24 hours
Answer: A. Bony tenderness at the distal fibular tip with inability to bear weight
Rationale: Focal bony tenderness at the distal fibular tip and inability to bear weight are
Ottawa Ankle Rule criteria that raise suspicion for fracture. Swelling, isolated inversion
pain, and delayed ecchymosis are common in sprains.
Page 4 of 73
Ezra Levy | Complete Focused Exam,
Right Ankle Injury, Subjective &
1. A patient reports an inversion ankle injury while stepping off a curb. Which
subjective finding is MOST critical to obtain first?
A. Whether the patient heard or felt a pop at the time of injury
B. The patient's usual shoe size and brand
C. The patient's dietary calcium intake
D. Whether the patient has ever had a foot X-ray
Answer: A. Whether the patient heard or felt a pop at the time of injury
Rationale: A pop or snap suggests ligamentous rupture or fracture, which directly changes
urgency and imaging decisions. Shoe size, calcium intake, and prior X-rays are less
immediately relevant to acute injury triage.
2. Which structure is MOST commonly injured in an inversion ankle sprain?
A. Anterior talofibular ligament
B. Deltoid ligament
C. Posterior tibiofibular ligament
D. Plantar fascia
Answer: A. Anterior talofibular ligament
Rationale: Inversion forces stress the lateral ligament complex, with the anterior
talofibular ligament being the most frequently injured. The deltoid ligament is injured with
eversion, and the plantar fascia is not a lateral ankle stabilizer.
Page 1 of 73
,3. According to the Ottawa Ankle Rules, which finding mandates radiographic
imaging?
A. Bone tenderness at the posterior edge of the distal 6 cm of the fibula
B. Swelling that resolves with elevation
C. Pain with active dorsiflexion only
D. A history of a previous sprain
Answer: A. Bone tenderness at the posterior edge of the distal 6 cm of the fibula
Rationale: The Ottawa Ankle Rules require imaging if there is tenderness at the posterior
edge or tip of the distal 6 cm of the fibula or tibia, or inability to bear weight. Swelling that
resolves, isolated dorsiflexion pain, and prior sprain do not meet imaging criteria.
4. When assessing neurovascular status of an injured ankle, which combination is
MOST appropriate?
A. Capillary refill, dorsalis pedis pulse, and sensation of the first web space
B. Radial pulse, pupil response, and grip strength
C. Temperature of the contralateral knee and thigh
D. Deep tendon reflexes at the patella
Answer: A. Capillary refill, dorsalis pedis pulse, and sensation of the first web space
Rationale: Neurovascular assessment of the ankle includes distal pulses (dorsalis pedis,
posterior tibial), capillary refill, and sensation, particularly the deep peroneal nerve
distribution in the first web space. The other options assess unrelated areas or systems.
Page 2 of 73
,5. A patient has swelling over the lateral malleolus and pain with weight-bearing.
Which documentation entry is MOST precise?
A. Right lateral ankle edema and tenderness noted; unable to bear weight without pain.
B. Ankle looks bad and hurts a lot.
C. Patient has a sprained ankle.
D. Some swelling and pain in the leg.
Answer: A. Right lateral ankle edema and tenderness noted; unable to bear weight
without pain.
Rationale: Objective documentation should specify location (right lateral), finding (edema,
tenderness), and functional limitation (unable to bear weight). The other entries are vague,
subjective, or lack laterality and specificity.
6. Which special test is used to assess for an anterior talofibular ligament injury?
A. Anterior drawer test
B. McMurray test
C. Lachman test
D. Phalen test
Answer: A. Anterior drawer test
Rationale: The anterior drawer test assesses the anterior talofibular ligament by
translating the talus forward. McMurray and Lachman assess the knee, and Phalen tests
for carpal tunnel syndrome.
Page 3 of 73
, 7. A patient with an acute ankle injury is prescribed RICE. Which instruction reflects
current best practice?
A. Apply ice for 20 minutes every 2 hours while awake.
B. Apply heat continuously for the first 48 hours.
C. Avoid all movement for 6 weeks.
D. Massage the area vigorously to reduce swelling.
Answer: A. Apply ice for 20 minutes every 2 hours while awake.
Rationale: Current RICE guidance recommends ice for approximately 20 minutes every 2
hours during the acute phase to reduce inflammation. Heat, prolonged immobilization, and
vigorous massage would worsen acute swelling and injury.
8. Which finding during the focused exam would MOST suggest a fracture rather than
a sprain?
A. Bony tenderness at the distal fibular tip with inability to bear weight
B. Mild swelling that improves with elevation
C. Pain reproduced only with inversion
D. Ecchymosis appearing after 24 hours
Answer: A. Bony tenderness at the distal fibular tip with inability to bear weight
Rationale: Focal bony tenderness at the distal fibular tip and inability to bear weight are
Ottawa Ankle Rule criteria that raise suspicion for fracture. Swelling, isolated inversion
pain, and delayed ecchymosis are common in sprains.
Page 4 of 73
