Prometric Exam Questions for Sports Medicine Specialists 2026: 20 MCQs with Answers on Concussion, Heat Illness, ACL and Meniscal Injury, Ankle Sprains, Stress Fractures, Tendinopathy, Exercise Prescription, Cardiac Screening, Anti-doping and Return to Play

The specialist sports medicine paper (SPM5792 at DHA, and the equivalents at SCFHS, QCHP, NHRA and the other authorities) is 100 to 150 single-best-answer questions in up to three hours with a pass mark of about 60%. Candidates with a sports and exercise medicine fellowship, MSc or diploma plus specialist training, or an orthopaedic or family medicine background with recognised SEM training, sit it after the authority confirms the title. The Gulf hosts elite sport (Qatar's Aspetar, Saudi Arabia's football and events investment, Dubai's sports city) and has an obesity and diabetes epidemic that exercise medicine addresses, so the paper combines athlete care with exercise prescription for chronic disease and the heat physiology that defines the region. This set covers what recurs. The licensing route is in the sports medicine doctor guide.

Head injury and heat

Question 1

A footballer collides heads with an opponent, is dazed for a few seconds, has a headache and says he feels "foggy" but wants to continue. The sideline management is:

1. Allow him to continue if he can answer simple questions
2. Remove him from play immediately and do not return him the same day; assess with a standardised tool (SCAT6) in a quiet area, observe for red flags (deteriorating consciousness, repeated vomiting, seizure, focal deficit, neck pain), arrange medical follow-up, and begin a graded return-to-sport protocol after an initial 24 to 48 hours of relative rest, with symptom-limited activity, then progressive exercise stages each lasting at least 24 hours and medical clearance before full contact
3. Give an analgesic and return him after 15 minutes
4. CT scan for every head knock

Answer: B. "If in doubt, sit them out" is the consensus (Amsterdam 2022); adolescents are managed more conservatively and return to school precedes return to sport.

Question 2

A marathon runner in Dubai collapses at 35 km with a core (rectal) temperature of 41.2 °C, confusion and hot skin. The immediate management is:

1. Transport to hospital first, then cool
2. Cool first, transport second: immediate whole-body cold-water immersion (ice-water or cold-water tub) aiming to bring core temperature below 39 °C within 30 minutes, with airway protection, intravenous fluids and glucose check; rectal temperature is the only reliable field measurement, and antipyretics are ineffective and potentially harmful
3. Oral fluids and rest in the shade
4. Paracetamol and ice packs to the groin only

Answer: B. Exertional heat stroke mortality depends on the duration of hyperthermia; Gulf events use wet-bulb globe temperature thresholds to modify or cancel competition, and acclimatisation over 10 to 14 days reduces risk.

Question 3

Which statement about hydration in endurance exercise in hot conditions is correct?

1. Athletes should drink as much as possible to prevent all weight loss
2. Drinking to thirst or a planned intake that limits body mass loss to about 2 to 3% balances dehydration against exercise-associated hyponatraemia, which results from overdrinking hypotonic fluids and presents with confusion, vomiting and seizures; a collapsed athlete who has gained weight should not be given more fluid until sodium is checked
3. Salt tablets prevent all cramps
4. Caffeine is banned for hydration reasons

Answer: B. Severe exercise-associated hyponatraemia is treated with hypertonic saline, not isotonic fluids.

Cardiac screening

Question 4

A 19-year-old footballer at pre-participation screening has a family history of sudden death in a 30-year-old uncle, and his ECG shows deep T-wave inversion in V4 to V6. The appropriate action is:

1. Clear him to play; T-wave inversion is a normal athletic finding
2. Withhold clearance pending cardiology evaluation with echocardiography and probably cardiac MRI, because lateral T-wave inversion is an abnormal finding under the International Criteria for ECG interpretation in athletes and, with the family history, raises concern for hypertrophic cardiomyopathy
3. Prescribe a beta blocker and clear him
4. Repeat the ECG in a year

Answer: B. Normal training-related findings include sinus bradycardia, first-degree AV block, incomplete RBBB, early repolarisation and isolated voltage criteria for LVH; T-wave inversion beyond V2 in white athletes, ST depression, pathological Q waves and prolonged QT are abnormal. FIFA, the AFC and Gulf leagues mandate ECG-inclusive screening.

Question 5

A 45-year-old sedentary man with type 2 diabetes and hypertension wants to start a vigorous exercise programme. Before clearance he most needs:

1. No assessment; exercise is always safe
2. Risk stratification using current pre-participation guidance (symptoms, known cardiovascular, metabolic or renal disease, and intended intensity); as an asymptomatic person with known metabolic disease planning vigorous activity, medical clearance and an exercise test may be recommended before progressing beyond light to moderate intensity, with foot assessment for neuropathy and retinopathy review
3. Coronary angiography in all cases
4. A chest radiograph

Answer: B. The ACSM pre-participation algorithm replaced the older risk-factor counting approach; moderate exercise can usually begin without testing, with gradual progression.

Knee

Question 6

A netball player lands from a jump, feels a pop, has immediate swelling within two hours and cannot continue. Lachman and pivot shift tests are positive. The diagnosis and the most useful next steps are:

1. Medial collateral ligament sprain; a hinged brace
2. Anterior cruciate ligament rupture, often with meniscal or chondral injury; clinical examination (Lachman is the most sensitive test), MRI to confirm and assess associated injury, early physiotherapy to restore range and quadriceps function, and shared decision-making about reconstruction versus structured rehabilitation based on age, activity, instability and associated injury, with reconstruction usual in pivoting athletes
3. Patellar dislocation; immobilisation for six weeks
4. Osteoarthritis; steroid injection

Answer: B. Return to pivoting sport after reconstruction typically takes 9 to 12 months with criteria-based testing; female athletes have two to eight times the ACL injury rate, and neuromuscular prevention programmes (for example FIFA 11+) reduce it.

Question 7

A 25-year-old has a locked knee that cannot fully extend after a twisting injury, with joint-line tenderness and a positive McMurray test. The most likely diagnosis and treatment are:

1. Degenerative meniscal tear; physiotherapy alone
2. Bucket-handle meniscal tear with mechanical locking; MRI and early arthroscopic repair where the tear is in the vascular (red) zone, which preserves the meniscus and reduces later osteoarthritis, with partial meniscectomy only for irreparable tears
3. Patellar tendinopathy; eccentric loading
4. Osgood-Schlatter disease

Answer: B. Degenerative tears in middle-aged patients without locking are managed with exercise therapy first; arthroscopic partial meniscectomy adds little in that group.

Ankle, leg and hip

Question 8

According to the Ottawa ankle rules, a radiograph after an ankle injury is indicated when there is pain in the malleolar zone and:

1. Any swelling
2. Bone tenderness at the posterior edge or tip of the lateral or medial malleolus (distal 6 cm), or inability to bear weight for four steps both immediately after injury and in the emergency department; foot radiographs are indicated for midfoot pain with tenderness at the base of the fifth metatarsal or navicular, or the same weight-bearing criterion
3. Age under 18
4. Bruising

Answer: B. The rules have near 100% sensitivity for clinically significant fractures and reduce imaging by about a third.

Question 9

A footballer has a grade II lateral ankle sprain (anterior talofibular ligament) with no fracture. The evidence-based management is:

1. Six weeks in a plaster cast
2. Short-term protection with a functional brace or tape, early weight-bearing and mobilisation, cryotherapy and compression for comfort, progressive exercise therapy with balance and proprioceptive training (which reduces re-injury), and gradual return to sport with bracing or taping in the first season; surgery is reserved for chronic instability failing rehabilitation
3. Complete rest for a month
4. Corticosteroid injection into the ligament

Answer: B. Syndesmosis (high ankle) injuries, identified by squeeze and external rotation tests, take far longer and may need fixation if unstable.

Question 10

A 22-year-old female distance runner has three weeks of progressive localised shin pain, worse with running, tenderness over the medial tibia, and a history of amenorrhoea and restrictive eating. The most likely diagnosis and the broader concern are:

1. Shin splints; continue running with taping
2. Tibial bone stress injury (stress fracture), confirmed by MRI (radiographs are often normal early), managed with relative rest and graded return; the broader concern is relative energy deficiency in sport (RED-S) with menstrual dysfunction and low bone density, requiring nutritional rehabilitation, DXA scan and multidisciplinary care
3. Compartment syndrome; fasciotomy
4. Osteosarcoma; biopsy

Answer: B. High-risk stress fractures (anterior tibial cortex, femoral neck tension side, navicular, fifth metatarsal base, medial malleolus) need strict non-weight-bearing or fixation because of non-union risk.

Question 11

A sprinter feels a sudden sharp pain in the posterior thigh during acceleration and cannot continue. Examination shows tenderness in the mid-biceps femoris with pain on resisted knee flexion and no palpable gap. Management and prognosis are:

1. Immediate surgical repair
2. Acute hamstring strain (likely grade II); relative rest and early progressive loading with eccentric strengthening (for example the Nordic hamstring exercise), lumbopelvic control and running progression, with return typically in two to six weeks depending on grade and location; proximal free tendon and intramuscular tendon injuries take longer, and complete proximal avulsions with a palpable gap are surgical
3. Six weeks of immobilisation
4. Corticosteroid injection

Answer: B. Re-injury rates are high (up to a third) in the first two weeks after return; previous injury is the strongest risk factor, and Nordic hamstring programmes halve injury rates.

Question 12

A 28-year-old footballer has insidious groin pain worse with kicking and sprinting, tenderness at the adductor origin and pain on resisted adduction, with no hernia and a normal hip examination. According to the Doha agreement classification the diagnosis and management are:

1. Inguinal hernia; surgical repair
2. Adductor-related groin pain; active exercise therapy with progressive adductor and core strengthening (for example the Copenhagen adduction exercise), load management, and return to sport with a graded programme; imaging is used to exclude hip joint pathology (femoroacetabular impingement, labral tear) and stress fracture
3. Femoral neck stress fracture; non-weight-bearing
4. Osteitis pubis; six months' rest

Answer: B. The Doha agreement (2015) classifies groin pain as adductor-, iliopsoas-, inguinal- or pubic-related, hip-related, or other; clinical entities guide treatment better than imaging.

Tendons and shoulder

Question 13

A 40-year-old recreational runner has six months of morning Achilles stiffness and pain 3 to 5 cm above the insertion, with a tender thickened tendon. The first-line treatment is:

1. Corticosteroid injection into the tendon
2. A progressive loading programme (eccentric heel drops or heavy slow resistance) over at least 12 weeks with load modification and footwear advice, then extracorporeal shockwave therapy as an adjunct if progress stalls; corticosteroid injection into the Achilles is avoided because of rupture risk
3. Complete rest for three months
4. Immediate surgical debridement

Answer: B. Fluoroquinolone antibiotics increase tendinopathy and rupture risk and are avoided in athletes where alternatives exist; insertional tendinopathy avoids loading into dorsiflexion initially.

Question 14

A 20-year-old rugby player has a first-time anterior shoulder dislocation reduced in the emergency department. Which statement about management is correct?

1. Recurrence is rare in this age group, so no further treatment is needed
2. Recurrence risk after a first dislocation in a young contact athlete is very high (often over 70%), so after assessment for associated injuries (Bankart lesion, Hill-Sachs defect, bony Bankart, axillary nerve, rotator cuff tear in older patients), early arthroscopic stabilisation is often recommended in this group, with rehabilitation and sport-specific return otherwise
3. Immobilisation for three months is standard
4. External rotation bracing eliminates recurrence

Answer: B. In patients over 40, rotator cuff tears accompany dislocation frequently and are the priority to assess.

Exercise medicine

Question 15

Which exercise prescription is recommended for an adult with type 2 diabetes and obesity?

1. Avoid exercise until weight is normal
2. At least 150 minutes a week of moderate-intensity aerobic activity (or 75 minutes vigorous) spread over at least three days with no more than two consecutive days without activity, plus resistance training two to three times a week, reduced sedentary time with breaks every 30 minutes, gradual progression, foot care, glucose monitoring with insulin or sulfonylurea dose adjustment to avoid hypoglycaemia, and attention to heat in outdoor exercise
3. Vigorous exercise only
4. Walking 10 minutes a week

Answer: B. Resistance training improves glycaemic control independently of aerobic exercise; the Gulf's high physical inactivity rates make exercise prescription a public health priority tested on the paper.

Question 16

A Muslim professional footballer asks how to train and compete safely during Ramadan. Evidence-based advice includes:

1. Stop all training for the month
2. Maintain training with adjusted timing (sessions in the evening after iftar or before suhoor), prioritise fluid and carbohydrate intake between sunset and dawn with a late suhoor, protect sleep with scheduled naps, reduce volume while maintaining intensity, monitor body mass and hydration, and accept that well-managed fasting athletes show little loss of performance; the medical team should respect the athlete's choice to fast
3. Intravenous fluids during the day
4. Train at midday to acclimatise

Answer: B. Ramadan and sport research led by Aspetar and FIFA underpins these recommendations; dehydration and sleep loss, not glucose, are the main performance limiters.

Paediatric and anti-doping

Question 17

A 13-year-old gymnast has anterior knee pain and a tender prominent tibial tubercle without effusion or instability. The diagnosis and management are:

1. Patellar tendon rupture; surgery
2. Osgood-Schlatter disease (tibial tubercle apophysitis), a self-limiting traction injury during growth; activity modification guided by pain rather than complete rest, quadriceps and hamstring flexibility and strengthening, ice and analgesia, with reassurance that it resolves at skeletal maturity; avoid steroid injection
3. Septic arthritis; aspiration
4. Tumour; biopsy

Answer: B. Apophyseal injuries (Sever's disease at the heel, Sinding-Larsen-Johansson at the inferior patellar pole) replace tendinopathies in skeletally immature athletes; growth plate injuries, not ligament tears, follow twisting injuries in this group.

Question 18

An elite athlete with asthma needs an inhaled corticosteroid and a short-acting beta-2 agonist. Under the World Anti-Doping Code:

1. All inhaled asthma medications are prohibited
2. Inhaled salbutamol (up to 1,600 µg over 24 hours in divided doses, not exceeding 600 µg over 8 hours), formoterol and salmeterol within specified limits, and inhaled corticosteroids are permitted without a Therapeutic Use Exemption; oral and injected glucocorticoids are prohibited in competition, and other beta-2 agonists require a TUE with documented objective evidence of asthma
3. A TUE is needed for inhaled salbutamol at any dose
4. Only oral prednisolone is permitted

Answer: B. The Prohibited List changes annually; team doctors are responsible for checking every medication, and strict liability applies to the athlete.

Question 19

A professional athlete asks for an intra-articular corticosteroid injection two days before a competition. Under anti-doping rules the doctor should:

1. Inject without any paperwork because local injections are always allowed
2. Recognise that all injectable glucocorticoids are prohibited in competition, with washout periods defined by route and drug (for example several days for intra-articular triamcinolone), so an injection this close to competition risks an adverse analytical finding unless a Therapeutic Use Exemption is granted in advance; discuss alternatives and timing
3. Give oral prednisolone instead
4. Refuse to treat the athlete

Answer: B. WADA introduced washout periods for injectable glucocorticoids in 2022; documenting medical necessity and applying for a TUE through the national anti-doping organisation is the correct route.

Question 20

Which approach to return-to-play decision-making is recommended?

1. Return when pain-free, regardless of function
2. A criteria-based, shared decision using a structured framework (such as the StARRT framework: tissue health, tissue stresses and risk tolerance modifiers), including objective functional and sport-specific tests (strength symmetry, hop tests, psychological readiness), time since injury, competition context and the athlete's and team's risk tolerance, documented clearly
3. Return when the coach needs the player
4. Return based on time alone

Answer: B. The team doctor's duty is to the athlete-patient first; conflicts of interest with clubs and federations are a tested ethics theme.

How to practise

• Learn the consensus statements: concussion (Amsterdam 2022), heat illness, athlete ECG criteria, Doha groin pain agreement, RED-S, return to sport.
• Know the clinical rules and tests: Ottawa rules, Lachman, McMurray, squeeze test, apophysitis patterns.
• Know the exercise prescriptions for diabetes, obesity, hypertension and cardiac disease, and the anti-doping basics.
• Practise under time in the Sports Medicine bank with the error-log method.

Related sets: orthopaedic surgery questions, family medicine questions, emergency medicine questions and physiotherapy questions.

Frequently asked questions

How many questions are in the Prometric sports medicine specialist exam?

Typically 100 to 150 single-best-answer MCQs in up to three hours, with a pass mark of about 60%, varying by authority.

Which sports medicine topics come up most?

Concussion, heat illness, cardiac screening, knee and ankle injuries, stress fractures and RED-S, tendinopathy, exercise prescription in chronic disease and anti-doping rules.

Does the exam include exercise medicine for non-athletes?

Yes. Exercise prescription for diabetes, obesity, hypertension and cardiac rehabilitation is a significant part of the Gulf papers.

Can an orthopaedic surgeon or family physician sit the sports medicine paper?

Only when the authority recognises their sports and exercise medicine training for the title; otherwise they sit their primary specialty paper.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.