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Ottawa ankle rule — MCCQE Part 1 MCQ

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ModerateFracturesOttawa ankle ruleMCCQE Part 1

A 25-year-old runner twists her ankle and has tenderness at the posterior edge of the lateral malleolus and inability to bear weight for four steps. Which of the following is the most appropriate next step?

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Correct answer: E — Order ankle radiographs

Order ankle radiographs is the single best answer because the age, timing, examination findings and investigations in the vignette fit Ottawa ankle rule better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Ottawa Ankle Rules, with attention to acuity, safety-netting and local provincial pathways.

Reference: Ottawa Ankle Rules