An MRI of the ankle shows a whitish, irregular abnormality in the Achilles tendon. What is the most likely finding and its corresponding management?

1. A

   A. Thompson tests positive

2. B

   B. Steroid injection

3. C

   C. Plaster cast

4. D

   D. Surgical repair

Appeared in: INI-CET EXAM -2026

Explanation

• The MRI finding of a 'whitish, irregular abnormality' on a T2-weighted image signifies edema, inflammation, and fluid in a gap, which is characteristic of an acute Achilles tendon rupture.
• The flowchart in the image confirms that identifying a lesion in the Achilles tendon region leads to a pathological diagnosis, using 'Achilles Rupture' as a specific example.
• Surgical repair is a primary and definitive treatment for a complete Achilles tendon rupture, aimed at restoring the tendon's length and tension for optimal functional recovery.
• This intervention is often preferred for active individuals as it typically results in a lower rate of re-rupture and a quicker return to activities compared to non-operative methods.

Why Other Options Were Wrong

• Option A: A positive Thompson test is a clinical sign used to diagnose an Achilles tendon rupture, not a method of management. The question asks for management in addition to the finding.
• Option B: Steroid injections into or around the Achilles tendon are contraindicated, especially with a suspected tear or rupture. Corticosteroids can weaken the tendon, inhibit healing, and increase the risk of a complete rupture.
• Option C: While a plaster cast is a valid non-operative treatment for an Achilles rupture, surgical repair is often considered the more definitive treatment to reduce re-rupture rates and improve functional outcomes, especially in younger, more active patients.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Achilles Tendon Rupture as background academic context rather than a clinical decision trigger.
• The nurse's role in post-operative care for an Achilles tendon repair is crucial. It includes wound management, monitoring for neurovascular compromise, preventing deep vein thrombosis (DVT), managing pain, and educating the patient on the strict rehabilitation protocol, including weight-bearing restrictions.
• What if? - If the patient were an 85-year-old with severe diabetes and heart disease, the risks of surgery would likely outweigh the benefits. In such a case, non-operative management with a plaster cast (Option C) would become the most appropriate choice.

How to Approach the Question

• First, analyze the clinical information in the stem. An MRI showing a 'whitish, irregular abnormality' in the Achilles tendon strongly suggests a tear or rupture.
• Next, examine the accompanying image. The flowchart confirms the diagnostic context, explicitly using 'Achilles Rupture' as the example diagnosis for a lesion in this area.
• Carefully read the question. It asks for both a 'finding' and its 'management'. Recognize that the question is flawed as no single option provides both elements.
• Evaluate the options based on the confirmed diagnosis of Achilles rupture. Option A is a finding, not management. Option B is incorrect management. Options C and D are both valid management strategies.
• Since the diagnosis is already established by the MRI, the most logical next step is to determine management. Between the two valid management options, surgical repair is often presented as the more definitive treatment for a complete rupture in exam scenarios unless patient factors suggest otherwise.

Concept Tested & Keywords

• Concept Tested: Management of Achilles Tendon Rupture
• Stem keywords: MRI, ankle, Achilles tendon, whitish, irregular abnormality
• Lead-in keywords: most likely finding, corresponding management
• Clinical cues: The image of the diagnostic flowchart explicitly mentions 'Achilles Rupture' as a potential diagnosis, guiding the interpretation of the MRI findings.

Question ID

QFW3PWSoJJvdXAgkRIYUgD

Copy ID

Reference Book

E6 Medicine Harrison 22e Part 2 p. 879-882