The four questions every clinical case asks

A worked APEP-style case, start to finish: what to do first, whether to image, what return to sport really depends on, and what to say when the patient pushes back.

Published 2026-09-19.

The Australian Physiotherapy Council says the Written Assessment tests knowledge, problem-solving and decision-making, and its own guidance for candidates warns against preparing by memorising facts. That distinction decides how you should study.

A recall question asks what you know. A case asks what you would do, then what you would do when the patient disagrees with you. Here is one case in full, in the order it is asked.

The patient

A 22-year-old recreational soccer player presents the morning after a match. Changing direction, they planted the right foot and felt the knee twist, heard a pop, and had significant pain. The knee swelled within about two hours.

Today: walking is difficult, there is a moderate effusion, active flexion is limited by pain, the knee feels unstable, there is no obvious deformity, and there is no previous knee injury.

And the line that changes everything: "I think it's just a sprain. Can you tape it so I can play this weekend?"

Question 1. What is the most appropriate initial approach?

The tempting answer is to accept the patient's own description and start treating. The other trap runs the opposite way: repeated high-force ligament testing to nail down an ACL rupture on day one, or functional running tests to see whether the knee holds.

The mechanism, the pop, the rapid swelling and the instability are all concerning for significant internal derangement. The order that survives scrutiny is the ordinary one: history, examination, differential diagnosis, then a decision about whether further investigation or referral is needed.

You do not diagnose an ACL rupture on the spot. You also do not accept a 22-year-old's self-diagnosis of a sprain. Both errors are failures of reasoning rather than gaps in knowledge, which is exactly what this kind of question is built to find.

Question 2. Does this need imaging or referral?

Now that the assessment has happened, the question is what it changes. Imaging is not a way of being thorough; it is a decision with a reason attached, and someone has to own it.

This is where candidates trained in other systems most often go wrong, because the referral pathway they learned is not the Australian one. The question is not only what is clinically indicated, but who orders it, who receives it, and what you do while you wait.

Question 3. What has to be true before return to sport?

Not how many weeks. What has to be true. Criteria-based progression is the standard the assessment expects, and the answer that names a timeframe rather than a threshold is the distractor.

This is also where a case stops rewarding memorisation. You cannot recall the answer for a patient you met four questions ago; you have to carry their presentation forward and apply it.

Question 4. The player still wants to play on Saturday.

Most question banks stop at question 3. The APEP pathway does not, and neither does practice.

The player is 22, the season matters to them, and they came in asking for tape. Holding a safe, defensible position while keeping the person on side is a professional skill, and it is assessable: it shows up as scope of practice, informed consent, documentation, and how you explain a decision the patient does not want to hear.

This is the part of the exam that punishes a purely clinical preparation. You can know the ligament anatomy perfectly and still answer this one badly.

What this means for how you prepare

• Practise in cases, not in single questions. A question you answer in isolation teaches you a fact; a case teaches you a sequence.
• Read the explanation for the options you did not pick. The wrong answers are where the reasoning lives, because each one is a mistake somebody actually makes.
• Track what kind of question you get wrong, not just how many. Consistently missing risk and safety is a different problem from consistently missing management, and it needs different study.
• Rehearse the uncomfortable ones. Consent, scope, pressure from a patient or a coach, a colleague doing something you are not comfortable with. These are not soft topics on this pathway.

A note on what this is

APEP Exam Prep is an independent resource. It is not endorsed by, affiliated with or connected to the Australian Physiotherapy Council, and it contains no real exam questions. The case above is one of hundreds written for practice. For the official format, rules and content of the assessment, go to the APC.