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5. Sports Medicine MCQs

Practice Set 10 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 181

Topic: Shoulder & Hip Sports

The internal snapping hip syndrome, characterized by an audible and palpable snap over the anterior hip with hip extension, is most commonly caused by which of the following?

. Iliotibial band over the greater trochanter
. Gluteus maximus over the greater trochanter
. Iliopsoas tendon over the iliopectineal eminence
. Rectus femoris over the anterior inferior iliac spine
. Acetabular labral tear

Correct Answer & Explanation

. Iliopsoas tendon over the iliopectineal eminence

Explanation

Internal snapping hip syndrome is caused by the iliopsoas tendon snapping over the iliopectineal eminence or the femoral head. External snapping hip involves the IT band or gluteus maximus snapping over the greater trochanter.

Question 182

Topic: 5. Sports Medicine

Compared to hamstring autograft, the use of a bone-patellar tendon-bone (BPTB) autograft for ACL reconstruction is associated with a higher incidence of which of the following complications?

. Postoperative infection
. Graft failure
. Anterior knee pain
. Deep vein thrombosis
. Arthrofibrosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

BPTB autografts have historically been associated with a higher incidence of anterior knee pain and kneeling pain compared to hamstring autografts. However, graft failure rates are generally comparable or slightly lower for BPTB in young, high-demand athletes.

Question 183

Topic: Shoulder & Hip Sports

A 24-year-old overhead athlete presents with shoulder pain and weakness. On examination, he has a positive Hornblower's sign. Which muscle is most likely pathologically involved?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Teres major

Correct Answer & Explanation

. Teres minor

Explanation

Hornblower's sign evaluates teres minor pathology. It is positive if the patient is unable to hold the forearm in external rotation when the arm is abducted to 90 degrees.

Question 184

Topic: 5. Sports Medicine

During an anterior cruciate ligament (ACL) reconstruction, the risk of injuring the infrapatellar branch of the saphenous nerve is highest when utilizing which graft?

. Bone-patellar tendon-bone autograft
. Hamstring (gracilis and semitendinosus) autograft
. Quadriceps tendon autograft
. Achilles tendon allograft
. Fascia lata autograft

Correct Answer & Explanation

. Hamstring (gracilis and semitendinosus) autograft

Explanation

The infrapatellar branch of the saphenous nerve is at the highest risk of injury during the harvest of hamstring tendons via an oblique or longitudinal anteromedial tibial incision.

Question 185

Topic: 5. Sports Medicine

An isolated popliteus tendon avulsion from the femoral footprint in an adult athlete is generally best managed by:

. Nonoperative management with brief immobilization and early physical therapy
. Primary repair with suture anchors
. Reconstruction using a semitendinosus allograft
. Surgical excision of the torn tendon
. Prolonged immobilization in a cylinder cast for 6 weeks

Correct Answer & Explanation

. Nonoperative management with brief immobilization and early physical therapy

Explanation

Isolated popliteus tendon injuries are rare and typically do well with nonoperative management, allowing athletes to return to play after targeted physical therapy.

Question 186

Topic: Knee Sports

Which of the following physical examination findings is most indicative of a combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury?

. Positive Dial test at 30 degrees but negative at 90 degrees
. Positive Dial test at both 30 and 90 degrees
. Increased anterior translation of the tibia in internal rotation
. A positive pivot shift test
. A positive Lachman test with a soft endpoint

Correct Answer & Explanation

. Positive Dial test at both 30 and 90 degrees

Explanation

A positive Dial test (increased external rotation >10 degrees compared to the contralateral side) at 30 degrees indicates an isolated PLC injury. Positivity at both 30 and 90 degrees indicates combined PLC and PCL injuries.

Question 187

Topic: Knee Sports

During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, non-anatomic femoral tunnel placement that is too proximal will most likely result in which of the following?

. Graft laxity in full extension
. Graft tensioning predominantly in early flexion only
. Increased graft tension and restriction in deep knee flexion
. Development of patella baja
. Lateral patellar tilt in extension

Correct Answer & Explanation

. Increased graft tension and restriction in deep knee flexion

Explanation

Placing the femoral tunnel too proximal during MPFL reconstruction causes the graft to tighten excessively as the knee moves into deep flexion, leading to restricted motion and elevated medial patellofemoral cartilage pressures.

Question 188

Topic: Knee Sports

What is the most classic and frequent anatomical location for osteochondritis dissecans (OCD) lesions in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove
. Inferior pole of the patella
. Posterior lateral tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Approximately 70-80% of knee osteochondritis dissecans (OCD) lesions occur on the lateral aspect of the medial femoral condyle.

Question 189

Topic: 5. Sports Medicine

A 25-year-old athlete undergoes an inside-out repair of a medial meniscus tear. Postoperatively, he complains of medial-sided knee pain and paresthesias along the medial aspect of the lower leg. Which nerve was most likely injured?

. Tibial nerve
. Common peroneal nerve
. Saphenous nerve
. Sural nerve
. Deep peroneal nerve

Correct Answer & Explanation

. Saphenous nerve

Explanation

The saphenous nerve runs posteromedially and is at high risk during inside-out repair of the medial meniscus, particularly when sutures are passed blindly through the posteromedial capsule.

Question 190

Topic: Shoulder & Hip Sports

The "peel-back" mechanism during the late cocking phase of overhead throwing is primarily responsible for the development of which shoulder pathology?

. Bankart lesion
. Hill-Sachs lesion
. SLAP tear
. Rotator cuff interval widening
. Subscapularis tendon rupture

Correct Answer & Explanation

. SLAP tear

Explanation

The peel-back mechanism occurs when maximal external rotation shifts the biceps vector posteriorly, placing torsional stress on the superior labrum and leading to Type II SLAP tears.

Question 191

Topic: Shoulder & Hip Sports

In treating massive, irreparable rotator cuff tears in patients without severe glenohumeral arthritis, a superior capsular reconstruction (SCR) primarily aims to achieve which biomechanical effect?

. Restore active internal rotation strength
. Prevent superior migration of the humeral head
. Directly reconstruct the subscapularis footprint
. Deepen the glenoid concavity to prevent anterior instability
. Replace the stabilizing function of the long head of the biceps

Correct Answer & Explanation

. Prevent superior migration of the humeral head

Explanation

Superior capsular reconstruction utilizes a graft to bridge the glenoid and greater tuberosity. This depresses the humeral head, prevents superior migration, and restores a stable fulcrum for the deltoid.

Question 192

Topic: Knee Sports

An 18-year-old football player sustains a high-energy valgus and twisting knee injury. MRI confirms rupture of the ACL, MCL, and a medial meniscus tear. What is the classic eponym for this injury pattern?

. Terrible triad of the knee
. Segond's triad
. O'Donoghue's unhappy triad
. Dial's pattern
. Stener's triad

Correct Answer & Explanation

. O'Donoghue's unhappy triad

Explanation

O'Donoghue's unhappy triad traditionally consists of injury to the ACL, MCL, and the medial meniscus. Note that modern literature shows lateral meniscus tears are actually more common in acute ACL injuries.

Question 193

Topic: Shoulder & Hip Sports

Which specific radiographic view is considered the most sensitive for profiling the posterolateral humeral head to identify a Hill-Sachs lesion?

. True AP (Grashey) view
. Stryker notch view
. Scapular Y view
. Zanca view
. West Point axillary view

Correct Answer & Explanation

. Stryker notch view

Explanation

The Stryker notch view is obtained with the patient supine and the arm elevated, directing the beam cephalad. It is specifically designed to profile the posterolateral humeral head and optimally identify Hill-Sachs defects.

Question 194

Topic: 5. Sports Medicine

The proposed site of pathology for athletes with groin pain and diagnosed with athletic pubalgia is:

. Direct inguinal hernia
. Indirect inguinal hernia
. Rectus abdominus insertion and adductor longus muscle origin
. Pectineus muscle
. Sartorius muscle

Correct Answer & Explanation

. Rectus abdominus insertion and adductor longus muscle origin

Explanation

Athletic pubalgia syndrome is the result of trunk hyperextension and thigh hyperabduction. This can result in injury to the rectus abdominus insertion and origin of the adductor longus muscle. By definition, a hernia is not present. The pectineus and sartorius muscles are not implicated in athletic pubalgia.

Question 195

Topic: 5. Sports Medicine

The initial management of athletic pubalgia consists of:

. Modified Bassini hernia repair
. Adductor release
. Hip arthroscopy
. Core trunk stabilization and rest
. Laparoscopic hernia repair

Correct Answer & Explanation

. Core trunk stabilization and rest

Explanation

The initial management of athletic pubalgia consists of a period of rest followed by core trunk stabilization, stretching, and gradual return to functional activities. Despite reports of low success rates after nonoperative treatment, this management must be instituted prior to surgical considerations. Reattachment of the inferolateral edge of the rectus using a modified Bassini repair has resulted in return to sports activities for the majority of patients, but the procedure should follow a nonoperative trial. Adductor release can be part of the operative approach after failure of nonoperative management. Hip joint pathology is not consistently associated with athletic pubalgia.

Question 196

Topic: 5. Sports Medicine

The most common physical finding in patients with athletic pubalgia is:

. Tenderness over the pubic tubercle
. Inguinal hernia
. Tenderness to palpation of the adductor longus
. Pain with resisted hip adduction
. Pain with resisted sit-ups

Correct Answer & Explanation

. Pain with resisted hip adduction

Explanation

In a series of 157 high-performance athletes diagnosed with athletic pubalgia, 88% of patients had pain with resisted hip adduction. Peripubic tenderness was found in one-fourth of patients. By definition, a hernia is not present. Less than one-third of patients had tenderness at the origin of the adductor longus, and less than one-half of patients had pain with resisted situps.

Question 197

Topic: Shoulder & Hip Sports

Magnetic resonance imaging (MRI) of the pelvis in patients with athletic pubalgia reveals:

. Pathology at the rectus abdominus in the majority of patients
. No abnormalities
. Labral pathology
. Nonspecific findings in 25% of patients
. Rectus abdominus pathology in 12% of patients and nonspecific findings in 90% of patients

Correct Answer & Explanation

. Rectus abdominus pathology in 12% of patients and nonspecific findings in 90% of patients

Explanation

Although only 12% of patients with athletic pubalgia will demonstrate MRI abnormalities, more than 90% of patients will have nonspecific findings localized to the symptomatic side. Labral pathology is not a common finding in patients diagnosed with athletic pubalgia.

Question 198

Topic: 5. Sports Medicine

Adductor longus tenotomy in athletes with chronic adductor pain resistant to nonoperative treatment results in:

. Full objective strength
. Return to sport at a lower level of play for most athletes
. Return to full sports for most athletes despite decreased objective adductor strength
. Inability to return to sports
. Unacceptable complication rates

Correct Answer & Explanation

. Return to full sports for most athletes despite decreased objective adductor strength

Explanation

In a series of 16 athletes undergoing adductor tenotomy for chronic adductor symptoms, 12 patients returned to competitive sports at a mean 14 weeks after surgery. A decrease in objective strength was noted that did not affect functional results.

Question 199

Topic: 5. Sports Medicine

In order of frequency, the most common compartments involved in chronic exertional compartment syndrome are:

. Deep posterior and anterior compartments
. Anterior and lateral compartments
. Anterior and superficial posterior compartments
. Anterior and deep posterior compartments
. Lateral and deep posterior compartments

Correct Answer & Explanation

. Anterior and deep posterior compartments

Explanation

The most common compartment involved in chronic exertional compartment syndrome in athletes is the anterior compartment followed by the deep posterior compartment and lateral compartments. The superficial posterior compartment is only rarely involved.

Question 200

Topic: 5. Sports Medicine

The resting pressure criteria for diagnosing chronic exertional compartment syndrome in athletes is equal to or greater than:

. 10 mm Hg
. 15 mm Hg
. 20 mm Hg
. 25 mm Hg
. 30 mm Hg

Correct Answer & Explanation

. 15 mm Hg

Explanation

The criteria for diagnosing chronic exertional compartment syndrome from compartment pressure measurements include one or more of the following: More than or equal to 15 mm Hg resting pressure A 1-minute postexercise pressure of more than or equal to 30 mm Hg A 5-minute postexercise pressure of more than or equal to 20 mm Hg

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