Menu

5. Sports Medicine MCQs

Practice Set 101 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 2001

Topic: Knee Sports

Figure 68 shows the MRI scan of a 13-year-old boy who has had knee pain and swelling following training lessons for ski racing for the past 6 months. The only abnormal finding on physical examination is an effusion. Management should consist of

. Cast immobilization for 6 weeks
. Activity modification and re-evaluation in 2 months
. Internal fixation with or without bone grafting
. Retrograde drilling of the defect without articular cartilage penetration
. Drilling of the defect directly through the articular cartilage

Correct Answer & Explanation

. Cast immobilization for 6 weeks

Explanation

The lesion is osteochondritis dissecans. The primary determinant of treatment is an age of the patient at presentation. The presence of open physes classifies the lesion as the Juvenile form. It is theorized that, in both adult and juvenile forms, the articular cartilage softens as it loses the support of the subchondral layer of bone. If the disease process is not arrested, additional trauma causes separation of a bone fragment, and a crater remains. Most children who have juvenile osteochondritis dissecans and open physes can be successfully managed non-operatively. Cahill proposed limitation of activities until the patient was free of symptoms as well as protected weight bearing with use of splints or crutches. He recommended that nonoperative treatment be abandoned if symptoms persist for 3 months.

Question 2002

Topic: 5. Sports Medicine
The primary function of structure “A” in Figure 29 is to limit
. posterior tibial displacement at 90 degrees of flexion.
. varus knee laxity at 30 degrees of flexion.
. varus knee laxity at 0 degrees of flexion.
. anterolateral rotation of the tibia on the femur.
. posterolateral rotation of the tibia on the femur.

Correct Answer & Explanation

. posterolateral rotation of the tibia on the femur.

Explanation

DISCUSSION: The primary function of the popliteofibular ligament is to resist posterolateral rotation of the tibia on the femur, although it also secondarily resists varus angulation and posterior displacement of the tibia on the femur. The posterior cruciate ligament resists posterior tibial displacement, especially at 90 degrees of flexion. The lateral collateral ligament primarily resists varus displacement at 30 degrees of flexion but also resists posterolateral rotatory displacement with flexion that is less than approximately 50 degrees. The anterior and posterior cruciate ligaments resist varus displacement (along with the lateral collateral ligament) at 0 degrees of flexion. The anterior cruciate ligament primarily resists anterolateral displacement of the tibia on the femur.

Question 2003

Topic: Shoulder & Hip Sports

A 25-year-old lineman is referred to your office for a second opinion. 1 year ago, he underwent an arthroscopic procedure for shoulder instability. He complains of persistent sense of instability despite the surgery. Which of the following is a contraindication to revision arthroscopic labral repair for recurrent anterior glenohumeral instability? Review Topic

. Glenoid bone loss of 10%
. Capsular attenuation from prior thermal capsulorraphy
. Anterior labral periosteal sleeve avulsion (ALSPA ) lesion
. Glenoid labral articular defect (GLAD) lesion
. Combined Superior Labrum from Anterior to Posterior tear (SLAP) and recurrent Bankart lesion

Correct Answer & Explanation

. Capsular attenuation from prior thermal capsulorraphy

Explanation

Capsular attenuation or postthermal capsular necrosis from prior thermal capsulorraphy is a contraindicated to arthroscopic repair.Thermal capsulorrhaphy utilizes heat generated by radiofrequency or laser ablation to cause capsular shrinkage in an effort to treat shoulder instability. However, high recurrence rates have been found, especially around two to three weeks after the index procedure, when the capsular tissue is the weakest. In the setting of recurrence following thermal capsulorrhaphy, open revision is recommended.Creighton et al. reported on a series of 18 patients undergoing revision arthroscopic stabilization. Of the 18, 3 failed with recurrent instability, all with previous thermal capsulorrhaphy.Miniaci et al. reviewed the outcomes following thermal capsulorrhaphy noting high rates of recurrent instability, especially in the setting of initial treatment for multidirectional instability.Park et al. reported on a series of 14 patients undergoing revision following thermal capsulorrhaphy. Ten out of 14 patients had signs of capsular thinning, insufficiency and attenuation.Wong et al. surveyed 379 shoulder surgeons on the complications following thermal capsulorrhaphy. Capsular insufficiency and thinning were commonly associated with recurrent instability.Hecht et al. performed thermal capsulorrhaphy and biomechanical analysis of the capsule in a sheep model. The authors found that the capsule was weakest at the 2-3 week post-operative timepoint, leading to the highest rate insufficiency, attenuation and mechanical failure at this time.Incorrect answers:

Question 2004

Topic: Shoulder & Hip Sports

Figure 55 shows the radiograph of a 30-year-old man who sustained a closed comminuted fracture of the right clavicle. Examination reveals decreased sensation in the radial nerve distribution. Weakness is noted with shoulder abduction, internal rotation, and wrist extension. A displaced bone fragment is most likely pressing on what portion of the brachial plexus? Review Topic

. C5 and C6 spinal roots
. Superior trunk
. Anterior division of the inferior trunk
. Posterior cord
. Lateral and posterior cords

Correct Answer & Explanation

. Posterior cord

Explanation

Clavicular fractures are occasionally complicated by injury to the brachial plexus. A displaced bone fragment pressing on the posterior cord proximal to the upper subscapularis nerve would account for these findings.

Question 2005

Topic: 5. Sports Medicine

-Figure 39 is the anteroposterior radiograph of a marathon runner who has left groin pain that prevents her from running. She recently got back into her usual running routine after an ankle injury preventedbher from running for several months. She now has pain with any weight bearing. What is the most appropriate treatment option?

. Hip resurfacing arthroplasty
. Hip arthroscopy with removal of the cam lesion
. Internal fixation of the femoral neck with multiple screws
. Trial of nonsurgical treatment with no weight bearing on the left leg
. Vitamin D level assessment and supplementation with 50000 units weekly

Correct Answer & Explanation

. Hip resurfacing arthroplasty

Explanation

Question 2006

Topic: 5. Sports Medicine
Figure 1 is the MR image of a 14-year-old football player who injured his right knee during a game. He describes feeling a "pop" and then needing help walking off the field. His knee is visibly swollen. Knee range of motion is between 0° and 70°. What is the most appropriate treatment option?
. Open reduction and internal fixation of the lateral condyle
. Microfracture of the chondral defect
. Immediate anterior cruciate ligament (ACL) reconstruction
. Delayed ACL reconstruction

Correct Answer & Explanation

. Delayed ACL reconstruction

Explanation

DISCUSSION: The MR image shows bone bruises (“kissing contusions”) consistent with an ACL tear. During the ACL subluxation event, the posterolateral tibial plateau subluxes anteriorly, making contact with the mid portion of the lateral femoral condyle and resulting in this characteristic bone bruise pattern on MRI. Randomized clinical trials comparing early accelerated versus nonaccelerated rehabilitation programs have demonstrated no significant differences in long-term results with regard to function, reinjury, and successful return to play. These studies did not address timing of return to play with an early accelerated rehabilitation program. At 2 and 3 years postsurgically, there are no differences in laxity, number of graft failures, or KOOS scores.

Question 2007

Topic: 5. Sports Medicine

A 38-year-old man is three quarters of the way through the Hawaiian Ironman events run in a temperature of 60 degrees F. He is sweating profusely and suddenly collapses. Prior to this he had been drinking large amounts of bottled water at every water stop. What is the most likely diagnosis? Review Topic

. Hypernatremia
. Hypothermia
. Hyponatremia
. Subendocardial myocardial infarction
. Ruptured berry aneurysm

Correct Answer & Explanation

. Hypernatremia

Explanation

Hyponatremia is often seen in endurance athletes such as triathloners, ultramarathoners, and marathoners after prolonged exertion. It is commonly attributed to excess free water intake that fails to replete massive sodium losses that result from sweating as reported by O'Connor. Exercise-induced hyponatremia is generally asymptomatic, particularly in patients in whom the sodium is only mildy reduced. Up to 10% of ultradistance athletes have a sodium level of 135 mEq/L or less, but those who are symptomatic usually have a sodium level of 125 mEq/L as reported by Noakes and O'Connor. The best way to prevent hyponatremia is to maintain the proper volume and types of fluid intake to ensure fluid balance during exercise. Beverages containing carbohydrates in concentrations of 4% to 8% (ie, "sports drinks") are recommended for athletes participating in exercise lasting more than an hour (eg, marathon runners, etc.) To avert brainstem herniation and death, severe, acute hyponatremia requires rapid correction. Oral rehydration with salty solutions is safe and effective in patients with mild symptoms. Too rapid correction has been reported to cause central pontine myelinolysis; therefore, correction ought to be performed slowly. Hypernatremia, hypothermia, subendocardial myocardial infarction, or ruptured berry aneurysm are unlikely in this scenario.

Question 2008

Topic: Shoulder & Hip Sports
A 21-year-old pitcher reports shoulder pain with hard throwing. He notes that the pain occurs in the early acceleration phase of his throw. Given his history, what structures are at greatest risk for injury?
. Posterosuperior labrum, greater tuberosity, articular side of the rotator cuff
. Posterior glenoid, humeral head, bursal side of the rotator cuff
. Biceps anchor, articular side of the rotator cuff, supraspinatus tendon
. Biceps tendon, bursal side of the rotator cuff, superior labrum
. Subscapularis, anterior labrum, humeral head

Correct Answer & Explanation

. Posterosuperior labrum, greater tuberosity, articular side of the rotator cuff

Explanation

DISCUSSION: Internal impingement in the thrower’s shoulder occurs in the abducted, externally rotated position as described by Walch and associates. The injury is thought to occur from repetitive contact between the posterosuperior portion of the labrum and glenoid against the articular side of the rotator cuff and greater tuberosity. REFERENCES: Paley KJ, Jobe FW, Pink MM, et al: Arthroscopic findings in the overhand throwing athlete: Evidence for posterior internal impingement of the rotator cuff. Arthroscopy 2000;16:35-40. Jazrawi LM, McCluskey GM III, Andrews JR: Superior labral anterior and posterior lesions and internal impingement in the overhead athlete. Instr Course Lect 2003;52:43-63. Walch G, Boileau P, Noel E, et al: Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: An arthroscopic study. J Shoulder Elbow Surg 1992;1:238-245.

Question 2009

Topic: Knee Sports

The patient returns 4 days after surgery and says he has noticed a red, swollen knee since yesterday. He reports a fever of 38.0°C since last evening and denies traumatic injury. He has an erythematous knee with a large, tense effusion; his range of motion is limited; and the surgical incisions are not draining. Radiographs taken in the office show no change from the immediate postsurgical images. Aspiration in the office returns 50 cc of cloudy, blood-tinged synovial fluid, and analysis of the fluid reveals a white blood cell count of 92000 (reference range 4500-11000 /µL). Which bacteria is most commonly responsible for this clinical scenario?

. Staphylococcus epidermidis
. Staphylococcus aureus (S. aureus)
. Propionibacterium acnes (P. acnes)
. Beta-hemolytic Streptococcus

Correct Answer & Explanation

. Staphylococcus epidermidis

Explanation

Video 39 for referenceThis patient has a history of failed primary and revision ACL reconstructions, both times with medial meniscus repairs. The clinical scenario suggests a recurrent ACL injury with a recurrent medial meniscus tear that is now locked. The most critical risk factor for ACL reconstruction is age younger than 20 years. The meniscal repair success rate using an all-inside device is between 80% and 90%. Traditionally, it was believed that healing rates werehigher in ACL reconstruction, but current literature demonstrates a similar rate of healing associated with ACL reconstruction and no reconstruction of stable knees.The images show a vertical femoral tunnel resulting from this patient’s prior reconstruction and revision. The MR images reveal a locked bucket-handle tear of the medial meniscus, and the examination shows a positive Lachman test finding attributable to ACL graft failure. In the setting of a young individual who has failed 2 meniscal repairs, a third repair is not indicated. In addition to a revision ACL reconstruction to stabilize the knee, a partial medial meniscectomy is indicated. An attempt at revision medial meniscus repair would be indicated if the technique were poor in the first attempt, but a failed repair otherwise should indicate the need for partial meniscectomy. The postsurgical images reveal a much more anatomic position of the femoral tunnel that should provide better rotational control of the knee, thereby improving the pivot shift (compared to the vertical femoral tunnel).This patient has an obvious postsurgical infection based on the timing, examination, and results of the aspiration. In multiple studies of septic arthritis following ACL reconstruction, the most common pathogen was coagulase-negative staph (Staphylococcus epidermidis), followed by S. aureus. If S. aureus is the causative pathogen, the rate of necessary graft removal is higher because of the aggressive nature of this specific bacteria.

Question 2010

Topic: Shoulder & Hip Sports
What is the most common result if the acetabulum is rotated too far anteriorly during a periacetabular osteotomy?
. Posterior dislocation
. Limited hip flexion
. Heterotopic ossification
. Femoral nerve injury
. Fracture of the posterior column

Correct Answer & Explanation

. Limited hip flexion

Explanation

DISCUSSION: In patients with hip dysplasia who undergo a periacetabular osteotomy, the authors note that the freed acetabular segment can be overcorrected for the deformity. If it is placed too anteriorly, then hip flexion is limited. Posterior dislocation is a rare complication. The other complications should not occur as a result of this procedure. REFERENCES: Hussell JG, Rodriguez JA, Ganz R: Technical complications of the Bernese periacetabular osteotomy. Clin Orthop 1999;363:81-92. Myers SR, Eijer H, Ganz R: Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop 1999;363:93-99.

Question 2011

Topic: 5. Sports Medicine
A 15-year-old girl who competes in gymnastics has immediate pain and giving way of the left elbow after falling from the uneven parallel bars and landing on her outstretched arms. Examination reveals swelling and tenderness about the elbow, especially over the medial side. Measurement of elbow motion shows 0° to 125° of flexion, and valgus stress at the elbow is painful. AP, lateral, and stress radiographs are shown in Figures 9a through 9c. Management should consist of
. arthroscopic repair of the ulnar collateral ligament.
. direct surgical repair of the ulnar collateral ligament.
. reconstruction of the ulnar collateral ligament with a palmaris longus tendon autograft.
. a hinged elbow brace to allow early protected range of motion.
. immobilization of the elbow to allow healing of the ulnar collateral ligament.

Correct Answer & Explanation

. reconstruction of the ulnar collateral ligament with a palmaris longus tendon autograft.

Explanation

DISCUSSION: While many low-demand patients with injuries to the ulnar collateral ligament can be treated nonsurgically, Jobe and associates described two situations in which ulnar collateral ligament reconstruction is indicated: (1) an acute complete rupture in a competitive athlete who uses the upper extremities extensively and who wishes to remain active; and (2) chronic pain or instability that does not improve after at least 3 months of nonsurgical management. Rarely is direct surgical repair of the ligament possible or able to withstand the valgus stresses applied to the elbow. Most authors recommend surgical reconstruction of the ulnar collateral ligament using a palmaris longus, plantaris, or fourth toe extensor tendon autograft.

Question 2012

Topic: 5. Sports Medicine
A 50-year-old patient who plays tennis sustained the deformity shown in Figure 27 following a high volley. Further diagnostic work-up should include
. an electromyogram (EMG) of the upper extremity.
. an ultrasound of the short head of the biceps.
. an MRI scan of the rotator cuff.
. a CT scan with contrast of the anterior labrum.
. a subclavian venogram.

Correct Answer & Explanation

. an MRI scan of the rotator cuff.

Explanation

DISCUSSION: The patient has a rupture of the long head of the biceps; however, patients older than age 45 years are at greater risk of having an associated rotator cuff tear. An MRI scan should be ordered to avoid missing concomitant rotator cuff pathology. While patients may report pain radiating down the arm at the time of the tendon rupture, an EMG is not indicated. The short head of the biceps is intact and needs no further work-up, even though the muscle descends in most cases. The anterior labrum can be injured but is not associated with this deformity. REFERENCES: Neer CS II, Bigliani LU, Hawkins RJ: Rupture of the long head of the biceps related to the subacromial impingement. Orthop Trans 1977;1:114. Hawkins RJ, Murnaghan JP: The shoulder, in Gruess RL, Ronnie WRJ (eds): Adult Orthopaedics. New York, NY, Churchill Livingstone, 1984, pp 945-1054.

Question 2013

Topic: 5. Sports Medicine

A 26-year-old elite female swimmer underwent a left medial meniscal allograft transplantation. She returns to clinic 3 years later with knee pain. What is the most likely cause for late presenting knee pain in this patient population? Review Topic

. Late immune rejection of the meniscal graft
. Loss of graft fixation
. Osteoarthritis
. Graft tear due to acellularity
. Late-onset graft infection

Correct Answer & Explanation

. Late immune rejection of the meniscal graft

Explanation

The most common long-term complication after meniscal transplantation is meniscal graft tear. Graft failure that results from graft tears is thought to be related to the acellularity of graft tissue.Meniscal allograft transplantation is considered a salvage treatment option for young patients (<50 years old) with symptomatic meniscal deficiencies. The overall complication rate ranges from 4-36%, which include meniscal tearing, acute immune rejection, superficial and deep infection, chronic knee pain, etc. Graft tears make up>50% of these complications.Rath et al. evaluated 18 of 23 patients who had underwent meniscal allograft transplantation. They showed that 8 of 22 allograft menisci (36%) tore during the 8-year study period. They believe the decreased biologic activity of the graft over time may be a major factor that contributes to the high frequency of graft re-tearing.Sekiya et al. reviewed meniscal allograft transplantation. They concluded that meniscal allograft transplantation may partially restore native meniscal function. Data has also shown that the progression of degenerative arthritic changes in transplanted meniscus-deficient knee compartments is slowed with this procedure.Illustration A shows a basic schematic of meniscal transplantation. Here the graft is secured by anterior + posterior bone plugs and sutures to secure the transplanted meniscus into its native anatomical position.Incorrect<1%.

Question 2014

Topic: Knee Sports

Injury to the popliteal artery during total knee arthroplasty (TKA) is most likely when placing a sharp retractor

. directly posterior to the posterior cruciate ligament (PCL).
. posteromedial to the PCL.
. posterolateral to the PCL.
. in the posteromedial corner of the knee.

Correct Answer & Explanation

. directly posterior to the posterior cruciate ligament (PCL).

Explanation

DISCUSSIONVascular complications during TKA are rare but do occur. Traditionally, it was taught that the popliteal artery was situated posterior to the PCL; however, more recent anatomic dissections have demonstrated that this artery is usually posterolateral to the PCL.

Question 2015

Topic: 5. Sports Medicine
Reconstruction of the posterior cruciate ligament (PCL) via the inlay technique involves exposure of the PCL tibial insertion site by a posterior
. lateral approach through the lateral gastrocnemius/biceps femoris interval.
. approach using the medial sural cutaneous nerve to split the medial and lateral gastrocnemius interval.
. medial approach between the medial gastrocnemius and semitendinosus muscles.
. medial approach between the medial gastrocnemius and semimembranosus interval.
. medial approach between the semitendinosus and semimembranosus interval.

Correct Answer & Explanation

. medial approach between the medial gastrocnemius and semimembranosus interval.

Explanation

DISCUSSION: The posterior medial approach through the semimembranosus/medial gastrocnemius interval is used in the inlay technique for PCL reconstruction. Exposure of the posterior capsule of the knee through this interval provides the greatest margin of safety to avoid injury to the tibial nerve, motor branch of the medial gastrocnemius, and the peroneal nerve. The direct posterior approach using the medial sural cutaneous nerve allows exposure of the popliteal neurovascular structures, but deep dissection through this interval places the motor branch of the medial gastrocnemius at risk. The interval between the semitendinosus and semimembranosus is used in accessory incisions with medial meniscus repairs but does not allow exposure of the PCL insertion.

Question 2016

Topic: Shoulder & Hip Sports

Figure 40 shows the MRI scan of a 23-year-old man with a history of recurrent anterior shoulder instability. What is the most likely diagnosis? Review Topic

. Humeral avulsion of the inferior glenohumeral ligament (HAGL lesion)
. Osseous Bankart lesion
. Perthes lesion
. Anterior labroligamentous periosteal sleeve avulsion (ALPSA lesion)
. Glenolabral articular disruption (GLAD lesion)

Correct Answer & Explanation

. Humeral avulsion of the inferior glenohumeral ligament (HAGL lesion)

Explanation

The MRI scan shows an ALPSA lesion. This is also known as a medialized Bankart with medial displacement of the torn anterior labrum. During surgical stabilization, the labrum and periosteal sleeve must be mobilized and repaired laterally to reduce recurrent instability. A Perthes lesion is a nondisplaced labral tear. A GLAD lesion represents a nondisplaced anterior labral tear with an associated articular cartilage injury.

Question 2017

Topic: Shoulder & Hip Sports

What is the primary sign/symptom with unidirectional posterior instability of the shoulder? Review Topic

. Instability
. Dead arm symptoms
. Locking or catching
. Decreased range of motion
. Pain

Correct Answer & Explanation

. Instability

Explanation

Posterior labral tears and pathology are usually associated with recurrent chronic injury to the shoulder. Situations such as blocking in football load the humeral head posteriorly, and may predispose to posterior labral injury. Unlike anterior and superior labral pathology, symptoms of posterior labral tears are often vague, though pain with activity is most common. Instability is usually associated with anterior labral pathology. Dead arm symptoms are associated with anterior and superior pathology, especially in throwers. Mechanical locking and catching are less common for any labral pathology. Range of motion with posterior labral pathology is usually unaffected.

Question 2018

Topic: Shoulder & Hip Sports

Which of the following 50-year-old patients with an irreparable rotator cuff tendon is the best candidate for an isolated latissimus dorsi muscle transfer? Review Topic

. Man with active elevation to 90 degrees
. Woman with active elevation to 45 degrees
. Woman with a Hornblower's sign (complete absence of external rotation with abduction)
. Man with superior escape of the humeral head
. Man with full motion and a positive lift-off test

Correct Answer & Explanation

. Man with active elevation to 90 degrees

Explanation

Patients with superior escape or a torn subscapularis (demonstrated by a positive lift-off test) will not benefit from a latissimus dorsi transfer, even if combined with a pectoralis muscle transfer. In the study by Iannotti and associates, women had poorer outcomes than men, and patients with preoperative elevation below shoulder level or 90 degrees also had poorer outcomes. Patients with complete loss of external rotator function have worse function after latissimus dorsi transfer than patients with some external rotation function.

Question 2019

Topic: 5. Sports Medicine
What mechanism contributes to strength gains during conditioning of the preadolescent athlete?
. Enhanced neurogenic adaptations
. Advanced myogenic adaptations
. Increased contractile proteins
. Increased short-term energy sources
. Thickening of the connective tissue

Correct Answer & Explanation

. Enhanced neurogenic adaptations

Explanation

DISCUSSION: Prepubescent athletes gain strength through neurogenic adaptations, including recruitment of motor units, reduced inhibition, and learned motor skills. Myogenic adaptations (muscle hypertrophy) occur after puberty and include increased contractile proteins, thickening of the connective tissue, and increased short-term energy sources such as creatine phosphate.

Question 2020

Topic: 5. Sports Medicine
Sudden cardiac death in the young athlete is most frequently caused by
. hypertrophic cardiomyopathy.
. active myocarditis.
. mitral valve prolapse.
. aortic rupture.
. coronary artery disease.

Correct Answer & Explanation

. hypertrophic cardiomyopathy.

Explanation

DISCUSSION: Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in athletes, accounting for 40% of reported cases. Most athletes have no previous symptoms, and sudden death may be the first clinical manifestation. The prevalence of hypertrophic cardiomyopathy in the general population is 1 in 500, with a mortality rate of 2% to 4% in young adults. Athletes with active myocarditis should not engage in sports for up to 6 months, and although they may be at risk for the development of chronic cardiomyopathy, it is rarely a cause of sudden cardiac death. Mitral valve prolapse with an accompanying systolic murmur is common in the general population, but infrequently a cause of sudden cardiac death. Weakening of the aortic wall associated with Marfan syndrome can result in abrupt rupture of the aorta. This accounts for 3% of sudden cardiac deaths in young athletes. Marfan syndrome usually can be detected on preparticipation screenings by its skeletal and ocular manifestations. Atherosclerotic coronary artery disease is the most common cause of sudden cardiac death in older athletes, accounting for 75% of reported cases. However, it is much less common in the young competitive athlete.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page