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5. Sports Medicine MCQs

Practice Set 103 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 2041

Topic: 5. Sports Medicine

A college athlete has a knee injury requiring surgery. He has acne, gynecomastia, and well-developed muscles related to the use of anabolic steroids. What association with steroid use is concerning for surgery and anesthesia? Review Topic

. Fluid and electrolyte imbalance
. Increased bleeding time
. Impaired liver function
. Lowered oxygen requirements
. Splenomegaly

Correct Answer & Explanation

. Fluid and electrolyte imbalance

Explanation

Anabolic steroids increase procoagulant factors VII and IX and thromboxane, all of which lead to hypercoagulability which would decrease bleeding time. Liver function is usually upregulated as oral steroids induce hepatic enzymes and patients are therefore less sensitive to anesthetic agents. Anabolic steroids have a mineralocorticoid effect and users frequently use diuretics to mask this effect. Both can lead to fluid and electrolyte imbalances. Cardiovascular effects include hypertension, left ventricular hypertrophy, impaired diastolic filling, and thrombosis. Large muscle mass and high calorie intake lead to high ventilatory requirements caused by increased oxygen consumption and carbon dioxide production. Anabolic steroids have no effect on the spleen.

Question 2042

Topic: 5. Sports Medicine

During a knee arthroscopy on a 38-year-old patient with isolated medial knee pain and no lateral symptoms, a routine examination of the lateral compartment reveals a discoid lateral meniscus. The discoid lateral meniscus is not torn. Based on these findings, what is the most appropriate action? Review Topic

. Complete lateral meniscectomy
. Lateral meniscal repair
. Saucerization of the lateral meniscus
. Microfracture of the lateral femoral condyle
. Do nothing surgically to the lateral meniscus

Correct Answer & Explanation

. Complete lateral meniscectomy

Explanation

The most appropriate action is to note this finding in the surgical report but do nothing surgically in the lateral compartment. Multiple studies have shown that asymptomatic discoid lateral menisci seen on routine knee arthroscopies for other pathology need not be addressed surgically. They do not cause problems later in life and do not need to be treated prophylactically.

Question 2043

Topic: Shoulder & Hip Sports

A 23-year-old woman with recurrent anterior instability undergoes an open Bankart procedure. Six months after surgery the patient reports shoulder

. Physical therapy
. Biceps tenolysis
. Subscapularis repair
. Supraspinatus repair
. Pectoralis major repair

Correct Answer & Explanation

. Physical therapy

Explanation

The axial MRI scan shows rupture of the subscapularis tendon with dislocation of the biceps tendon. Treatment should include a biceps tenotomy or tenodesis in conjunction with a subscapularis repair. A pectoralis major transfer may be necessary in chronic cases where the subscapularis is irreparable, but in this patient the tendon is repairable. As a single operation, biceps tenolysis will not correct the instability, and would likely result in a cosmetic deformity. Physical therapy will not restore subscapularis function.

Question 2044

Topic: 5. Sports Medicine

Figures  below  show  the  radiographs  obtained  from  a  19-year-old  woman  with  a  3-year  history  of progressive hip pain in the left groin with activity, which is unresponsive to activity modification and physical therapy. Examination reveals normal range of motion, with pain on anterior impingement testing. What treatment is associated with the best long-term results?

. Hip arthroscopy with labral repair B. Reverse periacetabular osteotomy C. Varus rotational osteotomy
. Open surgical dislocation with rim trimming

Correct Answer & Explanation

. Hip arthroscopy with labral repair B. Reverse periacetabular osteotomy C. Varus rotational osteotomy

Explanation

DISCUSSION:This patient has symptomatic femoroacetabular impingement as well as clinical and radiographic signs of acetabular retroversion, including a cross-over sign, ischial spine sign, and posterior wall sign bilaterally. Good   midterm   to   long-term   outcomes   have   been   reported   with   reverse   (anteverting)   Bernese periacetabular osteotomy (PAO). In patients with less retroversion, open or arthroscopic rim trimming with labral refixation have shown good short-term results, but longer-term results have yet to be fully delineated. Isolated  hip  arthroscopy  and  labral  repair  would  not  be  indicated  without  addressing  the retroversion  deformity.  Femoral  varus  rotational  osteotomy  plays  no  role  in  the  treatment  of  this pathology.  Open  surgical  dislocation  with  rim  trimming  could  be  considered  in  patients  with  less deformity, but some studies have shown inferior long-term results compared with reverse PAO.

Question 2045

Topic: 5. Sports Medicine
Medial dislocation of the long head of the biceps tendon in the shoulder is most commonly caused by a
. tear of the subscapularis tendon.
. tear of the supraspinatus tendon.
. tear of the transverse ligament.
. type I SLAP tear.
. congenitally shallow bicipital groove.

Correct Answer & Explanation

. tear of the subscapularis tendon.

Explanation

DISCUSSION: Medial dislocation of the biceps tendon in the shoulder is commonly associated with subscapularis tendon tears. Although type II SLAP tears can result in bicipital instability, type I SLAP lesions do not. Congenitally shallow grooves and tears of the transverse ligaments usually do not lead to dislocation of the biceps tendon. Supraspinatus tendon tears are associated with long head of the biceps tendon ruptures but do not cause biceps tendon dislocations.

Question 2046

Topic: 5. Sports Medicine
A 23-year-old man who is a competitive overhead athlete has shoulder pain. Based on the pathology shown in Figure 47, what treatment option would yield the highest satisfaction and return to overhead sports?
. Biceps tenodesis
. Biceps tenotomy
. Labral debridement
. Labral repair
. Rotator cuff debridement

Correct Answer & Explanation

. Labral repair

Explanation

DISCUSSION: The patient has a classic type II SLAP tear that will respond best to arthroscopic repair. Labral debridement has been shown to lead to predictably poor results, and biceps tenodesis and tenotomy may be appropriate for an older patient who is not a competitive overhead athlete.

Question 2047

Topic: 5. Sports Medicine
A coach of three football teams—the B team, junior varsity team, and varsity team—wants to study the average times in the 40-yard dash for his players. Which test would help him determine if the mean 40-yard dash times for the athletes on one team are different from those on the other teams?
. Independent 2-sample t test
. Analysis of variance (ANOVA)
. Chi-square test
. Fisher’s exact test

Correct Answer & Explanation

. Analysis of variance (ANOVA)

Explanation

DISCUSSION: Data collected in research studies fall into one of two categories—continuous or discrete. Continuous data can be displayed on a curve. Examples include height, weight, and time recorded in a 40-yard dash. Discrete data represent data that fall into specific categories such as gender or the presence or absence of a risk factor. ANOVA is used to determine statistical significance in mean values of continuous data when there are more than two independent samples. The 2-sample t test compares mean values of continuous data between two independent groups. The Chi-square test and Fisher's exact tests are tests used to analyze discrete data.

Question 2048

Topic: Knee Sports

A patient competing in a professional motocross race sustained a direct blow to the knee after falling off his bike at high speed. He sustained several lacerations as shown in Figure 60. He is able to actively extend his knee painlessly and his Lachman examination is negative. What is the most likely injury? Review Topic

. Anterior cruciate ligament tear
. Patella fracture
. Patellar tendon tear
. Tibial tubercle avulsion
. Posterior cruciate ligament tear

Correct Answer & Explanation

. Anterior cruciate ligament tear

Explanation

It is important to recognize the injury pattern sustained by this motocross rider by inspection of his traumatic scars present anteriorly over the proximal tibia and the dorsum of the ankle and dorsum of the forefoot, indicating that his foot was in a plantar flexed position with a concomitant blow to the anterior tibia. This is a classic mechanism for a posterior cruciate ligament injury, and external clues (the scars) should not be overlooked when examining the knee. Occasionally, a posterior cruciate ligament injury is overlooked; however, putting together the patient's history, the examination (especially the posterior drawer and quadriceps active tests) provide a reliable diagnosis. Additional pathology should also be ruled out, such as a posterolateral corner injury and intra-articular pathology. Patella fracture, tibial tubercle avulsion, and patella tendon tears are unlikely because the patient can actively extend the knee. An anterior cruciate ligament tear is unlikely with a negative Lachman examination.

Question 2049

Topic: 5. Sports Medicine

Heat transfer from the skin to the environment when the ambient temperature exceeds 35°C primarily is attributable to

. evaporation.
. conduction.
. convection.
. radiation.

Correct Answer & Explanation

. evaporation.

Explanation

DISCUSSIONHeat transfer from the skin to the environment occurs through conduction, convection, evaporation, and radiation. Evaporation of sweat is the primary mechanism by which core body temperature is regulated when the ambient temperature exceeds 35°C. High humidity can inhibit the evaporation of sweat, placing athletes at increased risk for heat-related illness, which is defined as a core temperature above 40°C. Symptoms include dizziness, confusion, irritability, hyperventilation, nausea, vomiting, fatigue, and collapse. Initial treatment involves rapid cooling through immersion in cold or ice water to prevent end-stage organ failure.

Question 2050

Topic: Shoulder & Hip Sports

What is the most likely diagnosis? Review Topic

. Pectoralis major tendon rupture
. Supraspinatus rupture
. Subscapularis rupture
. Bankart tear
. Humeral avulsion of the inferior glenohumeral ligament

Correct Answer & Explanation

. Pectoralis major tendon rupture

Explanation

The MRI scan shows detachment of the subscapularis from its insertion on the lesser tuberosity. The examination finding is consistent with a positive lift-off test, also indicating a tear of the subscapularis.

Question 2051

Topic: Knee Sports

A 24-year-old football player sustains a contact injury to his right knee. Physical examination reveals a positive dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of knee flexion, the external rotation is symmetric between both knees. Which of the following injury patterns is most consistent with these findings?

. Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury
. Combined posterior cruciate ligament (PCL) and posterolateral corner (PLC) injury
. Isolated posterior cruciate ligament (PCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined posterior cruciate ligament (PCL) and medial collateral ligament (MCL) injury

Correct Answer & Explanation

. Combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) injury

Explanation

The dial test is used to evaluate combined or isolated posterolateral corner (PLC) and posterior cruciate ligament (PCL) injuries. Asymmetry of >10 degrees of external rotation at 30 degrees of knee flexion, but symmetric rotation at 90 degrees, is indicative of an isolated PLC injury. If the asymmetry is present at both 30 and 90 degrees of flexion, it indicates a combined PCL and PLC injury. The primary restraint to external rotation at 30 degrees is the popliteofibular ligament and fibular collateral ligament.

Question 2052

Topic: Knee Sports

A 15-year-old skeletally mature gymnast presents with chronic anterior knee pain and mechanical catching. MRI demonstrates a 2 x 2 cm osteochondritis dissecans (OCD) lesion with subchondral fluid indicative of instability, but the articular cartilage overlying it is intact. Where is the most common anatomical location for an OCD lesion in the knee?

. Central aspect of the medial femoral condyle
. Lateral aspect of the medial femoral condyle
. Central aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Anterior aspect of the lateral femoral condyle

Correct Answer & Explanation

. Central aspect of the medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle (often remembered by the mnemonic LAME: Lateral Aspect Medial Epicondyle/Condyle). It accounts for roughly 70-80% of all knee OCD lesions. Surgical fixation is indicated in skeletally mature patients with unstable lesions.

Question 2053

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, the surgeon inadvertently places the femoral tunnel too proximal and anterior to the anatomic footprint (Schöttle point). What is the primary kinematic consequence of this technical error?
. The graft will tighten in extension and become lax in flexion.
. The graft will tighten in flexion and cause loss of knee flexion.
. The graft will be lax throughout the entire range of motion.
. The graft will cause obligate patella alta.
. The graft will cause excessive medial translation of the patella in full extension only.

Correct Answer & Explanation

. The graft will tighten in flexion and cause loss of knee flexion.

Explanation

The anatomic femoral origin of the MPFL is crucial for proper graft kinematics. If the femoral tunnel is placed too proximal and anterior, the distance between the patellar attachment and the femoral attachment increases as the knee flexes. This causes the graft to become inappropriately tight in flexion, leading to restricted knee flexion, increased medial patellofemoral contact pressures, and potential early graft failure or osteoarthritis.

Question 2054

Topic: Knee Sports

A 40-year-old active patient with medial compartment osteoarthritis and varus alignment is scheduled for a medial opening wedge high tibial osteotomy (HTO). Which of the following is an expected sagittal plane biomechanical alteration associated with this specific procedure?

. Decreased posterior tibial slope, which unloads an anterior cruciate ligament (ACL) graft.
. Decreased posterior tibial slope, which increases strain on the posterior cruciate ligament (PCL).
. Increased posterior tibial slope, which increases strain on the anterior cruciate ligament (ACL).
. Increased posterior tibial slope, which unloads the anterior cruciate ligament (ACL).
. No predictable change in tibial slope occurs with a medial opening wedge HTO.

Correct Answer & Explanation

. Decreased posterior tibial slope, which unloads an anterior cruciate ligament (ACL) graft.

Explanation

A medial opening wedge HTO characteristically increases the posterior tibial slope due to the triangular anatomy of the proximal tibia (the medial aspect is narrower anteriorly than posteriorly). An increase in posterior tibial slope promotes anterior tibial translation, which functionally acts as a PCL agonist (unloading the PCL) but acts as an ACL antagonist by increasing strain on the ACL or an ACL graft.

Question 2055

Topic: Knee Sports

A 55-year-old female presents with sudden onset medial knee pain after squatting. MRI confirms a posterior root tear of the medial meniscus with 4 mm of meniscal extrusion. What is the biomechanical consequence of this specific injury on the knee joint?

. Loss of hoop stresses, resulting in contact mechanics equivalent to a totally intact meniscus
. Loss of hoop stresses, resulting in contact mechanics equivalent to a total medial meniscectomy
. Increased anterior translation of the tibia, increasing load on the anterior cruciate ligament
. Decreased medial compartment contact pressures by redirecting loads to the lateral compartment
. No significant change in peak contact pressures if meniscal extrusion is less than 5 mm

Correct Answer & Explanation

. Loss of hoop stresses, resulting in contact mechanics equivalent to a totally intact meniscus

Explanation

A posterior root tear of the medial meniscus disconnects the meniscal attachment to the tibial plateau. This failure disrupts the circumferential hoop stresses that the meniscus normally converts axial loads into. Biomechanical studies have shown that a meniscal root tear leads to a complete loss of hoop stresses, causing meniscal extrusion and resulting in peak tibiofemoral contact pressures that are biomechanically equivalent to those of a total meniscectomy.

Question 2056

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two functional bundles: the anteromedial (AM) and posterolateral (PL) bundles. During the physical examination of an ACL-deficient knee, which bundle's primary function is evaluated by the pivot shift test?

. Anteromedial bundle, which is tightest in flexion
. Anteromedial bundle, which is tightest in extension
. Posterolateral bundle, which is tightest in flexion
. Posterolateral bundle, which is tightest in extension
. Posterolateral bundle, which acts primarily as a restraint to varus stress

Correct Answer & Explanation

. Anteromedial bundle, which is tightest in flexion

Explanation

The PL bundle of the ACL is tightest in extension and is the primary restraint to rotatory instability (anterolateral subluxation of the tibia), which is clinically evaluated by the pivot shift test. The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation (evaluated by the anterior drawer test).

Question 2057

Topic: 5. Sports Medicine
A 21-year-old collegiate hockey player sustains a grade III (complete) tear of the superficial medial collateral ligament (sMCL). What is the primary restraint to valgus stress at 25-30 degrees of knee flexion, and what is the typical initial treatment?
. Deep MCL; immediate surgical repair
. Deep MCL; hinged knee brace and early physical therapy
. Superficial MCL; hinged knee brace and early physical therapy
. Superficial MCL; surgical reconstruction with autograft
. Posterior oblique ligament (POL); surgical repair

Correct Answer & Explanation

. Superficial MCL; hinged knee brace and early physical therapy

Explanation

The superficial medial collateral ligament (sMCL) is the primary restraint to valgus stress at all angles of knee flexion, but its function is most readily isolated and tested clinically at 25-30 degrees of flexion, where the secondary restraints (such as the posterior capsule) are relaxed. The standard of care for isolated Grade III MCL injuries is nonoperative management with a hinged knee brace and early functional rehabilitation, which has excellent outcomes.

Question 2058

Topic: Knee Sports

During the surgical reconstruction of an isolated posterior cruciate ligament (PCL) injury utilizing a single-bundle technique, the graft is typically positioned to recreate the function of the dominant bundle. Which bundle is reconstructed, and at what angle is it maximally tensioned?

. Anteromedial bundle; tightest in flexion
. Anteromedial bundle; tightest in extension
. Anterolateral bundle; tightest in flexion
. Posteromedial bundle; tightest in flexion
. Posteromedial bundle; tightest in extension

Correct Answer & Explanation

. Anteromedial bundle; tightest in flexion

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The AL bundle is larger, stronger, and tightest in knee flexion, making it the primary restraint to posterior tibial translation in the flexed knee. Single-bundle PCL reconstruction aims to recreate the AL bundle. The PM bundle is tightest in extension.

Question 2059

Topic: 5. Sports Medicine

A 48-year-old male presents with acute knee pain and inability to actively extend his knee after a fall. On examination, a palpable defect is noted superior to the patella. Which of the following statements is most accurate regarding extensor mechanism ruptures?

. Patellar tendon ruptures are more common in patients >50 years old
. Quadriceps tendon ruptures typically occur at the tibial tubercle
. Quadriceps tendon ruptures are more common in patients >40 years old
. Patellar tendon ruptures are most commonly midsubstance tears
. Surgical repair of a complete quadriceps tendon rupture routinely requires a partial patellectomy

Correct Answer & Explanation

. Patellar tendon ruptures are more common in patients >50 years old

Explanation

Quadriceps tendon ruptures are classically seen in patients over the age of 40, while patellar tendon ruptures are more common in patients under the age of 40. Both typically avulse from the bone (patella) rather than tearing midsubstance. Repair does not routinely require patellectomy.

Question 2060

Topic: Knee Sports

A 50-year-old female presents with acute posterior medial knee pain after squatting. MRI reveals an isolated complete tear of the medial meniscus posterior root. The biomechanical consequence of leaving this injury untreated is most equivalent to which of the following conditions?

. Anterior cruciate ligament (ACL) deficiency
. Total medial meniscectomy
. Partial lateral meniscectomy
. Posterior cruciate ligament (PCL) deficiency
. Isolated medial collateral ligament (MCL) sprain

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) deficiency

Explanation

A complete tear of the medial meniscal root disrupts the meniscal hoop stresses entirely, leading to meniscal extrusion. Biomechanical studies have proven that a posterior root tear effectively renders the meniscus nonfunctional, altering contact pressures identically to a total medial meniscectomy.

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