Menu

5. Sports Medicine MCQs

Practice Set 118 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 2341

Topic: Shoulder & Hip Sports

A 55-year-old manual laborer with an irreparable, massive posterosuperior rotator cuff tear and intact cartilage undergoes a Superior Capsular Reconstruction (SCR) using a thick dermal allograft. The primary biomechanical goal of the dermal allograft in this procedure is to:

. Recreate the anterior-posterior force couple between the subscapularis and infraspinatus
. Act as an interpositional spacer to eliminate bone-on-bone friction during elevation
. Prevent superior translation of the humeral head during active elevation by static tethering
. Serve as a biological scaffold to induce regeneration of the native supraspinatus tendon
. Dynamically tether the long head of the biceps to the superior glenoid rim

Correct Answer & Explanation

. Prevent superior translation of the humeral head during active elevation by static tethering

Explanation

Superior Capsular Reconstruction (SCR) addresses irreparable supraspinatus/infraspinatus tears. The graft is attached medially to the superior glenoid and laterally to the greater tuberosity. Its primary biomechanical function is to serve as a static restraint, recreating the superior capsule to depress the humeral head and prevent its superior translation during active deltoid elevation.

Question 2342

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. CT evaluation reveals 25% anterior glenoid bone loss. Which of the following procedures is most appropriate to restore stability?

. Arthroscopic Bankart repair with Remplissage
. Open Bankart repair
. Latarjet procedure
. Arthroscopic SLAP repair
. Putti-Platt procedure

Correct Answer & Explanation

. Latarjet procedure

Explanation

In cases of anterior shoulder instability with critical glenoid bone loss (>20-25%), a coracoid transfer (Latarjet procedure) is the gold standard. Soft tissue procedures alone, such as an arthroscopic Bankart repair, have unacceptably high failure rates in this setting.

Question 2343

Topic: Shoulder & Hip Sports

A 40-year-old female recreational basketball player notes pain deep within her shoulder that occurs with activity. Pain began insidiously 6 months previously. She has completed a physical therapy program, and an intra-articular corticosteroid injection provided excellent temporary relief. Physical examination shows symmetric range of motion of her shoulder. She has a positive O'Brien’s active compression test. There is no pain with cross-arm adduction or tenderness to palpation over the acromioclavicular joint. Resisted abduction is nonpainful and strong. MRI shows increased signal in the substance of the superior labrum, low-grade bursal surface fraying of the supraspinatus, and mild degenerative changes within the acromioclavicular joint. What is the best treatment option?

. Biceps tenodesis
. Superior labrum anterior to posterior (SLAP) repair
. Rotator cuff repair
. Distal clavicle excisionThe patient has a clinical history and physical examination consistent with degenerative superior labral pathology, which is supported by the MRI scan. She has failed appropriate nonoperative treatment, and surgical intervention would be indicated. In a middle-aged patient with a degenerative superior labral tear, biceps tenodesis has been shown to have better outcomes and return to sport than SLAP repair. In a young patient with a traumatic superior labral tear, repair would be indicated. The other MRI findings noted are incidental and asymptomatic in this patient. As a result, rotator cuff repair or distal clavicle excision is not indicated.

Correct Answer & Explanation

. Biceps tenodesis

Explanation

A 50-year-old man sustained an external rotation traction injury to his right arm. He felt a pop in the anterior aspect of his shoulder associated with immediate pain and swelling. The MRI scan shows a tear of the subscapularis tendon, as shown in Figures 1 and 2. The arrow points to what anatomic structure?

Question 2344

Topic: 5. Sports Medicine
In patient selection for meniscal allograft transplantation, which of the following variables has the greatest influence on outcome?
. Grade of chondromalacia
. Limb alignment
. Patient age
. Patient weight
. Postoperative level of activity

Correct Answer & Explanation

. Grade of chondromalacia

Explanation

Many clinical studies to date show that the extent of arthritis is the most common variable that has the greatest influence on outcome. The success rate of allograft transplantation is significantly diminished in patients who have grade IV chondromalacia of the knee or notable flattening and general joint incongruity.

Question 2345

Topic: 5. Sports Medicine
An 18-year-old lacrosse player is diagnosed with infectious mononucleosis. What is the recommendation for return to play?
. Full participation once symptoms resolve
. Full participation once the splenomegaly resolves
. Full participation 4 weeks after the onset of symptoms regardless of the size of the spleen
. Full participation 4 weeks after both the onset of illness and findings of a normal-sized spleen
. No participation for 8 weeks

Correct Answer & Explanation

. Full participation 4 weeks after both the onset of illness and findings of a normal-sized spleen

Explanation

DISCUSSION: Infectious mononucleosis commonly affects adolescents and young adults. It is a febrile illness accompanied by acute pharyngitis. Splenomegaly may occur and predispose the athlete to splenic rupture. Splenic rupture has been reported in nonathletes as well as in patients with normal-sized spleens. Clinical evidence supports a return to all sports 4 weeks after the onset of symptoms provided that the spleen has returned to normal size.

Question 2346

Topic: 5. Sports Medicine
When performing an arthroscopic subacromial decompression, bleeding can be encountered when dividing the coracoacromial ligament because of injury to what artery?
. Anterior humeral circumflex
. Acromial branch of the thoracoacromial trunk
. Clavicular branch of the thoracoacromial trunk
. Dorsal scapular
. Subscapular

Correct Answer & Explanation

. Acromial branch of the thoracoacromial trunk

Explanation

DISCUSSION: The acromial branch of the thoracoacromial trunk courses along the coracoacromial ligament. This artery enters the ligament approximately 5 mm below the acromial edge. Division of the ligament at its insertion on the acromion minimizes the risk of bleeding.

Question 2347

Topic: 5. Sports Medicine
A 21-year-old collegiate scholarship football player has an episode of transient quadriplegia. An MRI scan of the cervical spine reveals cord edema and severe congenital spinal stenosis. The athlete has aspirations of playing on a professional level and demands that he be allowed to play. The team physician should give what recommendation to the college?
. Do not allow the athlete to return to football.
. Allow the athlete to participate.
. Allow the athlete to play only if he signs a waiver.
. Suggest that the college and athlete enter binding arbitration.
. Allow the athlete to play with special equipment.

Correct Answer & Explanation

. Do not allow the athlete to return to football.

Explanation

DISCUSSION: Federal courts have ruled that a student-athlete does not have a constitutional right to participate in athletics against medical advice. As long as the student retains his scholarship, the college is under no legal or ethical obligation to allow the student to participate in sports.

Question 2348

Topic: 5. Sports Medicine
Which of the following statements correctly describes the results of gamma irradiation of musculoskeletal allograft?
. Exposure to 1.5 megarads effectively eliminates HIV.
. Exposure to 4 megarads does not affect graft mechanical properties.
. Gamma irradiation has been associated with chronic inflammation after implantation.
. Gamma irradiation is commonly used alone for sterilization.
. HIV cannot be eliminated with gamma irradiation alone without compromising the mechanical properties of the graft.

Correct Answer & Explanation

. HIV cannot be eliminated with gamma irradiation alone without compromising the mechanical properties of the graft.

Explanation

Low dose gamma irradiation (less than 3.0 megarads) with antibiotic soaks is one of the most common techniques for secondary sterilization. Elimination of HIV with gamma irradiation requires doses estimated to be greater than 3.5 megarads. Gamma irradiation levels of 4 megarads have been shown to alter the mechanical properties of human infrapatellar tendons. Ethylene oxide, also used for allograft sterilization, has been associated with a chronic inflammatory process that resolved after graft removal.

Question 2349

Topic: 5. Sports Medicine
A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform
. the player but not the team.
. the team but not the player.
. neither the team nor the player.
. both the team and the player.
. the team, the player, and the media.

Correct Answer & Explanation

. both the team and the player.

Explanation

When you are employed as a team physician, you are obligated to inform the players and the team organization of all athletically relevant medical issues. This differs significantly from the normal rule of patient confidentiality. If the player came to see you and you were not the team physician, you may not inform the team unless the player so desires. As the team physician, you are not obligated to inform the media.

Question 2350

Topic: 5. Sports Medicine
Significant anterior tibial translation occurs during which of the following rehabilitation exercises?
. Terminal weight-bearing knee extension
. Terminal non-weight-bearing knee extension
. Terminal weight-bearing knee flexion
. Terminal non-weight-bearing knee flexion
. Mid-range weight-bearing knee flexion

Correct Answer & Explanation

. Terminal non-weight-bearing knee extension

Explanation

Terminal non-weight-bearing knee extension exercises from 60 degrees to 0 degrees of flexion increase anterior tibial translation. It is for this reason that this type of exercise should be avoided in the early phase of rehabilitation following anterior cruciate ligament reconstruction so as not to place a tensile strain on the graft. The other rehabilitation exercises either lead to posterior tibial translation in relation to the femur or have no significant effect on tibial translation.

Question 2351

Topic: Knee Sports

Which of the following describes the tensioning pattern of the native posterior cruciate ligament (PCL) bundles during knee range of motion?

. The anterolateral bundle is tight in extension and lax in flexion
. The posteromedial bundle is tight in flexion and lax in extension
. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension
. Both bundles exhibit isometric behavior throughout the full arc of motion
. The anterolateral bundle primarily restrains varus rotation in full extension

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and the posteromedial bundle is tight in extension

Explanation

The PCL consists of two main bundles: the anterolateral (AL) and posteromedial (PM). The larger AL bundle tightens during knee flexion, while the smaller PM bundle tightens in extension.

Question 2352

Topic: Knee Sports

A 55-year-old female presents with acute posterior knee pain after descending stairs. MRI reveals a posterior root tear of the medial meniscus. Biomechanically, this injury is most equivalent to which of the following?

. An intact meniscus with an anterior horn tear
. A total medial meniscectomy
. A partial meniscectomy with intact hoop stresses
. A complete anterior cruciate ligament tear
. An isolated medial collateral ligament rupture

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A complete posterior root tear of the medial meniscus disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in altered peak contact pressures and kinematics equivalent to a total meniscectomy.

Question 2353

Topic: Knee Sports

In medial patellofemoral ligament (MPFL) reconstruction, identifying the correct femoral attachment (Schottle point) is critical. Where is this point located on a true lateral radiograph of the knee?

. Anterior to the posterior femoral cortical line and distal to the Blumensaat line
. Anterior to the posterior femoral cortical line and proximal to the Blumensaat line
. Posterior to the posterior femoral cortical line and distal to the Blumensaat line
. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat line
. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and distal to Blumensaat line

Correct Answer & Explanation

. 1 mm anterior to the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to Blumensaat line

Explanation

Schottle point is located radiographically 1 mm anterior to the extension of the posterior femoral cortical line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the Blumensaat line.

Question 2354

Topic: 5. Sports Medicine

A 45-year-old construction worker presents with persistent shoulder pain. MRI arthrogram demonstrates a Type II SLAP tear without rotator cuff pathology. Conservative management has failed. Which surgical intervention provides the most reliable return to function in this demographic?

. SLAP repair with suture anchors
. Arthroscopic debridement of the superior labrum
. Biceps tenodesis
. Biceps tenotomy
. Diagnostic arthroscopy with subacromial decompression alone

Correct Answer & Explanation

. Biceps tenodesis

Explanation

In patients over 40 years old, particularly laborers or those who do not participate in overhead throwing sports, primary biceps tenodesis offers superior outcomes and a lower complication rate compared to SLAP repair.

Question 2355

Topic: Knee Sports

Which of the following factors is most strongly associated with a poor prognosis for nonoperative healing in a patient with an osteochondritis dissecans (OCD) lesion of the medial femoral condyle?

. Patient age of 10 years
. Lesion size of 1 cm
. Open distal femoral physis
. Presence of cystic changes deep to the lesion on MRI
. Lesion location on the classic lateral aspect of the medial femoral condyle

Correct Answer & Explanation

. Presence of cystic changes deep to the lesion on MRI

Explanation

Signs of instability on MRI, such as high T2 signal behind the fragment or cystic changes deep to the lesion, indicate a poor prognosis for conservative management. Closed physes are also a strong predictor of non-healing.

Question 2356

Topic: Knee Sports

Regarding the anatomy and biomechanics of the anterior cruciate ligament (ACL), which of the following statements best describes the anteromedial (AM) bundle?

. It is tightest in full extension.
. It primarily controls rotatory stability of the knee.
. It is tightest in deep flexion.
. It originates posterior to the PL bundle on the lateral femoral condyle.
. It inserts posterior to the PL bundle on the tibial footprint.

Correct Answer & Explanation

. It primarily controls rotatory stability of the knee.

Explanation

The anteromedial (AM) bundle of the ACL is tightest in knee flexion and primarily restrains anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 2357

Topic: Shoulder & Hip Sports

A baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. He is diagnosed with internal impingement. Which of the following is the hallmark pathological finding?

. Subacromial bursitis leading to extrinsic compression
. Impingement of the articular surface of the posterosuperior rotator cuff against the posterosuperior labrum
. Anteroinferior labral tear (Bankart lesion)
. Coracoid impingement of the subscapularis tendon
. Degeneration of the long head of the biceps tendon

Correct Answer & Explanation

. Impingement of the articular surface of the posterosuperior rotator cuff against the posterosuperior labrum

Explanation

Internal impingement occurs in the abducted and externally rotated (ABER) position, causing the articular surface of the supraspinatus and infraspinatus to abut against the posterosuperior glenoid labrum. This can lead to partial articular-sided cuff tears and labral fraying.

Question 2358

Topic: Knee Sports
During a medial patellofemoral ligament (MPFL) reconstruction, accurate identification of the femoral attachment (Schöttle's point) is critical to prevent graft anisometry. Radiographically, this anatomic point is located:
. Anterior to the posterior femoral cortical extension line.
. Distal to the posterior extent of Blumensaat's line.
. Proximal to the adductor tubercle.
. Between the adductor tubercle and the medial epicondyle.
. Anterior to Blumensaat's line.

Correct Answer & Explanation

. Anterior to Blumensaat's line.

Explanation

The anatomical femoral origin of the MPFL sits in a saddle between the medial epicondyle and the adductor tubercle. On a true lateral radiograph, Schöttle's point is 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior border of the medial femoral condyle, and proximal to Blumensaat's line.

Question 2359

Topic: Shoulder & Hip Sports

A 35-year-old male presents with isolated weakness in external rotation of his dominant shoulder. MRI reveals a paralabral cyst in the spinoglenoid notch. Which of the following physical examination findings is most likely?

. Weakness in shoulder abduction
. Atrophy of both the supraspinatus and infraspinatus
. Normal strength in the initial 30 degrees of shoulder abduction
. Positive lift-off test
. Decreased sensation over the lateral deltoid

Correct Answer & Explanation

. Normal strength in the initial 30 degrees of shoulder abduction

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to external rotation weakness. Supraspinatus function remains intact, allowing for normal initial shoulder abduction.

Question 2360

Topic: Knee Sports

Which structure serves as the primary restraint to varus stress of the knee at 30 degrees of flexion?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Fibular collateral ligament (LCL)
. Popliteofibular ligament
. Iliotibial band

Correct Answer & Explanation

. Fibular collateral ligament (LCL)

Explanation

The fibular collateral ligament (LCL) is the primary restraint to varus stress at both 0 and 30 degrees of knee flexion. The popliteus and popliteofibular ligament primarily restrain external rotation.

Test Yourself

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

On this Page