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5. Sports Medicine MCQs

Practice Set 14 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 261

Topic: Shoulder & Hip Sports

A ballet dancer complains of a deep "snapping" sensation in her anterior groin when extending her hip from a flexed and abducted position. There is no pain over the greater trochanter. What is the anatomical structure causing this internal snapping hip syndrome?

. Iliotibial band snapping over the greater trochanter
. Gluteus maximus snapping over the greater trochanter
. Iliopsoas tendon snapping over the iliopectineal eminence
. Rectus femoris snapping over the anterior inferior iliac spine
. Hamstring origin snapping over the ischial tuberosity

Correct Answer & Explanation

. Iliopsoas tendon snapping over the iliopectineal eminence

Explanation

Internal snapping hip syndrome (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the femoral head during hip extension. External snapping hip involves the IT band or gluteus maximus snapping over the greater trochanter.

Question 262

Topic: 5. Sports Medicine

An ice hockey player presents with chronic lower abdominal and groin pain exacerbated by resisted sit-ups and coughing. Examination reveals no obvious inguinal hernia bulge, but there is marked tenderness over the pubic tubercle and the external inguinal ring. What is the most likely diagnosis?

. Osteitis pubis
. Athletic pubalgia
. Adductor longus tendon rupture
. Femoral neck stress fracture
. Iliopsoas bursitis

Correct Answer & Explanation

. Athletic pubalgia

Explanation

Athletic pubalgia, commonly called a "sports hernia", represents a weakening or micro-tear of the posterior inguinal wall (conjoint tendon and rectus abdominis insertion). It causes insidious groin pain worsened by valsalva and resisted trunk flexion.

Question 263

Topic: 5. Sports Medicine

A 22-year-old football player sustains a knee injury. MRI shows a complete tear of the anterior cruciate ligament (ACL) and a medial meniscus posterior horn tear. If a bone-patellar tendon-bone (BPTB) autograft is used for reconstruction, what is the most common post-operative complication?

. Patellar fracture
. Anterior knee pain
. Graft rupture
. Arthrofibrosis
. Patellar tendon rupture

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain is the most frequently reported complication following ACL reconstruction with a BPTB autograft, occurring in up to 10-20% of patients. Patellar fracture and tendon rupture are rare complications.

Question 264

Topic: Knee Sports
A 16-year-old gymnast complains of chronic anterior knee pain. On examination, the patella is highly mobile laterally. You suspect patellofemoral instability. Reconstruction of the medial patellofemoral ligament (MPFL) is planned. Where is the normal anatomic femoral origin of the MPFL?
. Just proximal and posterior to the medial epicondyle
. Anterior to the medial epicondyle
. Distal to the adductor tubercle
. On the medial joint line
. At the superior pole of the patella

Correct Answer & Explanation

. Just proximal and posterior to the medial epicondyle

Explanation

The femoral footprint of the MPFL is located in a saddle-shaped depression between the medial epicondyle and the adductor tubercle, anatomically described as proximal and posterior to the medial epicondyle (Schöttle's point).

Question 265

Topic: 5. Sports Medicine

A 28-year-old weightlifter feels a sudden "pop" in his anterior shoulder while doing a heavy bench press. He has loss of the anterior axillary fold contour. Which of the following is the most likely diagnosis?

. Long head of the biceps rupture
. Pectoralis major tendon rupture
. Subscapularis tear
. Coracobrachialis rupture
. Anterior shoulder dislocation

Correct Answer & Explanation

. Pectoralis major tendon rupture

Explanation

Pectoralis major tendon ruptures typically occur during eccentric contraction, such as the eccentric phase of a bench press. It classically presents with bruising and loss of the anterior axillary fold.

Question 266

Topic: Knee Sports

A 30-year-old runner presents with lateral knee pain that is worse when running downhill. Tenderness is maximal 2-3 cm proximal to the lateral joint line. Examination reveals a positive Noble compression test. What is the most likely diagnosis?

. Lateral meniscus tear
. Popliteus tendinitis
. Iliotibial band friction syndrome
. Biceps femoris tendinopathy
. LCL sprain

Correct Answer & Explanation

. Iliotibial band friction syndrome

Explanation

Iliotibial band friction syndrome commonly presents with lateral knee pain in runners, localized proximal to the lateral epicondyle. The Noble compression test is classically positive.

Question 267

Topic: 5. Sports Medicine

A 23-year-old hockey player presents with athletic pubalgia (sports hernia). He has pain with resisted sit-ups. Which structure is most commonly involved in the pathogenesis of this condition?

. Conjoint tendon
. Rectus abdominis and adductor longus aponeurosis
. Iliopsoas tendon
. Pectineus
. Sartorius

Correct Answer & Explanation

. Rectus abdominis and adductor longus aponeurosis

Explanation

Athletic pubalgia involves an injury to the rectus abdominis insertion and the adductor longus origin on the pubis, often referred to as the rectus abdominis/adductor longus aponeurotic plate.

Question 268

Topic: Shoulder & Hip Sports

A 20-year-old baseball pitcher presents with a SLAP tear. During which phase of throwing does a type II SLAP tear most commonly become symptomatic due to the peel-back mechanism?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The "peel-back" mechanism of the superior labrum occurs in the late cocking phase of throwing, when the shoulder is in maximal abduction and external rotation.

Question 269

Topic: Shoulder & Hip Sports

A 26-year-old rugby player has recurrent anterior shoulder instability. CT scan shows a 25% anterior glenoid bone loss. What is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Remplissage procedure
. Latarjet procedure
. Putti-Platt procedure
. Capsular shift

Correct Answer & Explanation

. Latarjet procedure

Explanation

For patients with significant anterior glenoid bone loss (>20-25%), a Latarjet procedure (coracoid transfer) is indicated to restore the glenoid arc and provide a sling effect, reducing recurrence rates.

Question 270

Topic: 5. Sports Medicine

A 17-year-old male baseball pitcher complains of lateral elbow pain. Radiographs reveal an osteochondritis dissecans (OCD) lesion of the capitellum with an open physis. What is the most appropriate initial management for a stable lesion?

. Arthroscopic drilling
. Open reduction and internal fixation
. Cessation of throwing for 3 to 6 months
. Microfracture
. Osteochondral autograft transfer

Correct Answer & Explanation

. Cessation of throwing for 3 to 6 months

Explanation

In a young athlete with an open physis and a stable capitellar OCD lesion, initial management is nonoperative, consisting of strict cessation of throwing for 3-6 months to allow for spontaneous healing.

Question 271

Topic: Knee Sports

Which of the following physical examination findings is most specific for a complete posterior cruciate ligament (PCL) injury?

. Positive Lachman test
. Positive posterior sag sign
. Positive pivot shift test
. Positive Dial test at 30 degrees only
. Positive McMurray test

Correct Answer & Explanation

. Positive posterior sag sign

Explanation

The posterior sag sign (Godfrey's test) is highly specific and sensitive for PCL insufficiency. A posterior step-off of the tibia relative to the femoral condyles at 90 degrees of flexion confirms the diagnosis.

Question 272

Topic: 5. Sports Medicine

A 24-year-old professional quarterback undergoes shoulder arthroscopy for a symptomatic labral tear. The surgeon notes a type II SLAP lesion caused by a 'peel-back' mechanism. This biomechanical force is maximal during which phase of the throwing motion?

. Wind-up
. Early cocking
. Late cocking
. Acceleration
. Follow-through

Correct Answer & Explanation

. Late cocking

Explanation

The peel-back mechanism occurs during the late cocking phase of throwing when the shoulder is maximally abducted and externally rotated. This position causes a torsional force at the base of the biceps, peeling the superior labrum off the glenoid.

Question 273

Topic: Knee Sports

A 14-year-old gymnast presents with chronic anterior knee pain. Imaging reveals an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Inferior pole of the patella
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans of the knee is the lateral aspect of the medial femoral condyle. It accounts for approximately 70-80% of all knee OCD lesions.

Question 274

Topic: Knee Sports

During medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability, accurate anatomic placement of the femoral tunnel is critical for graft isometry. The normal femoral footprint of the MPFL is located:

. Anterior and proximal to the medial epicondyle
. Posterior and distal to the medial epicondyle
. In the saddle between the adductor tubercle and the medial epicondyle
. Directly on the adductor tubercle
. Anterior to the adductor tubercle

Correct Answer & Explanation

. In the saddle between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL is located in the saddle-shaped depression between the medial epicondyle and the adductor tubercle. Non-anatomic placement can lead to abnormal graft tension and restricted range of motion.

Question 275

Topic: Shoulder & Hip Sports
The infraspinatus is strengthened best by which exercise:
. External rotation at 70° of elevation
. Internal rotation at 70° of elevation
. External rotation at 0° of elevation
. Internal rotation at 0° of elevation
. Scapular elevation with internal humeral rotation

Correct Answer & Explanation

. External rotation at 0° of elevation

Explanation

The infraspinatus is primarily responsible for external rotation, humeral head depression, and posterior approximation at lower elevations, whereas the teres minor functions at higher elevations. Therefore, external rotation with the arm near the side of the body is optimal for strengthening the infraspinatus. External rotation at approximately 70° is more appropriate for strengthening the teres minor.

Question 276

Topic: 5. Sports Medicine

When comparing male and female competitive athletes, what can be said regarding anterior cruciate ligament injuries:

. Females have a lower relative risk for anterior cruciate ligament (AC L) injuries.
. Females have an increased relative risk for AC L injuries.
. Males and female competitive athletes have equal risk for injuries.
. A comparison is difficult to make due to the different sports played by each sex.
. There have been no studies examining this association as it may be construed as sexist.

Correct Answer & Explanation

. Females have an increased relative risk for AC L injuries.

Explanation

It has been shown that competitive female athletes have an increased relative risk for anterior cruciate ligament injury in college sports as well as during military training. Possible causative factors have been suggested (body movement, muscular strength, joint laxity, limb alignment, notch dimensions, effects of estrogen), but none have been proven as of yet.

Question 277

Topic: Knee Sports

The best clinical test for diagnosis of an anterior cruciate ligament (AC L) rupture is:

. Anterior drawer
. Pivot shift
. Losee
. Lachman
. Single leg hop

Correct Answer & Explanation

. Lachman

Explanation

The Lachman test provides the best predictive value of all clinical tests for diagnosis of an anterior cruciate ligament rupture. The diagnosis of a complete AC L rupture can be reliably made clinically without the added expense of a preoperative magnetic resonance image.

Question 278

Topic: Knee Sports

The reason a patient with an acute rupture of the anterior cruciate ligament will usually have a hemarthrosis is due to disruption of what main blood supply to the ligament:

. Lateral superior geniculate artery
. Medial superior geniculate artery
. Middle geniculate artery
. Medial inferior geniculate artery
. Lateral inferior geniculate artery

Correct Answer & Explanation

. Middle geniculate artery

Explanation

The major blood supply to the anterior cruciate ligament arises from the ligamentous branches of the middle genicular artery, with minor contribution from the terminal branches of the medial and lateral inferior genicular arteries. The AC L is covered in a synovial fold that is richly supplied by the middle geniculate artery.

Question 279

Topic: 5. Sports Medicine

A 30-year-old competitive body builder felt a severe pain in his proximal humerus after performing a bench press exercise. He has significant ecchymoses over the anterior aspect of his proximal arm and axilla. There is significant limitation of motion due to pain, with pain to palpation over the insertion of the pectoralis major and the axilla. A magnetic resonance image showed more than 80% avulsion of the pectoralis major from the humerus. What treatment should this patient undergo:

. Subscapularis transfer
. Primary repair of the tendon to bone through drill holes or with anchors
. Wait until swelling decreases and range of motion returns to normal, then perform a primary repair
. No treatment is necessary, the patient will have functional results with rehabilitation
. Semitendinosis augmentation with repair of the pectoralis tendon through drill holes once swelling and motion are normal

Correct Answer & Explanation

. Primary repair of the tendon to bone through drill holes or with anchors

Explanation

A complete rupture of the pectoralis insertion demands early surgical treatment in the active athlete. Results of late repair are inferior when compared with primary repair. The tendon is either sutured to bone or anchors are placed to augment repair. Results of those with surgery within one week of injury have been shown to be superior compared to those with delayed surgery or no surgery.

Question 280

Topic: 5. Sports Medicine

When making an anteromedial portal for ankle arthroscopy, which structure is most "at risk" for injury:

. The superficial peroneal nerve
. The dorsalis pedis artery
. The extensor hallucis longus
. The posterior tibial nerve
. The saphenous vein

Correct Answer & Explanation

. The saphenous vein

Explanation

The anteromedial portal is adjacent to the saphenous vein, and injury may occur if care is not taken when creating the portal. A nick in the skin is made and then blunt hemostats are used to spread in line with the neurovascular structures to decrease the likelihood of injury. The anterolateral portal is associated with injury to the superficial peroneal nerve. The anterior-central portal is associated with injury to the dorsalis pedis artery.

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