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5. Sports Medicine MCQs

Practice Set 15 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 281

Topic: Knee Sports

A patient underwent bone-patellar-bone anterior cruciate ligament reconstruction. Postoperative radiographs show the femoral tunnel has been placed too far anteriorly. What is the most likely clinical result of anterior placement of the femoral tunnel:

. Limited extension
. Anterior instability
. Anterior knee pain
. Limited flexion
. Posterior instability

Correct Answer & Explanation

. Limited flexion

Explanation

A femoral tunnel that has been placed too anterior will limit extension. Numerous studies have shown the most common technical mistake intraoperatively is placement of either the tibial or the femoral tunnel, or both, too far anteriorly. Either of these aberrant placements may cause impingement of the graft and thus promote formation of a large lump of fibrous tissue, known as a Cyclops lesion. This lesion forms anterior to the graft, potentially blocking extension of the knee.

Question 282

Topic: 5. Sports Medicine

During a wrist arthroscopy in a basketball player who has ulnar-sided wrist pain, the articular disk of the triangular fibrocartilage complex is observed. A probe is inserted and the disk is free floating without tension, (a negative "trampoline test"). What does this signify:

. Flexor carpi ulnaris subluxation
. Distal radioulnar joint disruption
. Scapholunate instability
. Tear in either the central or peripheral portion of the TFC C
. Ulnar abutment syndrome

Correct Answer & Explanation

. Tear in either the central or peripheral portion of the TFC C

Explanation

A probe should be used to test the integrity of the articular disc of the TFC C . This disk should be fairly taught, similar to a trampoline. When the articular disk is floppy and floating without tension, a tear in either the central or peripheral portion must be suspected.

Question 283

Topic: 5. Sports Medicine

A football player has suffered a concussion. It is his first such injury. He suffered loss of consciousness for about 30 seconds and was confused after for 45 minutes. He is now fully asymptomatic at the end of the football game (1 hour after injury). When should he return to play:

. The next day
. After one month if computed tomography (C T) scan of the brain is negative
. In 1 week
. He should sit out the rest of the season.
. The next day, if C T scan of the brain is negative

Correct Answer & Explanation

. In 1 week

Explanation

This patient has suffered a grade 2, or moderate concussion. These patients may return to play after one week if asymptomatic. Grade 1: No LOC , posttraumatic amnesia <30 minutes; return to play when symptoms resolve Grade 2: LOC <5 minutes or posttraumatic amnesia >30 minutes; return to play after one week if asymptomatic. Grade 3: LOC >5 minutes, or posttraumatic amnesia >24 hours; minimum delay of 1 month, then may return if asymptomatic.

Question 284

Topic: Knee Sports

The anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) function synergistically. Which of the following best describes the primary biomechanical role of the posterolateral bundle?

. It is primarily tight in flexion and resists posterior tibial translation.
. It is the primary restraint to anterior tibial translation at 90 degrees of flexion.
. It is primarily tight in extension and highly controls rotatory loads.
. It is thicker and stronger than the AM bundle in the native knee.
. It attaches to the medial wall of the lateral femoral condyle near the roof of the notch.

Correct Answer & Explanation

. It is primarily tight in extension and highly controls rotatory loads.

Explanation

The PL bundle is tight in extension and provides the primary restraint against rotatory loads. Conversely, the AM bundle tightens in flexion and serves as the primary restraint to anterior tibial translation at 90 degrees of flexion.

Question 285

Topic: Knee Sports

A 24-year-old male sustains a knee injury during a soccer match. Physical exam reveals a positive Dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the uninjured side, but symmetric external rotation at 90 degrees. Which structure is most likely isolated in this injury?

. Posterior cruciate ligament
. Anterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Combined PCL and popliteofibular ligament

Correct Answer & Explanation

. Posterolateral corner

Explanation

Increased external rotation at 30 degrees of flexion but not at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If external rotation is increased at both 30 and 90 degrees, it suggests a combined PCL and PLC injury.

Question 286

Topic: 5. Sports Medicine

A 19-year-old female athlete experiences recurrent patellar instability. An MRI confirms an incompetent medial patellofemoral ligament (MPFL). During anatomic reconstruction, where should the femoral attachment of the graft be placed?

. Anterior to the medial epicondyle and distal to the adductor tubercle
. Posterior to the adductor tubercle and proximal to the medial epicondyle
. Between the adductor tubercle proximally and the medial epicondyle distally
. Directly onto the adductor magnus tendon insertion
. 1 cm proximal to the vastus medialis obliquus insertion

Correct Answer & Explanation

. Between the adductor tubercle proximally and the medial epicondyle distally

Explanation

Schottle's point defines the anatomic femoral footprint of the MPFL. It is located radiographically between the adductor tubercle (proximal) and the medial epicondyle (distal), and slightly posterior to the posterior cortex line of the femoral diaphysis.

Question 287

Topic: Shoulder & Hip Sports

A 35-year-old professional volleyball player presents with painless weakness in external rotation of his right shoulder. MRI reveals a paralabral cyst located strictly in the spinoglenoid notch. Which muscle or muscles are most likely affected by this specific nerve entrapment?

. Supraspinatus only
. Infraspinatus only
. Supraspinatus and infraspinatus
. Teres minor
. Subscapularis

Correct Answer & Explanation

. Infraspinatus only

Explanation

Entrapment of the suprascapular nerve at the spinoglenoid notch affects only the infraspinatus muscle, leading to isolated external rotation weakness. Entrapment at the more proximal suprascapular notch affects both the supraspinatus and the infraspinatus.

Question 288

Topic: Knee Sports

Which of the following describes the functional anatomy of the anterior cruciate ligament (ACL) bundles during knee motion?

. The anteromedial bundle is tight in extension and lax in flexion
. The posterolateral bundle is tight in flexion and lax in extension
. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension
. Both bundles are equally tight throughout the entire range of motion
. The anteromedial bundle controls rotatory stability more than the posterolateral bundle

Correct Answer & Explanation

. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension

Explanation

The anteromedial (AM) bundle of the ACL is tightest in flexion and primarily controls anterior translation. The posterolateral (PL) bundle is tightest in extension and provides primary control against rotatory loads.

Question 289

Topic: Shoulder & Hip Sports

A 65-year-old female undergoes arthroscopic repair for a massive, retracted supraspinatus and infraspinatus tear. To minimize the risk of postoperative retear, which biomechanical principle is most critical?

. Using a single-row repair to preserve the lateral footprint blood supply
. Minimizing tension on the repair by maximizing footprint coverage
. Creating a high-tension double-row repair to ensure gap closure
. Utilizing non-absorbable sutures to bridge the gap without tissue reduction
. Relying on isolated margin convergence without bone anchor fixation

Correct Answer & Explanation

. Minimizing tension on the repair by maximizing footprint coverage

Explanation

Minimizing tension on the repair site is the single most critical factor for biological healing in massive rotator cuff tears. Over-tensioning compromises blood flow and significantly increases the risk of structural failure.

Question 290

Topic: Knee Sports

The anterior cruciate ligament (ACL) consists of two distinct functional bundles. Which of the following statements correctly describes the biomechanical role of the posterolateral bundle?

. It is the primary restraint to anterior tibial translation at 90 degrees of flexion
. It is tightest in full extension and provides primary rotational stability
. It originates on the high and anterior aspect of the femoral footprint
. It is the primary restraint to valgus laxity
. It is predominantly isometric throughout the range of motion

Correct Answer & Explanation

. It is tightest in full extension and provides primary rotational stability

Explanation

The posterolateral (PL) bundle of the ACL is tightest in extension and provides the primary restraint to internal rotation. The anteromedial (AM) bundle is tightest in flexion and resists anterior translation.

Question 291

Topic: Knee Sports

A 45-year-old patient suffers an acute posterior root tear of the medial meniscus. Biomechanically, this injury is most equivalent to which of the following conditions?

. Anterior cruciate ligament deficient knee
. Total medial meniscectomy
. Partial peripheral meniscectomy
. Posterior cruciate ligament deficient knee
. Isolated medial collateral ligament sprain

Correct Answer & Explanation

. Total medial meniscectomy

Explanation

A posterior root tear of the medial meniscus disrupts the hoop stresses, causing the meniscus to extrude under load. Biomechanically, this completely eliminates the load-sharing function, rendering the knee equivalent to one with a total medial meniscectomy.

Question 292

Topic: Knee Sports

The medial patellofemoral ligament (MPFL) provides the primary soft tissue restraint to lateral patellar translation at which of the following knee flexion angles?

. 0 to 30 degrees
. 45 to 60 degrees
. 60 to 90 degrees
. 90 to 120 degrees
. Beyond 120 degrees

Correct Answer & Explanation

. 0 to 30 degrees

Explanation

The MPFL is the primary restraint to lateral patellar displacement in early flexion (0 to 30 degrees). Beyond 30 degrees, the patella engages the trochlear groove, and bony stability becomes the primary restraint.

Question 293

Topic: 5. Sports Medicine

When performing anterior cruciate ligament reconstruction using a bone- patellar tendon-bone autograft fixated with interference screws, up to how many degrees of divergence between the bone plug and the screw provides mechanically acceptable initial fixation strength on the femoral side?

. 5°
. 10°
. 15°
. 20°
. 30°

Correct Answer & Explanation

. 30°

Explanation

Biomechanical studies have shown that up to 30° of divergence between the femoral bone plug and interference screw can be accepted without significantly compromising initial fixation strength.

Question 294

Topic: 5. Sports Medicine

A 20-year-old male collegiate basketball player experiences a near syncopal episode during a particularly rigorous conditioning session. Appropriate management should include:

. More intensive conditioning
. A short break, allowing the athlete to return when he feels ready
. Discontinuation of participation for 1 week
. Urgent cardiac evaluation
. Urgent neurological evaluation

Correct Answer & Explanation

. Urgent cardiac evaluation

Explanation

A near syncopal episode in a young athlete may be a sign of an underlying life threatening condition. Most commonly, this is related to cardiac pathology, such as hypertrophic cardiomyopathy, idiopathic hypertrophic subaortic stenosis, or arrhythmias. These conditions require urgent medical attention as they are frequently life threatening. The athlete should not be allowed to participate until a complete medical (including cardiac) work up has been performed.

Question 295

Topic: 5. Sports Medicine

On a cellular level, the nutritional supplement creatine has the following effect:

. Increases water retention in cells
. Decreases water retention in cells
. C auses hydrolysis of cells
. C auses increased organelle production
. C auses decreased organelle production

Correct Answer & Explanation

. Increases water retention in cells

Explanation

Creatine is a popular nutritional supplement with athletes, and has a cellular effect of increasing water retention. This effect decreases the amount of free water available to the athlete and may result in cramping and dehydration. In season use of creatine is not recommended.

Question 296

Topic: 5. Sports Medicine

Septic arthritis of the knee within 4 weeks following anterior cruciate ligament (AC L) reconstruction using bone-patellar tendonbone autograft should initially be treated with:

. C ulture-specific intravenous antibiotics
. C ulture-specific intravenous antibiotics and surgical irrigation with graft retention
. C ulture-specific intravenous antibiotics and surgical irrigation with graft removal
. Culture-specific intravenous antibiotics, surgical irrigation with graft removal, and immediate revision reconstruction
. C ulture-specific intravenous antibiotics, surgical irrigation with graft removal, and delayed revision reconstruction

Correct Answer & Explanation

. C ulture-specific intravenous antibiotics and surgical irrigation with graft retention

Explanation

In a recent study that surveyed surgeons with expertise in AC L reconstruction surgery, 85% of surgeons selected culture-specific intravenous antibiotics and surgical irrigation of the joint with graft retention as initial treatment for the infected patellar tendon autograft. Sixty-four percent of surgeons chose this regimen as treatment for the infected allograft.

Question 297

Topic: Knee Sports

In the setting of chronic anterior cruciate ligament (AC L) deficiency, which of the following meniscal tear patterns is most common:

. Peripheral posterior horn tears of the medial meniscus
. Peripheral posterior horn tears of the lateral meniscus
. Peripheral anterior horn tears of the medial meniscus
. Peripheral anterior horn tears of the lateral meniscus
. C entral posterior horn tears of the medial meniscus

Correct Answer & Explanation

. Peripheral posterior horn tears of the medial meniscus

Explanation

Medial meniscal tears account for approximately 45% of acute tears and 70% of chronic tears in patients with AC L insufficiency. Peripheral posterior horn tears of the medial meniscus are the most common type of tear associated with chronic AC L deficiency.

Question 298

Topic: Shoulder & Hip Sports

Which of the following describes the correct relationship between the suprascapular nerve and the suprascapular vessels as they pass through the suprascapular notch:

. The suprascapular nerve, artery, and vein all pass below the transverse scapular ligament.
. The suprascapular nerve, artery, and vein all pass superficially to the transverse scapular ligament.
. The suprascapular nerve passes superficially to the transverse scapular ligament while the artery and vein pass deep to it.
. The suprascapular nerve and artery pass deep to the transverse scapular ligament while the suprascapular vein passes superficially to it.
. The suprascapular nerve passes deep to the transverse scapular ligament while the suprascapular artery and vein pass above it.

Correct Answer & Explanation

. The suprascapular nerve passes deep to the transverse scapular ligament while the suprascapular artery and vein pass above it.

Explanation

The suprascapular nerve is a branch of the upper trunk of the brachial plexus at Erbs point. The suprascapular nerve receives branches primarily from the fifth cervical nerve root. The nerve follows the omohyoid muscle laterally and passes beneath the anterior border of the trapezius muscle to the upper border of the scapula where it joins the suprascapular artery. It passes through the suprascapular notch deep to the transverse scapular ligament. The artery and vein pass superficial to the ligament and join the nerve distally in the suprascapular fossa. After innervating the supraspinatus muscle, the nerve passes around the lateral free margin of the scapular spine (spinoglenoid notch) to innervate the infraspinatus muscle.

Question 299

Topic: Knee Sports

Which of the following describes the most accurate femoral attachment site of the medial patellofemoral ligament (MPFL) in relation to the medial epicondyle and adductor tubercle?

. Anterior and distal to the medial epicondyle
. Posterior and proximal to the medial epicondyle (between the adductor tubercle and medial epicondyle)
. Directly on the adductor tubercle
. Distal to the adductor tubercle and posterior to the medial epicondyle
. Anterior to the adductor tubercle

Correct Answer & Explanation

. Posterior and proximal to the medial epicondyle (between the adductor tubercle and medial epicondyle)

Explanation

The femoral footprint of the MPFL is located in a saddle-like sulcus posterior and proximal to the medial epicondyle, and distal and anterior to the adductor tubercle.

Question 300

Topic: Knee Sports

In posterior cruciate ligament (PCL) reconstruction, the tibial inlay technique was developed primarily to avoid which of the following complications associated with the transtibial technique?

. Popliteal artery injury
. Anterior knee pain
. "Killer turn" graft attenuation
. Tibial nerve palsy
. Graft-tunnel mismatch

Correct Answer & Explanation

. "Killer turn" graft attenuation

Explanation

The tibial inlay technique avoids the acute angle (the "killer turn") that the graft makes as it exits the posterior tibial tunnel in a transtibial reconstruction. This reduces graft abrasion and attenuation.

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