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5. Sports Medicine MCQs

Practice Set 16 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 301

Topic: Shoulder & Hip Sports

Which of the following is the primary stabilizing mechanism of the Latarjet procedure in treating anterior shoulder instability?

. Deepening of the glenoid concavity via the bone block
. The "sling effect" of the conjoined tendon on the inferior subscapularis and capsule
. Restoring the anatomic origin of the long head of the biceps
. Shortening of the anterior capsule to limit external rotation
. Dynamic stabilization from the transferred pectoralis minor

Correct Answer & Explanation

. The "sling effect" of the conjoined tendon on the inferior subscapularis and capsule

Explanation

The Latarjet procedure provides stability primarily via the "sling effect" of the conjoined tendon across the inferior subscapularis when the arm is abducted and externally rotated. This accounts for 50-70% of the stabilizing effect.

Question 302

Topic: 5. Sports Medicine

The "peel-back" mechanism, causing Type II SLAP lesions in overhead-throwing athletes, is primarily driven by which shoulder motion during the late cocking phase?

. Maximal internal rotation and adduction
. Maximal external rotation and abduction
. Maximal forward flexion and internal rotation
. Extension and internal rotation
. Scapular protraction and depression

Correct Answer & Explanation

. Maximal external rotation and abduction

Explanation

In the late cocking phase of throwing, the shoulder is in maximal abduction and external rotation. This position places a torsional force on the biceps anchor, leading to the "peel-back" mechanism of SLAP tears.

Question 303

Topic: Shoulder & Hip Sports

A 24-year-old hockey player presents with groin pain exacerbated by flexion and internal rotation. Radiographs demonstrate an elevated alpha angle on the frog-leg lateral view. What is the primary pathomechanical consequence of this structural abnormality?

. Pincer impingement causing posterior labral tears
. Cam impingement leading to chondral delamination at the anterosuperior acetabulum
. Dysplastic instability leading to ligamentum teres hypertrophy
. Ischiofemoral impingement causing quadratus femoris edema
. Subspine impingement causing rectus femoris tendinosis

Correct Answer & Explanation

. Cam impingement leading to chondral delamination at the anterosuperior acetabulum

Explanation

An elevated alpha angle indicates a Cam-type deformity, which is an aspherical femoral head-neck junction. This creates shear forces during flexion and internal rotation, typically causing anterosuperior acetabular chondral delamination.

Question 304

Topic: 5. Sports Medicine

The Female Athlete Triad consists of low energy availability, menstrual dysfunction, and low bone mineral density. What is the primary hormonal mechanism mediating the low bone mineral density in these patients?

. Hyperandrogenism
. Hypoestrogenism secondary to hypothalamic amenorrhea
. Hypercortisolemia due to adrenal fatigue
. Hypothyroidism secondary to overtraining
. Elevated parathyroid hormone levels

Correct Answer & Explanation

. Hypoestrogenism secondary to hypothalamic amenorrhea

Explanation

Low energy availability suppresses the hypothalamic-pituitary-ovarian axis, leading to hypothalamic amenorrhea. The resulting hypoestrogenism causes increased osteoclastic activity and decreased bone density.

Question 305

Topic: Knee Sports
A 25-year-old athlete undergoes Matrix-Induced Autologous Chondrocyte Implantation (MACI) for a 3 cm² focal chondral defect on the medial femoral condyle. What is the primary histologic composition of the target repaired tissue?
. Pure Type I collagen
. Hyaline-like cartilage rich in Type II collagen
. Fibrocartilage rich in Type III collagen
. Pure Type I and Type X collagen
. Calcified cartilage with disorganized Type II collagen

Correct Answer & Explanation

. Hyaline-like cartilage rich in Type II collagen

Explanation

Unlike microfracture which predominantly produces fibrocartilage (Type I collagen), MACI aims to produce hyaline-like cartilage, which is rich in Type II collagen and aggrecan, providing superior wear characteristics.

Question 306

Topic: 5. Sports Medicine

A 28-year-old weightlifter presents with a spontaneous distal biceps tendon rupture. He admits to the chronic use of anabolic-androgenic steroids. How do these substances predispose athletes to tendon ruptures?

. By increasing tendon elasticity causing sudden failure
. By creating a disproportionate increase in muscle strength compared to tendon structural adaptation
. By directly inducing focal necrosis within the tendon watershed zones
. By decreasing total collagen synthesis in the body
. By downregulating matrix metalloproteinases in the peritenon

Correct Answer & Explanation

. By creating a disproportionate increase in muscle strength compared to tendon structural adaptation

Explanation

Anabolic steroids lead to rapid muscle hypertrophy and force generation that outpaces the slower structural adaptation of tendons. They also alter collagen fibril architecture, making tendons stiffer and more prone to mechanical failure.

Question 307

Topic: Knee Sports

The primary restraint to lateral patellar translation at 0 to 30 degrees of knee flexion is the:

. Medial patellofemoral ligament
. Medial patellotibial ligament
. Medial retinaculum
. Vastus medialis obliquus
. Lateral trochlear ridge

Correct Answer & Explanation

. Medial patellofemoral ligament

Explanation

The medial patellofemoral ligament (MPFL) provides approximately 50-60% of the restraint to lateral patellar translation in early flexion. Beyond 30 degrees, the patella engages the trochlear groove, and bony stability becomes the primary restraint.

Question 308

Topic: 5. Sports Medicine

Second impact syndrome in athletes is a rare but catastrophic complication occurring when a player sustains a second head injury before symptoms from an initial concussion have resolved. The rapid neurological decline is primarily due to:

. Massive acute subdural hematoma
. Rupture of a pre-existing cerebral aneurysm
. Loss of cerebral vascular autoregulation leading to rapid brain swelling
. Sudden onset of status epilepticus
. Acute hydrocephalus from aqueductal stenosis

Correct Answer & Explanation

. Loss of cerebral vascular autoregulation leading to rapid brain swelling

Explanation

Second impact syndrome results from a failure of cerebral vascular autoregulation. This causes catastrophic engorgement of the cerebral vasculature, leading to rapid brain swelling, elevated intracranial pressure, and potential herniation.

Question 309

Topic: 5. Sports Medicine

During anterior cruciate ligament (ACL) reconstruction using a hamstring autograft, tensioning and fixing the graft at full extension rather than 20-30 degrees of flexion is most likely to result in:

. A lax graft in extension
. Over-constraint of the knee in flexion
. Increased anterior tibial translation in flexion
. Decreased graft-tunnel incorporation
. Increased risk of posterior cruciate ligament rupture

Correct Answer & Explanation

. Over-constraint of the knee in flexion

Explanation

Depending on specific tunnel placement, tensioning the ACL graft in full extension can capture the joint, making the graft excessively tight as the knee flexes. This leads to over-constraint and a loss of terminal knee flexion.

Question 310

Topic: Knee Sports

The most common anatomic location for Osteochondritis Dissecans (OCD) lesions in the knee is the:

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central trochlear groove
. Inferior pole of the patella
. Weight-bearing surface of the medial tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

Approximately 70-80% of knee OCD lesions occur on the lateral aspect of the medial femoral condyle. This area corresponds to the classic location evaluated during the Wilson test.

Question 311

Topic: Knee Sports

Concurrent anterior cruciate ligament (ACL) reconstruction at the time of meniscus repair is known to improve meniscus healing rates. This biological enhancement is primarily attributed to:

. Decreased post-operative weight-bearing
. Release of bone marrow elements into the joint during tunnel drilling
. Immediate restoration of normal knee kinematics
. Post-operative use of continuous passive motion (CPM)
. Avoidance of post-operative NSAID use

Correct Answer & Explanation

. Release of bone marrow elements into the joint during tunnel drilling

Explanation

Drilling femoral and tibial tunnels during ACL reconstruction releases bone marrow elements, stem cells, and growth factors into the intra-articular environment. This creates a biologically favorable hemarthrosis that significantly enhances meniscal healing.

Question 312

Topic: Shoulder & Hip Sports

In the evaluation of femoroacetabular impingement (FAI), an alpha angle greater than 55 degrees measured on a modified Dunn lateral radiograph is most indicative of:

. Pincer impingement
. Cam impingement
. Acetabular retroversion
. Coxa profunda
. Protrusio acetabuli

Correct Answer & Explanation

. Cam impingement

Explanation

The alpha angle is used to quantify the loss of anterior head-neck offset in the proximal femur. An angle greater than 50-55 degrees indicates the presence of a cam deformity, which can lead to chondrolabral damage during hip flexion.

Question 313

Topic: 5. Sports Medicine
Long-term use of anabolic-androgenic steroids in power athletes is associated with an increased risk of tendon ruptures. On a cellular level, this is primarily due to:
. Increased collagen cross-linking making tendons excessively stiff
. Inhibition of matrix metalloproteinases leading to tissue hypertrophy
. A dysplastic collagen fibril architecture with decreased crimp pattern
. Excessive deposition of type III collagen relative to type I collagen
. Increased vascularity of the tendon substance leading to mechanical weakness

Correct Answer & Explanation

. A dysplastic collagen fibril architecture with decreased crimp pattern

Explanation

Anabolic steroids alter tendon biomechanics by producing a dysplastic collagen fibril architecture with decreased crimp. This reduces the tendon's ability to absorb shock and tensile loads, significantly increasing the risk of spontaneous rupture.

Question 314

Topic: 5. Sports Medicine

A 45-year-old recreational tennis player undergoes arthroscopy for a symptomatic Type II SLAP tear. The most appropriate management to optimize return to play and patient satisfaction in this specific age demographic is:

. Debridement of the labrum only
. Anatomic repair of the superior labrum with suture anchors
. Biceps tenotomy or tenodesis
. Capsular plication
. Subacromial decompression alone

Correct Answer & Explanation

. Biceps tenotomy or tenodesis

Explanation

In patients older than 35-40 years with a Type II SLAP tear, primary biceps tenodesis yields better clinical outcomes, higher return to sport, and lower complication rates compared to SLAP repair. SLAP repairs in older patients often result in postoperative stiffness and persistent pain.

Question 315

Topic: Knee Sports

The "killer turn" in Posterior Cruciate Ligament (PCL) reconstruction refers to the acute angle the graft must negotiate at the:

. Femoral tunnel aperture
. Tibial tunnel aperture
. Intercondylar notch
. Medial femoral condyle articular margin
. Tibial spine

Correct Answer & Explanation

. Tibial tunnel aperture

Explanation

In a transtibial PCL reconstruction, the graft must make an acute 90-degree turn as it exits the posterior tibial tunnel aperture to reach the femoral attachment. This "killer turn" can lead to increased graft abrasion and attenuation over time.

Question 316

Topic: Shoulder & Hip Sports

According to the "Glenoid Track" concept in anterior shoulder instability, a Hill-Sachs lesion is considered "off-track" if it:

. Is wider than the anterior-to-posterior distance of the glenoid.
. Extends medial to the medial margin of the glenoid track.
. Engages the anterior glenoid rim only when the arm is internally rotated.
. Involves more than 40% of the humeral head articular surface.
. Is accompanied by a bony Bankart lesion of any size.

Correct Answer & Explanation

. Extends medial to the medial margin of the glenoid track.

Explanation

An off-track Hill-Sachs lesion extends medial to the calculated medial margin of the glenoid track. This means the lesion can engage the anterior rim of the glenoid during abduction and external rotation, necessitating procedures like a remplissage or Latarjet.

Question 317

Topic: Knee Sports

When performing an anatomic posterolateral corner (PLC) reconstruction of the knee, which three primary structures are typically reconstructed to restore varus and external rotation stability?

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament
. Fibular collateral ligament, biceps femoris tendon, and iliotibial band
. Popliteus tendon, lateral collateral ligament, and lateral meniscus root
. Arcuate ligament, fabellofibular ligament, and popliteofibular ligament
. Lateral collateral ligament, anterior lateral ligament, and popliteus tendon

Correct Answer & Explanation

. Fibular collateral ligament, popliteus tendon, and popliteofibular ligament

Explanation

Anatomic PLC reconstruction aims to recreate the three major static stabilizers of the posterolateral knee. These are the fibular collateral ligament (FCL), the popliteus tendon (PLT), and the popliteofibular ligament (PFL).

Question 318

Topic: 5. Sports Medicine

The primary underlying etiology of the Female Athlete Triad, now conceptualized as Relative Energy Deficiency in Sport (RED-S), is:

. Estrogen deficiency
. Low energy availability with or without disordered eating
. Primary amenorrhea
. Decreased bone mineral density
. Over-training syndrome

Correct Answer & Explanation

. Low energy availability with or without disordered eating

Explanation

The underlying driver of RED-S and the female athlete triad is low energy availability. This creates an energy deficit that disrupts the hypothalamic-pituitary-ovarian axis, leading to menstrual dysfunction and compromised bone health.

Question 319

Topic: 5. Sports Medicine

A high school football player sustains a concussion. According to the standard graduated return-to-play protocol, what is the minimum duration required for each progression step before advancing to the next level?

. 12 hours
. 24 hours
. 48 hours
. 72 hours
. 1 week

Correct Answer & Explanation

. 24 hours

Explanation

The standard graduated return-to-play protocol dictates that an athlete must remain asymptomatic for at least 24 hours at each step before progressing to the next intensity level. If symptoms return, they must drop back to the previous asymptomatic level.

Question 320

Topic: Knee Sports

Which of the following statements accurately describes the biomechanical role of the anteromedial (AM) bundle of the anterior cruciate ligament?

. It is tightest in full extension
. It primarily resists anterior tibial translation in flexion
. It primarily controls rotatory stability in extension
. It has a femoral origin posterior to the posterolateral bundle
. It is smaller and weaker than the posterolateral bundle

Correct Answer & Explanation

. It primarily resists anterior tibial translation in flexion

Explanation

The AM bundle is tightest in flexion and is the primary restraint to anterior tibial translation at 90 degrees of flexion. The posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

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