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5. Sports Medicine MCQs

Practice Set 163 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 3241

Topic: Knee Sports



During surgical reconstruction of the posterolateral corner (PLC) of the knee, accurate femoral tunnel placement is required. What is the normal anatomic relationship of the femoral footprints of the fibular collateral ligament (FCL) and the popliteus tendon?

. The popliteus footprint is proximal and posterior to the FCL
. The popliteus footprint is distal and anterior to the FCL
. The popliteus footprint is directly posterior to the FCL
. The popliteus footprint is proximal and anterior to the FCL
. The popliteus and FCL share an identical footprint

Correct Answer & Explanation

. The popliteus footprint is distal and anterior to the FCL

Explanation

On the lateral femoral epicondyle, the popliteus tendon insertion is situated distal and anterior to the attachment of the fibular collateral ligament. Precise identification of these footprints is critical for anatomic PLC reconstruction.

Question 3242

Topic: Knee Sports

Which of the following best describes the precise anatomic attachment of the popliteus tendon on the lateral femoral condyle relative to the fibular collateral ligament (FCL)?

. Proximal and posterior
. Proximal and anterior
. Distal and posterior
. Distal and anterior
. Directly deep to the FCL origin

Correct Answer & Explanation

. Distal and anterior

Explanation

The femoral footprint of the popliteus tendon is situated anterior and distal (inferior) to the origin of the fibular collateral ligament on the lateral femoral condyle. Understanding this relationship is critical for anatomical posterolateral corner reconstructions.

Question 3243

Topic: 5. Sports Medicine

Which of the following structures passes anterior to the medial malleolus and is at risk during the placement of the anteromedial portal in ankle arthroscopy?

. Sural nerve
. Saphenous vein and nerve
. Posterior tibial artery
. Deep peroneal nerve
. Tibial nerve

Correct Answer & Explanation

. Saphenous vein and nerve

Explanation

The great saphenous vein and the saphenous nerve travel anterior to the medial malleolus. They are at significant risk of injury during the establishment of the anteromedial ankle arthroscopy portal.

Question 3244

Topic: Knee Sports

The anterior cruciate ligament (ACL) is composed of two primary bundles. Which statement accurately describes the tension pattern of these bundles during knee range of motion?

. The anteromedial bundle is tight in extension; the posterolateral bundle is tight in flexion
. The anteromedial bundle is tight in flexion; the posterolateral bundle is tight in extension
. Both bundles are equally tight in full flexion
. Both bundles are lax in full extension
. The posterolateral bundle restrains anterior translation exclusively in flexion

Correct Answer & Explanation

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

Explanation

The anteromedial (AM) bundle of the ACL is tight in flexion, whereas the posterolateral (PL) bundle is tight in extension. This biomechanical relationship is fundamental in assessing knee stability and performing anatomic ACL reconstructions.

Question 3245

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player presents with isolated weakness of external rotation of the shoulder. An MRI reveals a paralabral cyst. If the cyst is located strictly at the spinoglenoid notch, which muscle will show denervation changes on EMG?

. Supraspinatus only
. Infraspinatus only
. Both supraspinatus and infraspinatus
. Teres minor
. Deltoid

Correct Answer & Explanation

. Infraspinatus only

Explanation

The suprascapular nerve innervates the supraspinatus before passing through the spinoglenoid notch to innervate the infraspinatus. Compression at the spinoglenoid notch results in isolated infraspinatus weakness, whereas compression at the suprascapular notch affects both.

Question 3246

Topic: Knee Sports
In the anatomic reconstruction of the medial patellofemoral ligament (MPFL), the femoral tunnel placement is highly sensitive. The exact anatomic femoral insertion of the MPFL is located in which relation to bony landmarks?
. Just distal to the medial epicondyle
. Between the medial epicondyle and adductor tubercle
. Anterior to the adductor tubercle
. Posterior to the adductor tubercle
. On the superficial medial collateral ligament only

Correct Answer & Explanation

. Between the medial epicondyle and adductor tubercle

Explanation

The anatomic femoral origin of the MPFL (Schöttle's point) is located in the saddle-shaped sulcus between the medial epicondyle and the adductor tubercle.

Question 3247

Topic: 5. Sports Medicine

A 19-year-old collegiate soccer player sustains a concussion during a match. He is completely asymptomatic at rest 4 days post-injury and has normal neurocognitive testing. What is the correct next step in his management according to the standard stepwise return-to-play guidelines?

. Return to full contact practice immediately
. Light aerobic exercise
. Sport-specific exercise without head impact
. Non-contact training drills
. Clearance for unrestricted game play

Correct Answer & Explanation

. Light aerobic exercise

Explanation

The stepwise return-to-play protocol begins with light aerobic exercise once the athlete is asymptomatic at rest for 24 to 48 hours. Each subsequent step requires at least 24 hours without symptom recurrence before progressing.

Question 3248

Topic: Knee Sports
A patient presents with a combined grade III posterior cruciate ligament (PCL) injury and posterolateral corner (PLC) injury. During biomechanical testing, isolated sectioning of the popliteofibular ligament would result in maximum increased external tibial rotation at which knee flexion angle?
. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

The posterolateral corner structures are the primary restraint to external tibial rotation at 30 degrees of knee flexion. At 90 degrees, the PCL becomes an important secondary restraint to external rotation.

Question 3249

Topic: 5. Sports Medicine

Which of the following pathophysiological mechanisms is primarily responsible for the rapid deterioration and high mortality seen in Second Impact Syndrome?

. Acute epidural hematoma expansion
. Loss of cerebral autoregulation leading to vascular engorgement
. Massive traumatic subarachnoid hemorrhage
. Excitotoxic neuronal apoptosis
. Diffuse axonal shearing

Correct Answer & Explanation

. Loss of cerebral autoregulation leading to vascular engorgement

Explanation

Second Impact Syndrome occurs when an athlete sustains a second head injury before initial concussion symptoms resolve. This triggers a catastrophic loss of cerebral autoregulation, causing massive cerebral vascular engorgement, malignant edema, and brain herniation.

Question 3250

Topic: Shoulder & Hip Sports

A 55-year-old laborer has a massive, irreparable subscapularis tendon tear. He presents with severe weakness in internal rotation, a positive belly-press test, and pain. Which of the following tendon transfers is the most appropriate surgical option to restore function?

. Latissimus dorsi transfer
. Lower trapezius transfer
. Pectoralis major transfer
. Teres major transfer
. Biceps rerouting

Correct Answer & Explanation

. Pectoralis major transfer

Explanation

A pectoralis major tendon transfer is the procedure of choice for irreparable subscapularis tears to restore active internal rotation and dynamic anterior joint stability. Latissimus dorsi and lower trapezius transfers are indicated for irreparable posterosuperior (supraspinatus/infraspinatus) tears.

Question 3251

Topic: 5. Sports Medicine

Which of the following is the most frequently reported complication associated with the use of a bone-patellar tendon-bone (BPTB) autograft for anterior cruciate ligament (ACL) reconstruction?

. Graft rupture within the first year
. Anterior knee pain
. Patellar fracture
. Deep surgical site infection
. Arthrofibrosis

Correct Answer & Explanation

. Anterior knee pain

Explanation

Anterior knee pain, often related to donor site morbidity, is the most common complication following BPTB autograft ACL reconstruction. Patellar fracture and patellar tendon rupture are severe but rare complications.

Question 3252

Topic: 5. Sports Medicine

During the sideline evaluation of an athlete with a suspected concussion, the Vestibular/Ocular Motor Screening (VOMS) tool is utilized. Which of the following is NOT a standard component of this assessment?

. Smooth pursuits
. Saccades
. Convergence
. Vestibulo-ocular reflex (VOR)
. Optokinetic nystagmus (OKN) testing

Correct Answer & Explanation

. Optokinetic nystagmus (OKN) testing

Explanation

The VOMS tool assesses vestibular and ocular motor impairments via smooth pursuits, saccades, near point of convergence, VOR, and visual motion sensitivity. OKN testing is not a standard component of this clinical screening tool.

Question 3253

Topic: Shoulder & Hip Sports

When performing an arthroscopic rotator cuff repair, aggressive medial mobilization of a chronically retracted supraspinatus tendon places the suprascapular nerve at greatest risk of traction injury at which anatomic location?

. Spinoglenoid notch
. Suprascapular notch
. Base of the coracoid process
. Quadrilateral space
. Triangular interval

Correct Answer & Explanation

. Suprascapular notch

Explanation

The suprascapular nerve is firmly tethered at the suprascapular notch beneath the superior transverse scapular ligament. Excessive medial mobilization (>3 cm) of a retracted supraspinatus tendon risks traction injury to the nerve at this location.

Question 3254

Topic: Knee Sports

In an anatomic posterolateral corner (PLC) reconstruction using the LaPrade technique, the fibular attachment of the fibular collateral ligament (FCL) graft should be placed:

. Anterior and distal to the popliteofibular ligament attachment
. Posterior and proximal to the popliteofibular ligament attachment
. Directly on the tip of the fibular styloid
. Distal to the biceps femoris insertion
. On the medial aspect of the fibular head

Correct Answer & Explanation

. Anterior and distal to the popliteofibular ligament attachment

Explanation

The native FCL attaches to the lateral aspect of the fibular head, slightly anterior and distal to the attachment of the popliteofibular ligament and the fibular styloid. Anatomic graft placement here is crucial to restore native kinematics.

Question 3255

Topic: Shoulder & Hip Sports

According to the Goutallier classification evaluated on non-contrast CT or MRI, which stage of fatty infiltration in the rotator cuff musculature represents an equal amount of fat and muscle tissue?

. Stage 1
. Stage 2
. Stage 3
. Stage 4
. Stage 5

Correct Answer & Explanation

. Stage 3

Explanation

Goutallier Stage 3 is characterized by an equal amount of fat and muscle tissue within the muscle belly. Stage 1 has fatty streaks, Stage 2 has more muscle than fat, and Stage 4 has more fat than muscle.

Question 3256

Topic: Knee Sports

A 25-year-old male presents with lateral knee pain after a rugby tackle. The Dial test demonstrates 15 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but symmetric rotation at 90 degrees of flexion. What is the most likely diagnosis?

. Isolated lateral collateral ligament (LCL) injury
. Isolated posterolateral corner (PLC) injury
. Combined PCL and PLC injury
. Isolated posterior cruciate ligament (PCL) injury
. Combined ACL and PLC injury

Correct Answer & Explanation

. Isolated posterolateral corner (PLC) injury

Explanation

A positive Dial test (>10 degrees of increased external rotation) at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated posterolateral corner (PLC) injury. An increase at both 30 and 90 degrees suggests a combined PCL and PLC injury.

Question 3257

Topic: 5. Sports Medicine

In the immediate sideline assessment of a suspected concussion using the SCAT tool, which of the following findings is considered a 'Red Flag' that necessitates immediate removal from play and emergency medical evaluation?

. Photophobia
. Delayed verbal responses
. Repeated vomiting
. Retrograde amnesia
. Mild dizziness

Correct Answer & Explanation

. Repeated vomiting

Explanation

Repeated vomiting is a 'Red Flag' symptom indicating a potential structural brain injury or increasing intracranial pressure, requiring immediate emergency transport. The other symptoms are common in uncomplicated concussions.

Question 3258

Topic: 5. Sports Medicine

A 45-year-old overhead throwing athlete undergoes shoulder arthroscopy. A PASTA (Partial Articular Supraspinatus Tendon Avulsion) lesion is identified involving 60% of the tendon footprint. What is the most appropriate management?

. Debridement alone
. Acromioplasty without repair
. Completion of the tear and formal repair
. Coracoacromial ligament release
. Biceps tenodesis alone

Correct Answer & Explanation

. Completion of the tear and formal repair

Explanation

High-grade articular-sided partial rotator cuff tears (>50% footprint thickness) are generally treated with either tear completion and repair or an in situ repair. Debridement alone is insufficient and leads to high failure rates for tears >50%.

Question 3259

Topic: Shoulder & Hip Sports

In the transverse plane of the shoulder, the dynamic glenohumeral force couple that acts to compress and stabilize the humeral head against the glenoid during active motion is primarily formed by the:

. Supraspinatus and deltoid
. Subscapularis and infraspinatus/teres minor
. Latissimus dorsi and pectoralis major
. Biceps and triceps
. Coracobrachialis and short head of biceps

Correct Answer & Explanation

. Subscapularis and infraspinatus/teres minor

Explanation

In the transverse plane, the anterior subscapularis and the posterior infraspinatus and teres minor form a critical force couple. This balances the joint, compressing and centering the humeral head within the glenoid during motion.

Question 3260

Topic: 5. Sports Medicine

Which of the following premorbid factors is most strongly associated with a prolonged recovery and the development of Post-Concussion Syndrome (PCS) following a sport-related mild traumatic brain injury?

. Male sex
. Personal history of migraines
. Age older than 30 years
. Playing a non-contact sport
. High socioeconomic status

Correct Answer & Explanation

. Personal history of migraines

Explanation

A personal or family history of migraines, learning disabilities, ADHD, anxiety, depression, and female sex are all established pre-injury risk factors for a prolonged recovery and post-concussion syndrome.

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