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5. Sports Medicine MCQs

Practice Set 17 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 321

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), the femoral tunnel must be placed accurately at Schöttle's point. Where is this radiographic point located on a true lateral radiograph?
. Anterior to the posterior cortical line and proximal to the posterior medial condyle
. Anterior to the posterior cortical line and distal to the Blumensaat line
. Posterior to the posterior cortical line and proximal to the Blumensaat line
. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial condyle, and proximal to the level of the posterior point of the Blumensaat line
. Centered exactly on the adductor tubercle

Correct Answer & Explanation

. 1 mm anterior to the posterior cortical line, 2.5 mm distal to the posterior border of the medial condyle, and proximal to the level of the posterior point of the Blumensaat line

Explanation

Schöttle's point is located 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior border of the medial condyle origin, and proximal to the posterior extent of Blumensaat's line. Proper placement is crucial to avoid graft anisometry.

Question 322

Topic: Shoulder & Hip Sports

An anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion differs from a classic Bankart lesion in that the ALPSA lesion involves:

. A bony fracture of the anterior inferior glenoid rim
. An avulsion of the inferior glenohumeral ligament from the humeral head
. An intact periosteum with the labrum displaced medially and inferiorly along the glenoid neck
. A complete rupture of the anterior labrum with disruption of the scapular periosteum
. A superior labral tear extending into the biceps anchor

Correct Answer & Explanation

. An intact periosteum with the labrum displaced medially and inferiorly along the glenoid neck

Explanation

In an ALPSA lesion, the anterior labrum is avulsed but the anterior scapular periosteum remains intact, acting as a sleeve. This allows the labroligamentous complex to heal in a medially displaced and externally rotated position, potentially leading to higher recurrence rates if not properly mobilized during repair.

Question 323

Topic: Shoulder & Hip Sports

A volleyball player presents with posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst in the spinoglenoid notch. Which muscle is predominantly affected?

. Supraspinatus
. Infraspinatus
. Teres minor
. Deltoid
. Subscapularis

Correct Answer & Explanation

. Infraspinatus

Explanation

The suprascapular nerve innervates both the supraspinatus and infraspinatus. Entrapment at the suprascapular notch affects both, whereas entrapment distal to this at the spinoglenoid notch leads to isolated infraspinatus weakness (external rotation).

Question 324

Topic: Shoulder & Hip Sports

In athletes with femoroacetabular impingement (FAI), a Cam lesion typically produces chondral damage by which of the following mechanisms?

. Linear impaction of the acetabular rim during terminal extension
. Shear forces generated by an aspherical femoral head entering the acetabulum during flexion and internal rotation
. Global overcoverage of the femoral head leading to pincer-type compression
. Direct avulsion of the ligamentum teres during deep flexion
. Ischemic necrosis of the anterosuperior labrum due to capsular stretching

Correct Answer & Explanation

. Shear forces generated by an aspherical femoral head entering the acetabulum during flexion and internal rotation

Explanation

A Cam lesion is an aspherical extension of the femoral head-neck junction. During hip flexion and internal rotation, this non-spherical portion enters the acetabulum, generating significant shear forces that peel the cartilage away from the labrum at the anterosuperior rim.

Question 325

Topic: Knee Sports

When performing an isolated single-bundle posterior cruciate ligament (PCL) reconstruction using an anterolateral bundle equivalent, what is the optimal knee flexion angle for securing the graft?

. 0 degrees (full extension)
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 90 degrees

Explanation

An isolated single-bundle PCL reconstruction typically recreates the stronger anterolateral (AL) bundle. Because the AL bundle is tightest in flexion, the graft is optimally tensioned and fixed at 90 degrees of knee flexion while applying an anterior drawer force.

Question 326

Topic: Knee Sports

In posterior cruciate ligament (PCL) anatomy and biomechanics, which of the following statements most accurately describes the function of its distinct bundles?

. The anterolateral bundle is tight in extension and lax in flexion.
. The posteromedial bundle is the primary restraint to posterior translation at 90 degrees of flexion.
. The anterolateral bundle is tight in flexion and is the primary restraint to posterior translation at 90 degrees.
. Both bundles exhibit uniform tension throughout the entire arc of knee motion.
. The posteromedial bundle primarily resists external rotation of the tibia at 30 degrees of flexion.

Correct Answer & Explanation

. The anterolateral bundle is tight in flexion and is the primary restraint to posterior translation at 90 degrees.

Explanation

The PCL consists of the anterolateral (AL) and posteromedial (PM) bundles. The larger AL bundle is tight in flexion, providing the primary restraint to posterior tibial translation at 90 degrees, while the PM bundle is tight in extension.

Question 327

Topic: Knee Sports

Biomechanical studies have demonstrated that a medial meniscus posterior root tear alters knee joint contact mechanics in a manner most biomechanically equivalent to which of the following?

. An anterior cruciate ligament (ACL) rupture
. A bucket-handle medial meniscus tear
. A total medial meniscectomy
. A partial lateral meniscectomy
. An isolated deep medial collateral ligament (MCL) tear

Correct Answer & Explanation

. A total medial meniscectomy

Explanation

A medial meniscus posterior root tear completely disrupts the circumferential hoop stresses of the meniscus. Biomechanically, this results in increased peak contact pressures and decreased contact area equivalent to a total medial meniscectomy.

Question 328

Topic: Knee Sports
During anatomic reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral attachment (Schöttle's point) is critical for restoring normal patellar kinematics. Radiographically, where is this point located on a strict lateral view of the knee?
. Anterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle
. Posterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle
. Anterior to the posterior cortex extension line, distal to the Blumensaat line, and proximal to the adductor tubercle
. Posterior to the posterior cortex extension line, distal to the Blumensaat line, and anterior to the medial epicondyle
. Directly over the medial epicondyle, anterior to the adductor tubercle

Correct Answer & Explanation

. Posterior to the posterior cortex extension line, proximal to the posterior medial femoral condyle articular surface, and distal to the adductor tubercle

Explanation

Schöttle's point is radiographically defined as 1 mm anterior to the posterior cortex line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior medial epicondyle.

Question 329

Topic: 5. Sports Medicine

A 19-year-old female collegiate cross-country runner is diagnosed with the 'Female Athlete Triad'. Which of the following represents the primary underlying pathophysiologic driver of this condition?

. Excessive mechanical loading on immature osteoid
. Low energy availability with or without disordered eating
. Primary ovarian failure resulting in hypoestrogenism
. Hyperthyroidism induced by prolonged endurance training
. Genetic predisposition to low peak bone mineral density

Correct Answer & Explanation

. Low energy availability with or without disordered eating

Explanation

The Female Athlete Triad consists of low energy availability, menstrual dysfunction, and low bone mineral density. Low energy availability (caloric intake insufficient for energy expenditure) is the primary driver, leading to functional hypothalamic amenorrhea.

Question 330

Topic: Knee Sports

A 22-year-old football player sustains a posterolateral corner (PLC) injury. During clinical evaluation, increased varus gapping is noted at 30 degrees of knee flexion, but not at 0 degrees. Which structure is the primary restraint being tested at 30 degrees of flexion?

. Popliteofibular ligament
. Fibular collateral ligament (FCL)
. Popliteus tendon
. Iliotibial band
. Lateral capsule

Correct Answer & Explanation

. Fibular collateral ligament (FCL)

Explanation

The fibular collateral ligament (FCL) is the primary restraint to varus stress at 30 degrees of knee flexion. If varus gapping is present at 0 degrees, it typically indicates combined cruciate and FCL injuries.

Question 331

Topic: General Sports & Tendon
Which of the following cellular changes is considered the histologic hallmark of chronic tendinopathy (e.g., tennis elbow or Achilles tendinopathy) rather than an acute inflammatory process?
. Dense infiltration of polymorphonuclear leukocytes
. Abundant type I collagen proliferation with highly organized fibril alignment
. Angiofibroblastic hyperplasia with disorganized type III collagen
. Presence of widespread ischemic necrosis and lipid pooling
. Hypertrophy of the synovial sheath with fibrinoid exudate

Correct Answer & Explanation

. Angiofibroblastic hyperplasia with disorganized type III collagen

Explanation

Chronic tendinopathy is characterized by angiofibroblastic hyperplasia (tendinosis), marked by disorganized collagen (primarily type III), hypercellularity of fibroblasts, and neovascularization, without a significant acute inflammatory infiltrate.

Question 332

Topic: 5. Sports Medicine

A 30-year-old athlete sustains an acute Achilles tendon rupture. In counseling the patient regarding nonoperative versus operative management, current evidence suggests that operative management is associated with which of the following compared to nonoperative management with early functional rehabilitation?

. Higher rate of re-rupture but lower rate of superficial infection
. Lower rate of re-rupture but higher rate of deep vein thrombosis
. Equivalent rates of re-rupture but higher rate of superficial infection
. Significant improvements in patient-reported outcome scores at 2 years
. Earlier return to weight-bearing activities but increased stiffness

Correct Answer & Explanation

. Equivalent rates of re-rupture but higher rate of superficial infection

Explanation

Recent high-quality studies show that when early functional rehabilitation protocols are utilized, the re-rupture rates between operative and nonoperative management are similar. Operative management carries a higher risk of complications like wound breakdown and infection.

Question 333

Topic: Shoulder & Hip Sports

The Latarjet procedure is often used for recurrent anterior shoulder instability with significant glenoid bone loss. What is the most commonly injured nerve during this procedure?

. Axillary nerve
. Musculocutaneous nerve
. Suprascapular nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is the most commonly injured nerve during a Latarjet procedure due to its proximity to the coracoid process and conjoint tendon, which is mobilized and transferred during the operation.

Question 334

Topic: 5. Sports Medicine

A high school football player suffers a suspected concussion. According to the standard return-to-play guidelines (Concussion in Sport Group), what is the minimum duration required for each progression step before advancing to the next level of exertion?

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

Correct Answer & Explanation

. 24 hours

Explanation

The return-to-play protocol involves a stepwise progression of activity. Athletes must remain asymptomatic for at least 24 hours at each step before advancing to the next level of exertion.

Question 335

Topic: Shoulder & Hip Sports

Internal snapping hip syndrome is often a source of groin pain in dancers and martial artists. The snapping sensation is typically caused by the snapping of which structure over the iliopectineal eminence?

. Iliotibial band
. Rectus femoris tendon
. Iliopsoas tendon
. Gluteus maximus tendon
. Sartorius tendon

Correct Answer & Explanation

. Iliopsoas tendon

Explanation

Internal snapping hip (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the anterior femoral head, often producing an audible click and groin pain.

Question 336

Topic: Knee Sports

During the 'screw-home' mechanism of the knee in terminal extension, there is an obligatory external rotation of the tibia relative to the femur. This is primarily driven by which anatomical feature?

. The increased length and curvature of the medial femoral condyle compared to the lateral femoral condyle
. The active contraction of the popliteus muscle
. The geometry of the lateral meniscus
. The tension provided by the anterior cruciate ligament in extension
. The attachment of the iliotibial band on Gerdy's tubercle

Correct Answer & Explanation

. The increased length and curvature of the medial femoral condyle compared to the lateral femoral condyle

Explanation

The 'screw-home' mechanism is passively driven by the asymmetry of the femoral condyles; the medial femoral condyle has a longer articular surface. This dictates external tibial rotation as the knee locks into full extension.

Question 337

Topic: 5. Sports Medicine

A 35-year-old recreational basketball player suffers a patellar tendon rupture. Biomechanically, the patella functions primarily to increase the mechanical advantage of the quadriceps by:

. Decreasing the angle of pull of the patellar tendon on the tibial tubercle
. Increasing the lever arm (moment arm) of the extensor mechanism
. Centralizing the pull of the vastus medialis and lateralis
. Decreasing the patellofemoral joint reaction forces
. Shifting the center of rotation of the knee joint posteriorly

Correct Answer & Explanation

. Increasing the lever arm (moment arm) of the extensor mechanism

Explanation

The patella acts as a fulcrum to increase the moment arm (lever arm) of the quadriceps muscle group. This significantly increases the mechanical advantage and force generation of the extensor mechanism.

Question 338

Topic: Shoulder & Hip Sports

Cam-type femoroacetabular impingement (FAI) is frequently diagnosed in young male athletes with groin pain. The underlying pathomorphology is best described by which of the following?

. Focal over-coverage of the femoral head by the acetabulum
. An aspherical femoral head with decreased anterior head-neck offset
. Acetabular retroversion leading to anterior over-coverage
. A deep acetabular socket (coxa profunda)
. An excessively large alpha angle in a normally spherical femoral head

Correct Answer & Explanation

. An aspherical femoral head with decreased anterior head-neck offset

Explanation

Cam-type FAI is caused by an aspherical femoral head (often a 'bump' at the anterolateral head-neck junction), which leads to a decreased head-neck offset. This asphericity causes a shear injury to the acetabular cartilage and labrum during flexion.

Question 339

Topic: Knee Sports

All of the following represent mechanisms of injury to the posterior cruciate ligament except:

. Posteriorly directed force on the anterior aspect of the flexed knee
. Fall onto a flexed knee
. Valgus force applied to a flexed and externally rotated knee
. Hyperflexion
. Hyperextension

Correct Answer & Explanation

. Valgus force applied to a flexed and externally rotated knee

Explanation

All of the above except application of valgus force to a flexed and externally rotated knee have been described in posterior cruciate ligament injuries. Application of a valgus force to a flexed and externally rotated knee would more likely result in an anterior cruciate ligament injury.

Question 340

Topic: Shoulder & Hip Sports

Internal impingement of the shoulder between the posterosuperior glenoid rim and the rotator cuff typically occurs with the arm in this position:

. Abduction and internal rotation
. Adduction and external rotation
. Adduction and internal rotation
. Abduction, external rotation, and extension
. Abduction, external rotation, and flexion

Correct Answer & Explanation

. Abduction, external rotation, and extension

Explanation

Internal impingement of the shoulder occurs with the arm in the abducted, externally rotated, and extended position. This entity may be responsible for shoulder pain commonly occurring in overhead and throwing athletes. Initial treatment is focused on therapy that strengthens the anterior structures and scapular retractors and stretches the posterior structures. If nonoperative treatment fails, arthroscopic debridement, thermal capsular shrinkage, and humeral derotational osteotomy have all been used with varying degrees of success.

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