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5. Sports Medicine MCQs

Practice Set 18 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 341

Topic: Shoulder & Hip Sports

This slide is a computed tomogram of the shoulder of a 22-year-old rugby player. The most likely diagnosis is:

. Anterior shoulder instability
. Posterior shoulder instability
. Glenohumeral arthritis
. Supraspinatus tear
. Subscapularis tear

Correct Answer & Explanation

. Posterior shoulder instability

Explanation

The computed tomogram shows a posterior avulsion of the glenoid rim and an impaction fracture of the anterior aspect of the humeral head consisted with a prior posterior dislocation.

Question 342

Topic: Knee Sports

Which of the following statements correctly describes the functional biomechanics of the anterior cruciate ligament (ACL) bundles?

. The anteromedial bundle is tight in extension and the posterolateral bundle is tight in flexion
. The posterolateral bundle is tight in flexion and is the primary restraint to anterior translation at 90 degrees
. The anteromedial bundle is tight in flexion and the posterolateral bundle is tight in extension
. Both bundles exhibit isometric tension throughout the full arc of motion
. The anteromedial bundle controls rotatory stability near extension

Correct Answer & Explanation

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

Explanation

The ACL is composed of two main bundles: the anteromedial (AM) and posterolateral (PL). The AM bundle tightens in flexion and is the primary anterior restraint at 90 degrees, while the PL bundle tightens in extension and resists rotatory loads.

Question 343

Topic: Knee Sports

A 24-year-old male presents with a locked knee after a twisting injury during a soccer match. An MRI is obtained as shown below.

What is the most likely diagnosis?

. Complete anterior cruciate ligament rupture
. Bucket-handle tear of the medial meniscus
. Posterior cruciate ligament avulsion
. Discoid lateral meniscus
. Patellar tendon rupture

Correct Answer & Explanation

. Bucket-handle tear of the medial meniscus

Explanation

The clinical presentation of a locked knee following a twisting injury is classic for a bucket-handle meniscus tear. On sagittal MRI, a displaced meniscal fragment lying anterior to the posterior cruciate ligament creates the classic "double PCL" sign.

Question 344

Topic: Knee Sports

The posterolateral corner (PLC) of the knee, consisting primarily of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, functions as the primary restraint to which of the following combined forces?

. Valgus and external rotation
. Valgus and internal rotation
. Varus and external rotation
. Varus and internal rotation
. Anterior translation and varus

Correct Answer & Explanation

. Varus and external rotation

Explanation

The posterolateral corner (PLC) structures work together to resist varus gapping, external tibial rotation, and posterior tibial translation. Injury to the PLC is best assessed clinically with the dial test at 30 and 90 degrees.

Question 345

Topic: Shoulder & Hip Sports

A professional volleyball player presents with insidious onset of shoulder weakness. Examination reveals marked atrophy of the infraspinatus with isolated weakness in external rotation, but normal supraspinatus bulk and strength. Where is the most likely site of nerve compression?

. Suprascapular notch
. Spinoglenoid notch
. Quadrilateral space
. Triangular interval
. Cervical neural foramen (C5 radiculopathy)

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch results in isolated infraspinatus denervation, as the motor branch to the supraspinatus has already branched off. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 346

Topic: Knee Sports
During reconstruction of the medial patellofemoral ligament (MPFL), identifying the correct femoral origin is critical to ensure appropriate graft isometry. Radiographically, the anatomic femoral attachment (Schöttle's point) is located where?
. Distal to the medial epicondyle and anterior to Blumensaat's line
. Between the adductor tubercle and the medial epicondyle
. Directly on the medial epicondyle
. Proximal to the adductor tubercle along the posterior cortex
. Distal to the joint line on the anteromedial tibia

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The anatomic femoral origin of the MPFL lies in a saddle-shaped sulcus between the adductor tubercle proximally and the medial epicondyle distally. Radiographically, Schöttle's point represents this location slightly anterior to the posterior femoral cortex line.

Question 347

Topic: Shoulder & Hip Sports

In the assessment of anterior glenohumeral instability, the concept of the "glenoid track" is utilized to evaluate bone loss. An "engaging" Hill-Sachs lesion is best defined clinically and radiographically as a defect that:

. Remains strictly within the boundaries of the normal glenoid track
. Involves the articular surface of the lesser tuberosity
. Engages the anterior glenoid rim when the shoulder is abducted and externally rotated
. Occupies greater than 10% of the humeral head circumference
. Is oriented completely parallel to the anterior glenoid rim during internal rotation

Correct Answer & Explanation

. Engages the anterior glenoid rim when the shoulder is abducted and externally rotated

Explanation

An engaging Hill-Sachs lesion is an "off-track" defect. During the extremes of abduction and external rotation, the defect drops over the anterior glenoid rim, causing the joint to lever out and dislocate.

Question 348

Topic: Knee Sports

The posterior cruciate ligament (PCL) provides the primary restraint to posterior tibial translation and is composed of two functional bundles. Which statement accurately describes the tension pattern of the anterolateral (AL) bundle?

. Tight in extension and lax in flexion
. Tight in flexion and lax in extension
. Tight in both terminal flexion and terminal extension equally
. Isometric across the entire range of motion
. Primary restraint against varus angulation

Correct Answer & Explanation

. Tight in flexion and lax in extension

Explanation

The PCL has a larger anterolateral (AL) bundle and a smaller posteromedial (PM) bundle. The AL bundle is tight in flexion and lax in extension, whereas the PM bundle is tight in extension.

Question 349

Topic: Knee Sports
Unlike the medial collateral ligament (MCL), the anterior cruciate ligament (ACL) possesses a notoriously poor intrinsic healing capacity following complete rupture. Which biological factor is a primary driver of this clinical observation?
. Complete lack of vascular supply to the ligament substance
. Upregulation of plasmin in synovial fluid which dissolves the fibrin clot
. High concentrations of type III collagen preventing cross-linking
. Absolute absence of fibroblasts within the normal ligament stroma
. The intra-articular environment maintains a core temperature too low for angiogenesis

Correct Answer & Explanation

. Upregulation of plasmin in synovial fluid which dissolves the fibrin clot

Explanation

The ACL has an inadequate healing response because synovial fluid continuously bathes the torn ends. The upregulation of plasminogen activators converts plasminogen to plasmin, which prematurely dissolves the provisional fibrin clot necessary for organized healing.

Question 350

Topic: Knee Sports

The primary restraint to varus stress at 30 degrees of knee flexion is the:

. Fibular collateral ligament
. Popliteus tendon
. Popliteofibular ligament
. Iliotibial band
. Anterior cruciate ligament

Correct Answer & Explanation

. Fibular collateral ligament

Explanation

The fibular collateral ligament (LCL) is the primary restraint to varus stress at 30 degrees of knee flexion. The popliteus complex provides secondary varus stability but is the primary restraint to external rotation.

Question 351

Topic: Knee Sports

The anterolateral bundle of the posterior cruciate ligament (PCL) is most taut in which position?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. 90 degrees of flexion

Explanation

The anterolateral bundle of the PCL is the larger of the two bundles and is most taut in flexion (around 80-90 degrees). Conversely, the posteromedial bundle is tightest in full extension.

Question 352

Topic: Shoulder & Hip Sports

Which of the following structures is NOT considered part of the boundaries or contents of the rotator cuff interval?

. Superior glenohumeral ligament
. Coracohumeral ligament
. Supraspinatus tendon
. Teres minor tendon
. Long head of the biceps tendon

Correct Answer & Explanation

. Teres minor tendon

Explanation

The rotator cuff interval is bounded by the supraspinatus superiorly, subscapularis inferiorly, and the coracoid base medially. It contains the long head of the biceps tendon, the superior glenohumeral ligament, and the coracohumeral ligament; the teres minor is posterior.

Question 353

Topic: Knee Sports

Evaluate the following image of a knee stress radiograph.

In an isolated posterior cruciate ligament (PCL) injury, the maximum posterior tibial translation observed at 90 degrees of flexion is typically:

. 1-2 mm
. 3-5 mm
. 10-12 mm
. Greater than 15 mm
. Zero translation

Correct Answer & Explanation

. 10-12 mm

Explanation

An isolated PCL injury typically results in 10-12 mm of posterior translation on stress radiographs. Translation significantly greater than 12 mm suggests a combined injury, usually involving the posterolateral corner.

Question 354

Topic: Knee Sports

During anterior cruciate ligament (ACL) reconstruction, non-anatomic anterior placement of the femoral tunnel will most likely result in a graft that is:

. Isometrically tensioned throughout the range of motion
. Over-tensioned in flexion and lax in extension
. Lax in flexion and over-tensioned in extension
. Over-tensioned in both flexion and extension
. Impinging on the posterior cruciate ligament (PCL)

Correct Answer & Explanation

. Over-tensioned in flexion and lax in extension

Explanation

A femoral tunnel placed too anteriorly (high in the notch) will result in a graft that is overly tight in flexion and loose in extension. This can lead to a loss of knee flexion and stretching or failure of the graft over time.

Question 355

Topic: Knee Sports

Which of the following components of the posterolateral corner (PLC) of the knee is the primary restraint to external tibial rotation at 30 degrees of knee flexion?

. Posterior oblique ligament
. Fibular collateral ligament (FCL)
. Popliteofibular ligament
. Anterolateral ligament (ALL)
. Oblique popliteal ligament

Correct Answer & Explanation

. Popliteofibular ligament

Explanation

The popliteofibular ligament and the popliteus tendon are the primary restraints to external rotation of the tibia. The FCL is the primary restraint to varus stress, not external rotation.

Question 356

Topic: Shoulder & Hip Sports

A 28-year-old volleyball player has weakness in external rotation but normal abduction strength. An MRI shows isolated atrophy of the infraspinatus. Entrapment of the suprascapular nerve is most likely occurring at which location?

. Suprascapular notch
. Quadrangular space
. Spinoglenoid notch
. Triangular interval
. Spiral groove

Correct Answer & Explanation

. Spinoglenoid notch

Explanation

The suprascapular nerve passes through the spinoglenoid notch to innervate the infraspinatus after having already supplied the supraspinatus. Compression at this notch (often by a paralabral cyst) results in isolated infraspinatus weakness.

Question 357

Topic: Knee Sports

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) can be biomechanically differentiated from the posterolateral (PL) bundle by which of the following characteristics?

. The AM bundle is tighter in extension and controls rotatory stability
. The AM bundle is tighter in flexion and controls anterior translation
. The PL bundle is tighter in flexion and controls anterior translation
. The PL bundle is the primary restraint to posterior translation
. Both bundles exhibit identical tension throughout the arc of motion

Correct Answer & Explanation

. The AM bundle is tighter in extension and controls rotatory stability

Explanation

The ACL is composed of the AM and PL bundles. The AM bundle is tightest in flexion and primarily restricts anterior translation, whereas the PL bundle is tightest in extension and provides rotational stability.

Question 358

Topic: Knee Sports
A 32-year-old male presents with recurrent patellar instability. The primary ligamentous restraint to lateral patellar translation at 0 to 30 degrees of knee flexion originates from a point strictly defined by radiographic landmarks. Where is this femoral origin located?
. Distal to the adductor tubercle and proximal to the medial epicondyle
. Proximal and posterior to the medial epicondyle
. Anterior to the medial collateral ligament origin
. Directly on the medial epicondyle
. At the adductor magnus insertion

Correct Answer & Explanation

. Proximal and posterior to the medial epicondyle

Explanation

The medial patellofemoral ligament (MPFL) originates between the medial epicondyle and the adductor tubercle (often termed Schöttle's point). This point is consistently located proximal and posterior to the medial epicondyle.

Question 359

Topic: Knee Sports

A 21-year-old football player sustains a high-energy knee injury. Clinical examination reveals a positive dial test at 30 degrees of knee flexion but symmetric external rotation at 90 degrees. This pattern is pathognomonic for an isolated injury to which structure?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Posterolateral corner
. Medial collateral ligament
. Posteromedial corner

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

An increase in external rotation of more than 10 degrees compared to the contralateral side at 30 degrees of flexion, but not at 90 degrees, indicates an isolated posterolateral corner (PLC) injury. Combined PLC and PCL injuries demonstrate increased rotation at both 30 and 90 degrees.

Question 360

Topic: 5. Sports Medicine

A 19-year-old athlete undergoes evaluation for shoulder instability.

Which of the following physical examination findings is most specific for a superior labrum anterior and posterior (SLAP) tear?

. Positive apprehension test
. Positive O'Brien's active compression test with deep joint pain
. Positive Neer impingement sign
. Positive Hornblower's sign
. Positive belly-press test

Correct Answer & Explanation

. Positive apprehension test

Explanation

O'Brien's test (active compression test) is considered positive for a SLAP tear when pain is elicited with the arm internally rotated and is relieved when the arm is externally rotated. Deep glenohumeral joint pain is specifically indicative of labral pathology.

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