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5. Sports Medicine MCQs

Practice Set 184 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 3661

Topic: Shoulder & Hip Sports

A 25-year-old professional baseball pitcher complains of vague deep shoulder pain. On physical exam, he has decreased internal rotation of 25 degrees compared to the contralateral side. A peel-back sign is positive. What is the primary pathologic mechanism contributing to his diagnosis?

. Anterior capsular laxity
. Posterior capsular contracture
. Subacromial spurring
. Pectoralis minor tightness
. Coracohumeral ligament thickening

Correct Answer & Explanation

. Anterior capsular laxity

Explanation

Glenohumeral internal rotation deficit (GIRD) in overhead athletes is caused by posterior capsular contracture. This leads to a posterosuperior shift of the humeral head during late cocking, resulting in internal impingement and SLAP tears.

Question 3662

Topic: Knee Sports

A 22-year-old football player sustains a high-energy tackle. Exam reveals increased external rotation of the tibia at 30 degrees of knee flexion but symmetric rotation at 90 degrees compared to the uninjured side. Varus stress is positive at 30 degrees. Which of the following structures is definitively injured?

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

Correct Answer & Explanation

. Anterior cruciate ligament

Explanation

Increased external rotation at 30 degrees of flexion with symmetric rotation at 90 degrees indicates an isolated posterolateral corner (PLC) injury. If rotation was increased at both 30 and 90 degrees, it would indicate a combined PLC and PCL injury.

Question 3663

Topic: Shoulder & Hip Sports

A 28-year-old rugby player has recurrent anterior shoulder instability. CT scan indicates a 25% anterior glenoid bone loss. Which of the following is the most appropriate surgical management?

. Arthroscopic Bankart repair
. Arthroscopic Remplissage
. Open Latarjet procedure
. Open inferior capsular shift
. Glenoid resurfacing with arthroplasty

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

For anterior glenoid bone loss greater than 20-25%, a soft tissue Bankart repair has an unacceptably high failure rate. A bone-block augmentation, such as the Latarjet procedure (coracoid transfer), is indicated to restore glenoid width and provide a dynamic sling effect.

Question 3664

Topic: 5. Sports Medicine

A 24-year-old weightlifter feels a sudden 'pop' in his anterior chest during a heavy bench press. He has weakness in internal rotation and a loss of the anterior axillary fold. MRI shows a pectoralis major tendon rupture. Which part of the muscle is most commonly ruptured in this scenario?

. Sternal head at the musculotendinous junction
. Sternal head at the humeral insertion
. Clavicular head at the musculotendinous junction
. Clavicular head at the humeral insertion
. Clavicular head at the origin

Correct Answer & Explanation

. Sternal head at the musculotendinous junction

Explanation

Pectoralis major ruptures in weightlifters most commonly involve the sternal head near or at the humeral insertion. This typically occurs when the arm is extended and externally rotated during the eccentric phase of a bench press.

Question 3665

Topic: Knee Sports
A 16-year-old female gymnast presents with recurrent lateral patellar dislocations. MRI reveals a torn medial patellofemoral ligament (MPFL). If reconstruction is planned, where is the precise anatomic femoral attachment (Schöttle's point) of the MPFL?
. Anterior to the posterior femoral cortex line and distal to the posterior medial condyle
. Anterior to the posterior femoral cortex line and proximal to the posterior medial condyle
. Posterior to the posterior femoral cortex line and proximal to the posterior condyle
. Anterior to the posterior femoral cortex line and distal to the medial epicondyle
. Between the adductor tubercle and the medial epicondyle

Correct Answer & Explanation

. Between the adductor tubercle and the medial epicondyle

Explanation

The femoral footprint of the MPFL (Schöttle's point) is located radiographically between the medial epicondyle and the adductor tubercle. It sits slightly anterior to the posterior femoral cortex extension line.

Question 3666

Topic: Knee Sports

A 35-year-old recreational basketball player reports catching and pain in his knee. MRI reveals a medial meniscal root tear. What are the biomechanical consequences of this injury if left untreated?

. Loss of meniscal hoop stresses leading to rapid articular cartilage degeneration
. Increased tension on the anterior cruciate ligament
. Decreased contact pressures in the medial compartment
. Posterolateral rotatory instability
. Medial collateral ligament attenuation

Correct Answer & Explanation

. Loss of meniscal hoop stresses leading to rapid articular cartilage degeneration

Explanation

A meniscal root tear biomechanically mimics a total meniscectomy by disrupting hoop stresses. This causes lateral extrusion of the meniscus and significantly increased contact pressures, leading to rapid osteoarthritis.

Question 3667

Topic: 5. Sports Medicine
A 21-year-old collegiate quarterback sustains a Grade III acromioclavicular (AC) joint separation on his non-dominant shoulder. He is currently in the middle of the season. What is the best initial management?
. Immediate surgical reconstruction using a coracoclavicular ligament graft
. Open reduction and internal fixation with a hook plate
. Sling immobilization, ice, and early range of motion as tolerated
. Figure-of-eight bracing for 6 weeks
. Excision of the distal clavicle

Correct Answer & Explanation

. Sling immobilization, ice, and early range of motion as tolerated

Explanation

Uncomplicated Grade III AC joint separations are typically managed non-operatively, especially in athletes mid-season. Sling immobilization followed by early rehabilitation allows most athletes to return to play within a few weeks.

Question 3668

Topic: Shoulder & Hip Sports

A 31-year-old professional tennis player undergoes arthroscopic evaluation of his shoulder for chronic pain. A SLAP lesion is suspected. What associated normal anatomic variant is most commonly confused with a type II SLAP tear?

. Buford complex
. Sublabral foramen
. Sublabral recess
. Glenoid dysplasia
. Biceps split

Correct Answer & Explanation

. Buford complex

Explanation

A sublabral recess is a normal anatomic variant characterized by an unattached anterosuperior labrum. Unlike a type II SLAP tear, the recess has smooth margins and the biceps anchor remains firmly attached to the superior tubercle.

Question 3669

Topic: 5. Sports Medicine
A 27-year-old female marathon runner complains of progressive anterior knee pain. She is diagnosed with a focal full-thickness articular cartilage defect (2 cm²) on the medial femoral condyle. She has failed conservative management. Which surgical option is most appropriate for a defect of this size?
. Arthroscopic debridement and lavage
. Microfracture
. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Total knee arthroplasty

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For symptomatic focal full-thickness chondral defects between 1 to 2.5 cm² in young active patients, osteochondral autograft transfer (OATS) provides hyaline cartilage repair. Microfracture is typically reserved for lesions smaller than 2 cm², while ACI is used for larger defects.

Question 3670

Topic: Knee Sports

A 20-year-old football lineman is diagnosed with a posterior cruciate ligament (PCL) injury. On physical examination, the posterior drawer test is performed. At what degree of knee flexion is the PCL the primary restraint to posterior tibial translation?

. 0 degrees
. 30 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 0 degrees

Explanation

The posterior cruciate ligament (PCL), particularly its anterolateral bundle, is the primary restraint to posterior tibial translation. This restraint is greatest and most easily tested at 90 degrees of knee flexion.

Question 3671

Topic: Shoulder & Hip Sports

A 29-year-old rock climber presents with a popping sensation in his shoulder. MRI reveals an isolated tear of the subscapularis tendon. Which physical examination test is most specific for this injury?

. O'Brien's active compression test
. Jobe's empty can test
. Bear hug test
. Neer impingement sign
. Hornblower's sign

Correct Answer & Explanation

. O'Brien's active compression test

Explanation

The Bear hug test, along with the lift-off and belly-press tests, are specific for evaluating the integrity of the subscapularis tendon. Hornblower's sign evaluates the teres minor, while Jobe's test evaluates the supraspinatus.

Question 3672

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder instability. Computed tomography reveals 25% anterior glenoid bone loss. What is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Open Bankart repair
. Latarjet procedure
. Remplissage alone
. Proximal humeral osteotomy

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

The Latarjet procedure (coracoid transfer) is indicated for patients with recurrent anterior shoulder instability and significant glenoid bone loss (typically >20-25%). Arthroscopic Bankart repair in this setting carries an unacceptably high failure rate.

Question 3673

Topic: Knee Sports
A 28-year-old soccer player sustains a knee injury. MRI shows an isolated complete posterior cruciate ligament (PCL) tear. Examination reveals a grade III posterior sag, but the patient is asymptomatic with straight-ahead running. What is the most appropriate initial management?
. Early PCL reconstruction
. Protected weight-bearing in full extension for 2-4 weeks followed by quadriceps strengthening
. Immediate aggressive hamstring strengthening
. Primary open repair of the PCL
. High tibial osteotomy

Correct Answer & Explanation

. Protected weight-bearing in full extension for 2-4 weeks followed by quadriceps strengthening

Explanation

Isolated PCL tears are generally treated nonoperatively with a brief period of immobilization in extension to reduce posterior tibial subluxation, followed by aggressive quadriceps strengthening. Hamstring strengthening is avoided initially as it exacerbates posterior tibial translation.

Question 3674

Topic: Knee Sports

A posterior root tear of the medial meniscus results in altered knee biomechanics that are most similar to which of the following conditions?

. Intact knee
. Total meniscectomy
. Partial meniscectomy
. Anterior cruciate ligament deficiency
. Posterior cruciate ligament deficiency

Correct Answer & Explanation

. Intact knee

Explanation

A medial meniscus posterior root tear disrupts the crucial hoop stresses of the meniscus, causing it to extrude under physiological load. This effectively leaves the medial compartment functioning biomechanically as if a total meniscectomy had been performed.

Question 3675

Topic: Shoulder & Hip Sports

A 40-year-old manual laborer has deep, aching shoulder pain. MRI arthrogram demonstrates a Type II SLAP tear. After failing a 4-month course of physical therapy, surgery is planned. What is the most reliable surgical treatment to provide pain relief and facilitate return to work?

. Arthroscopic SLAP repair
. Biceps tenodesis
. Debridement alone
. Coracoclavicular ligament reconstruction
. Biceps tenotomy

Correct Answer & Explanation

. Arthroscopic SLAP repair

Explanation

In older patients (typically >35-40 years old), primary biceps tenodesis is highly favored over SLAP repair for Type II SLAP tears. Tenodesis provides higher rates of patient satisfaction, lower complication rates, and a lower incidence of postoperative stiffness.

Question 3676

Topic: Knee Sports

In medial patellofemoral ligament (MPFL) reconstruction for recurrent patellofemoral instability, anatomic femoral tunnel placement is critical to avoid anisometry. Where is the anatomic femoral attachment of the MPFL located?

. Proximal to the adductor tubercle
. Distal to the adductor tubercle and proximal to the medial epicondyle
. Distal to the medial epicondyle
. Anterior to the medial epicondyle
. Posterior to the adductor tubercle

Correct Answer & Explanation

. Proximal to the adductor tubercle

Explanation

The MPFL femoral origin is located in a bony sulcus between the medial epicondyle (which is distal) and the adductor tubercle (which is proximal). Non-anatomic placement, particularly proximal or anterior, can lead to severe graft tensioning issues during knee flexion.

Question 3677

Topic: Knee Sports
A 22-year-old sustains a KD III-M multiligament knee injury. Which of the following nerve injuries is most commonly associated with disruption of the posterolateral corner (PLC) of the knee?
. Tibial nerve
. Deep peroneal nerve
. Common peroneal nerve
. Saphenous nerve
. Sural nerve

Correct Answer & Explanation

. Common peroneal nerve

Explanation

The common peroneal nerve courses directly around the fibular neck and is highly susceptible to traction injuries during the varus and hyperextension mechanisms that typically rupture the posterolateral corner structures.

Question 3678

Topic: 5. Sports Medicine

A 24-year-old soccer player presents with chronic anterolateral ankle pain. MRI reveals a 1.2 cm osteochondral lesion of the anterolateral talar dome. Nonoperative management has failed. What is the most appropriate initial surgical treatment?

. Osteochondral autograft transfer (OATS)
. Autologous chondrocyte implantation (ACI)
. Arthroscopic bone marrow stimulation (microfracture)
. Ankle arthrodesis
. Supramalleolar osteotomy

Correct Answer & Explanation

. Osteochondral autograft transfer (OATS)

Explanation

For symptomatic osteochondral lesions of the talus that are less than 1.5 cm in diameter and have failed conservative treatment, arthroscopic bone marrow stimulation (microfracture) remains the recommended first-line surgical treatment.

Question 3679

Topic: 5. Sports Medicine

A 16-year-old female soccer player undergoes anterior cruciate ligament (ACL) reconstruction. Which of the following graft choices is associated with the highest rate of clinical failure and re-rupture in this specific patient demographic?

. Bone-patellar tendon-bone autograft
. Hamstring autograft
. Quadriceps tendon autograft
. Allograft
. Contralateral BPTB autograft

Correct Answer & Explanation

. Bone-patellar tendon-bone autograft

Explanation

Multiple studies and registries have conclusively demonstrated that allografts have a significantly higher failure and re-rupture rate compared to autografts when utilized for ACL reconstruction in young, highly active athletes.

Question 3680

Topic: Shoulder & Hip Sports

A 30-year-old man presents with a locked posterior shoulder dislocation following a seizure. A CT scan reveals a reverse Hill-Sachs lesion involving 35% of the anterior articular surface. What is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Arthroscopic posterior capsulolabral repair
. Open reduction and lesser tuberosity transfer
. Latarjet procedure
. Total shoulder arthroplasty

Correct Answer & Explanation

. Closed reduction and sling immobilization

Explanation

For a locked posterior dislocation with an anterior articular defect (reverse Hill-Sachs lesion) involving 20% to 40% of the humeral head, transfer of the lesser tuberosity or subscapularis into the defect (modified McLaughlin or McLaughlin procedure) is indicated to prevent recurrent engagement.

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