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5. Sports Medicine MCQs

Practice Set 2 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 21

Topic: General Sports & Tendon

A 45-year-old runner presents with chronic posterior heel pain. MRI reveals severe insertional Achilles tendinopathy. The surgeon plans an aggressive debridement of the tendon insertion. If surgical debridement requires excision of greater than 50% of the tendon insertion, which of the following is the most appropriate next step?

. V-Y tendinous advancement of the gastrocnemius
. Flexor hallucis longus (FHL) tendon transfer
. Flexor digitorum longus (FDL) tendon transfer
. Peroneus brevis tendon transfer
. Primary repair with heavy nonabsorbable suture only

Correct Answer & Explanation

. Flexor hallucis longus (FHL) tendon transfer

Explanation

When surgical debridement of insertional Achilles tendinopathy compromises more than 50% of the tendon insertion, augmentation is required to prevent rupture. The flexor hallucis longus (FHL) is the preferred transfer due to its strength, axis of pull, and proximity.

Question 22

Topic: General Sports & Tendon
A 55-year-old male presents with non-insertional Achilles tendinopathy. He is prescribed an eccentric training program (Alfredson protocol). Which of the following best describes the physiologic rationale for this specific physical therapy regimen?
. It increases type III collagen synthesis
. It selectively decreases paratenon vascularity through ischemia
. It stimulates mechanotransduction leading to type I collagen synthesis and remodeling
. It lengthens the gastrocnemius-soleus complex by rupturing microadhesions
. It alters the footprint of the tendon on the calcaneal tuberosity

Correct Answer & Explanation

. It stimulates mechanotransduction leading to type I collagen synthesis and remodeling

Explanation

Eccentric training (such as the Alfredson protocol) promotes tendon healing via mechanotransduction. This leads to increased type I collagen synthesis, improved collagen alignment, and a decrease in pathological neovascularization within the tendinopathic tissue.

Question 23

Topic: 5. Sports Medicine

Following surgical repair of an acute Achilles tendon rupture, what is the primary advantage of initiating an early functional rehabilitation protocol compared to traditional prolonged cast immobilization?

. Decreased incidence of deep vein thrombosis and infection
. Lower rate of postoperative sural nerve entrapment
. Earlier return to work and sports without increasing the rerupture rate
. Elimination of the risk of wound dehiscence
. Increased type I collagen cross-linking by postoperative week 2

Correct Answer & Explanation

. Earlier return to work and sports without increasing the rerupture rate

Explanation

Early functional rehabilitation (early weight-bearing and active range of motion) after Achilles repair leads to an earlier return to work and sports, improved patient satisfaction, and no significant increase in rerupture rates.

Question 24

Topic: General Sports & Tendon

Which of the following biologic factors is most highly upregulated in the pathophysiology of chronic non-insertional Achilles tendinopathy, contributing directly to neovascularization?

. Tumor necrosis factor-alpha (TNF-a)
. Vascular endothelial growth factor (VEGF)
. Interleukin-1 (IL-1)
. Matrix metalloproteinase-1 (MMP-1)
. Transforming growth factor-beta (TGF-b)

Correct Answer & Explanation

. Vascular endothelial growth factor (VEGF)

Explanation

Chronic tendinopathy is characterized by angiofibroblastic dysplasia and neovascularization, driven predominantly by VEGF. Notably, there is an absence of acute inflammatory cells in chronic tendinosis.

Question 25

Topic: 5. Sports Medicine

A 40-year-old recreational athlete sustains an acute Achilles tendon rupture. Compared to traditional surgical repair, non-operative management utilizing early functional bracing and mobilization protocols has been shown to result in:

. Significantly higher rerupture rates
. Similar rerupture rates but decreased deep infection risk
. Higher rates of deep vein thrombosis
. Decreased plantar flexion strength at 2 years
. Increased risk of sural nerve injury

Correct Answer & Explanation

. Similar rerupture rates but decreased deep infection risk

Explanation

High-level studies show that non-operative management with early functional rehabilitation yields rerupture rates similar to surgical repair. It provides the distinct advantage of avoiding surgical complications such as deep infections.

Question 26

Topic: 5. Sports Medicine

A 20-year-old male distance runner complains of pain on the lateral aspect of his knee that reliably occurs 3 miles into his run and eventually causes him to terminate his run. The pain is made worse by running downhill. He recalls no injury to his knee and has noticed no swelling. What is the most likely diagnosis:

. Lateral meniscus tear
. Lateral collateral ligament sprain
. Iliotibial band tendinitis
. Lateral parapatellar plica
. Exertional compartment syndrome

Correct Answer & Explanation

. Iliotibial band tendinitis

Explanation

Iliotibial band tendinitis is the most common cause of lateral knee pain in runners. It generally occurs a few miles into a run and is exacerbated with downhill running. Iliotibial band tendinitis generally responds to nonoperative treatment consisting of stretching and nonsteroidal anti- inflammatory drugs but may require a corticosteroid injection or, rarely, surgical treatment.

Question 27

Topic: 5. Sports Medicine

Outcome following arthroscopic treatment of superior labrum anterior to posterior (SLAP) lesions is most affected by which of the following factors:

. Patient gender
. Level of sports participation
. Participation in overhead sports
. Dominance of involved arm
. Time to return to activity following surgery

Correct Answer & Explanation

. Participation in overhead sports

Explanation

Kim and colleagues reported on the results of 34 patients who underwent arthroscopic treatment of SLAP lesions and discovered that results were good in all patients, but individuals who participated in overhead sports did not have outcomes as good as those not participating in these types of activities.

Question 28

Topic: Knee Sports

All of the following are either primary or secondary stabilizers of the knee to posterior translation except:

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

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The posterior cruciate ligament is the primary stabilizer to posterior translation of the knee. Secondary stabilizers include the medial and lateral collateral ligaments and the posterolateral corner.

Question 29

Topic: Knee Sports

Which of the following is the most accurate clinical examination tool in detecting disruption of the posterior cruciate ligament:

. Posterior drawer test
. Quadriceps active drawer test
. Posterior sag test
. Reverse pivot shift test
. Reverse Lachman test

Correct Answer & Explanation

. Posterior drawer test

Explanation

The posterior drawer test is the most accurate method of clinically diagnosing posterior cruciate ligament disruption. Although the quadriceps active drawer test and the posterior sag test are useful, their reported accuracy is less than that of the posterior drawer test. The reverse pivot shift test evaluates posterolateral corner injuries.

Question 30

Topic: General Sports & Tendon

Reported hamstring strength deficit by isokinetic testing after complete proximal rupture is approximately:

. 10%
. 20%
. 60%
. 90%
. No deficit

Correct Answer & Explanation

. 60%

Explanation

In a series of 12 patients with complete or near complete proximal hamstring ruptures, the mean strength deficit measured 61% for the hamstring and 23% for the quadriceps musculature.

Question 31

Topic: General Sports & Tendon

Which of the following activities is associated with proximal hamstring ruptures:

. High jumping
. Skating
. Water skiing
. Swimming
. Basketball

Correct Answer & Explanation

. Water skiing

Explanation

Water skiing is associated with proximal hamstring ruptures in both novice and experienced skiers. The mechanisms, however, are reported to be different depending on the level of skier. The novice skier typically sustains the injury while trying to get up on one or two skis from a submerged position, whereas the injury is typically the result of a fall in an experienced skier.

Question 32

Topic: General Sports & Tendon

Patients with symptomatic chronic proximal hamstring ruptures typically complain of:

. Anterior thigh cramping with running
. Difficulty decelerating the leg during running
. Difficulty ascending stairs
. Difficulty descending stairs
. Difficulty accelerating the leg during running

Correct Answer & Explanation

. Difficulty decelerating the leg during running

Explanation

Patients typically complain of a pulling sensation or cramping in the posterior thigh with vigorous activity. In addition, they may describe difficulty controlling the leg, which has been attributed to the impaired deceleration of the thigh as a result of the complete rupture.

Question 33

Topic: General Sports & Tendon

The recommended treatment of a complete proximal hamstring rupture with 4-cm retraction in a young athletic adult is:

. Nonoperative rehabilitation
. Nonoperative rehabilitation followed by surgical repair if there is continued disability
. Surgical reattachment of the proximal hamstrings
. No rehabilitation or surgery is indicated
. C omplete proximal hamstring ruptures have not been reported

Correct Answer & Explanation

. Surgical reattachment of the proximal hamstrings

Explanation

Patients with disability secondary to chronic complete proximal hamstring ruptures have been increasingly identified. Because of the reports of continued weakness and poor leg control, more authors are recommending acute repair of these injuries. Chronic repairs are reported to be much more difficult although good results are reported.

Question 34

Topic: 5. Sports Medicine

A 19-year-old female collegiate cross-country runner presents with a tibial stress fracture. She reports irregular menstrual cycles for the past year. Laboratory evaluation of this patient is most likely to show which of the following abnormalities?

. Elevated estrogen
. Decreased luteinizing hormone (LH)
. Elevated parathyroid hormone (PTH)
. Decreased cortisol
. Elevated thyroid-stimulating hormone (TSH)

Correct Answer & Explanation

. Decreased luteinizing hormone (LH)

Explanation

The Female Athlete Triad involves low energy availability, which causes hypothalamic dysfunction. This leads to a decrease in GnRH, resulting in low LH, FSH, and estrogen, which ultimately predisposes the athlete to osteopenia and stress fractures.

Question 35

Topic: Knee Sports

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) is tightest in which position, and what is its primary biomechanical function?

. Tightest in extension; controls rotational stability
. Tightest in flexion; controls rotational stability
. Tightest in flexion; controls anterior tibial translation
. Tightest in extension; controls anterior tibial translation
. Tightest in mid-flexion; controls varus angulation

Correct Answer & Explanation

. Tightest in flexion; controls anterior tibial translation

Explanation

The AM bundle of the ACL is tightest in flexion and serves as the primary restraint to anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 36

Topic: 5. Sports Medicine

According to the consensus statements on concussion in sport, which of the following must be achieved before an athlete advances to the next step in the graduated return-to-play protocol?

. A 48-hour rest period between each step
. Normal MRI of the brain
. Completion of the current step without symptom exacerbation for 24 hours
. Prophylactic administration of NSAIDs
. Clearance by an independent neurologist

Correct Answer & Explanation

. Completion of the current step without symptom exacerbation for 24 hours

Explanation

The graduated return-to-play protocol requires athletes to remain symptom-free for 24 hours at their current level of exertion before progressing to the next stage. If symptoms return, they must drop back to the previous asymptomatic level.

Question 37

Topic: Knee Sports

During a posterior cruciate ligament (PCL) reconstruction using a transtibial tunnel technique, what is the anatomical structure at greatest risk during drilling of the tibial tunnel?

. Popliteal artery
. Common peroneal nerve
. Anterior tibial artery
. Tibial nerve
. Middle genicular artery

Correct Answer & Explanation

. Popliteal artery

Explanation

The popliteal artery is located directly posterior to the posterior capsule of the knee. Over-penetration of the guide pin or drill during transtibial PCL tunnel creation places the popliteal artery at significant risk of catastrophic injury.

Question 38

Topic: Knee Sports

The most common location for an osteochondritis dissecans (OCD) lesion in the adolescent knee is the:

. Lateral aspect of the medial femoral condyle
. Medial aspect of the lateral femoral condyle
. Central weight-bearing dome of the medial femoral condyle
. Anterior aspect of the lateral femoral condyle
. Trochlear groove

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The lateral aspect of the medial femoral condyle is the most frequent site of OCD lesions in the knee. This classic location accounts for approximately 70-80% of all knee OCD cases.

Question 39

Topic: General Sports & Tendon

Which of the following is the most consistent histological finding in chronic non-insertional Achilles tendinopathy?

. Abundant acute inflammatory cells (neutrophils)
. Mucoid degeneration and neovascularization
. Calcium hydroxyapatite crystal deposition
. Extensive fibrinoid necrosis
. Amyloid deposition

Correct Answer & Explanation

. Mucoid degeneration and neovascularization

Explanation

Chronic Achilles tendinopathy is an angiofibroblastic process characterized by collagen disorientation, mucoid (myxoid) degeneration, and neovascularization. Acute inflammatory cells are typically absent, which is why the condition is accurately termed "tendinosis."

Question 40

Topic: Shoulder & Hip Sports

Internal snapping hip syndrome is typically caused by the snapping of which structure over the iliopectineal eminence or the femoral head?

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

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. This typically happens as the hip extends from a flexed, abducted, and externally rotated position.

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