Menu

5. Sports Medicine MCQs

Practice Set 24 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 461

Topic: 5. Sports Medicine

A 17-year-old high school football player presents to the emergency department after being removed from play following a harsh tackle. The patient reports a sharp burning and stinging pain through his left arm that has not resolved since the tackle. A careful history revealed that this is the fourth episode of burning and stinging pain. In each episode of pain, the symptoms have lasted longer than the previous episode. The patient also reports that he has suffered from two prior episodes of transient weakness and numbness in all extremities following harsh tackles. Which of the following statements concerning this patient is correct:

. There is no contraindication to return to play in this patient.
. There is a relative contraindication to return to play in this patient.
. There is an absolute contraindication to return to play in this patient.
. Because this patient has suffered repeated episodes of transient pain after tackles, he is obviously experienced enough to not need education and counseling to help prevent recurrence.
. The patient should not participate in football games, but should feel free to continue lifting weights and practicing.

Correct Answer & Explanation

. There is an absolute contraindication to return to play in this patient.

Explanation

It is important to understand the current return to play criteria for cervical spine injuries in athletes. There is an absolute contraindication to return to play in patients who have: a) more than two previous episodes of transient quadriparesis/quadriplegia, b) clinical history, physical examination findings, or imaging confirmation of cervical myelopathy/myelomalacia, and c) continued cervical neck discomfort, decreased range of motion, or any evidence of a neurologic deficit from baseline after any cervical spine injury. Patient education and follow-up are always indicated in patients with burners and stingers. This patient should not participate in football games, exercise, or practice until full mobility and strength has returned, and all neurologic symptoms have resolved.

Question 462

Topic: 5. Sports Medicine

Which of the following statements concerning burners and stingers is incorrect:

. Burners and stingers typically result from depression of the ipsilateral shoulder and deviation of the neck to the contralateral side.
. Burners and stingers are commonly seen in elderly patients.
. In treating burners and stingers, it is important to restore pain-free mobility in the upper extremities by strengthening and stretching.
. Follow-up and patient education are important in all cases of burners and stingers, regardless of the duration of symptoms.
. None of the above

Correct Answer & Explanation

. Burners and stingers are commonly seen in elderly patients.

Explanation

Burners and stingers are usually seen in children, adolescents, and athletes. Choice A is correct, and explains why burners and stingers are typically seen in tackle injuries sustained by football players and in motorcycle accidents. Choices C and D are correct because management of patients with burners and stingers should always include strengthening, stretching, patient education, and follow-up.

Question 463

Topic: 5. Sports Medicine

A patient presents with pseudoarthrosis one year after an L4-L5 MIS TLIF. Given the constraints of minimally invasive approaches, what is the most common technical etiology for pseudarthrosis in this specific procedure?

. Inadequate removal of the cartilaginous endplate due to limited visualization
. Excessive use of local autograft from the facet joint
. Failure to resect the anterior longitudinal ligament
. Use of polyaxial rather than monoaxial pedicle screws
. Over-compression of the posterior instrumentation

Correct Answer & Explanation

. Inadequate removal of the cartilaginous endplate due to limited visualization

Explanation

The most common technical cause of pseudoarthrosis in MIS TLIF is incomplete disc removal and inadequate endplate preparation, as the limited "keyhole" visualization can make thorough contralateral disc space preparation challenging.

Question 464

Topic: 5. Sports Medicine

Compared to the traditional open posterior lumbar interbody fusion (PLIF), the minimally invasive (MIS) PLIF or TLIF approach is primarily associated with:

. Less multifidus muscle crush injury and ischemic necrosis
. Greater ability to correct severe rigid coronal deformities
. Lower rates of incidental dural tears
. Shorter operative times during the initial 20 cases
. Increased volume of local autograft harvested

Correct Answer & Explanation

. Less multifidus muscle crush injury and ischemic necrosis

Explanation

MIS techniques use serial dilation which splits, rather than strips and crushes, the paraspinal muscles. This drastically reduces multifidus atrophy and ischemic necrosis seen in open prolonged retractor placement.

Question 465

Topic: Knee Sports

The rapid and significant pain relief observed following a successful vertebroplasty is primarily attributed to mechanical stabilization of the microfractures and:

. Decompression of the central spinal canal
. Thermal necrosis of intraosseous nociceptive nerve endings
. Significant restoration of vertebral body height
. Chemical neurolysis from unreacted monomer leakage
. Improved vascular supply to the anterior spinal artery

Correct Answer & Explanation

. Thermal necrosis of intraosseous nociceptive nerve endings

Explanation

Pain relief in vertebroplasty is widely believed to result from the immediate mechanical stabilization of trabecular microfractures. Additionally, the exothermic polymerization of the PMMA cement causes thermal necrosis of intraosseous nerve endings, contributing to analgesia.

Question 466

Topic: Knee Sports

According to the Thoracolumbar Injury Classification and Severity (TLICS) score, which of the following patients has an absolute indication for surgical intervention?

. Compression fracture (1), PLC intact (0), neurologically intact (0)
. Burst fracture (2), PLC intact (0), neurologically intact (0)
. Compression fracture (1), PLC suspected/indeterminate (1), neurologically intact (0)
. Translation/rotation injury (3), PLC disrupted (3), incomplete spinal cord injury (3)
. Burst fracture (2), PLC intact (0), isolated nerve root injury (2)

Correct Answer & Explanation

. Translation/rotation injury (3), PLC disrupted (3), incomplete spinal cord injury (3)

Explanation

A TLICS score of >4 is an indication for surgery. The translation/rotation injury (3) with PLC disruption (3) and incomplete cord injury (3) scores a 9, strongly indicating surgical stabilization.

Question 467

Topic: 5. Sports Medicine

In the face of vertebral infection and progressive deformity, surgical reconstruction should:

. Never use instrumentation
. Never use allograft bone
. Always be approached posteriorly
. Always involve an aggressive debridement
. Always follow extensive antibiotic treatment until the infection is eradicated

Correct Answer & Explanation

. Never use instrumentation

Explanation

Surgical reconstruction in the face of spinal infection may be indicated should progressive neurological deficit or deformity occur. Such reconstruction may be successful if an aggressive debridement of all infectious foci is done, even if instrumentation or allograft is used. The optimal approach is dictated by the location of the infection and the type and degree of deformity (and is often anterior or anterior-posterior).

Question 468

Topic: Knee Sports

A 35-year-old construction worker falls from a height and sustains a burst fracture of L1. Neurological examination is completely normal. Which of the following radiographic findings would be an absolute indication for surgical stabilization rather than conservative management?

. 10 degrees of kyphotic angulation
. 20% loss of anterior vertebral body height
. Retropulsion of bone fragments occupying 20% of the canal
. Posterior ligamentous complex (PLC) disruption
. Transverse process fracture

Correct Answer & Explanation

. Posterior ligamentous complex (PLC) disruption

Explanation

Disruption of the posterior ligamentous complex (PLC) renders a thoracolumbar fracture highly unstable, dictating surgical stabilization. Degree of retropulsion alone without neurologic deficit or PLC injury does not absolutely mandate surgery.

Question 469

Topic: Knee Sports

A 13-year-old boy presents with vague anterior knee pain. Radiographs demonstrate an osteochondritis dissecans (OCD) lesion. What is the most common anatomic location for this lesion in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Inferior pole of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The classic and most common location for an osteochondritis dissecans (OCD) lesion of the knee is the lateral aspect of the medial femoral condyle (LAME acronym).

Question 470

Topic: 5. Sports Medicine

A 6-year-old girl is noted by her parents to have a painless, clunking sensation in her lateral knee with active flexion and extension. MRI confirms a complete, asymptomatic discoid lateral meniscus. What is the recommended management?

. Partial meniscectomy
. Total meniscectomy
. Meniscal repair and stabilization
. Observation
. Diagnostic arthroscopy

Correct Answer & Explanation

. Observation

Explanation

An asymptomatic discoid meniscus in a child should be managed with observation alone. Surgical intervention (such as partial meniscectomy or stabilization) is reserved for symptomatic patients (e.g., pain, catching, locking).

Question 471

Topic: 5. Sports Medicine

Which of the following groups is not at increased risk for community- acquired methicillin-resistant Staphylococcus aureus (C AMRSA):

. Athletes who participate in physical contact sports
. Patients who have had recent antibiotics
. People traveling abroad
. People living in crowded conditions
. Prison inmates

Correct Answer & Explanation

. People traveling abroad

Explanation

People traveling abroad are not considered at increased risk for C A-MRSA. Athletes who participate in physical contact sports, patients who have had recent antibiotics, people living in crowded conditions, and prison inmates are considered at increased risk for C A-MRSA.

Question 472

Topic: 5. Sports Medicine

A 15-year-old female develops rapid-onset fever, hypotension, and a diffuse macular erythroderma following knee arthroscopy. Blood cultures are sterile. The condition is mediated by a toxin that exerts its effect through which of the following mechanisms?

. Inhibition of protein synthesis via EF-2 elongation factor
. Cleavage of SNARE proteins
. Cross-linking of MHC class II molecules and T-cell receptors without antigen processing
. Activation of adenylate cyclase causing fluid hypersecretion
. Direct lysis of red blood cells

Correct Answer & Explanation

. Cross-linking of MHC class II molecules and T-cell receptors without antigen processing

Explanation

Toxic shock syndrome is typically caused by TSST-1 (a superantigen) produced by S. aureus. It binds directly to MHC class II and the T-cell receptor outside the normal antigen-binding groove, causing massive non-specific T-cell activation and a cytokine storm.

Question 473

Topic: 5. Sports Medicine

Which of the following factors best predicts the risk of disk degeneration in young adults:

. Smoking history
. Occupational exposure
. Gender
. Family history
. Participation in sports

Correct Answer & Explanation

. Family history

Explanation

Genetic factors are most predictive of disk degeneration. However, various genes have been identified as possible causative factors, possibly operating in different ways and interacting with environmental and other factors.

Question 474

Topic: Knee Sports

A 16-year-old boy presents with intermittent knee catching and pain. MRI reveals an unstable osteochondral fragment in the knee joint.

What is the most common location for osteochondritis dissecans in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the lateral femoral condyle
. Patellar articular surface

Correct Answer & Explanation

. Medial aspect of the medial femoral condyle

Explanation

The classic and most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle.

Question 475

Topic: Knee Sports
A 12-year-old boy twisted his knee while riding a bicycle. Based on his radiographs, which of the following is the most appropriate diagnosis:
. Patellar dislocation
. Traumatic osteochondritis dissecans
. Tibial spine avulsion
. Anterior cruciate ligament tear
. Tibial tubercle fracture

Correct Answer & Explanation

. Tibial spine avulsion

Explanation

This patient has a tibial spine avulsion, classified as type III by McKeever and Meyers. Treatment options include closed immobilization or arthroscopic or open reduction and internal fixation.

Question 476

Topic: 5. Sports Medicine

A 2-year-old child presents with a shortened lower extremity, anteromedial bowing of the tibia, and an absent lateral ray of the foot. What is the most common associated anomaly of the knee in this condition?

. Absent anterior cruciate ligament
. Patellar tendon rupture
. Posterior cruciate ligament contracture
. Discoid meniscus
. Patella baja

Correct Answer & Explanation

. Absent anterior cruciate ligament

Explanation

Fibular hemimelia is the most common long bone deficiency. It is frequently associated with anteromedial tibial bowing, absent lateral rays, ball-and-socket ankle, and knee instability due to an absent anterior cruciate ligament (ACL).

Question 477

Topic: Knee Sports

An 11-year-old boy presents with chronic knee pain. Radiographs reveal a classic osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this pathology?

. Medial aspect of the lateral femoral condyle
. Lateral aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Medial aspect of the medial femoral condyle
. Articular surface of the patella

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most frequent location for an osteochondritis dissecans lesion in the knee is the lateral aspect of the medial femoral condyle. This can be remembered by the mnemonic LAME.

Question 478

Topic: 5. Sports Medicine

When performing structural grafting for a pathological fracture and impending nonunion in a patient with fibrous dysplasia, which of the following graft types is most appropriate to minimize resorption and construct failure?

. Cancellous autograft
. Cancellous allograft
. Cortical allograft
. Demineralized bone matrix
. Synthetic calcium phosphate

Correct Answer & Explanation

. Cortical allograft

Explanation

Cortical allograft is preferred for structural support in fibrous dysplasia. Cancellous bone, especially autograft, is rapidly resorbed and replaced by dysplastic host bone tissue.

Question 479

Topic: 5. Sports Medicine

A 4-year-old child presents with an expansile osteofibrous dysplasia lesion in the anterior tibia causing progressive bowing. What is the recommended management approach to minimize the risk of recurrence and complications?

. Immediate marginal en bloc resection and allograft
. Curettage and autogenous bone grafting
. Bracing until skeletal maturity (age 15), then reassess for surgery
. Below-knee amputation
. Intralesional steroid injection

Correct Answer & Explanation

. Bracing until skeletal maturity (age 15), then reassess for surgery

Explanation

Osteofibrous dysplasia has a high recurrence rate if excised in young children. The preferred approach is to manage deformities conservatively with bracing until age 15, when spontaneous resolution or stabilization often occurs.

Question 480

Topic: Knee Sports

A 9-year-old child complains of a painful "snapping" sensation in the lateral knee. MRI reveals a Wrisberg variant discoid meniscus. What anatomical feature characterizes this specific variant?

. Complete fusion of the medial and lateral menisci
. Absence of the posterior meniscotibial (coronary) attachments
. Anomalous insertion into the anterior cruciate ligament
. Hypertrophy of the anterior horn only
. Ossification of the central meniscal body

Correct Answer & Explanation

. Absence of the posterior meniscotibial (coronary) attachments

Explanation

The Wrisberg variant of a discoid lateral meniscus lacks normal posterior meniscotibial (coronary) ligaments. Its only posterior attachment is the ligament of Wrisberg, leading to hypermobility and the classic "snapping" knee.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page