Menu

5. Sports Medicine MCQs

Practice Set 292 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 5821

Topic: 5. Sports Medicine

A 22-year-old collegiate athlete sustains an isolated anterior cruciate ligament (ACL) tear. He desires to return to competitive sports. What is the MOST crucial factor for a successful return to play following ACL reconstruction?

. Choice of graft (autograft vs. allograft)
. Aggressive early rehabilitation protocol
. Passing functional performance tests and adequate time from surgery
. Use of a functional knee brace post-surgery
. Surgeon's experience and volume

Correct Answer & Explanation

. Passing functional performance tests and adequate time from surgery

Explanation

While all options play a role, passing objective functional performance tests (e.g., hop tests, strength testing, balance) and adequate time from surgery (typically 9-12 months for high-level athletes) are the most crucial factors indicating readiness for return to play. Premature return increases the risk of re-injury. Graft choice, while important for long-term outcomes, is less critical than achieving functional milestones. Aggressive early rehab is part of the process but needs to be balanced with biological healing. Bracing is controversial and generally not supported as the primary factor for return to play in ACL patients.

Question 5822

Topic: Shoulder & Hip Sports

What is the primary function of the subscapularis tendon in the shoulder?

. Abduction
. External rotation
. Internal rotation
. Adduction
. Flexion

Correct Answer & Explanation

. Internal rotation

Explanation

The subscapularis is one of the four rotator cuff muscles and is the primary internal rotator of the shoulder. It also contributes to shoulder adduction. The supraspinatus is an abductor, and the infraspinatus and teres minor are external rotators. The deltoid is a major abductor.

Question 5823

Topic: Shoulder & Hip Sports

What is the primary goal of conservative management for rotator cuff tendinopathy without a full-thickness tear?

. Eliminate all shoulder pain permanently
. Avoid all overhead activities indefinitely
. Improve rotator cuff strength and scapular mechanics
. Initiate corticosteroid injections early
. Prepare for inevitable surgical repair

Correct Answer & Explanation

. Improve rotator cuff strength and scapular mechanics

Explanation

The primary goal of conservative management for rotator cuff tendinopathy is to improve rotator cuff strength, restore proper scapular mechanics, and optimize neuromuscular control of the shoulder. This addresses underlying biomechanical deficits that contribute to impingement and tendon overload. While pain reduction is a goal, complete elimination of pain may not always be achievable, and the focus is on functional restoration. Avoidance of overhead activities is temporary, not indefinite. Corticosteroid injections offer short-term relief but do not address the root cause and are not always initiated early. Surgical repair is typically reserved for failed conservative management or full-thickness tears.

Question 5824

Topic: 5. Sports Medicine

A patient undergoing shoulder arthroscopy is placed in the beach chair position. The anesthesiologist expresses concern about cerebral perfusion pressure (CPP) due to the elevation of the head. If the patient's brachial artery blood pressure is 100/60 mmHg (MAP 73 mmHg) and the cerebral venous pressure is estimated at 10 mmHg, what calculation is crucial for estimating the CPP at the brain level?

. Using the brachial artery pressure as is.
. Adjusting brachial artery pressure for hydrostatic gradient (1 mmHg per 1.25 cm height difference).
. Adding 10 mmHg to the brachial artery pressure.
. Subtracting 20 mmHg from the brachial artery pressure.
. Ignoring the head height as it's negligible.

Correct Answer & Explanation

. Adjusting brachial artery pressure for hydrostatic gradient (1 mmHg per 1.25 cm height difference).

Explanation

When a patient is in the beach chair position, the head is significantly elevated above the level of the heart/brachial artery where blood pressure is typically measured. To accurately estimate cerebral perfusion pressure (CPP = MAP - ICP or cerebral venous pressure), the mean arterial pressure at the level of the brain must be calculated. This involves adjusting the brachial artery MAP for the hydrostatic gradient. For every 1.25 cm (or approximately 1 inch) difference in height between the brachial artery cuff and the external auditory meatus (representing the Circle of Willis), there is approximately a 1 mmHg change in pressure. In an elevated head position, the pressure at the brain will belowerthan the brachial artery pressure, and this reduction must be accounted for by subtracting the hydrostatic difference.

Question 5825

Topic: 5. Sports Medicine

A 50-year-old male undergoes a complex shoulder arthroscopy. He receives large volumes of intravenous fluids, including both crystalloids and colloids. On post-operative day 1, he develops marked peripheral edema and crackles on lung auscultation. His serum sodium is 132 mEq/L. What is the most appropriate initial fluid management?

. Increase crystalloid infusion to improve urine output
. Administer a loop diuretic (e.g., Furosemide)
. Administer 3% hypertonic saline for hyponatremia
. Restrict fluids and continue colloid infusion
. Administer oral sodium chloride tablets

Correct Answer & Explanation

. Administer a loop diuretic (e.g., Furosemide)

Explanation

This patient is showing signs of volume overload (peripheral edema, pulmonary crackles) despite having mild hyponatremia (132 mEq/L), indicating hypervolemic hyponatremia or impending volume overload. The most appropriate initial management is to administer a loop diuretic (e.g., Furosemide) to promote diuresis and reduce excess fluid volume. Increasing crystalloid infusion would worsen the overload. 3% hypertonic saline is not indicated for mild, hypervolemic hyponatremia. Fluid restriction is also important, but a diuretic will actively remove excess fluid. Continuing colloid infusion might exacerbate the problem. Oral sodium tablets are contraindicated with volume overload.

Question 5826

Topic: 5. Sports Medicine

A 55-year-old female with a history of adrenal insufficiency on chronic steroid replacement (hydrocortisone) is undergoing elective shoulder arthroscopy. What is the most crucial blood pressure-related management strategy in the perioperative period for this patient?

. Aggressive use of vasopressors to maintain high blood pressure
. Strict fluid restriction to prevent volume overload
. Ensuring appropriate stress dose corticosteroids are administered
. Avoiding all anesthetic agents that cause vasodilation
. Monitoring for hypernatremia due to steroid use

Correct Answer & Explanation

. Ensuring appropriate stress dose corticosteroids are administered

Explanation

Patients with adrenal insufficiency require 'stress doses' of corticosteroids perioperatively to prevent adrenal crisis, which manifests as profound hypotension, hypoglycemia, and shock that can be refractory to vasopressors. This is the most crucial blood pressure-related management because an inadequate cortisol response can lead to life-threatening circulatory collapse. While vasopressors might be needed if crisis occurs, preventing it with corticosteroids is paramount. Fluid restriction is inappropriate; these patients are often relatively hypovolemic. Avoiding all vasodilating agents is not always feasible. Monitoring for hypernatremia is less relevant than preventing adrenal crisis.

Question 5827

Topic: Knee Sports

Which biomechanical principle is most critical for the successful healing of an articular cartilage defect treated with microfracture?

. Maintenance of a stable bone-cartilage interface through rigid fixation.
. Creation of a low-friction surface that resists shear forces.
. Formation of a fibrocartilaginous repair tissue with improved wear properties.
. Controlled, cyclic loading to stimulate chondrocyte differentiation and matrix production.
. Elimination of all weight-bearing for at least 6 months post-operatively.

Correct Answer & Explanation

. Controlled, cyclic loading to stimulate chondrocyte differentiation and matrix production.

Explanation

Microfracture aims to stimulate the growth of fibrocartilaginous repair tissue from mesenchymal stem cells (MSCs) released from subchondral bone. Controlled, cyclic loading (e.g., non-weight bearing range of motion or continuous passive motion) is crucial post-microfracture. This mechanical stimulation helps guide the differentiation of MSCs towards a chondrogenic lineage and promotes the production of a more organized and resilient repair matrix. While a stable interface is important, it's not the primary biomechanical principle guiding microfracture healing itself. The repair tissue formed (fibrocartilage) is generally inferior to native hyaline cartilage in wear properties, but the goal is to improve upon the defect. Eliminating all weight-bearing for 6 months is overly restrictive and detrimental to cartilage formation. Low friction is a characteristic of healthy cartilage, but the principle for healing involves stimulating cell differentiation.

Question 5828

Topic: 5. Sports Medicine

A 16-year-old female cheerleader reports sudden onset of sharp anterior knee pain during practice. She describes her kneecap 'moving out of place' and then 'moving back in.' On examination, she has a large hemarthrosis, patellar apprehension, and tenderness along the medial patellar facet. Her X-rays are normal, but an MRI shows edema within the medial patellofemoral ligament (MPFL) and a small osteochondral defect on the lateral femoral condyle. What is the most appropriate initial treatment?

. Immediate surgical MPFL reconstruction.
. Long-leg casting for 6 weeks.
. Conservative management with RICE, pain control, and early protected range of motion, followed by physical therapy.
. Diagnostic arthroscopy with loose body removal and debridement.
. Quadriceps strengthening exercises only.

Correct Answer & Explanation

. Conservative management with RICE, pain control, and early protected range of motion, followed by physical therapy.

Explanation

This is a classic presentation of acute patellar dislocation, with spontaneous reduction. The presence of hemarthrosis, patellar apprehension, and MPFL edema on MRI confirms the diagnosis. Initial treatment for a first-time patellar dislocation, even with an osteochondral defect, is typically conservative. This involves rest, ice, compression, elevation (RICE), pain control, and early protected range of motion, followed by a structured physical therapy program focusing on quadriceps (especially vastus medialis obliquus) and hip abductor strengthening. Surgical MPFL reconstruction is usually reserved for recurrent dislocations or persistent instability after failed conservative treatment. Long-leg casting is often avoided to prevent stiffness. Diagnostic arthroscopy might be considered if the osteochondral defect is large, displaced, or causes mechanical symptoms, but it's not the immediate first step. Quadriceps strengthening is part of rehab, not the sole initial treatment.

Question 5829

Topic: Shoulder & Hip Sports

A 38-year-old male presents with chronic insidious onset of groin pain, worse with activity and prolonged sitting. He denies trauma. Physical exam reveals pain with FADIR (flexion-adduction-internal rotation) and FABER (flexion-abduction-external rotation) tests. Radiographs show a prominent anterior inferior iliac spine (AIIS) and an alpha angle of 70 degrees. What is the most likely diagnosis?

. Osteoarthritis of the hip.
. Femoroacetabular impingement (FAI), cam type.
. Femoroacetabular impingement (FAI), pincer type.
. Sports hernia (athletic pubalgia).
. Stress fracture of the femoral neck.

Correct Answer & Explanation

. Femoroacetabular impingement (FAI), cam type.

Explanation

The clinical presentation of chronic groin pain, positive FADIR and FABER tests, and a high alpha angle (70 degrees) are classic for femoroacetabular impingement (FAI), specifically the cam type. A cam deformity describes an aspherical femoral head-neck junction that abuts the acetabular rim during hip flexion and internal rotation. A prominent anterior inferior iliac spine (AIIS) can contribute to a form of extra-articular impingement (subspine impingement) which sometimes coexists with pincer or cam morphology, but the elevated alpha angle is the defining radiographic feature of cam-type FAI. Osteoarthritis is typically a consequence of long-standing FAI, not the primary diagnosis in a 38-year-old with these specific findings. Sports hernia is an athletic pubalgia, which presents differently, primarily with lower abdominal or adductor pain. Stress fractures usually have a more acute onset and distinct radiographic findings.

Question 5830

Topic: 5. Sports Medicine

What is the most accurate predictor of success for anterior cruciate ligament (ACL) reconstruction using a hamstring autograft?

. Patient age.
. Quadriceps strength at 6 months post-surgery.
. Postoperative graft tunnel widening.
. Compliance with postoperative rehabilitation protocol.
. Type of fixation used for the graft.

Correct Answer & Explanation

. Compliance with postoperative rehabilitation protocol.

Explanation

Compliance with a comprehensive postoperative rehabilitation protocol is arguably the most critical and accurate predictor of success following ACL reconstruction, regardless of graft type. While patient age, quadriceps strength, graft tunnel widening, and fixation type all play a role, consistent and appropriate rehabilitation (including early range of motion, gradual strengthening, proprioception training, and sport-specific drills) is essential for achieving good functional outcomes, restoring stability, and reducing the risk of re-injury. Without proper rehab, even a perfectly executed surgery can result in a poor outcome.

Question 5831

Topic: Shoulder & Hip Sports

Which of the following conditions is an indication for surgical management of an acute rotator cuff tear?

. Small, partial-thickness tear in an elderly, sedentary patient.
. Full-thickness tear (>1 cm) in a young, active patient with acute trauma and significant weakness.
. Chronic, asymptomatic full-thickness tear.
. Degenerative full-thickness tear with minimal pain and good function.
. Impingement syndrome without a documented tear.

Correct Answer & Explanation

. Full-thickness tear (>1 cm) in a young, active patient with acute trauma and significant weakness.

Explanation

Surgical repair of an acute rotator cuff tear is strongly indicated in a young, active patient who sustains a full-thickness tear (especially greater than 1 cm) from acute trauma and experiences significant weakness. In this demographic and tear pattern, surgical repair offers the best chance for restoring function, preventing tear enlargement, and avoiding future degenerative changes. Small, partial tears, or tears in elderly/sedentary patients, or chronic asymptomatic/degenerative tears are often managed conservatively first. Impingement syndrome without a tear is also managed conservatively.

Question 5832

Topic: Knee Sports

Which of the following describes the most common long-term complication after anterior cruciate ligament (ACL) reconstruction, despite a successful surgery?

. Graft re-rupture.
. Chronic patellofemoral pain.
. Development of osteoarthritis.
. Infection.
. Arthrofibrosis.

Correct Answer & Explanation

. Development of osteoarthritis.

Explanation

Despite successful ACL reconstruction, the most common long-term complication is the development of osteoarthritis of the knee. Even with anatomical reconstruction and restoration of stability, the initial injury itself, associated meniscal or cartilage damage, and altered joint kinematics contribute to an accelerated degenerative process, leading to osteoarthritis in a significant percentage of patients over time. While graft re-rupture, patellofemoral pain, infection, and arthrofibrosis are all possible complications, osteoarthritis remains the most prevalent long-term issue impacting joint health and function.

Question 5833

Topic: 5. Sports Medicine

Which of the following describes the typical pattern of pain referral from the kidney to the musculoskeletal system that an orthopedic surgeon should be aware of?

. Anterior thigh pain, mimicking hip pathology.
. Shoulder pain, mimicking rotator cuff pathology.
. Flank pain radiating to the groin or anterior abdominal wall.
. Posterior calf pain, mimicking Achilles tendinopathy.
. Diffuse bilateral knee pain.

Correct Answer & Explanation

. Flank pain radiating to the groin or anterior abdominal wall.

Explanation

Pain originating from the kidney (e.g., renal colic from a stone, pyelonephritis) typically presents as flank pain. This pain can radiate anteriorly to the groin, anterior abdominal wall, or even down to the scrotum/labia, often mimicking musculoskeletal pain in the hip or groin region. An orthopedic surgeon should be aware of this referred pain pattern to differentiate it from true musculoskeletal pathology. Shoulder pain and posterior calf pain are not typical referral patterns for kidney issues. Anterior thigh pain can be from nerve compression, but flank-to-groin is classic for kidney. Diffuse bilateral knee pain is nonspecific.

Question 5834

Topic: Knee Sports

Which of the following ligaments is the primary static stabilizer preventing anterior translation of the tibia on the femur?

. Posterior Cruciate Ligament (PCL)
. Medial Collateral Ligament (MCL)
. Anterior Cruciate Ligament (ACL)
. Lateral Collateral Ligament (LCL)
. Patellar Tendon

Correct Answer & Explanation

. Anterior Cruciate Ligament (ACL)

Explanation

The Anterior Cruciate Ligament (ACL) is the primary static stabilizer preventing excessive anterior translation of the tibia relative to the femur and also limits internal rotation. The PCL prevents posterior translation. The MCL and LCL provide valgus and varus stability, respectively. The patellar tendon connects the patella to the tibia and is involved in knee extension.

Question 5835

Topic: Knee Sports

A 25-year-old basketball player lands awkwardly and feels a 'pop' in his knee. He experiences immediate pain and swelling. On examination, a positive Lachman test is noted. Which ligament is most likely injured?

. Medial collateral ligament (MCL)
. Lateral collateral ligament (LCL)
. Posterior cruciate ligament (PCL)
. Anterior cruciate ligament (ACL)
. Patellar ligament

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

A 'pop' sensation, immediate pain and swelling (hemarthrosis), and a positive Lachman test (anterior translation of the tibia on the femur with the knee in 20-30 degrees of flexion) are classic signs of an Anterior Cruciate Ligament (ACL) tear. MCL injuries typically result from valgus stress and show tenderness over the medial joint line. PCL injuries result from a direct blow to the tibia or hyperflexion. LCL injuries result from varus stress. Patellar ligament injury would affect the extensor mechanism.

Question 5836

Topic: Knee Sports

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

. Lateral femoral condyle
. Medial femoral condyle
. Patella
. Tibial plateau
. Fibular head

Correct Answer & Explanation

. Medial femoral condyle

Explanation

The most common location for osteochondritis dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle. This location accounts for approximately 85% of all knee OCD lesions. Other less common sites include the lateral femoral condyle and the patella.

Question 5837

Topic: Shoulder & Hip Sports

Which of the following tendons forms part of the 'rotator cuff' of the shoulder?

. Long head of the biceps brachii
. Pectoralis major
. Deltoid
. Supraspinatus
. Teres major

Correct Answer & Explanation

. Supraspinatus

Explanation

The rotator cuff is composed of four muscles and their tendons: supraspinatus, infraspinatus, teres minor, and subscapularis (SITS muscles). The supraspinatus is one of these four. The long head of the biceps brachii passes through the rotator cuff but is not part of it. Pectoralis major, deltoid, and teres major are not rotator cuff muscles.

Question 5838

Topic: 5. Sports Medicine

In orthopedic reconstructive surgery, varying bone graft materials are utilized based on their biologic properties. Which of the following graft options possesses osteogenic, osteoinductive, AND osteoconductive properties?

. Cancellous autograft
. Cortical allograft
. Demineralized bone matrix (DBM)
. Synthetic calcium phosphate
. Recombinant BMP-2

Correct Answer & Explanation

. Cancellous autograft

Explanation

A cancellous autograft is the 'gold standard' because it is the only option that contains living cells (osteogenic), growth factors like BMPs (osteoinductive), and a 3D scaffold (osteoconductive). Allografts are primarily osteoconductive. DBM is osteoconductive and osteoinductive. Synthetics are solely osteoconductive, and rBMP-2 is solely osteoinductive.

Question 5839

Topic: 5. Sports Medicine

A 25-year-old professional athlete sustains an anterior cruciate ligament (ACL) rupture during a soccer game. She reports hearing a 'pop' and describes immediate swelling and instability. Which of the following is the most sensitive physical examination test for diagnosing an acute ACL rupture?

. McMurray's test.
. Lachman test.
. Varus stress test.
. Patellar apprehension test.
. Posterior sag sign.

Correct Answer & Explanation

. Lachman test.

Explanation

The Lachman test is considered the most sensitive physical examination test for diagnosing an acute ACL rupture, especially when performed within the first few hours to days before significant guarding and swelling limit examination. It assesses anterior translation of the tibia on the femur with the knee in 20-30 degrees of flexion. McMurray's test is for meniscal tears. Varus stress tests the LCL. Patellar apprehension test is for patellar instability. Posterior sag sign/Posterior drawer test assesses PCL integrity.

Question 5840

Topic: Shoulder & Hip Sports

A 65-year-old female presents with chronic shoulder pain, weakness, and difficulty lifting her arm above her head. Physical examination reveals atrophy of the supraspinatus and infraspinatus muscles, a positive 'drop arm' test, and significant weakness with external rotation. Which of the following is the most likely diagnosis?

. Adhesive capsulitis.
. Subacromial impingement syndrome.
. Glenohumeral osteoarthritis.
. Massive rotator cuff tear.
. Bicipital tendinopathy.

Correct Answer & Explanation

. Massive rotator cuff tear.

Explanation

The combination of chronic pain, weakness, difficulty with overhead motion, atrophy of specific rotator cuff muscles (supraspinatus, infraspinatus), and a positive 'drop arm' test (inability to smoothly lower the arm from abduction) is highly indicative of a massive rotator cuff tear, often involving multiple tendons. Adhesive capsulitis primarily causes global stiffness. Impingement syndrome is typically painful arc syndrome without significant weakness or muscle atrophy. Glenohumeral osteoarthritis causes pain and stiffness, but rotator cuff signs are not primary. Bicipital tendinopathy causes anterior shoulder pain.

Test Yourself

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

On this Page