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5. Sports Medicine MCQs

Practice Set 293 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 5841

Topic: Shoulder & Hip Sports

A 58-year-old female presents with sudden onset of severe right shoulder pain and an inability to actively abduct or externally rotate her arm after lifting a heavy box. On examination, she has a positive 'hook test' and a visible 'Popeye' deformity in her upper arm. Which tendon is most likely injured?

. Supraspinatus tendon.
. Infraspinatus tendon.
. Subscapularis tendon.
. Long head of biceps tendon.
. Teres minor tendon.

Correct Answer & Explanation

. Long head of biceps tendon.

Explanation

The sudden onset of shoulder pain, inability to abduct/externally rotate (suggesting rotator cuff involvement), and specifically the 'Popeye' deformity (a bulge in the distal upper arm) along with a positive 'hook test' (for biceps pathology) are classic signs of a rupture of the long head of the biceps tendon. While rotator cuff injury is also likely, the 'Popeye' sign is pathognomonic for biceps rupture. Supraspinatus, infraspinatus, subscapularis, and teres minor are rotator cuff muscles but do not present with a 'Popeye' deformity upon rupture.

Question 5842

Topic: Shoulder & Hip Sports

A 30-year-old male presents with recurrent episodes of shoulder dislocation. Examination reveals anterior apprehension with the arm in abduction and external rotation, and a palpable defect on the posterior aspect of the humeral head on MRI. This defect is known as a:

. Bankart lesion.
. SLAP lesion.
. Hill-Sachs lesion.
. Reverse Bankart lesion.
. Os acromiale.

Correct Answer & Explanation

. Hill-Sachs lesion.

Explanation

The scenario describes recurrent anterior shoulder dislocation with an anterior apprehension sign. The defect on the posterior aspect of the humeral head, caused by impaction against the anterior inferior glenoid rim during dislocation, is known as a Hill-Sachs lesion. A Bankart lesion is an injury to the anterior inferior labrum and glenoid rim. A SLAP (Superior Labrum Anterior to Posterior) lesion involves the superior labrum. A reverse Bankart lesion is a posterior inferior labrum tear associated with posterior dislocation. Os acromiale is an unfused acromial apophysis.

Question 5843

Topic: Shoulder & Hip Sports

A 50-year-old construction worker complains of right shoulder pain, especially when lifting his arm overhead. He describes a 'catching' sensation and weakness with abduction. Physical exam reveals a positive Neer's and Hawkins' test. Resisted external rotation is weak. What is the most likely diagnosis?

. Adhesive capsulitis.
. Glenohumeral osteoarthritis.
. Rotator cuff tear.
. Bicipital tendinitis.
. Acromioclavicular joint arthritis.

Correct Answer & Explanation

. Rotator cuff tear.

Explanation

The patient's symptoms of pain with overhead activity, weakness with abduction and external rotation, and positive impingement signs (Neer's and Hawkins' tests) are highly suggestive of a rotator cuff tear. Resisted external rotation weakness specifically points to involvement of the supraspinatus or infraspinatus, both part of the rotator cuff. Adhesive capsulitis presents with global stiffness. Glenohumeral osteoarthritis typically causes grinding and limited range of motion, often in older patients. Bicipital tendinitis causes anterior shoulder pain. AC joint arthritis causes localized pain at the top of the shoulder.

Question 5844

Topic: Knee Sports

A 22-year-old collegiate athlete sustains an injury to his knee during a soccer match. He reports hearing a 'pop,' followed by immediate swelling and inability to continue playing. Lachman test is positive. What is the most likely diagnosis?

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

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) tear.

Explanation

The classic presentation of an ACL tear includes a 'pop' at the time of injury, immediate knee swelling (hemarthrosis), inability to continue activity, and a positive Lachman test (anterior translation of the tibia relative to the femur with the knee at 30 degrees flexion). While meniscal tears can also cause popping and swelling, the Lachman test is specific for ACL laxity. MCL and LCL tears present with valgus/varus instability respectively. PCL tears cause posterior instability.

Question 5845

Topic: Knee Sports

Which physical examination finding is highly specific for a meniscus tear in the knee?

. Positive Lachman test.
. Joint line tenderness with pain on twisting maneuvers (e.g., McMurray test).
. Valgus instability.
. Patellofemoral crepitus.
. Generalized knee effusion.

Correct Answer & Explanation

. Joint line tenderness with pain on twisting maneuvers (e.g., McMurray test).

Explanation

Joint line tenderness combined with pain or a 'click' during specific twisting maneuvers (like the McMurray test) is highly suggestive of a meniscus tear. The McMurray test attempts to trap the torn meniscal fragment between the femur and tibia. A positive Lachman test indicates ACL injury. Valgus instability indicates MCL injury. Patellofemoral crepitus suggests patellofemoral arthritis or chondromalacia. Generalized knee effusion can be present with many knee pathologies.

Question 5846

Topic: Knee Sports

What is the primary role of the anterior cruciate ligament (ACL) in the knee joint?

. Preventing varus stress.
. Preventing valgus stress.
. Preventing anterior translation of the tibia on the femur.
. Preventing posterior translation of the tibia on the femur.
. Preventing excessive knee hyperextension.

Correct Answer & Explanation

. Preventing anterior translation of the tibia on the femur.

Explanation

The anterior cruciate ligament (ACL) is the primary restraint to anterior translation of the tibia on the femur and also limits internal and external rotation of the tibia. It is crucial for knee stability, especially during rotational and pivoting movements. The medial collateral ligament (MCL) prevents valgus stress. The lateral collateral ligament (LCL) prevents varus stress. The posterior cruciate ligament (PCL) prevents posterior translation of the tibia. Hyperextension is limited by various capsular and ligamentous structures.

Question 5847

Topic: 5. Sports Medicine

A 28-year-old competitive athlete presents with acute onset knee pain, swelling, and a 'pop' sensation after a non-contact pivoting injury during soccer. On examination, Lachman test is positive, and there is significant effusion. What is the most sensitive and specific clinical test for an ACL tear?

. Anterior drawer test
. Pivot shift test
. Lachman test
. Posterior sag sign
. McMurray test

Correct Answer & Explanation

. Lachman test

Explanation

The Lachman test is considered the most sensitive and specific clinical test for an acute anterior cruciate ligament (ACL) tear, especially in the presence of swelling and pain. It assesses anterior translation of the tibia on the femur with the knee in 20-30 degrees of flexion, minimizing hamstring guarding. The pivot shift test is highly specific for ACL tears but can be difficult to perform accurately in an acute, painful knee. The anterior drawer test is less sensitive due to hamstring spasm in acute injuries. The posterior sag sign indicates a PCL injury, and the McMurray test assesses meniscal pathology.

Question 5848

Topic: Shoulder & Hip Sports

Which of the following describes the most common type of rotator cuff tear and its anatomical location?

. Subscapularis tear at its insertion on the lesser tuberosity.
. Infraspinatus tear at its musculotendinous junction.
. Supraspinatus tear at its insertion on the greater tuberosity.
. Teres minor tear at its insertion on the greater tuberosity.
. Biceps tendon tear in the bicipital groove.

Correct Answer & Explanation

. Supraspinatus tear at its insertion on the greater tuberosity.

Explanation

The supraspinatus tendon is the most commonly torn rotator cuff tendon, and tears most frequently occur at its insertion on the greater tuberosity. This area is vulnerable due to its location under the acromion, making it susceptible to impingement and wear. The other options describe less common sites or different tendons/structures.

Question 5849

Topic: Knee Sports

A 14-year-old male football player sustains a valgus stress injury to his knee. Examination reveals pain and laxity with valgus stress at 30 degrees of knee flexion, but stability at 0 degrees. What structure is most likely injured?

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

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

Laxity with valgus stress at 30 degrees of knee flexion, with stability at 0 degrees, is the classic presentation for an isolated medial collateral ligament (MCL) injury (Grade I or II). The MCL is the primary restraint to valgus stress. If there were laxity at 0 degrees, it would suggest a more severe injury involving the posterior oblique ligament and/or ACL. LCL is injured with varus stress. ACL and PCL injuries cause anteroposterior instability. The medial meniscus can be injured with valgus forces, but the primary instability described points to the MCL.

Question 5850

Topic: Shoulder & Hip Sports

A patient with a traumatic brachial plexus injury presents with a 'waiter's tip' posture (shoulder adducted and internally rotated, elbow extended, forearm pronated, wrist flexed). Which nerve roots are most likely affected?

. C8-T1
. C7-C8
. C5-C6
. T1-T2
. C6-C7

Correct Answer & Explanation

. C5-C6

Explanation

The 'waiter's tip' posture is characteristic of an Erb's palsy, which results from injury to the upper trunk of the brachial plexus, primarily involving the C5 and C6 nerve roots. This affects muscles innervated by these roots, including the deltoid, supraspinatus, infraspinatus, biceps, and brachialis, leading to the described posture. C8-T1 injuries cause Klumpke's palsy, affecting intrinsic hand muscles.

Question 5851

Topic: Knee Sports

Which of the following ligaments is considered the primary static stabilizer against posterior translation of the tibia on the femur?

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

Correct Answer & Explanation

. Posterior cruciate ligament (PCL)

Explanation

The Posterior Cruciate Ligament (PCL) is the strongest ligament in the knee and serves as the primary static stabilizer against posterior translation of the tibia on the femur, as well as providing some secondary restraint to varus, valgus, and rotational forces. The ACL is the primary restraint to anterior translation. The MCL and LCL provide valgus and varus stability, respectively. The posterior oblique ligament is part of the posteromedial corner and contributes to valgus stability and external rotation.

Question 5852

Topic: Knee Sports

Which of the following ligaments provides the most significant restraint to external rotation of the tibia on the femur?

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

Correct Answer & Explanation

. Anterior cruciate ligament (ACL)

Explanation

The anterior cruciate ligament (ACL) is the primary restraint to anterior translation of the tibia on the femur, but it also provides a significant secondary restraint to internal and external rotation, particularly preventing excessive external rotation. The PCL restrains posterior translation. The MCL and LCL primarily resist valgus and varus forces, respectively. The oblique popliteal ligament is part of the posteromedial corner and contributes to posterior stability.

Question 5853

Topic: 5. Sports Medicine

In the surgical planning for a highly comminuted intra-articular Colles fracture in an elderly patient with significant bone loss, what advanced technique might be considered in conjunction with volar plating?

. Solely K-wire fixation, as it is less invasive.
. No additional techniques, volar plating is always sufficient.
. Bone grafting (autograft or allograft) to fill metaphyseal defects.
. Dorsal plating as a primary method to address dorsal comminution.
. Dynamic external fixation as the sole treatment.

Correct Answer & Explanation

. Bone grafting (autograft or allograft) to fill metaphyseal defects.

Explanation

For highly comminuted intra-articular Colles fractures, especially in elderly patients with significant bone loss or metaphyseal defects, bone grafting (autograft or allograft) may be considered in conjunction with volar plating. This helps to support the articular surface, prevent subsidence, and promote healing in areas of deficient bone stock. While volar plating provides stability, it doesn't always address large metaphyseal voids that can lead to collapse. Dorsal plating has higher complication rates. External fixation may not provide adequate articular reduction. K-wires are typically insufficient for such complex fractures.

Question 5854

Topic: Shoulder & Hip Sports

A 25-year-old male sustains a traumatic anterior shoulder dislocation. After successful closed reduction, what is the most important imaging study to obtain if he reports recurrent instability?

. Standard shoulder radiographs (AP, scapular Y, axillary views)
. CT scan with 3D reconstruction
. MRI with intravenous contrast (arthrogram)
. Ultrasound of the rotator cuff
. Nerve conduction studies

Correct Answer & Explanation

. MRI with intravenous contrast (arthrogram)

Explanation

For recurrent shoulder instability, particularly after a traumatic dislocation, an MRI with intravenous contrast (arthrogram) is the most important imaging study. It provides the best visualization of soft tissue injuries associated with instability, such as a Bankart lesion (labral tear), Hill-Sachs lesion (osseous defect on the humeral head), HAGL lesion, or capsular laxity. Standard radiographs are good for initial diagnosis and bony lesions but lack soft tissue detail. CT scans are excellent for bony defects but less so for labral tears. Ultrasound is primarily for rotator cuff tears. Nerve conduction studies are for neurological deficits.

Question 5855

Topic: Shoulder & Hip Sports

A 40-year-old male presents with lateral hip pain, worse with walking, lying on the affected side, and prolonged sitting. Physical examination reveals tenderness over the greater trochanter and pain reproduction with resisted hip abduction. Radiographs are normal. What is the most likely diagnosis?

. Trochanteric bursitis
. Gluteus medius tear
. Femoral neck stress fracture
. Labral tear of the hip
. Osteoarthritis of the hip

Correct Answer & Explanation

. Gluteus medius tear

Explanation

The symptoms of lateral hip pain, tenderness over the greater trochanter, and pain with resisted hip abduction are classic for pathology involving the gluteus medius or minimus tendons, collectively known as 'greater trochanteric pain syndrome.' While 'trochanteric bursitis' is a common historical term, current understanding suggests that abductor tendinopathy (tear or degeneration) is the primary pathology in most cases, often accompanied by bursitis. Gluteus medius tear is a specific and accurate diagnosis within this spectrum. Femoral neck stress fracture would cause deep groin/hip pain, worse with impact, and often show signs on advanced imaging. Labral tears cause anterior hip or groin pain, often with clicking. Osteoarthritis of the hip causes deep groin pain, stiffness, and restricted range of motion.

Question 5856

Topic: Shoulder & Hip Sports

Which of the following is a classic finding on physical examination for a patient with a complete rupture of the pectoralis major tendon?

. Winged scapula.
. Pain and weakness with internal rotation of the humerus.
. Lack of palpable tendon with a 'divot' or defect in the anterior axillary fold.
. Positive Hawkins' sign.
. Inability to abduct the arm beyond 90 degrees.

Correct Answer & Explanation

. Lack of palpable tendon with a 'divot' or defect in the anterior axillary fold.

Explanation

A complete rupture of the pectoralis major tendon (typically at the humeral insertion) is characterized by a lack of a palpable tendon and a 'divot' or defect in the anterior axillary fold. The muscle belly may also retract medially, creating an asymmetry compared to the contralateral side. Patients experience pain and weakness, particularly with resisted adduction and internal rotation. Winged scapula is associated with serratus anterior or trapezius palsy. Positive Hawkins' sign is for subacromial impingement. Inability to abduct the arm beyond 90 degrees can be due to rotator cuff tears or severe impingement, not specific to pectoralis major rupture.

Question 5857

Topic: Knee Sports

What is the primary function of the posterior cruciate ligament (PCL)?

. Prevents anterior translation of the tibia on the femur
. Prevents posterior translation of the tibia on the femur
. Resists varus stress to the knee
. Resists valgus stress to the knee
. Limits hyperextension of the knee

Correct Answer & Explanation

. Prevents posterior translation of the tibia on the femur

Explanation

The primary function of the PCL is to prevent posterior translation of the tibia on the femur, especially when the knee is flexed. This is tested clinically with the posterior drawer test. The ACL prevents anterior translation of the tibia. The collateral ligaments resist varus (LCL) and valgus (MCL) stresses. The PCL also helps to limit hyperextension, but its primary role is posterior translation prevention.

Question 5858

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
. Trochlear groove

Correct Answer & Explanation

. Medial femoral condyle

Explanation

The medial femoral condyle is the most common location for osteochondritis dissecans (OCD) in the knee, particularly the lateral aspect of the medial femoral condyle. While OCD can occur in other locations, it is significantly less frequent there.

Question 5859

Topic: Knee Sports

Which structure provides the primary static restraint against posterior translation of the tibia in the knee?

. Anterior cruciate ligament
. Posterior cruciate ligament
. Medial collateral ligament
. Lateral collateral ligament
. Posterior horn of the medial meniscus

Correct Answer & Explanation

. Posterior cruciate ligament

Explanation

The posterior cruciate ligament (PCL) is the primary static stabilizer that prevents posterior translation of the tibia relative to the femur. This is its defining function, particularly at higher flexion angles. The ACL prevents anterior translation. The collateral ligaments provide varus/valgus stability. The menisci are secondary stabilizers and shock absorbers.

Question 5860

Topic: Knee Sports

Which specific ligament provides the primary restraint against valgus stress to the knee?

. Anterior cruciate ligament (ACL)
. Posterior cruciate ligament (PCL)
. Lateral collateral ligament (LCL)
. Medial collateral ligament (MCL)
. Posterolateral corner (PLC)

Correct Answer & Explanation

. Medial collateral ligament (MCL)

Explanation

The medial collateral ligament (MCL) is the primary static restraint against valgus stress to the knee. The LCL resists varus stress. The ACL and PCL provide anterior and posterior stability, respectively. The posterolateral corner (PLC) provides rotational and varus stability but is not the primary valgus stabilizer.

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