Menu

5. Sports Medicine MCQs

Practice Set 319 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 6361

Topic: Shoulder & Hip Sports

An active 55-year-old male undergoes arthroscopic rotator cuff repair with a concomitant subpectoral biceps tenodesis. Compared to a biceps tenotomy, what is the primary biomechanical and clinical advantage of tenodesis?

. Decreased postoperative pain
. Lower rate of superficial infection
. Maintenance of forearm supination strength and avoidance of a cosmetic deformity
. Faster healing of the rotator cuff repair
. Restoration of glenohumeral stability

Correct Answer & Explanation

. Decreased postoperative pain

Explanation

Biceps tenodesis maintains the length-tension relationship of the biceps muscle, which preserves forearm supination strength and prevents the cosmetic Popeye deformity often seen after tenotomy. Both procedures offer similar pain relief.

Question 6362

Topic: Shoulder & Hip Sports

A 24-year-old professional hockey player presents with chronic anterior groin pain exacerbated by hip flexion and internal rotation. AP pelvis radiographs reveal a prominent 'crossover sign'. Which of the following pathomorphologies is primarily associated with this radiographic finding?

. Decreased femoral head-neck offset
. Acetabular retroversion
. Coxa profunda
. Acetabular protrusion
. Femoral retroversion

Correct Answer & Explanation

. Decreased femoral head-neck offset

Explanation

The 'crossover sign' is seen on an AP pelvis radiograph when the anterior rim of the acetabulum projects laterally to the posterior rim in the superior portion of the joint. This indicates focal or global acetabular retroversion, which is a classic cause of pincer-type femoroacetabular impingement (FAI). Decreased head-neck offset represents a cam-type deformity, while coxa profunda and protrusio are depth-related abnormalities.

Question 6363

Topic: Shoulder & Hip Sports

When assessing an AP pelvis radiograph for suspected femoroacetabular impingement (FAI), the presence of a 'crossover sign' is indicative of which specific anatomic abnormality?

. Decreased femoral head-neck offset (Cam deformity)
. Focal anterior acetabular overcoverage (Acetabular retroversion)
. Global acetabular overcoverage (Coxa profunda)
. Ischiofemoral impingement
. Subspine impingement

Correct Answer & Explanation

. Decreased femoral head-neck offset (Cam deformity)

Explanation

The crossover sign occurs on an AP pelvis radiograph when the anterior rim of the acetabulum crosses the line of the posterior rim before reaching the lateral edge of the acetabulum. This indicates acetabular retroversion or focal anterior overcoverage, which is a classic cause of Pincer-type FAI.

Question 6364

Topic: 5. Sports Medicine

A patient is 5 years post-primary TKA and presents to the emergency department after a slip and fall. The patient cannot actively extend the knee. Lateral radiographs demonstrate patella alta. What is the most likely diagnosis?

. Quadriceps tendon rupture
. Patellar tendon rupture
. Tibial tubercle avulsion fracture
. Polyethylene insert dissociation
. Intra-articular loose body

Correct Answer & Explanation

. Quadriceps tendon rupture

Explanation

Inability to actively extend the knee indicates disruption of the extensor mechanism. A high-riding patella (patella alta) is pathognomonic for a patellar tendon rupture, as the unopposed pull of the quadriceps muscle draws the patella proximally. A quadriceps tendon rupture would result in a low-riding patella (patella baja).

Question 6365

Topic: Shoulder & Hip Sports

A 13-year-old obese boy presents with left hip pain and an obligatory external rotation of the hip with passive flexion. Radiographs confirm a stable slipped capital femoral epiphysis (SCFE). He undergoes in situ single-screw fixation. What is the most common long-term complication directly related to the residual deformity of this condition?

. Avascular necrosis
. Chondrolysis
. Femoroacetabular impingement (FAI)
. Deep joint infection
. Loss of fixation

Correct Answer & Explanation

. Avascular necrosis

Explanation

In situ pinning is the gold standard for a stable SCFE but does not correct the underlying abnormal anatomy (posterior and inferior slippage of the epiphysis relative to the metaphysis). This creates a prominent anterior metaphyseal bump that predictably leads to Cam-type femoroacetabular impingement (FAI) and early onset osteoarthritis.

Question 6366

Topic: Knee Sports

What is the most common anatomic location for Osteochondritis Dissecans (OCD) lesions in the knee?

. Lateral aspect of the medial femoral condyle
. Medial aspect of the medial femoral condyle
. Lateral aspect of the lateral femoral condyle
. Central ridge of the patella
. Posterior aspect of the lateral tibial plateau

Correct Answer & Explanation

. Lateral aspect of the medial femoral condyle

Explanation

The most common location for Osteochondritis Dissecans (OCD) in the knee is the lateral aspect of the medial femoral condyle (accounting for roughly 70-80% of cases). The classic mnemonic is LAME: Lateral Aspect of the Medial Epicondyle/condyle.

Question 6367

Topic: Shoulder & Hip Sports

A 25-year-old male athlete presents with groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 68 degrees on the Dunn lateral view. Which of the following accurately describes the primary pathomechanical consequence of this specific structural abnormality?

. Primary failure of the ligamentum teres with secondary instability
. Pincer-type impingement leading to posterior labral tears
. Delamination of the acetabular cartilage primarily at the anterosuperior quadrant
. Global retroversion of the acetabulum causing focal anterior overcoverage
. Ischiofemoral impingement during terminal hip extension

Correct Answer & Explanation

. Primary failure of the ligamentum teres with secondary instability

Explanation

An alpha angle greater than 50-55 degrees indicates a Cam-type femoroacetabular impingement (FAI), characterized by a non-spherical femoral head-neck junction. During flexion and internal rotation, this cam lesion engages the anterosuperior acetabulum. The shear forces generated by the cam bump pushing into the joint cause 'outside-in' delamination of the adjacent acetabular articular cartilage, often leaving the labrum initially intact but separated from the underlying cartilage.

Question 6368

Topic: Knee Sports

A 45-year-old female presents with acute medial knee pain after a deep squatting maneuver. MRI reveals a complete radial tear of the posterior horn root of the medial meniscus with 5 mm of medial meniscal extrusion. Biomechanically, the complete loss of the posterior root attachment leads to which of the following intra-articular consequences?

. An exponential increase in meniscal hoop stresses during load-bearing
. Tibiofemoral contact pressures that are biomechanically equivalent to a total medial meniscectomy
. A posterior shift in the center of the tibiofemoral contact area during extension
. Decreased tension and strain on the anterior cruciate ligament
. Immediate and complete delamination of the medial femoral condyle cartilage

Correct Answer & Explanation

. An exponential increase in meniscal hoop stresses during load-bearing

Explanation

The meniscal roots securely anchor the meniscus to the tibial plateau, allowing the conversion of axial compressive forces into circumferential 'hoop stresses' within the meniscal tissue. When a root tear occurs, this anchoring is lost, the meniscus extrudes, and the hoop stresses cannot be generated or maintained. Biomechanical studies have proven that a complete meniscal root tear eliminates load sharing, resulting in peak tibiofemoral contact pressures that are nearly identical to those seen after a complete total meniscectomy.

Question 6369

Topic: Shoulder & Hip Sports

A 24-year-old male athlete presents with anterior groin pain that is exacerbated by deep hip flexion and internal rotation. Radiographs reveal an osseous prominence at the anterolateral head-neck junction. What radiographic measurement is widely used to quantify this specific deformity, and what is the typical diagnostic threshold?

. Center-edge angle; less than 20 degrees.
. Tonnis angle; greater than 10 degrees.
. Alpha angle; greater than 50 to 55 degrees.
. Beta angle; less than 45 degrees.
. Neck-shaft angle; greater than 140 degrees.

Correct Answer & Explanation

. Center-edge angle; less than 20 degrees.

Explanation

The patient's presentation is characteristic of Femoroacetabular Impingement (FAI), specifically cam morphology. A cam lesion is an osseous bump at the femoral head-neck junction that disrupts the normal spherical shape of the head. It is quantified on Dunn view or cross-table lateral radiographs, or MRI, using the Alpha angle. An Alpha angle greater than 50 to 55 degrees is considered diagnostic of cam morphology. The Center-edge and Tonnis angles evaluate acetabular coverage (dysplasia).

Question 6370

Topic: 5. Sports Medicine

Following an anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone autograft, a patient develops a 'cyclops lesion'. Which of the following is the most characteristic clinical finding associated with this complication?

. Loss of terminal knee flexion
. Anterior knee pain during resisted extension
. Loss of terminal knee extension
. Recurrent instability during pivot-shift testing
. Medial joint line tenderness

Correct Answer & Explanation

. Loss of terminal knee flexion

Explanation

A 'cyclops lesion' is a localized form of anterior arthrofibrosis (a fibrovascular nodule) that typically forms anterior to the ACL graft in the intercondylar notch. Because of its location, it mechanically blocks the tibia from achieving full extension, leading to a hallmark loss of terminal knee extension.

Question 6371

Topic: Shoulder & Hip Sports

A 22-year-old rugby player has recurrent anterior shoulder dislocations. Preoperative imaging reveals an anterior glenoid bone loss of 25%. Which of the following surgical procedures is the most appropriate definitive management for this patient?

. Arthroscopic Bankart repair
. Latarjet procedure (coracoid transfer)
. Remplissage procedure alone
. Capsular plication
. Putti-Platt procedure

Correct Answer & Explanation

. Arthroscopic Bankart repair

Explanation

In the setting of significant anterior glenoid bone loss (typically >20-25%), soft tissue stabilization alone (e.g., Bankart repair) has unacceptably high failure rates. A bone block procedure, such as the Latarjet procedure (transfer of the coracoid process with the attached conjoint tendon to the anterior glenoid), is the gold standard for restoring stability.

Question 6372

Topic: Knee Sports

In a cruciate-retaining (CR) total knee arthroplasty, the posterior cruciate ligament (PCL) is preserved. During normal knee flexion, what is the primary biomechanical function of an intact PCL?

. Anterior femoral translation
. Posterior femoral rollback
. Internal tibial rotation
. Varus stability
. Prevention of hyperextension

Correct Answer & Explanation

. Anterior femoral translation

Explanation

The PCL functions to facilitate posterior femoral rollback during knee flexion. This rollback increases maximal flexion by preventing early posterior impingement and improves the mechanical advantage of the extensor mechanism.

Question 6373

Topic: Shoulder & Hip Sports

A 22-year-old elite baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. MRI shows partial-thickness articular-sided tearing of the posterior supraspinatus and anterior infraspinatus, along with posterosuperior labral fraying. What is the primary pathomechanism?

. Subcoracoid impingement
. Primary outlet impingement
. Internal impingement
. Quadrilateral space syndrome
. Parsonage-Turner syndrome

Correct Answer & Explanation

. Subcoracoid impingement

Explanation

Internal impingement occurs in overhead athletes during maximal abduction and external rotation (late cocking phase). The greater tuberosity abuts the posterosuperior glenoid, pinching the articular side of the rotator cuff and the posterosuperior labrum.

Question 6374

Topic: Knee Sports

During an anterior cruciate ligament (ACL) reconstruction, the surgeon identifies the two bundles of the native ACL. When does the posterolateral (PL) bundle experience its maximum tension?

. Full extension
. 30 degrees of flexion
. 60 degrees of flexion
. 90 degrees of flexion
. 120 degrees of flexion

Correct Answer & Explanation

. Full extension

Explanation

The ACL consists of the anteromedial (AM) and posterolateral (PL) bundles. The AM bundle tightens in flexion and is primarily responsible for anterior-posterior stability. The PL bundle is tightest in extension and provides critical rotational stability to the knee.

Question 6375

Topic: Shoulder & Hip Sports

Which muscle of the rotator cuff is primarily responsible for internal rotation of the humerus?

. Supraspinatus
. Infraspinatus
. Teres minor
. Subscapularis
. Teres major

Correct Answer & Explanation

. Supraspinatus

Explanation

The subscapularis inserts onto the lesser tuberosity of the humerus and is the primary internal rotator of the shoulder among the rotator cuff muscles. The infraspinatus and teres minor are external rotators, and the supraspinatus initiates abduction.

Question 6376

Topic: 5. Sports Medicine

Following an autograft anterior cruciate ligament (ACL) reconstruction, the graft undergoes a biological process of 'ligamentization'. During which chronological phase is the graft biomechanically at its weakest and most vulnerable to elongation or rupture?

. Incorporation phase (0-4 weeks)
. Early remodeling and revascularization phase (4-12 weeks)
. Maturation phase (3-6 months)
. Late maturation phase (6-12 months)
. The graft maintains a uniform tensile strength throughout the first year

Correct Answer & Explanation

. Incorporation phase (0-4 weeks)

Explanation

The graft undergoes four phases: initial necrosis, revascularization, cellular proliferation, and remodeling (ligamentization). The graft is biomechanically weakest during the early remodeling/revascularization phase (typically 4 to 12 weeks post-op). During this window, native cells undergo necrosis and the collagen matrix is reorganized, making the graft susceptible to stretch or failure before new collagen is adequately deposited and aligned.

Question 6377

Topic: Knee Sports

A 50-year-old female presents with acute medial knee pain after a deep squat. MRI reveals a complete radial tear of the posterior root of the medial meniscus. Biomechanically, this specific injury alters joint contact pressures in a manner equivalent to which of the following?

. A bucket-handle meniscal tear in the red-white zone
. An isolated complete anterior cruciate ligament rupture
. A total medial meniscectomy
. A peripheral longitudinal tear in the red-red zone
. A horizontal cleavage tear of the posterior horn

Correct Answer & Explanation

. A bucket-handle meniscal tear in the red-white zone

Explanation

A posterior root tear of the meniscus completely disrupts the circumferential hoop fibers of the meniscus. Biomechanical studies demonstrate that a complete root tear abolishes the meniscus's ability to resist hoop stresses and extrudes the meniscus, resulting in contact pressures and joint kinematics that are virtually equivalent to a total meniscectomy. Surgical repair is critical to restore hoop tension and prevent rapid osteoarthritis.

Question 6378

Topic: Shoulder & Hip Sports

A 38-year-old male presents with sudden onset, excruciating right shoulder pain that awakened him from sleep, lasting for 5 days before slowly resolving. Following pain resolution, he notices profound weakness in elevating and externally rotating his arm. MRI of the cervical spine and shoulder are normal. EMG demonstrates denervation isolated to the supraspinatus and infraspinatus. What is the most likely diagnosis?

. C5 cervical radiculopathy
. Parsonage-Turner syndrome (Idiopathic brachial neuritis)
. Acute massive rotator cuff tear
. Quadrilateral space syndrome
. Suprascapular nerve entrapment at the spinoglenoid notch

Correct Answer & Explanation

. C5 cervical radiculopathy

Explanation

Parsonage-Turner syndrome (idiopathic brachial neuritis) classically presents with a viral prodrome followed by severe, acute shoulder/girdle pain lasting days to weeks. As the pain subsides, profound weakness and atrophy of the affected muscles (often innervated by the suprascapular, axillary, or long thoracic nerves) become apparent. The normal MRIs and classical biphasic clinical course distinguish it from structural tears or isolated compressive neuropathies.

Question 6379

Topic: Shoulder & Hip Sports

When evaluating a patient with recurrent anterior shoulder instability, the concept of the 'glenoid track' is utilized to determine the risk of a Hill-Sachs lesion engaging the anterior glenoid rim. Which of the following best describes an 'off-track' Hill-Sachs lesion?

. The Hill-Sachs lesion width is narrower than the glenoid track width
. The intact anterior glenoid rim provides a fulcrum, preventing engagement
. The medial margin of the Hill-Sachs lesion extends medial to the glenoid track
. The lesion predominantly engages in internal rotation and forward elevation
. The Hill-Sachs lesion is located entirely within the articular surface of the humerus, lateral to the footprint

Correct Answer & Explanation

. The Hill-Sachs lesion width is narrower than the glenoid track width

Explanation

The glenoid track concept evaluates the interaction between bipolar bone loss (glenoid bone loss and Hill-Sachs lesion). The glenoid track represents the contact zone of the glenoid on the humeral head during abduction and external rotation. A Hill-Sachs lesion is 'off-track' (and thus will engage the anterior glenoid rim) if its medial margin extends further medial than the medial margin of the glenoid track.

Question 6380

Topic: 5. Sports Medicine

A 22-year-old collegiate soccer player undergoes anterior cruciate ligament (ACL) reconstruction using a doubled semitendinosus and gracilis (hamstring) autograft. Compared to bone-patellar tendon-bone (BPTB) autografts, hamstring autografts are associated with a higher incidence of which of the following long-term post-operative outcomes?

. Anterior knee pain during kneeling
. Patellar fracture
. Contralateral ACL tear
. Decreased hamstring strength in deep knee flexion
. Severe post-operative arthrofibrosis

Correct Answer & Explanation

. Anterior knee pain during kneeling

Explanation

Hamstring autograft harvesting inevitably leads to a selective deficit in deep knee flexion strength and internal tibial rotation strength, particularly past 90 degrees of flexion. BPTB autografts are more commonly associated with anterior knee pain, patellar fractures, and pain while kneeling.

Test Yourself

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

On this Page