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5. Sports Medicine MCQs

Practice Set 334 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 6661

Topic: Knee Sports

A 30-year-old male sustains a multi-ligamentous knee injury (dislocation equivalent) involving the ACL, PCL, and MCL. He has palpable but diminished distal pulses. What is the most appropriate imaging study to assess for vascular injury?

. Plain radiographs of the knee.
. Magnetic resonance imaging (MRI) of the knee.
. Computed tomography angiography (CTA) of the lower extremity.
. Duplex ultrasound of the popliteal artery.
. Venogram.

Correct Answer & Explanation

. Computed tomography angiography (CTA) of the lower extremity.

Explanation

Multi-ligamentous knee injuries, particularly those involving dislocation, have a high association with popliteal artery injury, even with palpable pulses. Given the diminished pulses (a 'soft sign' of vascular injury), a high-resolution imaging study is warranted to thoroughly evaluate the popliteal artery and its branches. Computed tomography angiography (CTA) has become the preferred imaging modality in this setting due to its rapid acquisition, high sensitivity, and ability to simultaneously assess for associated bony injuries or soft tissue hematomas. Duplex ultrasound can be useful but is highly operator-dependent. MRI is excellent for ligamentous and soft tissue detail but is not ideal for acute vascular assessment. Plain radiographs show only bony changes, and a venogram assesses veins, not arteries.

Question 6662

Topic: Knee Sports

A 25-year-old male presents with severe knee pain and swelling after a forced valgus injury. Physical examination reveals tenderness over the medial femoral condyle, but radiographs are normal. What is the most likely acute soft tissue injury?

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

Correct Answer & Explanation

. Medial collateral ligament (MCL) tear.

Explanation

A forced valgus injury (force applied to the lateral side of the knee, pushing the knee inwards) primarily stresses the medial collateral ligament (MCL). This typically results in an MCL tear, which causes pain and tenderness over the medial aspect of the knee. While ACL and meniscal tears can also occur with valgus injuries, an isolated MCL tear is very common and would present with localized medial tenderness and instability to valgus stress. LCL tears result from varus stress. PCL tears are often from dashboard injuries or hyperflexion. Patellar tendon rupture presents with inability to extend the knee and a high-riding patella.

Question 6663

Topic: 5. Sports Medicine

Which reconstructive option for limb salvage in the distal femur is most likely to be complicated by delayed union, non-union, or fracture, particularly in skeletally immature patients?

. Modular endoprosthesis
. Vascularized fibula autograft
. Massive allograft
. Rotationplasty
. Arthrodesis with internal fixation

Correct Answer & Explanation

. Massive allograft

Explanation

Massive allografts are frequently used for skeletal reconstruction after tumor resection. However, they have significant complication rates, with delayed union, non-union, and fracture being particularly common. Allografts are essentially devitalized bone and require a prolonged period for incorporation and remodeling, especially in younger patients. Infections are also a significant risk. Endoprostheses have risks of mechanical failure, infection, and loosening but not delayed union. Vascularized fibula autografts have better healing potential due to their vascularity but are small grafts. Rotationplasty avoids these specific bone healing complications. Arthrodesis has its own set of complications but is not primarily related to non-union of a massive graft.

Question 6664

Topic: 5. Sports Medicine

For an osteosarcoma of the proximal humerus involving the rotator cuff and neurovascular bundle, which surgical approach is often considered for good functional outcomes in a young, active patient?

. Forequarter amputation
. Resection and modular endoprosthesis with reverse total shoulder arthroplasty
. Resection and allograft-prosthesis composite
. Resection and shoulder arthrodesis
. Resection and vascularized fibula autograft

Correct Answer & Explanation

. Forequarter amputation

Explanation

For proximal humerus osteosarcoma with extensive involvement of the rotator cuff and neurovascular bundle, the functional outcomes of limb salvage with endoprosthetic reconstruction are often poor, resulting in a flail arm. In such cases, forequarter amputation, while a radical procedure, can provide better pain control and a more functional prosthetic fitting compared to a non-functional limb salvage. Modular endoprosthesis can be used, but if the rotator cuff and neurovascular bundle are sacrificed, active shoulder motion is severely compromised. Reverse total shoulder arthroplasty is for deltoid and remaining rotator cuff function, not after radical sacrifice. Allograft-prosthesis composites carry risks of allograft complications. Arthrodesis creates a stiff shoulder, and a vascularized fibula autograft is generally too small and structurally insufficient for major weight-bearing or highly functional shoulder reconstruction. The question implies extensive involvement making good function difficult, hence amputation might be considered a 'good functional outcome' in terms of enabling prosthetic use and pain control, versus a flail limb.

Question 6665

Topic: 5. Sports Medicine

What is the primary concern regarding the use of an allograft for reconstruction after tumor resection in a skeletally immature patient?

. Risk of tumor recurrence within the allograft.
. Host-versus-graft disease leading to allograft rejection.
. Potential for limb length discrepancy due to lack of growth.
. Superior infection resistance compared to endoprostheses.
. Rapid integration and remodeling, leading to early weight-bearing.

Correct Answer & Explanation

. Potential for limb length discrepancy due to lack of growth.

Explanation

A primary concern with allografts in skeletally immature patients is the potential for limb length discrepancy. Allografts are essentially devitalized bone and do not grow. As the child's contralateral limb continues to grow, a significant length discrepancy can develop, requiring subsequent procedures or leading to functional impairment. Tumor recurrence within the allograft is rare (unless there was an inadequate margin in the host bone). While immune responses occur, overt host-versus-graft disease leading to rejection is uncommon. Allografts are prone to infection, and integration is slow, not rapid, with delayed weight-bearing. Expandable endoprostheses or rotationplasty are often considered to address growth potential.

Question 6666

Topic: 5. Sports Medicine

What is the primary limitation of a vascularized fibula autograft for reconstruction of a large diaphyseal defect after osteosarcoma resection?

. Risk of donor site morbidity (e.g., ankle instability).
. Inability to achieve adequate length for large defects.
. High rates of non-union or delayed union.
. Difficulty in achieving vascular anastomoses.
. Potential for immunologic rejection.

Correct Answer & Explanation

. Inability to achieve adequate length for large defects.

Explanation

While vascularized fibula autografts provide excellent biological properties (live bone with blood supply), their primary limitation for large diaphyseal defects is the relatively small diameter and limited structural strength of the fibula, especially when reconstructing large weight-bearing bones like the femur or tibia. They are often combined with allografts (allograft-vascularized fibula composite) for structural support. Risk of donor site morbidity (ankle instability, pain) is a concern but not theprimarylimitation for reconstruction of a large defect. Vascularized grafts have excellent union rates compared to non-vascularized grafts/allografts. Technical difficulty with anastomoses is present but not the primary limitation of thegraft itself. Immunologic rejection is not an issue with autografts.

Question 6667

Topic: 5. Sports Medicine

What factor is most strongly correlated with an increased risk of local recurrence after intralesional curettage of an enchondroma?

. Patient age > 60 years
. Lesion size < 2 cm
. Incomplete lesion removal
. Use of autograft instead of allograft
. Location in the hand or foot

Correct Answer & Explanation

. Incomplete lesion removal

Explanation

Incomplete removal of the cartilaginous lesion during curettage is the most significant factor contributing to local recurrence of enchondromas. Microscopic remnants of the tumor matrix can regrow and lead to symptomatic recurrence. Other factors like patient age or graft type are less directly linked to recurrence than the completeness of the resection.

Question 6668

Topic: 5. Sports Medicine

A 12-year-old boy presents with a large NOF in the distal tibia that recently fractured. After curettage and bone grafting, what is an important consideration for postoperative management in this active patient?

. Immediate full weight-bearing on the affected limb.
. Strict non-weight-bearing until complete radiographic healing of the graft.
. Gradual progression of weight-bearing, often with protection, based on graft incorporation and fracture healing.
. A lifelong avoidance of contact sports.
. Initiation of adjuvant chemotherapy.

Correct Answer & Explanation

. Gradual progression of weight-bearing, often with protection, based on graft incorporation and fracture healing.

Explanation

After curettage and bone grafting for a pathological fracture through an NOF, a gradual progression of weight-bearing with protective immobilization (e.g., cast, brace, crutches) is essential. The timing and extent of weight-bearing depend on the size of the defect, the quality of the bone graft, and the stability provided by any internal fixation. Immediate full weight-bearing is usually not advisable, and strict non-weight-bearing until complete healing may be overly conservative and prolong recovery unnecessarily in all cases. Lifelong avoidance of sports or chemotherapy are incorrect for NOF.

Question 6669

Topic: 5. Sports Medicine

A 16-year-old male is found to have an incidentally discovered 3 cm NOF in his distal fibula. He is a high-level athlete. What is the most appropriate management given his activity level and lesion location?

. Immediate prophylactic curettage and bone grafting.
. Serial radiographic observation with no activity restrictions.
. Serial radiographic observation with activity modification (avoiding high-impact sports).
. Referral for radiation therapy.
. Biopsy to confirm diagnosis due to his activity level.

Correct Answer & Explanation

. Serial radiographic observation with activity modification (avoiding high-impact sports).

Explanation

For an asymptomatic NOF, even in an athlete, conservative management with serial radiographic observation is usually appropriate. However, given his high activity level and the potential, albeit lower, for fracture in the distal fibula (a less weight-bearing bone than tibia/femur), activity modification (e.g., avoiding high-impact sports) may be advisable to minimize stress on the bone until the lesion shows signs of healing. Immediate surgery is usually not indicated unless the lesion is larger or symptomatic with fracture risk. Biopsy is typically not needed for classic radiographic appearance. Radiation is contraindicated.

Question 6670

Topic: Knee Sports

A 48-year-old construction worker presents with chronic knee pain and instability after a previous knee dislocation treated non-operatively. Examination reveals a positive Lachman test and pivot shift. What is the most appropriate management at this stage?

. Quadriceps strengthening exercises.
. Arthroscopic debridement.
. Anterior cruciate ligament (ACL) reconstruction.
. Partial meniscectomy.
. Total knee arthroplasty.

Correct Answer & Explanation

. Anterior cruciate ligament (ACL) reconstruction.

Explanation

A positive Lachman test and pivot shift are clinical signs highly suggestive of anterior cruciate ligament (ACL) deficiency. Given the history of knee dislocation, significant ligamentous injury, including ACL rupture, is highly likely. For a relatively young, active patient with symptomatic instability, ACL reconstruction is the definitive treatment to restore stability and prevent further meniscal and articular cartilage damage. Quadriceps strengthening can help but won't address the mechanical instability. Arthroscopic debridement or partial meniscectomy address specific intra-articular pathologies but not primary instability. Total knee arthroplasty is reserved for end-stage arthritis.

Question 6671

Topic: 5. Sports Medicine

A 25-year-old male sustains a high-energy tibial shaft fracture, resulting in an 8 cm bone defect after debridement. The skin envelope is intact. What is the most appropriate reconstructive option for this defect?

. Bone graft (autograft or allograft).
. Vascularized fibular graft.
. Distraction osteogenesis (e.g., Ilizarov method).
. Segmental bone resection and primary shortening.
. Non-weight bearing for extended period hoping for spontaneous healing.

Correct Answer & Explanation

. Distraction osteogenesis (e.g., Ilizarov method).

Explanation

For large bone defects (typically >4-6 cm, or critical size defects), distraction osteogenesis (e.g., using an Ilizarov frame or similar external fixator) is a highly effective method. It allows for bone transport to fill the defect while maintaining limb length. Bone graft alone would be insufficient for an 8 cm defect. Vascularized fibular graft is an option but is more complex and has higher donor site morbidity. Segmental bone resection and primary shortening results in unacceptable leg length discrepancy for an 8cm defect. Non-weight bearing will not induce healing of such a large defect.

Question 6672

Topic: Knee Sports

Which of the following describes a 'terrible triad' injury of the knee?

. ACL, MCL, and lateral meniscus tear.
. ACL, PCL, and medial meniscus tear.
. ACL, MCL, and medial meniscus tear.
. ACL, LCL, and IT band tear.
. PCL, MCL, and medial meniscus tear.

Correct Answer & Explanation

. ACL, MCL, and medial meniscus tear.

Explanation

The 'terrible triad' of the knee classically refers to a combined injury involving the Anterior Cruciate Ligament (ACL), Medial Collateral Ligament (MCL), and medial meniscus. This injury typically results from a valgus stress with external rotation to a flexed knee. While other combinations of injuries can occur, this specific combination is historically known as the 'terrible triad' due to its prevalence and complexity.

Question 6673

Topic: Knee Sports

What is the most common mechanism of injury for a posterior cruciate ligament (PCL) rupture?

. Twisting injury with a planted foot.
. Hyperextension injury to the knee.
. Direct blow to the anterior tibia with the knee flexed.
. Valgus stress with external rotation.
. Varus stress with internal rotation.

Correct Answer & Explanation

. Direct blow to the anterior tibia with the knee flexed.

Explanation

The most common mechanism for a PCL rupture is a direct blow to the anterior tibia when the knee is flexed, often referred to as a 'dashboard injury' in motor vehicle accidents, or a fall onto a flexed knee. This forces the tibia posteriorly relative to the femur, stressing the PCL. Hyperextension can also injure the PCL but is less common. Twisting injuries, valgus, and varus stresses typically injure the ACL, MCL, or LCL, respectively.

Question 6674

Topic: 5. Sports Medicine

A 60-year-old male presents with elbow pain and stiffness. Radiographs demonstrate significant osteophyte formation on the anterior coronoid and posterior olecranon, with a 30-degree flexion contracture and pain at terminal extension. There are no loose bodies visible. Which of the following statements regarding arthroscopic management for this condition is most accurate?

. Arthroscopic osteophyte excision is contraindicated if a flexion contracture exceeds 20 degrees.
. The primary goal of arthroscopy is to perform a synovectomy and capsular release.
. A posterior approach is typically used to address both anterior and posterior osteophytes.
. Arthroscopic debridement can effectively treat both anterior and posterior impingement.
. Ulnar nerve decompression is routinely performed during elbow arthroscopy for OA.

Correct Answer & Explanation

. Arthroscopic debridement can effectively treat both anterior and posterior impingement.

Explanation

Arthroscopic debridement is an effective technique for addressing both anterior (coronoid) and posterior (olecranon) osteophytes, as well as loose body removal, in appropriate candidates with elbow osteoarthritis. The portals can be positioned to allow access to both compartments. Arthroscopic osteophyte excision is not strictly contraindicated by a flexion contracture exceeding 20 degrees; in fact, improving range of motion by removing these mechanical blocks is a key indication. While synovectomy and capsular release may be performed, addressing osteophytes and loose bodies is the primary goal for mechanical symptoms and pain. Ulnar nerve decompression is not routinely performed during every elbow arthroscopy for OA unless there are clear preoperative or intraoperative signs of ulnar neuropathy. A posterior approach alone typically addresses posterior osteophytes; separate anterior portals are required for anterior osteophytes, or a combination of approaches. Therefore, arthroscopic debridement is a versatile method for addressing both forms of impingement.

Question 6675

Topic: 5. Sports Medicine

Which of the following is considered the gold standard for diagnosing ulnar collateral ligament (UCL) insufficiency in the elbow?

. Plain radiographs with valgus stress views
. MRI with contrast
. Ultrasound dynamic evaluation
. Clinical examination with valgus stress testing
. Elbow arthroscopy

Correct Answer & Explanation

. Elbow arthroscopy

Explanation

While MRI with contrast can provide excellent anatomical detail of the UCL, and dynamic ultrasound can visualize gapping, the definitive diagnosis of UCL insufficiency often requires elbow arthroscopy. Arthroscopy allows for direct visualization of the ligament, assessment of its integrity, and probing for gapping under valgus stress. Clinical examination with valgus stress testing is highly sensitive but can be limited by patient guarding or pain. Plain radiographs are primarily for bony lesions. Therefore, arthroscopy is considered the gold standard for definitive diagnosis, especially when considering surgical reconstruction.

Question 6676

Topic: 5. Sports Medicine

Which of the following is considered an absolute contraindication for elbow arthroscopy?

. Previous open elbow surgery
. Diffuse synovitis
. Severe osteoarthritic changes
. Active infection
. Loose bodies in the joint

Correct Answer & Explanation

. Active infection

Explanation

Active infection in the joint is an absolute contraindication for any elective arthroscopic or open procedure due to the high risk of spreading the infection and leading to chronic septic arthritis. While severe osteoarthritic changes, previous surgery, or diffuse synovitis can make arthroscopy more challenging or less effective, they are not absolute contraindications. Loose bodies are an indication for arthroscopy.

Question 6677

Topic: Shoulder & Hip Sports

An 84-year-old lady's shoulder X-ray shows a large, well-circumscribed, amorphous calcification overlying the supraspinatus tendon insertion. She reports acute, severe pain. This presentation is most consistent with:

. Chronic rotator cuff tear
. Calcium pyrophosphate deposition disease (CPPD)
. Acute calcific tendinitis (CHADD)
. Osteoarthritis with loose body
. Septic arthritis

Correct Answer & Explanation

. Acute calcific tendinitis (CHADD)

Explanation

A large, amorphous, well-defined calcification in a tendon, particularly the supraspinatus, in the context of acute severe pain, is characteristic of acute calcific tendinitis, also known as Calcium Hydroxyapatite Deposition Disease (CHADD). The calcifications are typically within the tendon itself, not the joint space, and are not linear like CPPD. Chronic rotator cuff tears may show superior migration but not necessarily such a dense calcification. Loose bodies are intra-articular and often faceted. Septic arthritis is an infection.

Question 6678

Topic: Shoulder & Hip Sports

Radiographically, how can a chronic, massive rotator cuff tear leading to arthropathy be differentiated from an acute traumatic rotator cuff tear on a standard shoulder X-ray series?

. Acute tears always show clear bone fragments
. Chronic tears demonstrate superior migration of the humeral head and acromial erosion
. Acute tears show greater joint effusions
. Chronic tears have more severe soft tissue swelling
. Both are indistinguishable on plain X-rays.

Correct Answer & Explanation

. Chronic tears demonstrate superior migration of the humeral head and acromial erosion

Explanation

Chronic, massive rotator cuff tears, especially those leading to arthropathy, are characterized by distinct radiographic signs of superior migration of the humeral head and secondary degenerative changes such as acromial erosion and glenoid cartilage loss (rotator cuff arthropathy). Acute tears, particularly partial ones, often show no definitive changes on plain X-rays, although a large effusion or minor bone avulsions might be seen.

Question 6679

Topic: Shoulder & Hip Sports

An 84-year-old lady presents after falling on an outstretched arm. Her X-ray shows an anterior glenohumeral dislocation. What is a 'bony Bankart lesion' that might be visible on specific views?

. A compression fracture of the posterolateral humeral head
. A fracture of the posterior glenoid rim
. An avulsion fracture of the anterior-inferior glenoid rim
. A tear of the superior labrum
. A fracture of the greater tuberosity

Correct Answer & Explanation

. An avulsion fracture of the anterior-inferior glenoid rim

Explanation

A bony Bankart lesion is an avulsion fracture of the anterior-inferior glenoid rim, typically occurring during anterior glenohumeral dislocation when the humeral head impacts and avulses a piece of the glenoid. A compression fracture of the posterolateral humeral head is a Hill-Sachs lesion. A posterior glenoid rim fracture is a reverse bony Bankart. A superior labral tear is a SLAP lesion, which is soft tissue. Greater tuberosity fractures are separate.

Question 6680

Topic: Shoulder & Hip Sports

After a suspected posterior shoulder dislocation in an 84-year-old, which radiographic finding on the humeral head is indicative of a 'reverse Hill-Sachs lesion'?

. An impression fracture on the anteromedial aspect of the humeral head
. A fracture of the posterior glenoid rim
. A superior displacement of the greater tuberosity
. A fracture of the anatomical neck
. A lytic lesion in the subchondral bone

Correct Answer & Explanation

. An impression fracture on the anteromedial aspect of the humeral head

Explanation

A reverse Hill-Sachs lesion (or McLaughlin lesion) is an impression fracture on the anteromedial aspect of the humeral head, occurring when the humeral head impacts against the posterior glenoid rim during a posterior dislocation. A Hill-Sachs lesion (classic) is on the posterolateral aspect from anterior dislocation.

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