Question 1

Which of the following regimens is recommended for maintenance of cadiorespiratory fitness:

Explanation

Current recommendations for maintenance of cardiorespiratory fitness include 30 to 60 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate.

Question 2

All of the following muscles act in scapular retraction except:

Explanation

The trapezius, rhomboids, and levator scapulae all provide some degree of scapular retraction. The pectoralis minor is a scapular protractor.

Question 3

A 20-year-old male distance runner complains of pain on the lateral aspect of his knee that reliably occurs 3 miles into his run and eventually causes him to terminate his run. The pain is made worse by running downhill. He recalls no injury to his knee and has noticed no swelling. What is the most likely diagnosis:

Explanation

Iliotibial band tendinitis is the most common cause of lateral knee pain in runners. It generally occurs a few miles into a run and is exacerbated with downhill running. Iliotibial band tendinitis generally responds to nonoperative treatment consisting of stretching and nonsteroidal anti- inflammatory drugs but may require a corticosteroid injection or, rarely, surgical treatment.

Question 4

Outcome following arthroscopic treatment of superior labrum anterior to posterior (SLAP) lesions is most affected by which of the following factors:

Explanation

Kim and colleagues reported on the results of 34 patients who underwent arthroscopic treatment of SLAP lesions and discovered that results were good in all patients, but individuals who participated in overhead sports did not have outcomes as good as those not participating in these types of activities.

Question 5

Inversion injury of a plantarflexed foot results in disruption of the anterolateral capsuloligamentous structures in a sequential fashion. Which of the following is the order in which this disruption occurs:

Explanation

Inversion injury to the plantarflexed foot results in a predictable, sequential pattern of injury. Injury is initiated anteriorly with disruption of the anterolateral joint capsule and progresses posteriorly to the anterior talofibular ligament and ultimately to the calcaneofibular ligament.

Question 6

When treating recurrent inversion ankle sprains, physiotherapy should be directed at strengthening of which muscle or muscle group:

Explanation

The peroneals provide dynamic resistance to inversion of the ankle. Therapy programs designed for treating lateral ankle instability must attempt to maximize the function of these dynamic stabilizers.

Question 7

All of the following are either primary or secondary stabilizers of the knee to posterior translation except:

Explanation

The posterior cruciate ligament is the primary stabilizer to posterior translation of the knee. Secondary stabilizers include the medial and lateral collateral ligaments and the posterolateral corner.

Question 8

Which of the following most accurately describes the location of the tibial attachment of the posterior cruciate ligament:

Explanation

The tibial attachment of the posterior cruciate ligament is usually 10 mm to 15 mm inferior to the joint line. Reconstructions of the posterior cruciate ligament should attempt to replicate this tibial attachment site.

Question 9

Which of the following is the most accurate clinical examination tool in detecting disruption of the posterior cruciate ligament:

Explanation

The posterior drawer test is the most accurate method of clinically diagnosing posterior cruciate ligament disruption. Although the quadriceps active drawer test and the posterior sag test are useful, their reported accuracy is less than that of the posterior drawer test. The reverse pivot shift test evaluates posterolateral corner injuries.

Question 10

Completely lacerated muscles recover _% of their strength and % of their ability to shorten:

Explanation

Completely lacerated muscles recover 50% of their strength and 80% of their ability to shorten. Complete laceration is uncommon and is seen more often after trauma than after athletic accidents.

Question 11

Muscles at increased risk for injury include:

Explanation

Muscles that cross two joints and that are acting in an eccentric fashion are at increased risk for injury. Frequently injured muscles also have a high percentage of type II (fast twitch) fibers.

Question 12

Histology 7 days after muscle strain will most likely reveal:

Explanation

Inflammatory reaction is seen after 2 days. At 1 week, the inflammatory reaction is replaced by fibrous tissue, and some muscle regeneration may be evident. Muscle strains and tears heal through scarring with minimal replacement with normal muscle tissue.

Question 13

The initial treatment after a muscle strain includes:

Explanation

The usual initial treatment after a muscle strain involves rest, ice, compression, and elevation (RIC E). Although gentle range of motion exercises can be instituted as tolerated, aggressive stretching may cause further hemorrhage and muscle injury.

Question 14

Which of the following are important in prevention of muscle injury:

Explanation

Factors that decrease muscle injury include adequate warm up; a strong, flexible muscle; and improved muscle endurance. Fatigued muscles have diminished load to failure, total deformation, and energy to absorption prior to failure.

Question 15

Fatigued muscles are characterized as having:

Explanation

Factors that decrease muscle injury include adequate warm up; a strong, flexible muscle; and improved muscle endurance. Fatigued muscles have diminished load to failure, total deformation, and energy to absorption prior to failure.

Question 16

Reported hamstring strength deficit by isokinetic testing after complete proximal rupture is approximately:

Explanation

In a series of 12 patients with complete or near complete proximal hamstring ruptures, the mean strength deficit measured 61% for the hamstring and 23% for the quadriceps musculature.

Question 17

Which of the following activities is associated with proximal hamstring ruptures:

Explanation

Water skiing is associated with proximal hamstring ruptures in both novice and experienced skiers. The mechanisms, however, are reported to be different depending on the level of skier. The novice skier typically sustains the injury while trying to get up on one or two skis from a submerged position, whereas the injury is typically the result of a fall in an experienced skier.

Question 18

Patients with symptomatic chronic proximal hamstring ruptures typically complain of:

Explanation

Patients typically complain of a pulling sensation or cramping in the posterior thigh with vigorous activity. In addition, they may describe difficulty controlling the leg, which has been attributed to the impaired deceleration of the thigh as a result of the complete rupture.

Question 19

The recommended treatment of a complete proximal hamstring rupture with 4-cm retraction in a young athletic adult is:

Explanation

Patients with disability secondary to chronic complete proximal hamstring ruptures have been increasingly identified. Because of the reports of continued weakness and poor leg control, more authors are recommending acute repair of these injuries. Chronic repairs are reported to be much more difficult although good results are reported.

Question 20

When comparing operative to nonoperative treatment of Achilles tendon ruptures, the major difference in outcome reported in the literature is:

Explanation

In a review of the literature, the rerupture rate after nonoperatively treated Achilles tendon ruptures was 13.4% compared to 1.4% for operative treatment. A prospective randomized study also substantiated these findings. Although the number of patients returning to full sporting activity and plantarflexion strength measurements was higher in the operative group, the differences were not as marked as the rerupture rate.

Question 21

During which phase of the gait cycle or knee flexion angle does the iliotibial band experience the maximum friction against the lateral femoral epicondyle?

Explanation

The IT band rubs against the lateral femoral epicondyle most prominently at approximately 30 degrees of knee flexion. This typically occurs just after foot strike in runners, leading to ITB friction syndrome.

Question 22

Which two muscles act as the primary force couple to produce upward rotation of the scapula during arm elevation?

Explanation

Upward rotation of the scapula is primarily driven by the force couple of the trapezius (upper and lower parts) and the serratus anterior. Weakness in the serratus anterior causes scapular winging and disrupts this kinematic chain.

Question 23

A 19-year-old female collegiate cross-country runner presents with a tibial stress fracture. She reports irregular menstrual cycles for the past year. Laboratory evaluation of this patient is most likely to show which of the following abnormalities?

Explanation

The Female Athlete Triad involves low energy availability, which causes hypothalamic dysfunction. This leads to a decrease in GnRH, resulting in low LH, FSH, and estrogen, which ultimately predisposes the athlete to osteopenia and stress fractures.

Question 24

The anteromedial (AM) bundle of the anterior cruciate ligament (ACL) is tightest in which position, and what is its primary biomechanical function?

Explanation

The AM bundle of the ACL is tightest in flexion and serves as the primary restraint to anterior tibial translation. Conversely, the posterolateral (PL) bundle is tightest in extension and primarily controls rotatory stability.

Question 25

A baseball pitcher complains of deep shoulder pain during the late cocking phase of throwing. A physical exam reveals a positive O'Brien's test. Which of the following best describes the "peel-back" mechanism for this injury?

Explanation

The peel-back mechanism occurs during abduction and maximal external rotation (late cocking phase). The biceps vector shifts posteriorly, transmitting torsional force to the superior labrum, frequently causing a Type II SLAP tear.

Question 26

According to the consensus statements on concussion in sport, which of the following must be achieved before an athlete advances to the next step in the graduated return-to-play protocol?

Explanation

The graduated return-to-play protocol requires athletes to remain symptom-free for 24 hours at their current level of exertion before progressing to the next stage. If symptoms return, they must drop back to the previous asymptomatic level.

Question 27

A 16-year-old gymnast presents with chronic low back pain exacerbated by extension. Radiographs are normal, but an MRI shows bone marrow edema in the L5 pars interarticularis without a clear fracture line. What is the most appropriate initial management?

Explanation

An early pars stress reaction (edema on MRI without a frank fracture) has a high potential for healing. Management includes activity restriction and rigid antilordotic bracing until pain resolves.

Question 28

A 22-year-old elite basketball player sustains an acute Jones fracture. To minimize the risk of nonunion and expedite return to play, which of the following is the standard of care?

Explanation

In high-level or elite athletes, acute Jones fractures (Zone 2) are typically treated with intramedullary screw fixation. This approach significantly decreases nonunion rates and expedites return to sport compared to conservative management.

Question 29

During a posterior cruciate ligament (PCL) reconstruction using a transtibial tunnel technique, what is the anatomical structure at greatest risk during drilling of the tibial tunnel?

Explanation

The popliteal artery is located directly posterior to the posterior capsule of the knee. Over-penetration of the guide pin or drill during transtibial PCL tunnel creation places the popliteal artery at significant risk of catastrophic injury.

Question 30

An 11-year-old baseball pitcher presents with proximal arm pain. Radiographs reveal widening of the proximal humeral physis. What is the recommended treatment?

Explanation

Little Leaguer's shoulder is a stress fracture of the proximal humeral physis caused by repetitive rotational torque. Treatment requires absolute rest from throwing, typically for about 3 months, followed by a gradual return-to-throwing program.

Question 31

The most common location for an osteochondritis dissecans (OCD) lesion in the adolescent knee is the:

Explanation

The lateral aspect of the medial femoral condyle is the most frequent site of OCD lesions in the knee. This classic location accounts for approximately 70-80% of all knee OCD cases.

Question 32

Which type of muscle contraction generates the greatest peak force and is most commonly implicated in acute muscle strain injuries?

Explanation

Eccentric contractions occur when the muscle forcefully lengthens while under tension, generating the greatest peak forces. They are the primary mechanism behind most acute muscle strain injuries, such as hamstring tears during sprinting.

Question 33

During the throwing motion, which bundle of the ulnar collateral ligament (UCL) of the elbow is the primary restraint to valgus stress from 30 to 120 degrees of flexion?

Explanation

The anterior bundle of the UCL is the primary restraint to valgus stress in the elbow. Specifically, its anterior band is taut from roughly 0 to 90 degrees, making it the critical stabilizing structure during the throwing motion.

Question 34

Which of the following is the most consistent histological finding in chronic non-insertional Achilles tendinopathy?

Explanation

Chronic Achilles tendinopathy is an angiofibroblastic process characterized by collagen disorientation, mucoid (myxoid) degeneration, and neovascularization. Acute inflammatory cells are typically absent, which is why the condition is accurately termed "tendinosis."

Question 35

A football player sustains an external rotation injury to his ankle. Which physical examination test is most specific for diagnosing a syndesmotic (high ankle) sprain?

Explanation

The external rotation stress test (Kleiger's test) effectively stresses the distal tibiofibular syndesmosis. Pain over the anterior inferior tibiofibular ligament during this test is highly specific for a syndesmotic injury.

Question 36

Internal snapping hip syndrome is typically caused by the snapping of which structure over the iliopectineal eminence or the femoral head?

Explanation

Internal snapping hip (coxa saltans interna) occurs when the iliopsoas tendon snaps over the iliopectineal eminence or the anterior femoral head. This typically happens as the hip extends from a flexed, abducted, and externally rotated position.

Question 37

Following a total medial meniscectomy, contact stresses in the medial compartment of the knee are estimated to increase by approximately:

Explanation

The meniscus plays a crucial role in load distribution across the knee joint. A total medial meniscectomy decreases the contact area by roughly 75%, leading to a 200-300% increase in focal contact stresses and accelerating osteoarthritis.

Question 38

A soccer player presents with chronic groin pain exacerbated by kicking and cutting. An MRI demonstrates a "cleft sign." This represents an injury to the aponeurosis of which two structures?

Explanation

Core muscle injuries (athletic pubalgia) often involve the confluent aponeurosis of the rectus abdominis and the adductor longus at the pubic symphysis. The "cleft sign" on MRI indicates a tear or detachment in this common aponeurosis.

Question 39

How does an Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion differ from a classic Bankart lesion in anterior shoulder instability?

Explanation

In an ALPSA lesion, the anterior labrum is avulsed but the anterior scapular periosteum remains intact. This allows the labrum to heal in a medially displaced, nonfunctional position, often requiring surgical mobilization prior to repair.

Question 40

During a maximum-effort 100-meter sprint lasting approximately 10 seconds, which energy system provides the primary source of ATP?

Explanation

The ATP-CP (phosphagen) system is the primary energy source for short, high-intensity bursts of exercise lasting up to 10-15 seconds. Anaerobic glycolysis becomes the dominant source for maximal efforts lasting from 15 seconds up to about 2 minutes.

Question 41

A 24-year-old elite volleyball player complains of insidious onset anterior knee pain exacerbated by jumping. Ultrasound reveals a thickened patellar tendon with hypoechoic areas. Which of the following best describes the underlying histologic pathology?

Explanation

Patellar tendinopathy (jumper's knee) is fundamentally a degenerative process (tendinosis) rather than an inflammatory one. Histology characteristically shows mucoid degeneration, collagen disorganization, and neovascularization with an absence of inflammatory cells.

Question 42

During rehabilitation following an anterior cruciate ligament (ACL) reconstruction, which of the following exercises places the highest amount of strain on the healing ACL graft?

Explanation

Open kinetic chain (OKC) knee extension exercises near terminal extension (30 to 0 degrees) produce maximum anterior tibial translation forces, placing the highest strain on an ACL graft. Closed kinetic chain exercises generally provide compressive joint forces that protect the graft.

Question 43

A 21-year-old collegiate basketball player sustains a fracture at the metaphyseal-diaphyseal junction of the fifth metatarsal. He is eager to return to play this season. Which of the following is the most appropriate management?

Explanation

This is a Jones fracture, which occurs in a vascular watershed area with a historically high risk of nonunion. In competitive athletes, early intramedullary screw fixation is recommended to minimize nonunion risk and expedite a predictable return to play.

Question 44

Delayed onset muscle soreness (DOMS) typically peaks 24 to 72 hours after unaccustomed exercise. Which of the following types of muscle contraction is most strongly associated with the development of DOMS?

Explanation

DOMS is most closely associated with eccentric muscle contractions, where the muscle lengthens while under tension. This specific type of contraction causes significant microtrauma to muscle fibers and connective tissue, leading to subsequent inflammation and soreness.

Question 45

A 28-year-old bodybuilder presents with a dull ache in his right shoulder and difficulty lifting heavy weights overhead. On examination, lateral winging of the scapula is observed. Injury to which of the following nerves is the most likely cause?

Explanation

Lateral winging of the scapula is caused by weakness of the trapezius muscle, which is innervated by the spinal accessory nerve (CN XI). In contrast, medial winging is caused by serratus anterior weakness due to a long thoracic nerve palsy.

Question 46

A 19-year-old soccer player sustains a knee injury resulting in a bucket-handle tear of the medial meniscus. The tear is located in the peripheral 10-20% of the meniscus. From which of the following arteries does this specific region derive its primary blood supply?

Explanation

The peripheral 10-30% of the medial meniscus (the red-red zone) receives its blood supply from the capsular branches of the inferior medial and superior medial genicular arteries. The central portion is avascular and relies entirely on synovial fluid diffusion for nutrition.

Question 47

In the throwing athlete, a Type II SLAP lesion is most commonly produced by the 'peel-back' mechanism. During which phase of the throwing motion does this mechanism primarily occur?

Explanation

The 'peel-back' mechanism occurs during the late cocking phase of throwing when the shoulder is maximally abducted and externally rotated. This position places a torsional force on the biceps anchor, peeling the superior labrum off the glenoid rim.

Question 48

A 25-year-old bodybuilder presents with a dull ache in his right shoulder and difficulty lifting weights overhead. Physical examination reveals lateral winging of the scapula. Injury to which of the following nerves is the most likely cause?

Explanation

Lateral scapular winging is caused by trapezius muscle dysfunction, which is secondary to a spinal accessory nerve (CN XI) injury. In contrast, long thoracic nerve injury causes serratus anterior dysfunction, presenting as medial scapular winging.

Question 49

When comparing the biomechanical properties of a 10-mm bone-patellar tendon-bone (BPTB) graft to the native anterior cruciate ligament (ACL), which of the following statements is true?

Explanation

A 10-mm BPTB graft has approximately 168 percent of the strength (ultimate failure load) and is significantly stiffer than the native ACL. However, clinical success ultimately depends on biological incorporation and precise tunnel placement.

Question 50

A 22-year-old football player sustains a direct blow to the anteromedial tibia. Physical examination demonstrates a positive Dial test with 15 degrees of increased external rotation at 30 degrees of knee flexion compared to the contralateral side. At 90 degrees of flexion, the external rotation is symmetric bilaterally. What is the most likely diagnosis?

Explanation

An isolated PLC injury presents with increased external rotation on the Dial test at 30 degrees but not at 90 degrees of flexion. If increased external rotation is present at both 30 and 90 degrees, it indicates a combined PCL and PLC injury.

Question 51

Which of the following describes the underlying pathophysiology initiating the Female Athlete Triad (recognized as part of Relative Energy Deficiency in Sport)?

Explanation

The Female Athlete Triad is driven by low energy availability, which suppresses the hypothalamic-pituitary-ovarian axis. This results in functional hypothalamic amenorrhea and subsequent decreased bone mineral density.

Question 52

During the acceleration phase of a baseball pitch, significant valgus stress is placed on the elbow. Which structure provides the primary restraint to valgus stress at 90 degrees of elbow flexion?

Explanation

The anterior bundle of the ulnar collateral ligament (UCL) is the primary restraint to valgus stress at the elbow, particularly between 30 and 120 degrees of flexion. The posterior bundle acts only as a secondary restraint.

Question 53

A 12-year-old elite baseball pitcher presents with chronic medial elbow pain. Radiographs demonstrate widening and fragmentation of the medial epicondyle apophysis. What biomechanical forces are primarily responsible for this condition?

Explanation

Little League elbow encompasses several conditions caused by repetitive valgus overload during throwing. This creates tension forces on the medial structures (causing medial epicondyle apophysitis) and compressive forces on the lateral structures.

Question 54

A 24-year-old hockey player presents with deep anterior groin pain exacerbated by hip flexion and internal rotation. Imaging reveals an aspherical femoral head-neck junction with an alpha angle of 65 degrees. What is the most likely diagnosis?

Explanation

Cam-type femoroacetabular impingement is characterized by a non-spherical femoral head or reduced head-neck offset, objectively measured by an alpha angle greater than 50-55 degrees. It frequently causes chondral delamination and labral injury during deep flexion.

Question 55

Which of the following best describes the biomechanical consequence of a complete tear of the medial meniscus posterior root?

Explanation

A complete tear of the posterior root of the medial meniscus disrupts the meniscal ability to convert axial loads into hoop stresses. Biomechanically, this results in peak articular contact pressures equivalent to a total medial meniscectomy.

Question 56

A 21-year-old collegiate basketball player sustains an acute, undisplaced Zone 2 fracture of the proximal fifth metatarsal. What is the most appropriate management to ensure the fastest reliable return to play?

Explanation

Zone 2 fractures (Jones fractures) involve the metaphyseal-diaphyseal junction, an area with a tenuous blood supply. Intramedullary screw fixation is the standard of care for elite athletes to minimize nonunion risk and expedite return to play.

Question 57

Skeletal muscle fibers can be classified based on their metabolic and contractile properties. Which of the following characteristics is true regarding Type I muscle fibers?

Explanation

Type I muscle fibers are slow-twitch fibers that rely heavily on oxidative metabolism. They are highly fatigue-resistant and primarily recruited during prolonged endurance activities, such as long-distance running.

Question 58

A 22-year-old collegiate baseball pitcher complains of posterior shoulder pain during the late cocking phase of throwing. MRI demonstrates articular-sided partial tearing of the infraspinatus and posterosuperior labral fraying. What is the pathophysiologic mechanism?

Explanation

Internal impingement occurs when the shoulder is in maximum abduction and external rotation (late cocking phase). The undersurface of the supraspinatus and infraspinatus tendons becomes pinched between the greater tuberosity and the posterosuperior glenoid rim.

Question 59

A 30-year-old weightlifter feels a sudden pop in his anterior chest wall while performing a heavy bench press. He has bruising over his anterior axillary fold and weakness in internal rotation. If surgical repair is indicated, where does the ruptured tendon anatomically insert?

Explanation

The pectoralis major inserts on the lateral lip of the bicipital groove of the humerus. Ruptures typically occur at the musculotendinous junction or the tendinous insertion during forced eccentric contraction, such as the eccentric phase of a bench press.

Question 60

A 19-year-old female collegiate cross-country runner presents with a tibial stress fracture and a history of irregular menses for the past year. Dual-energy X-ray absorptiometry reveals reduced bone mineral density. In the context of the female athlete triad, a deficiency in which of the following hormones is the primary driver of her osteopenia?

Explanation

The female athlete triad consists of low energy availability, menstrual dysfunction, and low bone mineral density. Hypoestrogenism, secondary to hypothalamic amenorrhea caused by low energy availability, is the primary mechanism driving pathological bone loss.

Question 61

A 25-year-old male runner complains of bilateral lower leg pain that consistently begins 15 minutes into his runs and resolves entirely after 30 minutes of rest. Physical examination is unremarkable at rest, with normal distal pulses. What is the gold standard diagnostic step for the suspected condition?

Explanation

The clinical presentation is highly suggestive of chronic exertional compartment syndrome. The gold standard for diagnosis is the measurement of intra-compartmental pressures at rest, immediately after exercise, and 15 minutes post-exercise.

Question 62

A 28-year-old professional volleyball player presents with painless weakness in her dominant serving shoulder. Physical examination reveals isolated atrophy of the infraspinatus muscle and significant weakness during external rotation, but normal supraspinatus strength. At which anatomical location is the nerve most likely compressed?

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch denervates only the infraspinatus muscle, leading to isolated external rotation weakness. Compression at the suprascapular notch would affect both the supraspinatus and infraspinatus.

Question 63

When evaluating graft choices for an anterior cruciate ligament (ACL) reconstruction, which of the following autografts possesses the highest initial ultimate tensile load compared to the native ACL?

Explanation

A quadrupled hamstring autograft has an initial ultimate tensile load of over 4000 N, which is significantly stronger than the native ACL (approx. 2160 N) and the 10-mm BPTB graft (approx. 2977 N). However, clinical outcomes between BPTB and hamstring grafts remain largely similar.

Question 64

A 13-year-old baseball pitcher presents with insidious onset of pain in his throwing shoulder. Radiographs demonstrate widening and irregularity of the proximal humeral physis. What is the most appropriate initial management?

Explanation

Little League shoulder is an overuse epiphysiolysis of the proximal humerus caused by repetitive rotational stresses. The definitive initial treatment is absolute rest from throwing for typically 3 months, followed by a gradual return-to-throwing program.

Question 65

During shoulder arthroscopy in an overhead throwing athlete, a Type II SLAP (superior labrum anterior to posterior) tear is identified. The dynamic 'peel-back' mechanism that exacerbates this injury occurs primarily when the shoulder is placed in which of the following positions?

Explanation

The peel-back mechanism occurs during maximal abduction and external rotation, mimicking the late cocking phase of throwing. This position increases tension on the biceps anchor, causing it to peel back off the posterosuperior glenoid.

Question 66

A patient undergoes a 'dial test' to evaluate a knee injury. The test reveals more than 10 degrees of increased external tibial rotation at 30 degrees of knee flexion compared to the uninjured side. However, the external rotation is symmetric at 90 degrees of knee flexion. What injury pattern does this indicate?

Explanation

An increase in external rotation at 30 degrees of flexion that normalizes at 90 degrees indicates an isolated injury to the posterolateral corner. If the asymmetry persisted at both 30 and 90 degrees, it would suggest a combined PLC and PCL injury.

Question 67

A 14-year-old boy presents with knee pain and intermittent mechanical catching. Imaging confirms an osteochondritis dissecans (OCD) lesion. What is the most common anatomical location for this lesion in the knee?

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. This accounts for approximately 70-80% of knee OCD lesions.

Question 68

A college football running back sustains an acute hyperextension injury to his great toe while planting his foot on an artificial surface. He has exquisite tenderness over the plantar aspect of the 1st metatarsophalangeal (MTP) joint. What primary structure is injured in 'turf toe'?

Explanation

Turf toe is a severe sprain of the 1st MTP joint, specifically involving disruption or attenuation of the plantar plate and its capsuloligamentous structures due to an extreme hyperextension force.

Question 69

An athlete suffers an external rotation injury to the ankle and presents with a positive squeeze test and positive external rotation stress test. In a syndesmotic ankle sprain, which ligament is typically the first to be disrupted?

Explanation

In a high ankle (syndesmotic) sprain, external rotation forces sequentially tear the syndesmotic structures. The anterior inferior tibiofibular ligament (AITFL) is typically the first structure to fail.

Question 70

A 22-year-old baseball pitcher presents with posterior shoulder pain during the late cocking phase of throwing. He is diagnosed with internal impingement. This condition is characterized by pathological contact between the posterosuperior glenoid labrum and which of the following structures?

Explanation

Internal impingement is a condition common in overhead athletes where the articular undersurface of the posterosuperior rotator cuff (supraspinatus/infraspinatus) abuts the posterosuperior glenoid labrum during maximum shoulder abduction and external rotation.

Question 71

A 45-year-old recreational golfer complains of medial elbow pain. The pain is exacerbated by resisted wrist flexion and forearm pronation. This tendinopathy most commonly involves the origin of which muscle group?

Explanation

Medial epicondylitis (golfer's elbow) is an overuse tendinopathy that primarily affects the common flexor origin, most specifically involving the origins of the pronator teres and the flexor carpi radialis.

Question 72

During arthroscopic meniscus repair, an orthopedic surgeon assesses the vascularity of the tear. The primary blood supply to the peripheral meniscus in an adult originates from which of the following?

Explanation

The peripheral 10-25% of the meniscus (the red-red zone) is vascularized by a perimeniscal capillary plexus that originates from the superior and inferior medial and lateral genicular arteries. The middle genicular artery supplies the cruciate ligaments.

Question 73

Ligament healing typically progresses through inflammatory, proliferative, and remodeling phases. During the remodeling phase of a healing medial collateral ligament (MCL), which critical structural transition occurs?

Explanation

During the proliferative phase of ligament healing, mechanically weaker Type III collagen is laid down rapidly. In the remodeling phase, this Type III collagen is gradually replaced by stronger, highly organized Type I collagen.

Question 74

An 11-year-old male gymnast complains of anterior knee pain that is exacerbated by jumping. Physical examination reveals focal tenderness exclusively at the inferior pole of the patella. Radiographs demonstrate calcification and fragmentation at this exact site. What is the most likely diagnosis?

Explanation

Sinding-Larsen-Johansson syndrome is a traction apophysitis (osteochondrosis) at the inferior pole of the patella. It differs from Osgood-Schlatter disease, which presents with tenderness and prominence at the tibial tubercle.

Question 75

A patient lies supine with the knee flexed to 90 degrees and the foot flat on the table. The examiner asks the patient to contract their quadriceps while the examiner provides resistance against the foot. The examiner observes an anterior translation of the proximal tibia. What does this 'quadriceps active test' finding indicate?

Explanation

The quadriceps active test assesses for posterior cruciate ligament (PCL) insufficiency. In a PCL-deficient knee, the tibia rests in a posteriorly subluxated position at 90 degrees. Contraction of the quadriceps vector pulls the tibia anteriorly to its normal reduced position.

Question 76

A collegiate baseball pitcher presents with glenohumeral internal rotation deficit (GIRD). By true definition, GIRD involves a symptomatic loss of internal rotation compared to the contralateral non-throwing shoulder of at least how many degrees?

Explanation

GIRD is clinically defined as a loss of internal rotation of 20 degrees or more compared to the contralateral non-throwing shoulder. It results from adaptive posterior capsular contracture and osseous retroversion from repetitive throwing.

Question 77

A 21-year-old baseball pitcher is scheduled for an ulnar collateral ligament (UCL) reconstruction (Tommy John surgery). What is the most commonly utilized and historically preferred autograft for this procedure?

Explanation

The palmaris longus tendon is the most frequently used and historically standard autograft for UCL reconstruction due to its expendability and appropriate dimensions. If absent, alternative grafts like the gracilis or plantaris are used.

Question 78

A 40-year-old 'weekend warrior' felt a sudden pop in his heel while playing tennis. The orthopedic surgeon performs a Thompson test, which is positive. What is the physiological mechanism behind a normal (negative) Thompson test?

Explanation

A normal Thompson test occurs when squeezing the calf muscle belly manually pulls the intact Achilles tendon, mechanically producing plantarflexion of the foot. Absence of this plantarflexion indicates a complete disruption of the Achilles tendon.

Question 79

A rugby player sustains a direct blow to the superior aspect of the shoulder. Radiographs reveal that the distal clavicle is displaced superiorly, and the coracoclavicular distance is increased by 150% compared to the normal contralateral side. According to the Rockwood classification, what type of acromioclavicular (AC) joint injury is this?

Explanation

A Rockwood Type V injury is characterized by a severe superior displacement of the clavicle, with the coracoclavicular (CC) space widened by 100% to 300% relative to the normal side, accompanied by severe disruption of the deltotrapezial fascia.

Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 47

Orthopedic Prometric MCQs - Chapter 3 Part 47

Chapter Index