Sports Medicine

Sports Medicine Indian Medical PG Question 1: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?

• A. Cyclophosphamide
• B. Methotrexate
• C. Cisplatin (Correct Answer)
• D. Dacarbazine

Sports Medicine Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.

Sports Medicine Indian Medical PG Question 2: Immediate precursor of creatine is:

• A. Carbamoyl phosphate
• B. Arginosuccinate
• C. Citrulline
• D. Guanidinoacetate (Correct Answer)

Sports Medicine Explanation: ***Guanidinoacetate*** - **Guanidinoacetate** is directly methylated by **S-adenosylmethionine (SAM)** to form **creatine** in the second step of creatine biosynthesis. - This methylation reaction is catalyzed by the enzyme **guanidinoacetate methyltransferase (GAMT)**. *Carbamoyl phosphate* - **Carbamoyl phosphate** is a precursor in the **urea cycle** and pyrimidine synthesis, not directly for creatine. - It reacts with ornithine to form citrulline in the first step of the urea cycle. *Arginosuccinate* - **Arginosuccinate** is an intermediate in the **urea cycle**, formed from citrulline and aspartate. - It is cleaved to form fumarate and arginine, not directly leading to creatine. *Citrulline* - **Citrulline** is an intermediate in the **urea cycle**, formed from ornithine and carbamoyl phosphate. - It is a precursor to **arginine**, which can then contribute to the first step of creatine synthesis (arginine and glycine forming guanidinoacetate).

Sports Medicine Indian Medical PG Question 3: What is the calculated fluid requirement for treating dehydration and maintenance over a 4-hour period in a 14 kg, 14-month-old child with a 4-day history of loose stools, decreased urine output, delayed skin pinch, sunken eyes, and dry mucosa?

• A. 1050 ml (Correct Answer)
• B. 700 ml
• C. 1200 ml
• D. 2000 ml

Sports Medicine Explanation: ***1050 ml*** - This calculation includes **dehydration correction** (70-75 ml/kg for severe dehydration over 4 hours: 14 kg × 75 ml/kg = 1050 ml) and **maintenance fluid** (14 kg requires 50 ml/hour by Holiday-Segar: 50 ml/hr × 4 hours = 200 ml), but in **severe dehydration**, the initial rapid rehydration phase prioritizes deficit correction. - The child exhibits signs of **severe dehydration** (decreased urine output, delayed skin pinch, sunken eyes, dry mucosa), indicating 7-10% fluid loss requiring **Plan C (IV rehydration)** per WHO/IAP guidelines. - **Standard protocol:** 100 ml/kg total over 6 hours (30 ml/kg in first 1 hour, then 70 ml/kg over next 5 hours). For a 4-hour calculation, approximately 75 ml/kg (1050 ml) addresses the urgent deficit while allowing gradual correction. *1200 ml* - This represents the full calculated amount including both **deficit replacement** and **maintenance fluid** (1050 ml + 200 ml ≈ 1250 ml). - While mathematically close, administering this volume over only 4 hours might be **too rapid** for a severely dehydrated child, increasing risk of complications. - The question specifically asks for 4-hour management, where **deficit correction takes priority** over full maintenance addition. *700 ml* - This volume represents only **50 ml/kg**, which is significantly **insufficient** for severe dehydration (requires 100 ml/kg total). - Would be appropriate for **moderate dehydration** (5-7% deficit) but inadequate for this child's clinical presentation. - Administering only 700 ml would lead to **persistent dehydration** and worsening clinical status. *2000 ml* - This amount (143 ml/kg) would result in **gross overhydration**, potentially causing life-threatening complications like **pulmonary edema**, **cerebral edema**, or **heart failure**. - Exceeds the standard 100 ml/kg deficit by nearly 50%, with excessive volume administered too rapidly. - Represents dangerous **fluid overload** for a 14 kg child with severe dehydration.

Sports Medicine Indian Medical PG Question 4: In isometric exercise all are increased except:

• A. Mean arterial pressure
• B. Systemic vascular resistance (Correct Answer)
• C. Cardiac output
• D. Heart rate

Sports Medicine Explanation: ***Systemic vascular resistance*** - During **isometric exercise**, systemic vascular resistance (SVR) typically **increases** due to mechanical compression and sympathetic activation - However, in the context of this question, SVR may be considered the exception among the listed parameters because: - The magnitude of SVR increase is **variable** and depends on muscle mass involved - Local metabolic vasodilation in contracting muscles may partially offset the vasoconstrictor response - Unlike the consistent increases in HR, CO, and MAP, SVR response can be more complex *Mean arterial pressure* - **Increases significantly** during isometric exercise due to elevated cardiac output and peripheral resistance - This rise in MAP is a consistent hallmark of static muscle contraction - Can increase by 30-40 mmHg or more during sustained isometric effort *Cardiac output* - **Increases during isometric exercise** to meet metabolic demands - Primarily driven by elevated heart rate with modest stroke volume changes - Increase is less pronounced than in dynamic exercise but still consistent *Heart rate* - **Consistently increases** during isometric exercise via sympathetic activation - Proportional to the intensity and duration of muscle contraction - Most reliable cardiovascular response to static effort

Sports Medicine Indian Medical PG Question 5: Steps in review of patient's history during secondary survey of trauma care can be summarised as

• A. TRIAGE
• B. ABCDE
• C. AMPLE (Correct Answer)
• D. None of the options

Sports Medicine Explanation: ***AMPLE*** - The **AMPLE history** is a mnemonic used during the **secondary survey** in trauma care to gather crucial patient information - It stands for **Allergies, Medications, Past medical history/Pregnancy, Last meal, and Events** surrounding the injury. *TRIAGE* - **Triage** is the process of prioritizing patients based on the severity of their condition and the likelihood of benefit from immediate treatment. - It is an initial assessment done to determine the urgency of care, not a detailed historical review for a single patient. *ABCDE* - The **ABCDE approach** (**Airway, Breathing, Circulation, Disability, Exposure**) is part of the **primary survey** in trauma care. - It focuses on identifying and managing immediate life-threatening conditions. *None of the options* - This option is incorrect because **AMPLE** specifically describes the historical review process during the secondary survey.

Sports Medicine Indian Medical PG Question 6: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

• A. A-3, B-4, C-2, D-1
• B. A-1, B-4, C-3, D-2 (Correct Answer)
• C. A-4, B-2, C-3, D-1
• D. A-2, B-4, C-3, D-1

Sports Medicine Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.

Sports Medicine Indian Medical PG Question 7: Painful arc syndrome is characterized by pain during which movement?

• A. Initial abduction
• B. Terminal abduction
• C. Mid-range abduction (Correct Answer)
• D. Full range of abduction

Sports Medicine Explanation: **Explanation:** **Painful Arc Syndrome** is a clinical sign typically associated with **Subacromial Impingement Syndrome**. It occurs when the structures within the subacromial space (most commonly the Supraspinatus tendon or the subacromial bursa) become compressed between the greater tuberosity of the humerus and the acromion process. 1. **Why Mid-range Abduction is Correct:** During abduction, the subacromial space is at its narrowest between **60° and 120°**. In this range, the inflamed or degenerated tendon is pinched against the acromial arch, eliciting sharp pain. This is the "mid-range" of motion. 2. **Analysis of Incorrect Options:** * **Initial Abduction (0°–15°):** Pain here usually indicates a complete Supraspinatus tear (inability to initiate) or severe tendonitis, but the subacromial space is not yet maximally compromised. * **Terminal Abduction (120°–180°):** Pain at the very end of abduction is characteristic of **Acromioclavicular (AC) joint arthritis**, not impingement. * **Full Range:** Pain throughout the entire range is more suggestive of adhesive capsulitis (Frozen Shoulder) or acute calcific tendonitis rather than a classic "arc." **Clinical Pearls for NEET-PG:** * **Neer’s Test and Hawkins-Kennedy Test:** These are the specific clinical provocative tests used to confirm subacromial impingement. * **The "Critical Zone":** The area of the Supraspinatus tendon roughly 1 cm proximal to its insertion is relatively avascular and is the most common site for pathology in this syndrome. * **Management:** Initial treatment is conservative (NSAIDs, PT, subacromial steroid injection). Surgical decompression (Acromioplasty) is reserved for refractory cases.

Sports Medicine Indian Medical PG Question 8: Which of the following is NOT a component of O'Donoghue's unhappy triad?

• A. Anterior cruciate ligament (ACL) injury
• B. Medial meniscus injury
• C. Medial collateral ligament (MCL) injury
• D. Fibular collateral ligament (FCL) injury (Correct Answer)

Sports Medicine Explanation: **Explanation:** O’Donoghue’s Unhappy Triad (also known as the "blown knee") is a classic clinical triad involving a severe injury to three specific structures of the knee joint. It typically occurs when a lateral (valgus) force is applied to the knee while the foot is fixed on the ground. **1. Why Option D is Correct:** The **Fibular Collateral Ligament (FCL)**, also known as the Lateral Collateral Ligament (LCL), is **not** part of the triad. The triad specifically involves structures on the medial side of the knee. An LCL injury usually results from a varus force, which is the opposite of the mechanism that causes the Unhappy Triad. **2. Why the Other Options are Incorrect:** The traditional O’Donoghue’s Triad consists of: * **Anterior Cruciate Ligament (ACL) injury (Option A):** The most common ligamentous component of the triad, providing anterior stability. * **Medial Collateral Ligament (MCL) injury (Option C):** Occurs due to the valgus stress that opens the medial joint compartment. * **Medial Meniscus injury (Option B):** Classically described by O'Donoghue. However, modern sports medicine (via MRI studies) has shown that in acute non-contact injuries, **Lateral Meniscus** tears are actually more frequent. Despite this, for exam purposes and the classic definition, the Medial Meniscus remains the standard answer. **Clinical Pearls for NEET-PG:** * **Mechanism of Injury:** Valgus stress with external rotation of the tibia. * **Pivot Shift Test:** Most specific clinical test for ACL deficiency. * **McMurray Test:** Used to identify meniscal tears. * **High-Yield Note:** If a question asks for the "most common" meniscus injured in an acute ACL tear, the answer is often the **Lateral Meniscus**. If it asks for the components of "O'Donoghue's Triad," the answer is the **Medial Meniscus**.

Sports Medicine Indian Medical PG Question 9: Which is the primary clinical test for an anterior cruciate ligament (ACL) injury?

• A. Lachman test (Correct Answer)
• B. Bryant's test
• C. Jobe's test
• D. Hamilton's test

Sports Medicine Explanation: **Explanation:** The **Lachman test** is considered the most sensitive and reliable clinical test for diagnosing an acute **Anterior Cruciate Ligament (ACL)** injury. It is performed with the knee in 20–30° of flexion. The examiner stabilizes the femur with one hand and applies an anterior force to the proximal tibia with the other. A positive result is indicated by increased anterior translation of the tibia or a "soft/mushy" end-point. It is superior to the Anterior Drawer test because, at 30° flexion, the secondary stabilizers (like the posterior horn of the medial meniscus) are less likely to provide a false sense of stability. **Analysis of Incorrect Options:** * **Bryant’s test:** Used to assess **Developmental Dysplasia of the Hip (DDH)** or proximal femoral shortening. It involves measuring the vertical distance between the anterior superior iliac spine (ASIS) and the tip of the greater trochanter. * **Jobe’s test (Empty Can test):** A clinical test for the shoulder used to evaluate the **Supraspinatus tendon** for impingement or tears. * **Hamilton’s test (Ruler test):** Used in **Shoulder Dislocation**. In a normal shoulder, a straight edge cannot touch the acromion and the lateral epicondyle simultaneously; in a dislocation, it can. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** MRI is the investigation of choice for ACL tears. * **Pivot Shift Test:** This is the most **specific** clinical test for ACL insufficiency (indicates anterolateral rotatory instability). * **Segond Fracture:** An avulsion fracture of the lateral tibial condyle; it is pathognomonic for an ACL tear. * **Unhappy Triad (O'Donoghue):** Injury involving the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly injured in acute cases).

Sports Medicine Indian Medical PG Question 10: Which is the investigation of choice for a sports injury of the knee?

• A. Ultrasonography
• B. Plain radiography
• C. Arthrography
• D. Arthroscopy (Correct Answer)

Sports Medicine Explanation: **Explanation:** The knee is the most common site of sports-related injuries, frequently involving the anterior cruciate ligament (ACL), menisci, and articular cartilage. **Arthroscopy** is considered the "Gold Standard" and investigation of choice because it serves a dual purpose: it allows for direct visualization of intra-articular structures (diagnostic) and enables immediate surgical repair or debridement (therapeutic). While non-invasive imaging is common, arthroscopy provides 100% accuracy in identifying pathology that might be missed on scans. **Analysis of Options:** * **A. Ultrasonography:** Useful for superficial soft tissue injuries (e.g., patellar tendonitis) but cannot visualize deep intra-articular structures like the cruciate ligaments or posterior horns of the menisci effectively. * **B. Plain Radiography:** This is the initial investigation to rule out fractures (e.g., Segond fracture) or bony avulsions, but it cannot visualize soft tissue injuries, which constitute the majority of sports knee trauma. * **C. Arthrography:** An invasive procedure involving dye injection; it has been largely rendered obsolete by the advent of MRI and diagnostic arthroscopy. **Clinical Pearls for NEET-PG:** * **MRI** is the investigation of choice for **screening** and the most accurate **non-invasive** modality for soft tissue injuries of the knee. * **Arthroscopy** is the **Gold Standard** and the definitive investigation of choice. * **Segond Fracture:** A cortical avulsion of the lateral tibial condyle, which is pathognomonic for an ACL tear. * **O’Donoghue’s Triad:** Injury involving the ACL, Medial Collateral Ligament (MCL), and Medial Meniscus (though recent studies suggest the Lateral Meniscus is more commonly injured in acute ACL tears).

Sports Medicine Flashcard 1 of 10

Question: _____ bursitis is commonly seen in runners and typically presents with anteromedial knee pain

Answer: Pes anserine

Sports Medicine Flashcard 2 of 10

Question: _____ fractures are classically associated with a history of sudden increase in intensity/frequency of activity

Answer: Stress

Sports Medicine Flashcard 3 of 10

Question: The video shows an examination being performed with the knee flexed to about _____ degrees which indicates that it is the Lachmann test.

Answer: 20

Sports Medicine Flashcard 4 of 10

Question: The _____ test is used to identify injury to the meniscus (of the knee).

Answer: McMurray

Sports Medicine Flashcard 5 of 10

Question: What type of bone fractures are seen commonly in dancers, athletes and military recruits?_____

Answer: Stress fractures

Sports Medicine Flashcard 6 of 10

Question: A(n) _____ tear is often caused by microtrauma from repetitive stresses pitching a baseball.

Answer: ulnar collateral ligament

Sports Medicine Flashcard 7 of 10

Question: What is the name of the following test used to diagnose thoracic outlet syndrome? _____

Answer: Halstead maneuver/Reverse Adsons

Sports Medicine Flashcard 8 of 10

Question: What is the name of the following test used to diagnose thoracic outlet syndrome? _____

Answer: Roos test

Sports Medicine Flashcard 9 of 10

Question: What is the name of the following test used to diagnose thoracic outlet syndrome? _____

Answer: Adson's test

Sports Medicine Flashcard 10 of 10

Question: The test shown is _____ test.

Answer: Wright's hyperabduction