Sports Medicine — MCQs

Sports Medicine Indian Medical PG Practice Questions and MCQs

Question 21: Jumper's knee is primarily caused by:

A. Sacral fracture
B. Patellar tendonosis (Correct Answer)
C. Tibial fracture
D. Fibular fracture

Explanation: **Explanation:** **Jumper’s Knee**, clinically known as **Patellar Tendonitis/Tendonosis**, is a common overuse injury characterized by pain at the inferior pole of the patella. It is caused by repetitive stress on the extensor mechanism of the knee, typically seen in athletes involved in sports requiring frequent jumping and landing (e.g., basketball, volleyball). * **Why Patellar Tendonosis is Correct:** The pathology involves micro-tears and mucoid degeneration of the patellar tendon, most commonly at its origin at the **inferior pole of the patella**. While initially inflammatory (tendonitis), chronic cases show a lack of inflammatory cells and are more accurately termed "tendonosis." * **Why Incorrect Options are Wrong:** * **Sacral, Tibial, and Fibular Fractures:** These are acute traumatic bony injuries. While a tibial tuberosity avulsion can occur in adolescents (Osgood-Schlatter disease), Jumper's knee specifically refers to the soft tissue pathology of the tendon itself, not a fracture. **Clinical Pearls for NEET-PG:** 1. **Blazina Classification:** Used to grade the severity of Jumper’s Knee based on whether pain occurs before, during, or after activity. 2. **Physical Exam:** Tenderness is localized to the inferior pole of the patella; pain is elicited by resisted knee extension. 3. **Imaging:** MRI is the gold standard, showing tendon thickening and increased signal intensity. 4. **Management:** Primarily conservative (eccentric strengthening exercises). Surgery is reserved for refractory cases. 5. **Differential Diagnosis:** Must be distinguished from **Sinding-Larsen-Johansson syndrome**, which is traction apophysitis at the inferior patellar pole in children.

Question 22: The Female Athlete Triad consists of all EXCEPT:

A. Disordered eating
B. Amenorrhea
C. Osteoporosis
D. Absence of secondary sexual characteristics (Correct Answer)

Explanation: ### Explanation The **Female Athlete Triad** is a clinical spectrum of three interrelated conditions often seen in young women participating in sports that emphasize leanness or aesthetics (e.g., gymnastics, ballet, long-distance running). **1. Why "Absence of secondary sexual characteristics" is the correct answer:** The triad involves the **loss** of previously established physiological functions due to energy deficiency. The absence of secondary sexual characteristics (like breast development or pubic hair) refers to **primary amenorrhea** or delayed puberty, which is a developmental delay rather than the specific acquired syndrome defined by the Triad. While delayed menarche can be a component, the "absence of secondary sexual characteristics" is not one of the three defining pillars. **2. Analysis of Incorrect Options (The Three Components):** * **Disordered Eating (Low Energy Availability):** This is the "trigger" of the triad. It may range from unintentional caloric restriction to clinical eating disorders (Anorexia/Bulimia). The body enters a state of negative energy balance. * **Amenorrhea (Menstrual Dysfunction):** Low energy availability suppresses the hypothalamic-pituitary-ovarian axis, leading to decreased GnRH pulsatility, low estrogen levels, and functional hypothalamic amenorrhea. * **Osteoporosis (Low Bone Mineral Density):** The hypoestrogenic state (similar to menopause) increases bone resorption and decreases bone formation, leading to premature bone loss and increased risk of stress fractures. **3. Clinical Pearls for NEET-PG:** * **Updated Definition:** The *Female Athlete Triad Coalition* now views these as a continuum of **Energy Availability, Menstrual Function, and Bone Health.** * **RED-S:** The concept has been expanded by the IOC to **Relative Energy Deficiency in Sport (RED-S)**, which includes metabolic rate, immunity, and male athletes. * **Gold Standard Treatment:** The primary treatment is **nutritional rehabilitation** and increasing caloric intake to restore energy balance. * **High-Yield Association:** Always look for a history of **stress fractures** (especially of the metatarsals or tibia) in a young female athlete with irregular periods.

Question 23: A 17-year-old athletic girl complains of anterior knee pain on climbing stairs and on getting up after prolonged sitting. What is the likely diagnosis?

A. Blount's disease
B. Chondromalacia patella (Correct Answer)
C. Nail-patella syndrome
D. Bursitis

Explanation: ### Explanation **Correct Answer: B. Chondromalacia patella** **Clinical Reasoning:** The clinical presentation described is the classic triad of **Chondromalacia Patellae** (also known as Patellofemoral Pain Syndrome): 1. **Demographics:** Most common in adolescent girls and young athletes (due to a wider Q-angle). 2. **Anterior Knee Pain:** Pain is localized to the retropatellar region. 3. **Mechanical Aggravation:** Pain is exacerbated by activities that increase patellofemoral compressive forces, such as **climbing stairs**, squatting, or **prolonged sitting** (known as the **"Movie Sign"** or "Theater Sign"). The underlying pathology involves softening and degeneration of the articular cartilage on the undersurface of the patella, often due to maltracking. **Analysis of Incorrect Options:** * **A. Blount's disease:** This is developmental tibia vara (bowing of legs) caused by disordered ossification of the medial aspect of the proximal tibial physis. It presents with deformity rather than isolated retropatellar pain. * **C. Nail-patella syndrome:** A genetic disorder (LMX1B mutation) characterized by a tetrad of hypoplastic/absent nails, hypoplastic/absent patellae, iliac horns, and elbow dysplasia. * **D. Bursitis:** Prepatellar bursitis ("Housemaid’s knee") presents with localized swelling and tenderness over the superficial bursa, not deep-seated pain aggravated specifically by stair climbing or prolonged sitting. **NEET-PG High-Yield Pearls:** * **Movie Sign:** Pathognomonic for Chondromalacia Patella. * **Q-Angle:** An increased Q-angle (>15° in males, >20° in females) is a major predisposing factor. * **Clarke’s Test (Patellar Grind Test):** Positive when pain is elicited by compressing the patella into the trochlear groove while the patient contracts the quadriceps. * **Management:** Primarily conservative, focusing on **vastus medialis obliquus (VMO) strengthening** and activity modification. Surgery (e.g., lateral release) is reserved for refractory cases.

Question 24: Which of the following statements about nerve entrapment syndromes is FALSE?

A. Guyon's canal syndrome involves the ulnar nerve.
B. Cubital tunnel syndrome involves the ulnar nerve.
C. Cheiralgia paresthetica involves the femoral nerve. (Correct Answer)
D. Tarsal tunnel syndrome involves the posterior tibial nerve.

Explanation: **Explanation:** The correct answer is **C** because **Cheiralgia paresthetica** involves the **superficial branch of the radial nerve**, not the femoral nerve. It is a sensory neuropathy characterized by pain or numbness over the dorsal-radial aspect of the wrist and hand, often caused by tight watchbands, handcuffs, or repetitive trauma. In contrast, entrapment of the lateral femoral cutaneous nerve is known as *Meralgia paresthetica*. **Analysis of other options:** * **Option A (Guyon’s Canal Syndrome):** This is a true statement. It involves compression of the **ulnar nerve** as it passes through the fibro-osseous tunnel (Guyon’s canal) at the wrist, often seen in long-distance cyclists. * **Option B (Cubital Tunnel Syndrome):** This is a true statement. It is the second most common compression neuropathy, involving the **ulnar nerve** at the elbow (medial epicondyle). * **Option D (Tarsal Tunnel Syndrome):** This is a true statement. It involves compression of the **posterior tibial nerve** (or its branches) as it passes behind the medial malleolus. **High-Yield Clinical Pearls for NEET-PG:** * **Wartenberg’s Syndrome:** Another name for Cheiralgia paresthetica (radial nerve). * **Meralgia Paresthetica:** Involves the **Lateral Femoral Cutaneous Nerve** (L2-L3); common in obesity or those wearing tight belts. * **Double Crush Syndrome:** When a nerve is compressed at two different levels (e.g., cervical radiculopathy and Carpal Tunnel). * **Froment’s Sign:** Positive in Ulnar nerve palsy (Cubital/Guyon’s canal) due to adductor pollicis weakness.

Question 25: All of the following features in the knee are recognized to be consistent with a torn medial meniscus, except?

A. Excessive forward glide (Correct Answer)
B. Giving way
C. Locking
D. McMurray's sign

Explanation: **Explanation:** The correct answer is **A. Excessive forward glide**. **1. Why "Excessive forward glide" is the correct (except) option:** Excessive forward glide of the tibia on the femur is the hallmark of an **Anterior Cruciate Ligament (ACL) injury**, not a meniscal tear. This clinical finding is elicited through the **Anterior Drawer Test** or the **Lachman Test** (the most sensitive test for ACL deficiency). While meniscal tears often coexist with ACL injuries (the "unhappy triad"), the glide itself indicates ligamentous laxity rather than a meniscal lesion. **2. Analysis of incorrect options (Features of Medial Meniscus Tear):** * **Giving way (Option B):** This occurs due to reflex inhibition of the quadriceps when the torn meniscal fragment gets momentarily caught between the articular surfaces, causing the knee to "buckle." * **Locking (Option C):** A classic mechanical symptom, especially in "bucket-handle" tears. The displaced fragment becomes wedged in the joint space, physically preventing full extension of the knee. * **McMurray’s sign (Option D):** This is a specific provocative test for meniscal injuries. For a medial meniscus tear, the clinician externally rotates the foot and applies valgus stress while extending the knee from a flexed position; a palpable/audible "thud" or "click" indicates a positive result. **Clinical Pearls for NEET-PG:** * **Most common meniscus injured:** Medial meniscus (due to its firm attachment to the deep medial collateral ligament, making it less mobile than the lateral meniscus). * **Gold Standard Diagnosis:** MRI is the investigation of choice; however, **Arthroscopy** remains the "Gold Standard" for both diagnosis and treatment. * **Red Zone vs. White Zone:** Tears in the peripheral vascular "Red Zone" have healing potential and can be repaired, whereas "White Zone" tears (avascular) usually require partial meniscectomy.

Question 26: A spontaneous rupture of the Achilles tendon occurs in an 18-year-old male. This is most likely due to excess stress beyond which of the following?

A. Tendon strength (Correct Answer)
B. Bone strength
C. Muscle strength
D. Musculotendinous junction strength

Explanation: **Explanation:** The Achilles tendon is the strongest and thickest tendon in the human body, formed by the fusion of the gastrocnemius and soleus muscles. A spontaneous rupture occurs when the mechanical load applied to the tendon exceeds its intrinsic **tendon strength** (tensile strength). In young, healthy individuals, this usually occurs during eccentric loading or sudden forceful plantarflexion (e.g., sprinting or jumping). **Analysis of Options:** * **A. Tendon strength (Correct):** Rupture happens when the internal structural integrity of the collagen fibers is overwhelmed by external force. In an 18-year-old, the tendon is typically healthy, but the force generated during peak athletic activity can surpass the ultimate tensile strength of the tendon tissue itself. * **B. Bone strength:** If the force exceeded bone strength before tendon strength, it would result in an avulsion fracture of the calcaneus rather than a mid-substance tendon rupture. * **C. Muscle strength:** Muscle strength refers to the contractile force generated. While high muscle strength contributes to the load placed on the tendon, the rupture is a failure of the connective tissue, not the muscle fibers. * **D. Musculotendinous junction strength:** While tears can occur here (often called "Tennis Leg" when involving the medial gastrocnemius), a classic Achilles rupture occurs in the "watershed area" (2–6 cm proximal to the calcaneal insertion), where the tendon's own structural strength is the limiting factor. **Clinical Pearls for NEET-PG:** * **Simmonds/Thompson Test:** The most reliable clinical test (squeezing the calf fails to produce plantarflexion). * **Vulnerable Zone:** Ruptures most commonly occur 2–6 cm proximal to the insertion due to a relatively hypovascular zone. * **Risk Factors:** Fluoroquinolone use (e.g., Ciprofloxacin) and local corticosteroid injections are high-yield associations for spontaneous rupture. * **Management:** In young athletes, surgical repair is often preferred to reduce the rate of re-rupture compared to conservative casting.

Question 27: Painful arc syndrome is seen in all of the following conditions except?

A. Complete tear of supraspinatus (Correct Answer)
B. Fracture of the greater tuberosity
C. Subacromial bursitis
D. Supraspinatus tendinitis

Explanation: **Explanation:** The **Painful Arc Syndrome** refers to shoulder pain that occurs during mid-range abduction (typically between **60° and 120°**). This occurs because the subacromial space is narrowest in this range, causing the sensitive structures (supraspinatus tendon or subacromial bursa) to be compressed against the acromion process. **Why "Complete tear of supraspinatus" is the correct answer:** In a **complete (full-thickness) tear** of the supraspinatus, the patient is unable to initiate or maintain abduction effectively. Since the muscle cannot contract to pull the humerus into the subacromial space, the "impingement" mechanism does not occur in the same way. More importantly, the patient typically presents with a "Drop Arm Sign" rather than a painful arc, as they cannot control the limb through the 60°-120° range. **Analysis of Incorrect Options:** * **Supraspinatus tendinitis:** This is the most common cause. The inflamed, thickened tendon gets pinched during the middle arc of motion. * **Subacromial bursitis:** Inflammation of the bursa reduces the subacromial clearance, leading to classic impingement pain during abduction. * **Fracture of the greater tuberosity:** The supraspinatus inserts here. A fracture or malunion alters the anatomy of the subacromial space, leading to mechanical impingement and a painful arc. **NEET-PG High-Yield Pearls:** * **Range of Pain:** 60°–120° (Subacromial impingement); 120°–180° (Acromioclavicular joint pathology). * **Neer’s Test & Hawkins-Kennedy Test:** Clinical maneuvers used to elicit pain in impingement syndrome. * **Initiation of Abduction (0-15°):** Performed by the Supraspinatus. * **Main Abductor (15-90°):** Performed by the Deltoid. * **Overhead Abduction (>90°):** Involves scapular rotation by the Serratus Anterior and Trapezius.

Question 28: A Baker's cyst is a type of:

A. Pulsion diverticulum of the knee joint (Correct Answer)
B. Retention cyst
C. Bursitis
D. Benign tumor

Explanation: **Explanation:** A **Baker’s cyst** (also known as a popliteal cyst) is a fluid-filled sac located in the popliteal fossa. It is considered a **pulsion diverticulum** because it represents a herniation of the synovial membrane through the posterior capsule of the knee joint, typically between the medial head of the gastrocnemius and the semimembranosus muscle. **Why Option A is correct:** The cyst is formed when intra-articular pressure increases (often due to underlying pathology like osteoarthritis or a meniscal tear). This pressure "pushes" (pulsion) the synovium through a point of least resistance in the joint capsule, creating a diverticulum. It often communicates with the joint via a valve-like mechanism. **Why other options are incorrect:** * **Retention cyst:** These occur due to the obstruction of a gland's duct (e.g., a sebaceous cyst). A Baker’s cyst is a synovial herniation, not a glandular obstruction. * **Bursitis:** While a Baker’s cyst often involves the gastrocnemio-semimembranosus bursa, it is specifically a herniation/communication with the joint space rather than simple primary inflammation of a bursa. * **Benign tumor:** A Baker’s cyst is a reactive, fluid-filled structure, not a neoplastic growth of cells. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most commonly found between the **medial head of gastrocnemius and semimembranosus**. * **Associated Pathology:** In adults, it is usually secondary to **osteoarthritis** or **meniscal tears**. In children, it is often primary and idiopathic. * **Foucher’s Sign:** The cyst becomes firm on knee extension and soft on flexion. * **Complication:** Rupture of the cyst can mimic **Deep Vein Thrombosis (DVT)**, presenting with sudden calf pain and a positive Homan’s sign (Pseudothrombophlebitis).

Question 29: Lift-off test is used for assessing the strength of which of the following muscles?

A. Supraspinatus
B. Subscapularis (Correct Answer)
C. Infraspinatus
D. Biceps brachii

Explanation: **Explanation:** The **Lift-off test** (Gerber’s test) is the clinical gold standard for assessing the integrity and strength of the **Subscapularis** muscle. **1. Why Subscapularis is correct:** The subscapularis is the primary **internal rotator** of the shoulder. To perform the test, the patient places the dorsum of their hand against their mid-lumbar spine (internal rotation) and attempts to lift the hand away from the back against resistance. An inability to lift the hand or significant weakness indicates a subscapularis tear or dysfunction. If the patient cannot reach the small of their back, the **Belly-press test** is used as an alternative. **2. Why other options are incorrect:** * **Supraspinatus:** Assessed using the **Jobe’s test (Empty Can test)**. It is primarily responsible for the first 15° of abduction. * **Infraspinatus:** Along with the Teres minor, it is an **external rotator**. It is assessed using the External Rotation Lag Sign or resistance to external rotation with the arm at the side. * **Biceps brachii:** Assessed using **Speed’s test** or **Yergason’s test**, which evaluate for long head of biceps tendonitis or SLAP lesions. **Clinical Pearls for NEET-PG:** * **Rotator Cuff Muscles (SITS):** Supraspinatus (Abduction), Infraspinatus (External rotation), Teres minor (External rotation), Subscapularis (Internal rotation). * **Subscapularis** is the only rotator cuff muscle that inserts into the **Lesser Tuberosity** of the humerus; the other three insert into the Greater Tuberosity. * **Bear-hug test** is another highly sensitive test for subscapularis tears.

Question 30: The image displays a clinical maneuver. Which ligament's integrity is being assessed by this test?

A. Anterior cruciate ligament (Correct Answer)
B. Medial collateral ligament
C. Posterior cruciate ligament
D. Lateral collateral ligament

Explanation: ***Anterior cruciate ligament*** - The image demonstrates the **Anterior Drawer Test**, a clinical maneuver used to assess the integrity of the **Anterior Cruciate Ligament (ACL)**. - During this test, the examiner pulls the tibia anteriorly; excessive forward movement of the tibia relative to the femur indicates a positive test, suggesting an **ACL tear**. *Posterior cruciate ligament* - The **Posterior Cruciate Ligament (PCL)** is assessed with the **Posterior Drawer Test**, which involves pushing the tibia posteriorly, the opposite motion of what is shown. - The PCL prevents the posterior translation of the tibia, and its rupture is often associated with a **dashboard injury** or a direct blow to the anterior tibia. *Medial collateral ligament* - The **Medial Collateral Ligament (MCL)** is tested using the **Valgus Stress Test**, where a force is applied to the lateral side of the knee to test for medial joint space opening. - This maneuver is performed with the knee in slight flexion (20-30 degrees) and full extension, a different position and action than depicted. *Lateral collateral ligament* - The **Lateral Collateral Ligament (LCL)** is evaluated with the **Varus Stress Test**, where a force is applied to the medial side of the knee to check for lateral joint space opening. - This test, like the valgus stress test, is performed at different degrees of flexion and is distinct from the drawer test shown in the image.

Practice by Chapter

Sports Injuries: Epidemiology and Prevention

Practice Questions

Knee Ligament Injuries

Practice Questions

Meniscal Injuries

Practice Questions

Shoulder Instability

Practice Questions

Rotator Cuff Pathology

Practice Questions

Tendinopathies

Practice Questions

Muscle Strains and Contusions

Practice Questions

Ankle Sprains and Instability

Practice Questions

Overuse Injuries

Practice Questions

Return to Play Criteria

Practice Questions

Sports-Specific Conditioning

Practice Questions

Performance Enhancement

Practice Questions

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