Sports Medicine for Adolescents — MCQs
Post contusional syndrome includes:
What is the condition commonly known as jumper's knee?
A 22-year-old athlete has episodes of rhabdomyolysis after intense exercise. Which metabolic disorder should be suspected?
Identify the condition shown in the given X-ray:
274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?
Avascular necrosis of bone is LEAST likely to be associated with?
What is the age range of adolescence?
Which of the following age groups falls under the early adolescence age group?
Areola and papilla forming secondary mound in adolescent girls is classified under which stage of sexual maturity rating (SMR)?
Adolescence starts at what age?
Sports Medicine for Adolescents Indian Medical PG Practice Questions and MCQs
Question 1: Post contusional syndrome includes:
- A. Delirium
- B. Nausea & vomiting
- C. Headache (Correct Answer)
- D. All of the options
Explanation: ***Headache*** - **Headache** is the **most common and characteristic symptom** of **post-concussion syndrome (PCS)**, present in up to 90% of cases. - Typically described as tension-type or migraine-like headaches that persist for weeks to months after mild traumatic brain injury. - This is a **core diagnostic feature** of PCS according to ICD-10 (F07.2) and DSM-5 criteria. - Among the given options, this is the **most definitive symptom** of post-concussion syndrome. *Delirium* - **Delirium** is an acute confusional state with fluctuating consciousness, impaired attention, and cognitive dysfunction. - This is **NOT a feature of post-concussion syndrome**, which involves persistent symptoms in clear consciousness. - Delirium may occur immediately after severe traumatic brain injury but is not part of the chronic post-concussional syndrome picture. - Post-concussion syndrome involves cognitive difficulties (memory, concentration) but not delirium. *Nausea & vomiting* - **Nausea** can occur as part of post-concussion syndrome, particularly when associated with vestibular dysfunction or migraine-like headaches. - However, it is **less characteristic and less persistent** than headache, and is not present in all cases. - While recognized in ICD-10 criteria for PCS, nausea is not as defining or universal as headache. - Vomiting is less common in chronic PCS compared to acute concussion. *All of the options* - This is incorrect because **delirium is NOT a feature of post-concussion syndrome**. - While headache is the hallmark symptom and nausea can occur, delirium represents acute brain dysfunction, not the chronic syndrome. - PCS is characterized by persistent somatic (headache, dizziness), cognitive (concentration, memory problems), and psychological (irritability, anxiety) symptoms in clear consciousness.
Question 2: What is the condition commonly known as jumper's knee?
- A. Inflammation of the patellar tendon at its insertion on the patella.
- B. Tendinopathy of the quadriceps tendon.
- C. Injury to the hamstring tendon.
- D. Patellar tendonitis due to overuse of the patellar tendon. (Correct Answer)
Explanation: ***Patellar tendonitis due to overuse of the patellar tendon.*** - **Jumper's knee** is the common term for **patellar tendonitis**, which specifically refers to inflammation of the patellar tendon. - This condition is frequently caused by **overuse**, especially in activities involving repetitive jumping and landing. *Inflammation of the patellar tendon at its insertion on the patella.* - While jumper's knee does involve inflammation of the patellar tendon, it is more commonly at its insertion on the **tibial tubercle** or specifically its origin at the **inferior pole of the patella**, not necessarily at the patella itself. - This option is less precise as it describes only one aspect of the condition without mentioning the critical role of overuse. *Tendinopathy of the quadriceps tendon.* - **Tendinopathy of the quadriceps tendon** is a distinct condition affecting the tendon above the patella, known as **quadriceps tendinopathy**. - It presents with pain proximal to the patella, differentiating it from jumper's knee, which involves the tendon distal to the patella. *Injury to the hamstring tendon.* - An **injury to the hamstring tendon** would cause pain and symptoms on the posterior aspect of the knee or thigh. - This is completely unrelated to jumper's knee, which is characterized by anterior knee pain.
Question 3: A 22-year-old athlete has episodes of rhabdomyolysis after intense exercise. Which metabolic disorder should be suspected?
- A. Pompe disease
- B. Cori disease
- C. Von Gierke disease
- D. McArdle disease (Correct Answer)
Explanation: ***McArdle disease*** - This condition, also known as **glycogen storage disease type V**, is caused by a deficiency in **myophosphorylase** (muscle glycogen phosphorylase). - This enzyme defect prevents the breakdown of **glycogen in muscle** during exercise, leading to energy depletion, muscle pain, cramps, and **rhabdomyolysis**. *Pompe disease* - Caused by a deficiency in **lysosomal α-1,4-glucosidase** (acid maltase), leading to glycogen accumulation in lysosomes. - Presents with a wide range of symptoms including **cardiomyopathy**, hypotonia (in infants), and respiratory problems, but less commonly exercise-induced rhabdomyolysis in adults. *Cori disease* - Also known as glycogen storage disease type III, characterized by a deficiency in **glycogen debranching enzyme**. - Mainly affects the **liver and muscles**, causing hepatomegaly, hypoglycemia, and muscle weakness, but exercise-induced rhabdomyolysis is not its primary presentation. *Von Gierke disease* - This is **glycogen storage disease type I**, caused by a deficiency in **glucose-6-phosphatase**. - Primarily affects the **liver and kidneys**, leading to severe fasting hypoglycemia, hepatomegaly, lactic acidosis, and hyperlipidemia, but not typically rhabdomyolysis.
Question 4: Identify the condition shown in the given X-ray:
- A. Tibial tuberosity fracture
- B. Osgood-Schlatter disease (Correct Answer)
- C. Gerdy's tubercle fracture
- D. Lateral epicondyle of femur
Explanation: ***Correct Answer: Osgood-Schlatter disease*** - The X-ray shows characteristic **fragmentation** and **irregularity** of the **tibial tuberosity**, which is pathognomonic for Osgood-Schlatter disease. - This condition commonly affects **adolescents** during periods of rapid growth, causing **anterior knee pain** that worsens with activity. - The radiographic findings demonstrate chronic **traction apophysitis** at the insertion of the **patellar tendon**. *Incorrect: Tibial tuberosity fracture* - An acute tibial tuberosity fracture would show a **distinct fracture line** with possible displacement, rather than the chronic fragmentation pattern seen here. - This type of fracture typically results from **sudden forceful quadriceps contraction** and presents with acute onset of severe pain. *Incorrect: Gerdy's tubercle fracture* - Gerdy's tubercle is located on the **lateral aspect of the proximal tibia**, serving as the insertion point for the **iliotibial band**. - A fracture at this location would not explain the **anterior tibial tuberosity changes** visible in this X-ray image. *Incorrect: Lateral epicondyle of femur* - The lateral epicondyle of the femur is located at the **distal end of the femur**, not at the tibial tuberosity where the radiographic changes are visible. - Pathology at the lateral epicondyle would not cause the **tibial tuberosity fragmentation** seen in this X-ray.
Question 5: 274. A young athlete was found to have hypertrophic cardiomyopathy during testing for a competitive sport. Which of the following maneuvers will increase the murmur?
- A. Handgrip
- B. Valsalva maneuver (Correct Answer)
- C. Squatting
- D. Leaning forward
- E. Passive leg raise
Explanation: **Valsalva maneuver** - The **Valsalva maneuver** reduces **preload** by decreasing venous return to the heart. - A decrease in preload reduces the left ventricular chamber size, which in turn exacerbates the **left ventricular outflow tract (LVOT) obstruction** characteristic of hypertrophic cardiomyopathy (HCM), thereby **increasing the intensity of the murmur**. *Handgrip* - **Handgrip** is an isometric exercise that leads to an increase in **afterload** and **peripheral vascular resistance**. - Increased afterload causes the left ventricle to eject blood against higher pressure, which **enlarges the left ventricular chamber** and **reduces the LVOT obstruction**, thus **decreasing the intensity of the murmur** in HCM. *Squatting* - **Squatting** increases both **preload** (due to increased venous return) and **afterload** (due to increased peripheral vascular resistance). - The increased preload and afterload lead to an **increased left ventricular volume**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Passive leg raise* - **Passive leg raise** increases **preload** by increasing venous return to the heart from the lower extremities. - The increased preload leads to an **increased left ventricular chamber size**, which **reduces the LVOT obstruction** and therefore **decreases the intensity of the murmur** in HCM. *Leaning forward* - Leaning forward during auscultation is typically used to better hear **aortic regurgitation murmurs**, as it brings the aorta closer to the chest wall. - This maneuver does not significantly alter **cardiac preload or afterload** in a way that would consistently increase the murmur of hypertrophic cardiomyopathy.
Question 6: Avascular necrosis of bone is LEAST likely to be associated with?
- A. Osgood -Schlatter disease (Correct Answer)
- B. Long-term use of corticosteroids
- C. Sickle-cell disease
- D. Legg-Perthes disease
Explanation: ***Osgood-Schlatter disease*** - This condition is characterized by **inflammation of the patellar ligament** at its insertion into the tibial tuberosity, primarily due to repetitive stress in adolescents. - While it involves pain and swelling around the knee, it is a **traction apophysitis** and not a form of avascular necrosis. *Long-term use of corticosteroids* - **Corticosteroids** are a well-established risk factor for avascular necrosis, particularly in the femoral head, by affecting lipid metabolism and blood flow. - They can lead to **fat embolism** and increased intraosseous pressure, compromising blood supply to the bone. *Sickle-cell disease* - **Sickle cell disease** significantly increases the risk of avascular necrosis due to **vaso-occlusive crises**, where sickled red blood cells block small blood vessels. - This leads to **ischemia and infarction** in bone marrow, commonly affecting the femoral and humeral heads. *Legg-Perthes disease* - This is a specific type of **avascular necrosis of the femoral head** in children, causing a temporary interruption of blood supply to the epiphysis. - It results in the collapse of the femoral head and subsequent repair processes, consistent with the pathology of avascular necrosis.
Question 7: What is the age range of adolescence?
- A. 10-14 years
- B. 6-10 years
- C. 14-20 years
- D. 10-19 years (Correct Answer)
Explanation: ***10-19 years*** - This is the **universally accepted definition of adolescence** by the **World Health Organization (WHO)**, which is the international standard used globally for medical education and practice. - This range encompasses all three stages: **early adolescence (10-13 years)**, **middle adolescence (14-16 years)**, and **late adolescence (17-19 years)**. - It captures the complete spectrum of **pubertal development, physical maturation, cognitive development, and psychosocial changes** characteristic of adolescence. - Recognized by major pediatric bodies including the **Indian Academy of Pediatrics (IAP)**, **UNICEF**, and **American Academy of Pediatrics (AAP)**. *14-20 years* - This range excludes **early adolescence (10-13 years)**, missing the critical onset of puberty and early developmental changes. - While it extends to 20 years, it omits a significant portion of the adolescent period recognized by WHO. - Not a standard medical definition used in pediatric practice or competitive examinations. *10-14 years* - This represents only **early adolescence**, not the complete age range. - Misses middle and late adolescence, which are crucial periods for identity formation and psychosocial development. - Too narrow to be considered the full adolescent period. *6-10 years* - This age range corresponds to **middle childhood**, not adolescence. - Occurs before the onset of puberty and the hormonal changes that define adolescence. - Children in this stage are in the **concrete operational stage** of cognitive development, distinct from adolescent development.
Question 8: Which of the following age groups falls under the early adolescence age group?
- A. 8-10 yrs
- B. 10-13 yrs (Correct Answer)
- C. 14-16 yrs
- D. 17-19 yrs
Explanation: **10-13 yrs** - Early adolescence typically encompasses the ages between **10 to 13 years**, marked by the onset of **puberty** and significant physical and emotional changes. - During this stage, individuals experience rapid growth spurts, development of **secondary sexual characteristics**, and a budding sense of identity. *8-10 yrs* - This age range generally falls under **late childhood** or preadolescence, where children are still largely influenced by family and are developing fundamental social skills. - While some may begin to show early signs of puberty, it is not the primary defining characteristic of this age group. *14-16 yrs* - This period describes **middle adolescence**, characterized by increasing independence, peer influence, and heightened self-consciousness. - Physical changes related to puberty are often well-established during these years. *17-19 yrs* - This age group is considered **late adolescence**, a phase of more mature identity formation, future planning, and preparation for young adulthood. - Physical development has largely completed, and individuals focus on establishing personal values and career goals.
Question 9: Areola and papilla forming secondary mound in adolescent girls is classified under which stage of sexual maturity rating (SMR)?
- A. SMR Stage 5
- B. SMR Stage 2
- C. SMR Stage 3
- D. SMR Stage 4 (Correct Answer)
Explanation: ***SMR Stage 4*** - In **SMR Stage 4**, the **areola and papilla project above the level of the breast**, forming a **secondary mound** on top of the general breast contour. - This stage indicates significant breast development beyond the initial budding phase. *SMR Stage 5* - **SMR Stage 5** represents mature adult breasts, where the **areola recedes to merge with the general contour of the breast**, and only the **papilla (nipple) projects**. - There is no secondary mound in Stage 5, as the breast is fully developed. *SMR Stage 2* - **SMR Stage 2** is characterized by breast budding, known as the **"breast bud" stage**, where only the **papilla and areola are elevated as a small mound**. - This stage marks the initial onset of breast development, with no secondary mound formation. *SMR Stage 3* - In **SMR Stage 3**, the **breast and areola both enlarge and project as a single, continuous mound**. - While there is a general enlargement, the areola does not form a distinct secondary projection above the rest of the breast tissue.
Question 10: Adolescence starts at what age?
- A. 10 years (Correct Answer)
- B. 14 years
- C. 7 years
- D. 17 years
Explanation: ***10 years*** - According to the World Health Organization (WHO), adolescence generally spans the ages of **10 to 19 years**. - This period is characterized by significant **physical**, **psychological**, and **social development**. *14 years* - While 14 is within the adolescent period, it is not the typical **starting age** of adolescence as defined by health organizations. - This age represents the **middle stage** of adolescence rather than its beginning. *7 years* - This age falls within **middle childhood**, a period distinct from adolescence marked by different developmental milestones. - Children at 7 years old are still in a phase of developing foundational skills, not yet entering the rapid changes of **puberty**. *17 years* - This age is considered **late adolescence**, a phase where individuals are often preparing for adulthood and increased independence. - The onset of adolescence occurs significantly earlier than this age.
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