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ABIM Sports Medicine study materials
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ABIM Sports Medicine practice questions

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Question 1General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

During a maximal incremental treadmill test, which physiologic variable typically plateaus despite further increases in workload and is therefore used as the primary criterion for reaching maximal oxygen consumption?

  1. Oxygen uptake Correct answer.
  2. Minute ventilation
  3. Heart rate
  4. Respiratory exchange ratio

Explanation

VO2max is defined by a plateau in oxygen consumption as work rate rises. Other variables (RER, HR, ventilation) also reach maxima but continue to change or are not the defining plateau criterion.

Question 2General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which energy system predominates during a maximal-effort sprint lasting approximately 6 seconds?

  1. Fatty acid oxidation
  2. Oxidative phosphorylation
  3. Aerobic glycolysis
  4. Phosphagen (ATP-CP) system Correct answer.

Explanation

Very short, maximal efforts rely on stored ATP and creatine phosphate. This phosphagen system supplies energy for roughly the first 10 seconds before glycolysis contributes increasingly.

Question 3General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 24-year-old runner develops muscle cramping, confusion, and dark urine after a hot-weather marathon. Which finding best supports the diagnosis of exertional heat stroke rather than heat exhaustion?

  1. Core temperature above 40°C with central nervous system dysfunction Correct answer.
  2. Heavy sweating with a core temperature of 38.5°C
  3. Orthostatic dizziness that resolves with fluid intake
  4. Diffuse muscle tenderness without mental status change

Explanation

Exertional heat stroke is defined by hyperthermia (core temperature typically above 40°C) plus central nervous system dysfunction. Heat exhaustion lacks significant CNS dysfunction and usually responds to rest and rehydration.

Question 4General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

In a preparticipation cardiovascular screening of a high school athlete, which history finding most warrants further cardiac evaluation?

  1. Exertional syncope or near-syncope Correct answer.
  2. A heart murmur noted only in infancy
  3. A single episode of syncope during a febrile illness
  4. Mild palpitations after caffeine intake

Explanation

Exertional syncope raises concern for structural heart disease or arrhythmia and requires evaluation before clearance. Syncope with fever, caffeine-related palpitations, and remote resolved murmurs are lower-risk findings.

Question 5General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which statement best describes the mechanism by which a nonsteroidal anti-inflammatory drug relieves musculoskeletal pain?

  1. It blocks sodium channels on peripheral sensory neurons
  2. It inhibits acetylcholinesterase at the neuromuscular junction
  3. It blocks prostaglandin synthesis by inhibiting cyclooxygenase Correct answer.
  4. It directly antagonizes opioid receptors in the spinal cord

Explanation

NSAIDs inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis and thereby decreasing inflammation and pain sensitization. This distinguishes them from opioid, cholinergic, and local anesthetic mechanisms.

Question 6General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

An athlete taking warfarin for a mechanical valve asks about starting a new supplement. Which supplement most directly increases bleeding risk through interference with vitamin K or platelet function?

  1. Calcium carbonate
  2. Vitamin B12
  3. Fish oil Correct answer.
  4. Vitamin C

Explanation

High-dose fish oil can impair platelet aggregation and add to anticoagulant effect. Vitamin K-containing supplements are the classic direct antagonist of warfarin, but among these options fish oil carries the described antiplatelet interaction.

Question 7General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which of the following best represents a recommended pre-exercise carbohydrate strategy for an endurance athlete preparing for a prolonged event?

  1. Relying solely on fat intake on race morning
  2. Avoiding all carbohydrates for 24 hours before competition
  3. Consuming a high-carbohydrate meal 3 to 4 hours before exercise Correct answer.
  4. Restricting fluids to prevent gastrointestinal discomfort

Explanation

A carbohydrate-rich meal roughly 3 to 4 hours before endurance exercise helps maximize glycogen availability and is well tolerated. Carbohydrate avoidance and fat-only strategies do not optimize glycogen stores.

Question 8General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which biomechanical factor most increases the risk of an anterior cruciate ligament injury during a cutting maneuver?

  1. Knee valgus collapse with internal tibial rotation Correct answer.
  2. Wide stance with hip external rotation
  3. Forefoot landing with ankle dorsiflexion
  4. Increased knee flexion at foot strike

Explanation

Dynamic knee valgus combined with internal tibial rotation places high valgus and rotational stress on the ACL. Greater knee flexion and controlled hip/ankle positioning are protective.

Question 9General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

During sustained submaximal exercise in the heat, which cardiovascular adjustment primarily helps dissipate heat?

  1. Redistribution of cardiac output to skin Correct answer.
  2. Increased peripheral vascular resistance
  3. Reduced sweat rate
  4. Cutaneous vasoconstriction

Explanation

Heat stress causes cutaneous vasodilation and shunting of cardiac output to the skin to transfer heat to the environment. This is accompanied by increased sweat rate and reduced peripheral resistance.

Question 10General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which finding on the preparticipation physical examination most suggests Marfan syndrome and warrants further cardiac assessment?

  1. Positive thumb and wrist signs with aortic root dilation risk Correct answer.
  2. Arm span less than height
  3. Isolated flexible flat feet
  4. Mild kyphosis in adolescence

Explanation

The thumb (Steinberg) and wrist (Walker-Murdoch) signs reflect arachnodactyly and, with other features, raise concern for Marfan syndrome and associated aortic root disease. Isolated minor orthopedic findings are nonspecific.

Question 11General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which statement about cardiac output during graded exercise in a healthy young adult is most accurate?

  1. It rises primarily through increased stroke volume with little change in heart rate
  2. It rises primarily through increased heart rate with little change in stroke volume Correct answer.
  3. It remains constant until maximal effort
  4. It falls as peripheral resistance increases

Explanation

As exercise intensity rises, heart rate increases substantially while stroke volume plateaus early, so cardiac output is driven mainly by rate at higher workloads. Peripheral resistance falls rather than rises.

Question 12General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which medication class most commonly causes exercise-induced bronchoconstriction to worsen through beta-blockade?

  1. Inhaled corticosteroids
  2. Short-acting beta-2 agonists
  3. Nonselective beta-blockers Correct answer.
  4. Leukotriene receptor antagonists

Explanation

Nonselective beta-blockers antagonize beta-2 receptors in the airway and can precipitate or worsen bronchospasm. Inhaled corticosteroids and leukotriene antagonists treat airway inflammation, and beta-2 agonists are bronchodilators.

Question 13General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which physiologic change is most characteristic of long-term aerobic endurance training?

  1. Increased maximal stroke volume and plasma volume Correct answer.
  2. Increased resting heart rate
  3. Reduced mitochondrial enzyme activity
  4. Reduced capillary density in trained muscle

Explanation

Endurance training increases plasma volume, stroke volume, and capillary and mitochondrial density while lowering resting heart rate. These adaptations enhance oxygen delivery and utilization.

Question 14General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

An athlete with type 1 diabetes plans a prolonged morning run. Which strategy best reduces the risk of exercise-associated hypoglycemia?

  1. Skip breakfast to lower glucose
  2. Reduce pre-exercise insulin and consume carbohydrate before and during exercise Correct answer.
  3. Exercise immediately after a large insulin bolus
  4. Take extra rapid-acting insulin before exercise

Explanation

Adjusting insulin dosing and adding carbohydrate around exercise reduces hypoglycemia risk in type 1 diabetes. Additional insulin or fasting increases the risk of low glucose during activity.

Question 15General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which statement about the female athlete triad is most accurate?

  1. It is defined solely by disordered eating behaviors
  2. It requires all three components to be present for any clinical concern
  3. It affects only elite adult athletes
  4. It involves low energy availability, menstrual dysfunction, and low bone mineral density Correct answer.

Explanation

The triad comprises low energy availability, menstrual dysfunction, and reduced bone mineral density, and the components exist on a spectrum rather than requiring all three. It can affect athletes at many levels, including adolescents.

Question 16General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which of the following best explains why a periodized training program improves performance more than the same total volume performed without variation?

  1. It alternates stress and recovery to optimize adaptation and reduce overtraining Correct answer.
  2. It relies on detraining to enhance fitness
  3. It eliminates the need for recovery periods
  4. It keeps intensity constant to avoid injury

Explanation

Periodization systematically varies training load and recovery to promote adaptation while limiting overreaching. Constant loading or eliminating recovery impairs adaptation and raises overtraining risk.

Question 17General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 16-year-old basketball player reports anterior knee pain that worsens with jumping and is reproduced by resisted knee extension. Which diagnosis is most likely?

  1. Patellar tendinopathy Correct answer.
  2. Iliotibial band syndrome
  3. Medial collateral ligament sprain
  4. Achilles tendinopathy

Explanation

Anterior knee pain with jumping and pain on resisted knee extension localizes to the patellar tendon, consistent with patellar tendinopathy. IT band and Achilles problems produce lateral knee and posterior ankle pain, respectively.

Question 18General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which nutritional supplement has the strongest evidence for modestly improving high-intensity, short-duration performance?

  1. Creatine monohydrate Correct answer.
  2. Beta-carotene
  3. Glucosamine
  4. Vitamin E

Explanation

Creatine monohydrate increases phosphocreatine availability and has consistent evidence for improving short-duration, high-intensity performance. The other options lack such performance evidence.

Question 19General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which mechanism best explains the analgesic effect of topical diclofenac applied over a tendinopathic area?

  1. Local inhibition of cyclooxygenase and reduced prostaglandin synthesis Correct answer.
  2. Systemic opioid receptor activation
  3. Blockade of voltage-gated calcium channels
  4. Central serotonin reuptake inhibition

Explanation

Topical NSAIDs act locally to inhibit cyclooxygenase and lower prostaglandin-mediated pain and inflammation. They do not primarily act through opioid, calcium channel, or serotonergic mechanisms.

Question 20General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which preparticipation screening question is specifically aimed at identifying a risk for sudden cardiac death in young athletes?

  1. History of a prior ankle sprain
  2. History of seasonal allergies
  3. Family history of sudden cardiac death before age 50 Correct answer.
  4. History of asthma requiring an inhaler

Explanation

A family history of premature sudden cardiac death raises concern for inherited cardiomyopathies or channelopathies. Asthma, prior sprains, and allergies are relevant to participation but not to sudden cardiac death risk.

Question 21General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which statement about lactic acid production during intense exercise is most accurate?

  1. It permanently acidifies muscle until rest
  2. It occurs only when oxygen is completely absent
  3. It reflects glycolytic flux exceeding mitochondrial clearance and is a usable fuel Correct answer.
  4. It directly causes muscle damage and delayed soreness

Explanation

Lactate forms when glycolytic rate outpaces mitochondrial oxidation and is itself an important fuel that is cleared and reused. It is not the cause of delayed-onset soreness and does not require absolute anaerobiosis.

Question 22General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A powerlifter using a high-dose anabolic-androgenic steroid regimen presents with elevated blood pressure and dyslipidemia. Which mechanism best explains the lipid changes?

  1. Reduced hepatic triglyceride production
  2. Increased HDL synthesis with reduced LDL
  3. Increased hepatic lipase activity raising LDL and lowering HDL Correct answer.
  4. Enhanced clearance of LDL by upregulation of receptors

Explanation

Anabolic steroids increase hepatic lipase activity, which lowers HDL and raises LDL, contributing to atherogenic lipid profiles. They do not enhance LDL clearance or raise HDL.

Question 23General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which factor most limits maximal oxygen consumption in a healthy trained individual?

  1. Mitochondrial density in skeletal muscle
  2. Hemoglobin oxygen saturation at rest
  3. Pulmonary diffusion capacity
  4. Maximal cardiac output Correct answer.

Explanation

In healthy individuals, VO2max is primarily limited by maximal cardiac output and oxygen delivery rather than pulmonary diffusion. Mitochondrial density influences submaximal and peripheral extraction but is not the principal ceiling.

Question 24General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

Which biomechanical principle best explains why a longer moment arm at a joint increases the torque required from the muscles acting on it?

  1. Torque depends only on the mass of the limb
  2. Torque equals force divided by the moment arm
  3. Torque is independent of the distance from the axis
  4. Torque equals force multiplied by the perpendicular distance from the axis Correct answer.

Explanation

Torque is the product of force and the perpendicular distance (moment arm) from the axis of rotation. A longer moment arm increases torque for a given force, requiring greater muscle force to control the joint.

Question 25General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A runner training at altitude for several weeks returns to sea level. Which adaptation most contributes to improved endurance performance?

  1. Reduced plasma volume
  2. Decreased mitochondrial density
  3. Lowered erythropoietin levels
  4. Increased red blood cell mass and hemoglobin Correct answer.

Explanation

Chronic altitude exposure raises erythropoietin and increases red blood cell mass and hemoglobin, improving oxygen-carrying capacity on return to sea level. Plasma volume and mitochondrial density do not fall as an adaptive benefit.

Question 26General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 24-year-old recreational runner asks about proper hydration during a marathon. Which statement about fluid and electrolyte balance during prolonged exercise is most accurate?

  1. Dehydration always improves performance by reducing body weight.
  2. Sodium supplementation is unnecessary because sweat is isotonic.
  3. Overconsumption of hypotonic fluids can lead to dilutional hyponatremia. Correct answer.
  4. Thirst is a reliable indicator of severe dehydration during exercise.

Explanation

Drinking excessive hypotonic fluids without adequate sodium replacement can dilute serum sodium, causing exercise-associated hyponatremia, which may lead to cerebral edema and death. Sweat is hypotonic, so sodium loss occurs, and thirst is blunted during exercise, making it an unreliable guide to severe dehydration. Dehydration impairs performance, not improves it.

Question 27General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 30-year-old cyclist is prescribed a nonsteroidal anti-inflammatory drug (NSAID) for knee pain. Which statement best describes a potential interaction between NSAIDs and exercise?

  1. NSAIDs may impair renal function during dehydration and intense exercise. Correct answer.
  2. NSAIDs enhance muscle protein synthesis and improve recovery.
  3. NSAIDs increase sweat rate and improve thermoregulation.
  4. NSAIDs are contraindicated in all athletes because they cause tendon rupture.

Explanation

NSAIDs inhibit prostaglandin synthesis, which can reduce renal blood flow, especially when combined with dehydration and exercise, increasing the risk of acute kidney injury. They do not enhance protein synthesis or improve thermoregulation. While NSAIDs carry some risk, they are not absolutely contraindicated in all athletes.

Question 28General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

During a preparticipation physical evaluation, which historical feature is most suggestive of a condition associated with sudden cardiac death in a young athlete?

  1. A history of exertional syncope or near-syncope. Correct answer.
  2. A history of seasonal allergic rhinitis.
  3. A history of a single febrile seizure in infancy.
  4. A history of mild asthma controlled with an inhaler.

Explanation

Exertional syncope or near-syncope raises concern for structural heart disease or arrhythmia, such as hypertrophic cardiomyopathy or long QT syndrome, which are linked to sudden cardiac death. Asthma, febrile seizures, and allergic rhinitis are common and not typically associated with sudden cardiac death in athletes.

Question 29General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 22-year-old sprinter performs a vertical jump. Which biomechanical principle best explains the improved jump height when the countermovement (rapid squat before takeoff) is used?

  1. Decreased rate of force development.
  2. Increased moment arm at the knee joint.
  3. Reduced muscle spindle sensitivity.
  4. Storage and release of elastic energy in the musculotendinous unit. Correct answer.

Explanation

The countermovement stretch-shortening cycle stores elastic energy in tendons and other series elastic components, which is released during the subsequent concentric phase, enhancing force and power output. It does not increase the moment arm or decrease the rate of force development; in fact, it enhances the rate of force development.

Question 30General Principles of Sports Medicine (exercise physiology, biomechanics, pharmacology, nutrition, preparticipation evaluation)

A 28-year-old endurance athlete wants to optimize carbohydrate intake during a 3-hour cycling race. Which strategy is most consistent with current sports nutrition guidelines?

  1. Consume a single large dose of 200 grams of carbohydrate 30 minutes before the race.
  2. Consume 60–90 grams of carbohydrate per hour from multiple transportable sources. Correct answer.
  3. Consume only water and electrolytes throughout the race.
  4. Avoid carbohydrates during exercise to enhance fat oxidation.

Explanation

Current guidelines recommend 60–90 grams of carbohydrate per hour during prolonged endurance exercise, using multiple transportable carbohydrates (e.g., glucose and fructose) to increase absorption and oxidation rates. A single large dose before exercise can cause gastrointestinal distress, and avoiding carbohydrates or consuming only water impairs performance.

Question 31Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 19-year-old college basketball player collapses during a game and is found to have hypertrophic cardiomyopathy on evaluation. Which activity restriction is most appropriate?

  1. Participation limited to only noncontact sports such as swimming
  2. Full participation if the resting echocardiogram is normal
  3. Participation allowed with prophylactic beta-blockade alone
  4. Restriction from all competitive athletics except low-intensity class IA sports Correct answer.

Explanation

Hypertrophic cardiomyopathy with any high-risk features or symptoms generally warrants restriction from most competitive sports, with only low-intensity class IA activities permitted. Beta-blockade does not make competitive participation safe, and a normal resting echo does not exclude risk.

Question 32Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which finding on preparticipation screening most strongly suggests Marfan syndrome and warrants further cardiac evaluation?

  1. Isolated systolic murmur at the left sternal border
  2. Family history of early myocardial infarction
  3. Bilateral pes planus with genu valgum
  4. Arm span greater than height with a positive wrist sign Correct answer.

Explanation

Arachnodactyly with a positive wrist (Walker) or thumb sign plus increased arm span-to-height ratio are systemic features of Marfan syndrome, which requires aortic root imaging. Isolated murmurs and pes planus are nonspecific.

Question 33Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 24-year-old marathon runner has exercise-associated collapse with a core temperature of 41°C, altered mental status, and hot dry skin. Which is the most important immediate intervention?

  1. Rapid cold-water immersion with concurrent airway and circulatory support Correct answer.
  2. Oral rehydration with a hypertonic saline solution
  3. Intravenous dantrolene administration
  4. Passive cooling with fans and ice packs to the groin

Explanation

Exertional heat stroke is a medical emergency requiring immediate aggressive cooling, with cold-water immersion being the preferred method, alongside airway, breathing, and circulation support. Dantrolene is not effective for exertional heat stroke.

Question 34Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which electrolyte abnormality is most characteristic of exertional hyponatremia in endurance athletes?

  1. Serum sodium above 145 mEq/L with high serum osmolality
  2. Serum sodium below 135 mEq/L with normal or low serum osmolality Correct answer.
  3. Serum potassium above 6.0 mEq/L with peaked T waves
  4. Serum calcium below 7.0 mg/dL with Chvostek sign

Explanation

Exertional hyponatremia reflects dilutional low serum sodium with inappropriately low or normal osmolality, often from excessive hypotonic fluid intake. Hypernatremia and hyperkalemia are not characteristic.

Question 35Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 21-year-old football player has a first-time seizure during practice. Which action is most appropriate before return to contact sport?

  1. Immediate return to play if the seizure lasted under 2 minutes
  2. Return to play after 24 hours of observation alone
  3. Complete neurologic evaluation and imaging, and withhold contact until the cause is clarified Correct answer.
  4. Permanent disqualification from all contact sports

Explanation

A first seizure in an athlete requires evaluation to identify structural, metabolic, or other causes before clearance. Return to play should await this assessment, since the risk depends on the underlying etiology.

Question 36Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which is the most reliable field-side sign of concussion in a collision athlete?

  1. Presence of a headache alone
  2. Any observed loss of consciousness or amnesia with symptom provocation on SCAT5 Correct answer.
  3. Transient neck pain without neurologic symptoms
  4. A single episode of dizziness on standing

Explanation

Observed loss of consciousness, amnesia, and provoked symptoms on standardized assessment (SCAT5) are the strongest indicators of concussion. Isolated headache, neck pain, or orthostatic dizziness are nonspecific.

Question 37Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 17-year-old wrestler is found to have a blood glucose of 480 mg/dL with ketones and pH 7.20. Which is the most appropriate initial management?

  1. Intravenous fluid resuscitation with isotonic saline and an insulin infusion Correct answer.
  2. Subcutaneous rapid-acting insulin alone with oral fluids
  3. Immediate return to competition after glucose normalization
  4. Oral hypoglycemic therapy and outpatient follow-up

Explanation

Diabetic ketoacidosis requires isotonic fluid resuscitation and an intravenous insulin infusion with electrolyte monitoring. Subcutaneous insulin alone is inadequate and outpatient management is unsafe.

Question 38Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which recommendation applies to an athlete with type 1 diabetes who wishes to compete in endurance events?

  1. Discontinuation of insulin on competition days
  2. Complete avoidance of aerobic exercise
  3. Reliance on symptoms alone to guide glucose management
  4. Frequent glucose monitoring with individualized carbohydrate and insulin adjustment around exercise Correct answer.

Explanation

Athletes with type 1 diabetes can safely compete with frequent glucose monitoring and individualized adjustment of carbohydrate intake and insulin. Exercise is beneficial and insulin should not be stopped entirely.

Question 39Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 20-year-old cross-country runner has fatigue, pallor, and a hemoglobin of 9.5 g/dL with a low ferritin. Which is the most appropriate next step?

  1. Erythropoietin therapy
  2. Immediate blood transfusion
  3. Restriction from all training until hemoglobin normalizes
  4. Iron supplementation with evaluation for the source of iron deficiency Correct answer.

Explanation

Iron deficiency anemia in an athlete should be treated with iron replacement and a search for the cause, including gastrointestinal or menstrual sources. Transfusion and erythropoietin are not indicated for mild anemia.

Question 40Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which inherited condition most commonly causes sudden cardiac death in young athletes and is suggested by a prolonged QT interval on ECG?

  1. Aortic stenosis
  2. Long QT syndrome Correct answer.
  3. Wolff-Parkinson-White syndrome
  4. Brugada syndrome

Explanation

Long QT syndrome is an inherited channelopathy associated with syncope and sudden cardiac death, identified by a prolonged corrected QT interval. WPW and Brugada have different ECG signatures.

Question 41Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 22-year-old soccer player has mononucleosis with splenomegaly. Which is the most appropriate guidance for return to play?

  1. Permanent avoidance of all contact sports
  2. Avoid contact activity until splenomegaly resolves, typically at least 4 weeks Correct answer.
  3. Return after 3 days of rest
  4. Return to contact play immediately once fever resolves

Explanation

Infectious mononucleosis with splenomegaly carries a risk of splenic rupture, so contact activity should be avoided until the spleen has returned to normal size, generally at least 4 weeks. Fever resolution alone does not indicate safe return.

Question 42Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which finding in a young athlete suggests exercise-induced bronchoconstriction rather than a cardiac cause of exertional dyspnea?

  1. Cough and wheeze that begin after exercise and improve with a short-acting bronchodilator Correct answer.
  2. Palpitations with a documented irregular rhythm
  3. Chest pain that reliably occurs at peak exertion
  4. Syncope during sprinting

Explanation

Exercise-induced bronchoconstriction typically produces cough, wheeze, and chest tightness after exertion and responds to bronchodilators. Exertional chest pain, syncope, and arrhythmia raise concern for cardiac causes.

Question 43Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 25-year-old swimmer has hematuria and a creatinine of 2.8 mg/dL after a bout of rhabdomyolysis. Which is the most important preventive measure to reduce acute kidney injury?

  1. Loop diuretics to increase urine output
  2. Restriction of all oral fluids
  3. Nonsteroidal anti-inflammatory drugs for pain control
  4. Aggressive intravenous fluid resuscitation to maintain high urine output Correct answer.

Explanation

Early aggressive intravenous fluid resuscitation to maintain urine output reduces cast nephropathy in rhabdomyolysis. NSAIDs are nephrotoxic and should be avoided, and fluid restriction worsens injury.

Question 44Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which is the most appropriate recommendation for an athlete with a bleeding disorder such as hemophilia who wishes to participate in collision sports?

  1. Individualized risk assessment with hematology input and appropriate factor prophylaxis Correct answer.
  2. Permanent disqualification from all sports
  3. Blanket permission to participate in any contact sport
  4. Participation only with nonsteroidal anti-inflammatory drugs on hand

Explanation

Athletes with hemophilia can participate in many sports after individualized risk assessment and appropriate factor replacement, with hematology involvement. Blanket permission or disqualification ignores individual risk.

Question 45Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 30-year-old cyclist has palpitations and an ECG showing a delta wave with a short PR interval. Which is the most appropriate management before competitive return?

  1. Beta-blockade alone with immediate return to play
  2. Disqualification from all exercise permanently
  3. Reassurance and unrestricted competition
  4. Electrophysiology evaluation for possible accessory pathway ablation Correct answer.

Explanation

Wolff-Parkinson-White syndrome with a delta wave requires electrophysiology evaluation because of the risk of rapid conduction and sudden death; ablation is often curative. Reassurance or beta-blockade alone is inadequate.

Question 46Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which is the most appropriate screening recommendation for sickle cell trait in athletes?

  1. Routine exclusion from all competitive sports
  2. Screen with hemoglobin electrophoresis when status is unknown, with counseling on exertional sickling precautions Correct answer.
  3. Mandatory hydroxyurea therapy for all carriers
  4. No screening because the trait is clinically insignificant

Explanation

Sickle cell trait can cause exertional sickling and sudden collapse under extreme conditions, so screening with hemoglobin electrophoresis when status is unknown and counseling on hydration and pacing are recommended. Hydroxyurea is not indicated for trait.

Question 47Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 16-year-old athlete has a resting heart rate of 48 bpm, is asymptomatic, and is a well-trained distance runner. Which is the most appropriate action?

  1. Restriction from all exercise
  2. No further workup, as sinus bradycardia is a normal training adaptation Correct answer.
  3. Echocardiography to exclude structural disease in all cases
  4. Immediate pacemaker placement

Explanation

Sinus bradycardia is a common physiologic adaptation to endurance training in asymptomatic athletes and requires no intervention. Further workup is reserved for symptoms or abnormal findings.

Question 48Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which is the most appropriate initial management for an athlete with acute infectious gastroenteritis and mild dehydration before return to play?

  1. Antibiotics for all cases regardless of cause
  2. Loperamide with immediate return to play
  3. Immediate return to play to maintain conditioning
  4. Oral rehydration and gradual return once hydration and symptoms improve Correct answer.

Explanation

Most infectious gastroenteritis is self-limited and managed with oral rehydration, with return once hydration and symptoms improve. Antibiotics are not indicated for most cases, and antimotility agents can be harmful.

Question 49Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

A 28-year-old weightlifter develops flank pain and dark urine after an intense workout. Which laboratory finding best supports rhabdomyolysis?

  1. Elevated lipase with epigastric pain
  2. Elevated creatine kinase with myoglobinuria Correct answer.
  3. Elevated troponin with ST elevation
  4. Elevated D-dimer with leg swelling

Explanation

Rhabdomyolysis is marked by elevated creatine kinase and myoglobinuria, which can cause acute kidney injury. Troponin, lipase, and D-dimer reflect other processes.

Question 50Medical Issues in Athletes (cardiac, pulmonary, neurologic, endocrine, hematologic, renal, gastrointestinal, infectious disease)

Which cardiac condition is the most common cause of sudden cardiac death in athletes over age 35?

  1. Coronary artery disease Correct answer.
  2. Hypertrophic cardiomyopathy
  3. Congenital long QT syndrome
  4. Myocarditis

Explanation

In athletes older than 35, atherosclerotic coronary artery disease is the leading cause of sudden cardiac death, whereas congenital and inherited conditions predominate in younger athletes.