I85PREP
⌘ K
ABPMR Sports Medicine study materials
ABPMR Sports Medicine study resources

ABPMR Sports Medicine practice questions

One question at a time. Build your ABPMR Sports Medicine understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 24-year-old soccer player sustains a noncontact knee injury and presents with a tense effusion. Which examination test is most sensitive for an anterior cruciate ligament tear?

  1. Dial test
  2. Lachman test Correct answer.
  3. McMurray test
  4. Thessaly test

Explanation

The Lachman test is performed with the knee near 20 to 30 degrees of flexion, which relaxes the hamstrings and allows direct assessment of anterior tibial translation; it has the highest sensitivity for acute ACL disruption. The pivot shift is highly specific but difficult to elicit in an irritable, swollen knee. Meniscal and rotational tests do not assess the ACL.

Question 2Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Recurrent anterior shoulder dislocation most commonly produces avulsion of which structure?

  1. Long head of biceps anchor
  2. Anterior inferior glenoid labrum Correct answer.
  3. Coracoclavicular ligament
  4. Posterior glenoid labrum and capsule

Explanation

The Bankart lesion is avulsion of the anteroinferior labrum and capsule from the glenoid rim and is the expected lesion after anterior dislocation. It is often accompanied by capsular stretching and, in some patients, a bony Bankart or Hill-Sachs impaction.

Question 3Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which ligament is injured most often in a lateral ankle sprain?

  1. Deltoid ligament
  2. Calcaneofibular ligament of the lateral ankle
  3. Posterior talofibular ligament
  4. Anterior talofibular ligament Correct answer.

Explanation

In an inversion injury the anterior talofibular ligament is the first structure to fail and is the most frequently torn, followed by the calcaneofibular ligament and only rarely the posterior talofibular ligament. The deltoid is a medial stabilizer injured with forced eversion.

Question 4Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 13-year-old basketball player reports 3 months of anterior knee pain centered on a tender bony prominence at the tibial tuberosity, worse with jumping. What is the diagnosis?

  1. Patellar tendinopathy
  2. Sinding-Larsen-Johansson syndrome
  3. Plica syndrome
  4. Osgood-Schlatter disease Correct answer.

Explanation

Traction apophysitis of the tibial tubercle in a skeletally immature athlete is Osgood-Schlatter disease. Symptoms resolve as the apophysis closes, so treatment is load management, activity modification, and reassurance rather than immobilization.

Question 5Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which muscle group is the most common site of strain in a sprinter with acute posterior thigh pain?

  1. Quadriceps
  2. Hamstrings Correct answer.
  3. Adductor longus
  4. Iliopsoas

Explanation

The hamstrings, particularly the biceps femoris long head, are the most frequently strained group in sprinting because they must eccentrically decelerate hip flexion and knee extension during terminal swing. Most injuries occur at the proximal myotendinous junction.

Question 6Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Lateral epicondylitis most commonly involves the origin of which tendon?

  1. Brachioradialis origin
  2. Supinator muscle
  3. Extensor carpi radialis brevis Correct answer.
  4. Flexor carpi ulnaris tendon at the medial epicondyle

Explanation

Lateral elbow tendinopathy involves the origin of the extensor carpi radialis brevis at the lateral epicondyle, reproducing pain with resisted wrist extension and gripping. Histology shows angiofibroblastic degeneration rather than acute inflammation, which is why progressive loading rather than rest alone is the mainstay of treatment.

Question 7Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

An adolescent gymnast develops focal low back pain that worsens with extension. Which structure is involved in spondylolysis?

  1. Vertebral body
  2. Spinous process
  3. Facet joint capsule
  4. Pars interarticularis Correct answer.

Explanation

Spondylolysis is a stress fracture of the pars interarticularis, most often at L5, produced by repetitive extension and rotation. Early lesions may be radiographically silent, so bone scan or MRI is used when suspicion is high.

Question 8Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A recreational basketball player felt a pop at the back of the heel and cannot push off. Which test best detects a complete Achilles tendon rupture?

  1. Thompson test Correct answer.
  2. Windlass test
  3. Silfverskiöld test
  4. Ober test

Explanation

The Thompson test squeezes the calf with the patient prone; absence of plantarflexion indicates loss of Achilles continuity. A palpable gap, weakness of plantarflexion, and a positive Matles test support the diagnosis.

Question 9Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 22-year-old hockey player has 6 months of deep groin pain. Hip flexion, adduction, and internal rotation reproduce pain, and internal rotation is limited to 5 degrees. What is the most likely diagnosis?

  1. Adductor longus strain at the pubic origin
  2. Hip flexor tendinitis
  3. Femoroacetabular impingement Correct answer.
  4. Sports hernia

Explanation

Pain with the FADIR (flexion-adduction-internal rotation) test plus restricted internal rotation in a young athlete is characteristic of femoroacetabular impingement, often from cam morphology. Plain radiographs and MRI confirm alpha angle elevation and associated labral tearing.

Question 10Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 22-year-old basketball player pivots, feels a pop, and develops a tense knee effusion within 2 hours. What is the most likely diagnosis?

  1. Meniscal tear
  2. Patellar dislocation
  3. MCL sprain
  4. ACL tear Correct answer.

Explanation

A hemarthrosis that develops within a few hours of injury indicates an intra-articular source of bleeding, and in a pivoting athlete an ACL tear is the leading cause. Meniscal tears usually produce a delayed and smaller effusion, whereas medial collateral sprains are extra-articular and cause little fluid.

Question 11Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

After a seizure, a patient holds the arm in internal rotation and cannot externally rotate it. An axillary radiograph shows the humeral head posterior to the glenoid. What is the diagnosis?

  1. Acromioclavicular separation
  2. Posterior dislocation Correct answer.
  3. Inferior subluxation
  4. Anterior dislocation

Explanation

Posterior shoulder dislocation classically follows seizures or electrical shock and presents with a locked arm in internal rotation and limited external rotation. It is easily missed on a single AP view, so an axillary or scapular Y view is required.

Question 12Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 12-year-old pitcher reports progressive lateral shoulder pain with throwing, and radiographs show widening of the proximal humeral physis. What is the diagnosis?

  1. Capitellar osteochondritis dissecans
  2. Medial epicondyle apophysitis
  3. Little Leaguer's shoulder Correct answer.
  4. Ulnar collateral ligament sprain

Explanation

Repetitive throwing in a skeletally immature shoulder produces stress changes at the proximal humeral physis, known as Little Leaguer's shoulder, and is treated with rest from throwing followed by a graded return. Osteochondritis dissecans affects the capitellum and causes lateral elbow pain with catching.

Question 13Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 40-year-old has acute low back pain radiating down the posterior thigh and lateral foot, with an absent ankle reflex. Which nerve root is most likely affected?

  1. L5 nerve root
  2. S2 nerve root
  3. S1 nerve root Correct answer.
  4. L4 nerve root

Explanation

S1 radiculopathy from an L5-S1 disc herniation produces posterior leg and lateral foot pain, a diminished ankle reflex, and weakness of ankle plantarflexion. The L4 and L5 roots supply different dermatomes and reflexes, which allows clinical localization.

Question 14Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which test best supports a diagnosis of chronic exertional compartment syndrome?

  1. Nerve conduction studies of the peroneal nerve
  2. Resting compartment pressure measurement before exercise
  3. Post-exercise compartment pressure testing Correct answer.
  4. MRI of the lower leg performed at rest

Explanation

Resting pressures are usually normal in chronic exertional compartment syndrome, so the diagnosis depends on elevated needle-catheter pressures measured after the patient exercises enough to reproduce symptoms. Commonly cited thresholds include a pressure of 30 mmHg or more at 1 minute after exercise.

Question 15Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which examination maneuver best isolates the ulnar collateral ligament of the elbow?

  1. Cozen test with resisted wrist extension
  2. Moving valgus stress test Correct answer.
  3. Tinel percussion over the cubital tunnel
  4. Elbow flexion test for cubital tunnel syndrome

Explanation

Applying a valgus load through the arc of flexion, as in the moving valgus stress test, stresses the ulnar collateral ligament and reproduces medial elbow pain in throwing athletes. The other tests assess lateral tendinopathy or ulnar neuropathy.

Question 16Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 62-year-old felt a pop while climbing stairs and now has a palpable gap below the patella, patella alta, and inability to extend the knee. What is the diagnosis?

  1. Tibial tubercle avulsion
  2. Patellar tendon rupture Correct answer.
  3. Patellar fracture
  4. Quadriceps tendon rupture

Explanation

A gap inferior to the patella with a high-riding patella and loss of active extension indicates a patellar tendon rupture, which usually requires early surgical repair. A quadriceps tendon rupture produces the opposite patellar position, sitting low with a gap above the patella.

Question 17Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 12-year-old with obesity and a limp describes 2 weeks of knee pain, and hip examination shows obligate external rotation with markedly restricted internal rotation. What is the diagnosis?

  1. Legg-Calvé-Perthes disease
  2. Slipped capital femoral epiphysis Correct answer.
  3. Transient synovitis of the hip
  4. Greater trochanteric pain syndrome

Explanation

Referred knee pain with obligate external rotation and restricted internal rotation in a peripubertal child with obesity suggests slipped capital femoral epiphysis, which needs urgent stabilization to prevent further slip and avascular necrosis. Transient synovitis is typically acute, self-limited, and does not restrict rotation to this degree.

Question 18Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which fifth metatarsal fracture location carries the highest risk of nonunion?

  1. Tuberosity avulsion
  2. Distal diaphyseal spiral fracture pattern
  3. Cuboid impaction
  4. Metaphyseal-diaphyseal junction Correct answer.

Explanation

A Jones fracture occurs at the metaphyseal-diaphyseal junction, a watershed vascular zone, and is prone to delayed union or nonunion, often requiring nonweightbearing immobilization or intramedullary screw fixation. Tuberosity avulsions are typically extra-articular and heal reliably.

Question 19Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A football player develops transient burning down one arm with mild weakness after a tackle, and symptoms resolve within 10 minutes. What is the most likely diagnosis?

  1. Brachial plexus neuropraxia Correct answer.
  2. Rotator cuff strain
  3. Cervical spinal cord contusion
  4. Clavicle fracture

Explanation

A stinger is a transient brachial plexus neuropraxia from traction or compression at the neck and shoulder, producing unilateral burning, dysesthesia, and weakness that resolve within minutes. Bilateral symptoms or persistent deficits raise concern for cervical cord injury and require formal workup.

Question 20Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

After a first-time lateral patellar dislocation in a young athlete, which structure is most commonly injured?

  1. Anterior cruciate ligament
  2. Iliotibial band
  3. Medial patellofemoral ligament Correct answer.
  4. Lateral retinaculum

Explanation

The medial patellofemoral ligament is the primary restraint to lateral patellar translation and is torn in most acute lateral dislocations, often with a medial patellar avulsion or characteristic bone bruise pattern on MRI. The lateral retinaculum tends to stretch rather than rupture.

Question 21Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A small vertical avulsion fracture off the lateral tibial plateau is seen on knee radiographs. With which injury is this finding most strongly associated?

  1. Popliteus tendon avulsion from the lateral femoral condyle
  2. Superficial medial collateral ligament avulsion
  3. Lateral meniscal root avulsion
  4. Anterolateral ligament avulsion with ACL tear Correct answer.

Explanation

A Segond fracture represents avulsion of the anterolateral ligament complex and is strongly associated with an ACL tear, frequently with an accompanying meniscal injury. Its presence should prompt MRI and anticipatory counseling about ligament reconstruction.

Question 22Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A college pitcher has 20 degrees less internal rotation and 20 degrees more external rotation in his throwing shoulder than in the nonthrowing shoulder. What is the term for this pattern?

  1. Scapular dyskinesis with asymmetric scapular motion
  2. Posterior capsular contracture syndrome
  3. Adhesive capsulitis of the shoulder
  4. Glenohumeral internal rotation deficit Correct answer.

Explanation

Glenohumeral internal rotation deficit describes the adaptive loss of internal rotation with compensatory external rotation in the dominant throwing shoulder, reflecting posterior capsular tightness and osseous adaptation. When the total arc of motion is preserved and the shoulder is asymptomatic, it may need no treatment; with pain, posterior capsule stretching and scapular control are emphasized.

Question 23Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which cervical spine finding is considered an absolute contraindication to continued participation in collision football?

  1. Spear tackler's spine Correct answer.
  2. Healed clay shoveler's fracture
  3. Congenital block vertebra
  4. Cervical disc herniation

Explanation

Spear tackler's spine combines cervical stenosis, loss of normal cervical lordosis, and a history of spear tackling, and it carries an unacceptable risk of catastrophic cord injury, making it an absolute contraindication to collision sports. Other cervical conditions are judged individually based on stability, stenosis, and neurologic status.

Question 24Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

In a multiligament knee dislocation, which artery is at highest risk of injury?

  1. Femoral artery
  2. Anterior tibial artery
  3. Popliteal artery Correct answer.
  4. Peroneal artery

Explanation

The popliteal artery is tethered between the distal femur and proximal tibia, so a knee dislocation can stretch, occlude, or rupture it, with a high risk of limb loss if unrecognized. Ankle-brachial index measurement and CT angiography are indicated after reduction.

Question 25Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which examination maneuver is most suggestive of a syndesmotic ankle injury?

  1. Windlass test
  2. Talar tilt test
  3. Anterior drawer test of the ankle
  4. Squeeze test at mid-calf Correct answer.

Explanation

The squeeze test compresses the tibia and fibula above the ankle and provokes distal syndesmotic pain; external rotation stress and the cotton test provide additional support. Anterior drawer and talar tilt assess the lateral ligament complex rather than the tibiofibular syndesmosis.

Question 26Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 20-year-old soccer player rolls his ankle inward during a tackle. He has swelling and tenderness over the lateral malleolus. Which ligament is most commonly injured in this pattern?

  1. Deltoid ligament
  2. Anterior talofibular ligament Correct answer.
  3. Calcaneofibular ligament
  4. Posterior talofibular ligament

Explanation

Inversion injuries typically injure the lateral ankle ligaments in a predictable sequence, beginning with the anterior talofibular ligament. The anterior talofibular ligament is the weakest and most commonly torn ligament in a lateral ankle sprain.

Question 27Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

Which rotator cuff tendon is most frequently involved in degenerative full-thickness tears?

  1. Supraspinatus Correct answer.
  2. Infraspinatus
  3. Subscapularis
  4. Teres minor

Explanation

The supraspinatus passes beneath the acromion and is subjected to repetitive compression and wear. Degenerative rotator cuff tears most often begin at the supraspinatus insertion.

Question 28Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

In a sprinter with acute posterior thigh pain, which muscle is most commonly strained?

  1. Semitendinosus
  2. Adductor magnus
  3. Semimembranosus
  4. Biceps femoris Correct answer.

Explanation

Acute hamstring strains most often involve the long head of the biceps femoris. This muscle is subjected to high eccentric loads during terminal swing phase of sprinting.

Question 29Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A young athlete falls on an outstretched hand and has tenderness in the anatomic snuffbox. Which complication is most characteristic of a scaphoid waist fracture?

  1. Recurrent elbow instability after a sprain
  2. Extensor tendon rupture at the wrist
  3. Avascular necrosis of the proximal pole Correct answer.
  4. Median nerve compression at the wrist

Explanation

The scaphoid receives a retrograde blood supply, with the main vessel entering the distal portion and traveling proximally. A waist fracture can disrupt this supply and lead to avascular necrosis or nonunion of the proximal pole.

Question 30Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A football player receives a valgus force to the knee with the foot planted. He has medial knee pain and laxity with valgus stress at 30 degrees of flexion. Which structure is most likely injured?

  1. Anterior cruciate ligament
  2. Lateral collateral ligament
  3. Medial collateral ligament Correct answer.
  4. Posterior cruciate ligament

Explanation

The medial collateral ligament is the primary restraint to valgus stress at the knee. Testing at 30 degrees of flexion isolates the collateral ligament from the cruciate ligaments and posterior capsule.

Question 31Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A cyclist falls onto the point of the shoulder. Examination shows tenderness over the acromioclavicular joint and a step-off between the distal clavicle and acromion. Which injury is most likely?

  1. Clavicle shaft fracture
  2. Acromioclavicular separation Correct answer.
  3. Full-thickness rotator cuff tear
  4. Posterior shoulder dislocation

Explanation

A direct blow to the superior acromion drives the scapula downward and can disrupt the acromioclavicular ligaments. A visible step-off between the distal clavicle and acromion supports acromioclavicular joint separation.

Question 32Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 13-year-old basketball player has anterior knee pain localized to the tibial tubercle that worsens with jumping. Radiographs show fragmentation of the tibial tubercle. What is the diagnosis?

  1. Osgood-Schlatter disease Correct answer.
  2. Osteochondritis dissecans of the femoral condyle
  3. Patellar tendinopathy
  4. Sinding-Larsen-Johansson disease

Explanation

Osgood-Schlatter disease is a traction apophysitis at the tibial tubercle that occurs during the adolescent growth spurt. Repetitive jumping loads the patellar tendon insertion and can produce fragmentation of the tibial tubercle.

Question 33Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A lineman has midfoot pain after an axial load with the foot plantarflexed. There is swelling and pain with passive abduction of the forefoot. Which injury should be suspected?

  1. Achilles tendinopathy
  2. Lisfranc complex injury Correct answer.
  3. Plantar fasciitis
  4. Anterior ankle impingement

Explanation

An axial load on a plantarflexed foot can disrupt the tarsometatarsal ligament complex. Pain with passive forefoot abduction and midfoot swelling raises concern for a Lisfranc injury.

Question 34Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A 14-year-old gymnast has lateral elbow pain that worsens with weight-bearing on the hands. Radiographs show a lucent lesion in the capitellum with sclerotic margins. What is the most likely diagnosis?

  1. Lateral epicondylitis of the elbow
  2. Capitellar osteochondritis dissecans Correct answer.
  3. Medial epicondyle avulsion fracture
  4. Radial head fracture with displacement

Explanation

Repetitive compression across the radiocapitellar joint in a young gymnast can cause osteochondritis dissecans of the capitellum. Radiographs classically show a lucent capitellar lesion with sclerotic margins.

Question 35Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A high school wrestler has a direct blow to the iliac crest and localized pain with hip abduction and trunk side bending. Which diagnosis is most likely?

  1. Hip labral tear
  2. Adductor muscle strain
  3. Iliac crest contusion Correct answer.
  4. Sacroiliac joint dysfunction

Explanation

Direct trauma to the iliac crest can produce a hip pointer, which is a contusion of the iliac crest and overlying soft tissues. Pain is worsened by hip abduction and trunk side bending because these maneuvers tension the injured region.

Question 36Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A tennis player has dorsal wrist pain and a positive Finkelstein test. Which condition is most likely?

  1. de Quervain tenosynovitis Correct answer.
  2. Scaphoid fracture
  3. Triangular fibrocartilage tear
  4. Carpal tunnel syndrome

Explanation

de Quervain tenosynovitis involves the first dorsal extensor compartment, which contains the abductor pollicis longus and extensor pollicis brevis tendons. The Finkelstein test reproduces pain by stretching these tendons.

Question 37Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A marathon runner has medial tibial pain. Which finding is most consistent with medial tibial stress syndrome rather than a tibial stress fracture?

  1. A visible fracture line on plain radiographs
  2. Pain that persists at rest and awakens the patient
  3. Diffuse tenderness along a broad tibial area Correct answer.
  4. Focal tenderness confined to a 2-cm area

Explanation

Medial tibial stress syndrome produces diffuse tenderness along the posteromedial tibial border. A tibial stress fracture is more often associated with focal tenderness, rest pain, and eventually a visible fracture line.

Question 38Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A volleyball player has shoulder pain with overhead activity and weakness in external rotation. MRI shows an isolated tear of the teres minor. Which examination maneuver is most specific for this muscle?

  1. Hornblower sign Correct answer.
  2. Jobe test
  3. Lift-off test
  4. Cross-body adduction test

Explanation

The teres minor is a posterior cuff muscle that contributes to external rotation, especially with the arm abducted. The Hornblower sign detects teres minor weakness by assessing external rotation in that position.

Question 39Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A young weightlifter has deep anterior shoulder pain and a positive apprehension test at 90 degrees of abduction and external rotation. Which structure is most likely injured?

  1. Anterior labrum tear Correct answer.
  2. Subscapularis tendon tear
  3. Superior labrum tear
  4. Posterior labrum tear

Explanation

A positive apprehension test in abduction and external rotation suggests anterior shoulder instability. The anteroinferior labrum, as in a Bankart lesion, is the structure most commonly injured with anterior dislocation.

Question 40Musculoskeletal Medicine and Sports Injuries (knee, shoulder, hip, spine, extremity)

A hockey player sustains a direct blow to the lateral thigh. Three weeks later he has a firm, painful mass in the quadriceps, and radiographs show peripheral calcification. What is the diagnosis?

  1. Quadriceps muscle strain
  2. Femoral stress fracture
  3. Myositis ossificans Correct answer.
  4. Deep vein thrombosis

Explanation

Myositis ossificans can follow a quadriceps contusion and is characterized by heterotopic bone formation within the muscle. Peripheral calcification with a firm mass several weeks after trauma is typical.

Question 41Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A 19-year-old college football player has fever, sore throat, and fatigue, and his heterophile antibody test is positive. He wants to return to contact practice. Which finding is the most important reason to delay return to contact sports?

  1. Mild cervical lymphadenopathy
  2. Presence of splenomegaly Correct answer.
  3. Persistent fatigue
  4. Low-grade fever

Explanation

Infectious mononucleosis can cause splenic enlargement, and contact sports carry a risk of splenic rupture. Return to contact play is typically deferred until clinical recovery and resolution of splenomegaly, often for at least 4 weeks. Fever and fatigue are common but do not by themselves define the structural risk.

Question 42Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A cross-country skier develops cough and wheezing 10 minutes after finishing a cold-weather race. Spirometry shows a 12% drop in FEV1 after a standardized exercise challenge. Which medication is most appropriate to prevent symptoms before future races?

  1. Oral montelukast daily
  2. Oral prednisone before exercise
  3. Inhaled albuterol before exercise Correct answer.
  4. Inhaled fluticasone daily

Explanation

Exercise-induced bronchoconstriction is confirmed by a fall in FEV1 after exercise and is best prevented with a short-acting beta-agonist taken shortly before exercise. Daily inhaled corticosteroids or montelukast can be used as controller therapy but are not the first-line pre-exercise preventive choice. Oral prednisone is not appropriate for prophylaxis.

Question 43Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A healthy 20-year-old basketball player with sickle cell trait reports severe muscle cramps and dark urine after a hot, intense practice. Which is the most appropriate immediate concern?

  1. Splenic sequestration crisis
  2. Exertional rhabdomyolysis Correct answer.
  3. Aplastic crisis
  4. Acute chest syndrome

Explanation

Sickle cell trait can cause exertional sickling under heat, dehydration, and extreme exertion, leading to muscle breakdown and dark urine. Immediate management includes stopping exercise, cooling, hydrating, and checking for rhabdomyolysis. Splenic sequestration and aplastic crisis are more typical of sickle cell disease.

Question 44Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A wrestler has an annular scaly plaque on his forearm, and KOH microscopy shows hyphae. He is otherwise well. When can he return to wrestling according to common guidelines?

  1. Immediately, because tinea corporis is not contagious
  2. Only after a negative bacterial culture
  3. After one dose of oral antifungal
  4. After several days of antifungal therapy with lesion covered Correct answer.

Explanation

Tinea corporis is contagious and can spread through skin-to-skin contact in wrestling. Common return-to-play guidance requires antifungal treatment for several days and covering of the lesion. A negative bacterial culture is irrelevant because the cause is fungal.

Question 45Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

An adolescent with type 1 diabetes plans a morning soccer practice. Which is the most appropriate pre-exercise action?

  1. Exercise only after fasting for 6 hours
  2. Check blood glucose and consume carbohydrate if low Correct answer.
  3. Take an extra dose of long-acting insulin
  4. Skip insulin entirely that morning

Explanation

Exercise increases insulin sensitivity and can cause hypoglycemia, especially if insulin was taken and food intake is reduced. Checking glucose before exercise and taking carbohydrate when low is the safest approach. Omitting insulin entirely risks hyperglycemia and ketosis.

Question 46Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A 15-year-old baseball player is struck in the chest by a line drive and collapses. He is unresponsive and not breathing. What is the most appropriate immediate action?

  1. Perform the Heimlich maneuver
  2. Start CPR and apply an AED Correct answer.
  3. Place him in the recovery position
  4. Give him water and monitor

Explanation

Commotio cordis is a sudden arrhythmia caused by a blow to the chest during a vulnerable phase of repolarization. Immediate CPR and defibrillation with an AED are critical because survival depends on rapid restoration of circulation. The Heimlich maneuver and recovery position do not treat cardiac arrest.

Question 47Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A female distance runner has fatigue and reduced performance. Ferritin is 10 ng/mL and hemoglobin is normal. What is the most appropriate interpretation?

  1. Hemochromatosis
  2. Iron deficiency without anemia Correct answer.
  3. This is normal sports anemia and needs no treatment
  4. Stop all training indefinitely

Explanation

Ferritin of 10 ng/mL indicates depleted iron stores even when hemoglobin is normal. This is iron deficiency without anemia and can impair performance; a trial of iron and evaluation for blood loss are reasonable. True sports anemia is a dilutional pseudoanemia with normal iron stores.

Question 48Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A wrestler has grouped vesicles on his neck. Which condition requires exclusion from contact competition until lesions resolve?

  1. Herpes gladiatorum Correct answer.
  2. Tinea versicolor
  3. Molluscum contagiosum
  4. Pityriasis rosea

Explanation

Herpes gladiatorum is a contagious HSV skin infection common in wrestling and requires exclusion until lesions have resolved. Pityriasis rosea, tinea versicolor, and molluscum are not typically managed with the same strict contact-sport exclusion. Active herpes lesions can spread to opponents.

Question 49Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

Which cardiac condition is the most common cause of sudden cardiac death in young competitive athletes in the United States?

  1. Aortic stenosis
  2. Mitral valve prolapse
  3. Hypertrophic cardiomyopathy Correct answer.
  4. Atrial septal defect

Explanation

Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death in young competitive athletes in the United States. Aortic stenosis, mitral valve prolapse, and atrial septal defect can be important but are less common causes in this population.

Question 50Medical and Medical-Orthopaedic Conditions in Athletes (cardiopulmonary, endocrine, infectious, dermatologic, hematologic)

A tall basketball player has long limbs, arachnodactyly, and a family history of sudden death. Echocardiography shows aortic root dilation. Which activity restriction is most appropriate?

  1. Avoid high-intensity competitive sports and contact sports Correct answer.
  2. No restriction if blood pressure is normal
  3. Allow sports if he wears a beta-blocker
  4. Avoid only weightlifting

Explanation

Marfan syndrome with aortic root dilation carries a risk of aortic dissection, especially with high-intensity or contact sports. Restriction from high-intensity competitive and contact sports is appropriate, and beta-blockade may be used but does not eliminate risk. Normal blood pressure does not make the aorta safe.