MFSEM Written — Sports and Exercise Medicine (RCPI/RCSI, Ireland)

During high-intensity sprint exercise lasting approximately 10 seconds, which energy system provides the primary and most rapid source of adenosine triphosphate (ATP) resynthesis?

• AThe phosphagen (ATP-CP) system
• BAnaerobic glycolysis
• CAerobic oxidation of glucose
• DBeta-oxidation of free fatty acids

Which of the following cardiovascular adaptations is primarily responsible for the increase in maximal cardiac output observed in endurance-trained athletes compared to untrained individuals?

• AAn increase in maximal heart rate
• BAn increase in maximal stroke volume
• CAn increase in systemic arterial blood pressure
• DA decrease in blood plasma volume

What is widely considered the primary physiological limiting factor for maximal oxygen uptake (VO2 max) in healthy, active human subjects performing whole-body exercise at sea level?

• APulmonary diffusing capacity for oxygen
• BMitochondrial enzyme concentration and activity
• CMaximal cardiac output and oxygen delivery by the blood
• DCapillary density in the active skeletal muscle

During incremental exercise, the point at which blood lactate concentration begins to increase non-linearly above baseline levels is known as the lactate threshold. What physiological change primarily underlies this threshold?

• AA sudden decrease in active muscle oxygen availability (hypoxia)
• BAn imbalance between the rate of lactate production and the rate of lactate clearance
• CThe complete depletion of glycogen stores in Type I muscle fibers
• DA drop in blood pH below 7.0 that halts mitochondrial respiration

An athlete undergoes a 10-day heat acclimation program. Which of the following physiological adaptations is expected to occur earliest (within the first 3-5 days) in this process?

• APlasma volume expansion
• BIncreased sweat rate for a given core temperature
• CDecreased sodium concentration in sweat
• DIncreased myocardial contractility

Which muscle of the rotator cuff is primarily responsible for initiating the first 15 degrees of shoulder abduction, acting as a stabilizer for the humeral head within the glenoid fossa?

• AInfraspinatus
• BSupraspinatus
• CSubscapularis
• DTeres minor

A 24-year-old competitive swimmer presents with progressive anterolateral shoulder pain that is exacerbated by the recovery phase of the freestyle stroke. On examination, passive abduction of the shoulder to 90 degrees followed by internal rotation elicits sharp pain. What is the name of this diagnostic clinical test?

• ANeer's test
• BHawkins-Kennedy test
• CO'Brien's active compression test
• DSpeed's test

According to the Rockwood classification of acromioclavicular (AC) joint injuries, a Type III injury is characterized by which of the following pathological features?

• AA mild sprain of the AC ligament with intact coracoclavicular (CC) ligaments
• BRupture of both AC and CC ligaments with 25% to 100% clavicular displacement
• CPosterior displacement of the clavicle into or through the trapezius muscle
• DComplete superior displacement of the clavicle with greater than 100% deformity

What is the primary anatomical structure involved in lateral epicondylalgia (tennis elbow), and which specific muscle tendon is most frequently affected by microtearing and angiofibroblastic hyperplasia?

• APronator teres
• BFlexor carpi radialis
• CExtensor carpi radialis brevis (ECRB)
• DExtensor digitorum communis

A baseball pitcher presents with medial elbow pain that is exacerbated during the late cocking and early acceleration phases of throwing. On examination, there is joint laxity during the valgus stress test at 30 degrees of elbow flexion. Which bundle of the ulnar collateral ligament (UCL) is the primary constraint to valgus stress in this position?

• AAnterior band of the anterior bundle
• BPosterior bundle
• CTransverse bundle
• DLateral collateral ligament

A 19-year-old snowboarder falls onto an outstretched hand (FOOSH) and presents with radial-sided wrist pain. On examination, there is marked tenderness in the anatomical snuffbox. If initial plain radiographs are negative for a fracture, what is the most appropriate next step in management?

• AReassure the patient and return to full activities immediately
• BApply a thumb spica splint and repeat plain radiographs in 10-14 days
• CPerform urgent open reduction and internal fixation
• DOrder a diagnostic electromyogram (EMG)

A 15-year-old female gymnast presents with insidious-onset low back pain that is aggravated by lumbar hyperextension during back handsprings. Plain oblique radiographs demonstrate a defect in the pars interarticularis, often referred to as the 'scotty dog' sign. What is the correct clinical diagnosis?

• ASpondylolysis
• BSpondylolisthesis
• CDisc herniation
• DLumbar facet joint sprain

A rugby player is tackled and remains on the ground with neck pain. According to the NEXUS criteria, which of the following findings would preclude clinical clearance of the cervical spine, requiring radiographic evaluation?

• AAn active range of motion of 45 degrees bilaterally
• BThe presence of midline cervical spine tenderness
• CA normal level of alertness
• DNo history of alcohol intoxication

Femoroacetabular impingement (FAI) is a common cause of groin pain in young athletes. Which subtype of FAI is characterized by an abnormal femoral head-neck junction with an osteochondral prominence (often referred to as a 'pistol grip' deformity)?

• APincer impingement
• BCam impingement
• CSubspine impingement
• DIschiofemoral impingement

A dancer presents complaining of a painful 'clunking' sensation in the lateral hip when transitioning from flexion to extension. Physical examination reproduces a palpable and audible snap as the iliotibial band slides over the greater trochanter. What is the correct classification of this snap?

• AInternal snapping hip (coxa saltans)
• BExternal snapping hip (coxa saltans)
• CIntra-articular snapping hip
• DIliopsoas snapping hip

What is the most common post-mortem finding in cases of sudden cardiac death (SCD) in competitive athletes under the age of 35 in Western countries?

• AHypertrophic Cardiomyopathy (HCM)
• BArrhythmogenic Right Ventricular Cardiomyopathy (ARVC)
• CCoronary artery anomalies
• DSudden Arrhythmic Death Syndrome (SADS) / Normal Autopsy

According to the Seattle Criteria for ECG interpretation in athletes, which of the following findings is considered abnormal and warrants secondary investigation?

• ASinus bradycardia (heart rate >= 30 bpm)
• BFirst-degree AV block (PR interval > 200 ms)
• CT-wave inversion in leads V1 to V3 in an athlete under 16 years of age
• DPathological Q waves (Q/R ratio >= 0.25 or duration >= 40 ms in two contiguous leads)

A 17-year-old cross-country runner reports episodic shortness of breath and wheezing that begins 5 to 10 minutes after completing a hard run. What is the gold-standard diagnostic test to confirm Exercise-Induced Bronchoconstriction (EIB)?

• AA resting spirometry test showing normal FEV1
• BAn exercise challenge test showing a drop in FEV1 of 10% or more from baseline
• CA chest X-ray demonstrating hyperinflation of the lungs
• DA cardiopulmonary exercise test (CPET) showing reduced maximal oxygen pulse

Which of the following symptoms or signs identified on the field immediately following a head impact is considered a 'red flag' in the SCAT6, requiring urgent transfer to an emergency department?

• AMild headache
• BNeck pain or tenderness
• CDifficulty concentrating
• DFeeling slowed down

According to the current international consensus on concussion in sport, what is the minimum duration an athlete must spend at each step of the graded Return-to-Play protocol before progressing to the next stage?

• A12 hours
• B24 hours
• C48 hours
• D7 days

Relative Energy Deficiency in Sport (REDs) expands on the concept of the Female Athlete Triad. What is the fundamental physiological etiology that drives the health and performance consequences of REDs?

• AHigh training volumes exceeding 20 hours per week
• BLow Energy Availability (LEA)
• CInadequate dietary protein intake
• DPrimary hypothalamic dysfunction

Which of the following classes of substances is prohibited by WADA at all times (both in-competition and out-of-competition) due to its potential to enhance muscle mass and recovery?

• AStimulants
• BAnabolic Androgenic Steroids
• CGlucocorticoids
• DCannabinoids

To obtain a Therapeutic Use Exemption (TUE) for a prohibited substance, an athlete must demonstrate which of the following criteria?

• AThe substance is needed to treat an acute or chronic medical condition, and its use will…
• BThe substance has been prescribed by a registered medical practitioner in Ireland
• CThe athlete was unaware that the substance was on the prohibited list
• DThe athlete does not participate in international competitions

The Athlete Biological Passport (ABP) monitors biomarkers over time to detect doping. Which module of the ABP specifically tracks variables such as hemoglobin concentration and reticulocyte percentage to detect blood manipulation?

• AThe Steroidal Module
• BThe Hematological Module
• CThe Endocrinological Module
• DThe Proteomic Module

Under the Children First Act 2015 in Ireland, what is the role of a Designated Liaison Person (DLP) within a sports club or national governing body?

• ATo act as the head coach for youth development
• BTo serve as the primary resource for reporting child protection concerns to Tusla
• CTo coordinate travel and logistics for underage competitions
• DTo administer first aid during youth matches

Which of the following physiological mechanisms is primarily responsible for the phenomenon of 'cardiac drift' during prolonged, constant-workrate exercise in a warm environment?

• AA progressive increase in stroke volume offset by decreased heart rate
• BA progressive decrease in stroke volume due to fluid loss and cutaneous vasodilation, req…
• CAn acute failure of the left ventricle to contract efficiently under thermal stress
• DA sudden decrease in core temperature that triggers vasoconstriction

An elite distance runner utilizes the 'Live High, Train Low' (LHTL) altitude model. What is the physiological rationale for training at sea level while living at altitude?

• AAltitude exposure stimulates erythropoietin (EPO) release to increase red blood cell mass…
• BTraining at low altitude increases the lactate threshold through hyperventilation adaptat…
• CLiving at altitude decreases plasma volume to improve muscle buffering capacity
• DTraining at low altitude induces hyperoxia which increases mitochondrial density

According to Henneman's size principle, which type of motor units are recruited first during low-intensity skeletal muscle contraction, and what are their primary metabolic characteristics?

• ALarge motor units (Type IIx); high glycolytic capacity and rapid fatigue
• BSmall motor units (Type I); high oxidative capacity, high mitochondrial density, and high…
• CIntermediate motor units (Type IIa); high anaerobic capacity and low capillarization
• DLarge motor units (Type I); high lipid accumulation and rapid contraction velocity

Which of the following metabolic processes is the primary contributor to the rapid phase of Excess Post-exercise Oxygen Consumption (EPOC) immediately following high-intensity anaerobic exercise?

• AThe conversion of lactic acid to glucose (gluconeogenesis)
• BResynthesis of muscle phosphagen stores (ATP and creatine phosphate) and restoration of m…
• CMetabolic clearance of circulating catecholamines (epinephrine and norepinephrine)
• DElevated body temperature increasing the mitochondrial respiration rate (Q10 effect)

What is the primary physiological mechanism responsible for Delayed Onset Muscle Soreness (DOMS) following eccentric resistance training?

• AAccumulation of lactic acid in the muscle sarcoplasm
• BMicroscopic damage to muscle fibers (sarcomere disruption) and subsequent inflammatory re…
• CAcute intracellular calcium depletion within the sarcoplasmic reticulum
• DSystemic metabolic acidosis and accumulation of inorganic phosphate

A 22-year-old Gaelic football player presents with chronic, insidious groin pain that is aggravated by kicking, pivoting, and running. On examination, there is point tenderness over the pubic symphysis and pain during the squeeze test. Plain radiographs show osteitis pubis. What is the most appropriate initial management strategy for this condition?

• AUrgent surgical stabilization of the pubic symphysis
• BRelative rest, core and pelvic stabilization exercises, and addressing muscle imbalances
• CHigh-velocity chiropractic manipulation of the sacroiliac joint
• DImmediate return to play with aggressive local corticosteroid injections every 2 weeks

An athlete sustains a severe direct blow to the mid-thigh, resulting in a quadriceps contusion. Which of the following acute management practices is critical during the first 24-48 hours to minimize the risk of developing myositis ossificans?

• AAggressive deep tissue massage and heat therapy to disperse hematoma
• BImmobilization of the knee in 120 degrees of flexion using a splint or wrap, combined wit…
• CImmediate weight-bearing and return to heavy squatting exercises
• DRepeated passive hyperextension of the hip with knee flexion

A 21-year-old female basketball player lands from a jump with a valgus collapse and internal rotation of the knee, hearing a loud 'pop' followed by rapid swelling. On examination, a positive Lachman's test is noted. If the athlete undergoes reconstruction, which of the following is an advantage of using a bone-patellar tendon-bone (BTB) autograft over a quadrupled hamstring autograft?

• ALower incidence of donor-site anterior knee pain
• BLower incidence of post-operative patellar tendinitis
• CHigher rate of early bone-to-bone healing within the femoral and tibial tunnels
• DLower risk of graft harvest-associated saphenous nerve injury

An athlete undergoes arthroscopic evaluation for a suspected meniscal tear. The surgeon notes a tear located in the peripheral 10-30% of the meniscus. How is this zone classified regarding vascularity, and what does it imply for the surgical management of the tear?

• AThe white-white zone; poor healing potential, requiring partial meniscectomy
• BThe red-white zone; moderate healing potential, requiring partial meniscectomy
• CThe red-red zone; rich vascular supply and high healing potential, making it suitable for…
• DThe avascular zone; no healing potential, requiring total joint arthroplasty

An athlete presents with diffuse anterior knee pain that is aggravated by squatting, climbing stairs, and prolonged sitting (the 'theater sign'). On examination, there is patellar crepitus and pain with the patellar compression test. Which of the following rehabilitation focuses has the strongest evidence for reducing pain in Patellofemoral Pain Syndrome (PFPS)?

• AIsolated strengthening of the vastus medialis obliquus (VMO) using biofeedback
• BA combination of quadriceps-strengthening and hip-strengthening (abductors and external r…
• CRigid knee immobilization for 4 weeks to reduce joint friction
• DAggressive stretching of the lateral collateral ligament

A marathon runner complains of sharp, localized lateral knee pain that occurs after running approximately 5 kilometers. On examination, tenderness is elicited when pressure is applied over the lateral femoral epicondyle while passively extending the knee from 90 degrees to 30 degrees. What is the name of this diagnostic clinical test?

• ANoble's compression test
• BOber's test
• CThomas test
• DLachman's test

A runner presents with exercise-induced lower leg pain that resolves completely within 15-20 minutes after stopping exercise. To confirm a suspected diagnosis of Chronic Exertional Compartment Syndrome (CECS), intracompartmental pressures are measured. According to the Pedowitz criteria, which of the following post-exercise pressure values is diagnostic for CECS?

• AA resting pressure of 5 mmHg
• BA 1-minute post-exercise pressure of >= 30 mmHg
• CA 5-minute post-exercise pressure of 10 mmHg
• DA 15-minute post-exercise pressure of 5 mmHg

A 28-year-old tennis player rolls their ankle in inversion. According to the Ottawa Ankle Rules, which of the following presentations is an absolute indication for obtaining a radiographic series of the ankle?

• ALocalized tenderness over the anterior talofibular ligament (ATFL)
• BBone tenderness along the distal 6 cm of the posterior edge of the lateral malleolus
• CInability to perform a single-leg squat
• DLocalized edema over the lateral aspect of the foot

During a football match, an older player feels a sharp pain in the back of the calf and describes a sensation of 'being kicked.' On examination, squeezing the calf muscle fails to produce plantar flexion of the foot. What is the name of this clinical test and what pathology does it indicate?

• AHomans' test; Deep Vein Thrombosis (DVT)
• BSimmonds-Thompson test; Acute Achilles tendon rupture
• CTinel's sign; Tarsal tunnel syndrome
• DMulder's sign; Morton's neuroma

A runner presents with heel pain that is worst during the first few steps in the morning and after periods of rest. Passive extension of the first metatarsophalangeal joint reproduces the pain by tightening the plantar fascia. What biomechanical mechanism is demonstrated by this maneuver?

• AThe Windlass mechanism
• BThe stretch-shortening cycle
• CThe kinetic chain transfer
• DThe reciprocal inhibition loop

A marathon runner collapses near the finish line in hot, humid conditions. On examination, they are confused, combative, and have a rectal temperature of 41.5 degrees Celsius. What is the most critical and immediate intervention required to reduce mortality?

• ARapid transport to the nearest emergency department prior to cooling
• BImmediate whole-body cold-water immersion (CWI) on-site until core temperature drops belo…
• CAdministration of oral antipyretic medications (such as paracetamol or aspirin)
• DIntravenous administration of 2 liters of ice-cold normal saline without cooling

A skier presents with suspected superficial frostbite on their fingers. Which of the following is the correct method for rewarming the affected tissue, and what action must be avoided to prevent further tissue damage?

• ARubbing the hands vigorously with snow; avoid warm water
• BRewarming in a circulating water bath at 37-39 degrees Celsius; avoid dry heat sources an…
• CPlacing the hands directly over an open fireplace; avoid wet dressings
• DApplying topical vasodilators; avoid keeping the hands elevated

When distinguishing 'athlete's heart' from dilated cardiomyopathy (DCM) in a competitive athlete, which of the following findings is most characteristic of physiological adaptation (athlete's heart)?

• AA left ventricular end-diastolic diameter (LVEDD) of 62 mm with a preserved ejection frac…
• BA left ventricular ejection fraction of 35% at rest
• CSymmetrical wall thinning during exercise stress echocardiography
• DA maximal oxygen uptake (VO2 max) of less than 35 mL/kg/min

Which of the following ECG patterns is recognized as a normal, training-induced ethnic variant in asymptomatic Black athletes and does not require secondary cardiac investigation?

• AT-wave inversion in leads V1 to V4 preceded by ST-segment elevation
• BDeep T-wave inversion (>2 mm) in lateral leads (V5, V6, I, aVL)
• CST-segment depression > 0.5 mm in two or more leads
• DLeft bundle branch block (LBBB)

An athlete with Type 1 Diabetes Mellitus plans to perform 60 minutes of moderate-intensity cycling. Which of the following is the standard recommendation to prevent hypoglycemia during and after the exercise session?

• AIncrease the dose of rapid-acting insulin immediately prior to cycling
• BReduce the rapid-acting insulin dose before the exercise meal, and consume fast-acting ca…
• CWithhold all basal insulin for 24 hours prior to the exercise session
• DConsume only high-fat meals prior to the cycling session to promote beta-oxidation

An athlete presents with recurrent episodes of throat tightness and inspiratory stridor during high-intensity workouts. A laryngoscopy performed during an exercise challenge reveals paradoxical adduction of the vocal cords during inspiration. What is the diagnosis?

• AExercise-Induced Bronchoconstriction
• BVocal Cord Dysfunction (Exercise-Induced Laryngeal Obstruction)
• CTracheomalacia
• DAnaphylaxis

Many long-distance runners experience gastrointestinal symptoms such as cramping, flatulence, and diarrhea (often referred to as 'runner's trot'). What is the primary physiological mechanism driving these symptoms during intense running?

• ASplanchnic hypoperfusion (ischemia) due to shunting of blood to active skeletal muscle
• BExcessive activation of the parasympathetic nervous system
• CAcute hyperchlorhydria (excess stomach acid production)
• DAllergic reaction to dietary gluten triggered by core temperature elevation