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Surgical Anatomy & Approaches MCQs

Practice Set 102 of 102

This practice set contains high-yield board review questions covering key concepts in Surgical Anatomy & Approaches. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 2021

Topic: Surgical Anatomy & Approaches

When performing an anterolateral approach to the distal fibula for fracture fixation, the internervous plane lies between which two muscle compartments?

. Anterior and deep posterior
. Lateral and superficial posterior
. Anterior and lateral
. Lateral and deep posterior
. Superficial posterior and deep posterior

Correct Answer & Explanation

. Anterior and lateral

Explanation

Correct Answer: Anterior and lateralThe anterolateral approach to the distal fibula utilizes the internervous plane between the anterior compartment (containing the tibialis anterior and extensors, innervated by the deep peroneal nerve) and the lateral compartment (containing the peroneus longus and brevis, innervated by the superficial peroneal nerve).

Question 2022

Topic: Surgical Anatomy & Approaches

When performing an anterolateral approach to the distal fibula, the internervous plane utilized lies between muscles innervated by which two nerves?

. Deep peroneal nerve and superficial peroneal nerve
. Superficial peroneal nerve and sural nerve
. Tibial nerve and deep peroneal nerve
. Tibial nerve and superficial peroneal nerve
. Sural nerve and saphenous nerve

Correct Answer & Explanation

. Deep peroneal nerve and superficial peroneal nerve

Explanation

Correct Answer: AThe anterolateral approach utilizes the interval between the anterior compartment (tibialis anterior, extensors) and the lateral compartment (peroneus longus and brevis). The anterior compartment is innervated by the deep peroneal nerve, while the lateral compartment is innervated by the superficial peroneal nerve.

Question 2023

Topic: Surgical Anatomy & Approaches

A surgeon is performing a primary total hip arthroplasty using the direct anterior approach (Smith-Petersen). The superficial internervous plane lies between which two muscles?

. Tensor fasciae latae and Gluteus medius
. Sartorius and Tensor fasciae latae
. Rectus femoris and Gluteus minimus
. Adductor longus and Pectineus
. Gluteus maximus and Tensor fasciae latae

Correct Answer & Explanation

. Sartorius and Tensor fasciae latae

Explanation

The superficial interval in the direct anterior approach to the hip is between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve).

Question 2024

Topic: Surgical Anatomy & Approaches

A surgeon is performing a primary total hip arthroplasty utilizing the direct anterior approach. Which two nerves supply the muscles defining the superficial internervous plane of this approach?

. Superior gluteal nerve and inferior gluteal nerve
. Superior gluteal nerve and femoral nerve
. Femoral nerve and obturator nerve
. Inferior gluteal nerve and sciatic nerve
. Femoral nerve and sciatic nerve

Correct Answer & Explanation

. Superior gluteal nerve and femoral nerve

Explanation

The direct anterior approach (Smith-Petersen) utilizes a superficial internervous plane between the tensor fasciae latae (supplied by the superior gluteal nerve) and the sartorius (supplied by the femoral nerve). The deep plane is between the rectus femoris and gluteus medius.

Question 2025

Topic: Surgical Anatomy & Approaches

A 28-year-old male sustains a closed midshaft humerus fracture. On examination, he demonstrates a 'wrist drop' and an inability to extend his metacarpophalangeal joints. Which of the following sensory deficits is most likely to accompany this motor finding?

. Numbness over the volar aspect of the index finger
. Numbness over the dorsal first web space
. Numbness over the volar aspect of the small finger
. Numbness over the lateral forearm
. Numbness over the medial epicondyle

Correct Answer & Explanation

. Numbness over the dorsal first web space

Explanation

Correct Answer: Numbness over the dorsal first web spaceThe radial nerve is highly vulnerable to injury in midshaft humerus fractures, particularly as it courses through the spiral groove. Radial nerve palsy presents with motor deficits including loss of wrist and MCP joint extension ('wrist drop'). The sensory distribution of the superficial branch of the radial nerve supplies the dorsal aspect of the hand, specifically the dorsal first web space.

Question 2026

Topic: Surgical Anatomy & Approaches

A 28-year-old male presents to the emergency department after a motorcycle collision. Radiographs reveal a transverse midshaft humerus fracture. On physical examination, the patient is unable to extend his wrist or fingers, and he has decreased sensation over the dorsal web space of the hand. Which of the following nerves is most likely injured?

. Median nerve
. Ulnar nerve
. Radial nerve
. Axillary nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

Correct Answer: CThe radial nerve is highly vulnerable to injury in midshaft humerus fractures (particularly Holstein-Lewis fractures of the distal third) due to its close anatomical proximity as it spirals around the posterior aspect of the humerus in the spiral groove. Injury to the radial nerve results in a high radial nerve palsy, characterized by weakness or loss of wrist extension (wrist drop), finger extension, and thumb extension, along with sensory deficits over the dorsal first web space.

Question 2027

Topic: Surgical Anatomy & Approaches
A 35-year-old male sustains a severely displaced anterior posterior compression (APC III) pelvic ring injury. During surgical exploration via an anterior intrapelvic approach, a significant hemorrhage occurs superior to the superior pubic ramus. Which of the following vascular structures forms the anastomosis most likely injured in this region (corona mortis)?
. External iliac artery and internal pudendal artery
. External iliac vein and pudendal vein
. Deep inferior epigastric vessels and obturator vessels
. Superior gluteal artery and inferior gluteal artery
. Internal iliac artery and femoral artery

Correct Answer & Explanation

. Deep inferior epigastric vessels and obturator vessels

Explanation

The corona mortis is a critical vascular anastomosis connecting the external iliac or deep inferior epigastric system with the obturator system. It is highly susceptible to injury during pelvic trauma or anterior intrapelvic surgical approaches, leading to profuse bleeding.

Question 2028

Topic: Surgical Anatomy & Approaches

During an open posterior approach to the shoulder for a posterior capsulorrhaphy, the surgeon dissects inferior to the teres minor muscle. Which of the following neurovascular structures is at greatest risk of iatrogenic injury in this specific location?

. Suprascapular nerve and vessels
. Axillary nerve and posterior circumflex humeral artery
. Radial nerve and profunda brachii artery
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve and posterior circumflex humeral artery

Explanation

Correct Answer: BThe axillary nerve and posterior circumflex humeral artery exit the axilla through the quadrangular space, which is bordered superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus. Dissection inferior to the teres minor during a posterior approach places these structures at significant risk of injury.

Question 2029

Topic: Surgical Anatomy & Approaches

A 24-year-old male undergoes an open posterior capsulorrhaphy for recurrent posterior shoulder instability. Postoperatively, he complains of numbness over the lateral aspect of his shoulder and demonstrates weakness in active shoulder abduction beyond 15 degrees. Which of the following nerves was most likely injured during the surgical procedure?

. Suprascapular nerve
. Axillary nerve
. Radial nerve
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

Correct Answer: Axillary nerveThe axillary nerve is at significant risk during posterior shoulder surgery, particularly when dissecting near the inferior capsule or the inferior border of the teres minor. The axillary nerve exits the axilla through the quadrangular space and courses around the surgical neck of the humerus. Injury to this nerve results in weakness of the deltoid muscle (impairing shoulder abduction) and numbness over the lateral aspect of the shoulder (the "regimental badge" area) supplied by the superior lateral cutaneous nerve of the arm.

Question 2030

Topic: Surgical Anatomy & Approaches

During an open posterior shoulder stabilization, the surgeon dissects inferiorly along the posterior glenoid neck. Which of the following neurovascular structures is at greatest risk of iatrogenic injury in this specific location?

. Suprascapular nerve
. Axillary nerve
. Radial nerve
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

Correct Answer: B (Axillary nerve)The axillary nerve exits the quadrangular space and courses closely to the inferior capsule and the inferior aspect of the glenoid neck. Dissection inferior to the teres minor or along the inferior glenoid neck places the axillary nerve and the posterior circumflex humeral artery at significant risk of iatrogenic injury during posterior shoulder approaches.

Question 2031

Topic: Surgical Anatomy & Approaches

A 26-year-old male undergoes an open posterior bone block procedure (using an iliac crest autograft) for recurrent posterior shoulder instability with significant posterior glenoid bone loss. Postoperatively, the patient is noted to have weakness in shoulder abduction and decreased sensation over the lateral aspect of the shoulder. Which of the following nerves was most likely injured during the procedure?

. Suprascapular nerve
. Axillary nerve
. Radial nerve
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

Correct Answer: Axillary nerveThe axillary nerve is at significant risk during the posterior approach to the shoulder, particularly when dissecting inferior to the teres minor or when placing retractors at the inferior aspect of the glenoid neck. The nerve exits the quadrilateral space just inferior to the teres minor and wraps around the surgical neck of the humerus. Injury results in denervation of the deltoid (causing weakness in abduction) and teres minor, as well as numbness over the lateral shoulder (in the distribution of the superior lateral cutaneous nerve of the arm).

Question 2032

Topic: Surgical Anatomy & Approaches

A 28-year-old male is undergoing an open posterior capsular shift for recurrent posterior shoulder instability. During dissection and capsular release at the inferior-most aspect of the glenoid (6 o'clock position), which of the following nerves is at greatest risk of iatrogenic injury?

. Suprascapular nerve
. Musculocutaneous nerve
. Axillary nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

The axillary nerve, specifically its posterior branch, lies in close proximity (often within 10-15 mm) to the inferior and posteroinferior glenoid rim. Care must be taken during capsular dissection and suture passing at the 6 o'clock position to avoid tethering or injuring this nerve.

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