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 721
Topic: Surgical Anatomy & Approaches
A surgeon performs a primary total hip arthroplasty using the direct anterior (Smith-Petersen) approach. Which of the following represents the correct superficial internervous plane utilized in this surgical approach?
Correct Answer & Explanation
. Between the sartorius (femoral nerve) and tensor fasciae latae (superior gluteal nerve)
Explanation
The direct anterior approach to the hip utilizes a true internervous and intermuscular plane. The superficial interval is safely developed between the sartorius (supplied by the femoral nerve) and the tensor fasciae latae (supplied by the superior gluteal nerve).
Question 722
Topic: Surgical Anatomy & Approaches
A surgeon performs a THA using the direct anterior approach (DAA). This approach exploits a true internervous plane between which two muscles?
Correct Answer & Explanation
. Sartorius and tensor fasciae latae
Explanation
The direct anterior approach utilizes the Smith-Petersen interval. This is a true internervous plane between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve).
Question 723
Topic: Surgical Anatomy & Approaches
During a direct anterior (Smith-Petersen) approach to the hip for a primary total hip arthroplasty, the superficial surgical dissection passes between which of the following internervous muscle intervals?
Correct Answer & Explanation
. Sartorius and rectus femoris
Explanation
The direct anterior approach utilizes the superficial internervous plane between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve).
Question 724
Topic: Surgical Anatomy & Approaches
Following a total hip arthroplasty via a posterior approach, a patient exhibits a foot drop and inability to extend the great toe, but plantar flexion and foot inversion remain intact. Which specific nerve division is most likely injured?
Correct Answer & Explanation
. Common peroneal division of the sciatic nerve
Explanation
The common peroneal division of the sciatic nerve runs laterally and is securely tethered at the fibular head, making it highly susceptible to stretch injury during hip lengthening or retractor placement. It innervates the dorsiflexors and toe extensors.
Question 725
Topic: Surgical Anatomy & Approaches
When performing a primary total hip arthroplasty via the direct anterior (Smith-Petersen) approach, the superficial internervous plane lies between muscles supplied by which of the following nerves?
Correct Answer & Explanation
. Superior gluteal and Femoral nerves
Explanation
The superficial internervous plane for the direct anterior approach is between the tensor fasciae latae (superior gluteal nerve) and the sartorius (femoral nerve).
Question 726
Topic: Surgical Anatomy & Approaches
A surgeon utilizing the direct anterior (Smith-Petersen) approach for total hip arthroplasty enters the hip joint through a specific internervous plane superficially. This plane lies between which two muscles?
Correct Answer & Explanation
. Sartorius and tensor fasciae latae
Explanation
The direct anterior approach exploits the superficial internervous plane between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve).
Question 727
Topic: Surgical Anatomy & Approaches
During a direct anterior approach for a total hip arthroplasty, the patient sustains a nerve injury resulting in localized numbness over the anterolateral aspect of the thigh. Which nerve was most likely injured?
Correct Answer & Explanation
. Lateral femoral cutaneous nerve
Explanation
The lateral femoral cutaneous nerve is at high risk during the direct anterior approach (Smith-Petersen interval). Injury results in paresthesias or numbness over the anterolateral thigh.
Question 728
Topic: Surgical Anatomy & Approaches
During a direct anterior approach for total hip arthroplasty, the surgeon develops the superficial surgical interval. Between which two nerve territories does this true internervous plane lie?
Correct Answer & Explanation
. Femoral nerve and Superior gluteal nerve
Explanation
The direct anterior (Smith-Petersen) approach utilizes the internervous plane between the sartorius (innervated by the femoral nerve) and the tensor fasciae latae (innervated by the superior gluteal nerve).
Question 729
Topic: Surgical Anatomy & Approaches
When utilizing the direct anterior approach for total hip arthroplasty, the internervous plane is established between muscles supplied by which of the following pairs of nerves?
Correct Answer & Explanation
. Femoral nerve and superior gluteal nerve
Explanation
The direct anterior approach uses the internervous plane between the sartorius (femoral nerve) and the tensor fasciae latae (superior gluteal nerve).
Question 730
Topic: Surgical Anatomy & Approaches
During a direct anterior approach for a total hip arthroplasty, the surgeon develops the superficial internervous plane. Which of the following nerves innervates the muscle that forms the medial boundary of this surgical interval?
Correct Answer & Explanation
. Femoral nerve
Explanation
The superficial interval for the direct anterior (Smith-Petersen) approach is between the tensor fasciae latae (laterally) and the sartorius (medially). The sartorius is innervated by the femoral nerve.
Question 731
Topic: Surgical Anatomy & Approaches
During a direct anterior approach for a total hip arthroplasty, the surgeon utilizes the internervous plane between which of the following muscles?
Correct Answer & Explanation
. Tensor fasciae latae and sartorius
Explanation
The direct anterior (Smith-Petersen) approach to the hip exploits the internervous plane between the tensor fasciae latae (superior gluteal nerve) and the sartorius (femoral nerve). This allows access to the joint without detaching muscle insertions.
Question 732
Topic: Surgical Anatomy & Approaches
The posterior interosseous nerve (PIN) enters the posterior compartment of the forearm by passing between the two heads of which muscle?
Correct Answer & Explanation
. Supinator
Explanation
The PIN, a continuation of the deep branch of the radial nerve, enters the posterior compartment of the forearm by passing through the arcade of Frohse between the superficial and deep heads of the supinator muscle.
Question 733
Topic: Surgical Anatomy & Approaches
A 16-year-old male undergoes a deltopectoral approach for a proximal humerus fracture. Aggressive medial retraction of the conjoined tendon places which of the following nerves at highest risk of injury?
Correct Answer & Explanation
. Musculocutaneous nerve
Explanation
The musculocutaneous nerve typically enters the coracobrachialis muscle 5 to 8 cm distal to the coracoid process. Vigorous medial retraction of the conjoined tendon during a deltopectoral approach can stretch and injure this nerve.
Question 734
Topic: Surgical Anatomy & Approaches
The corona mortis, which is at risk of iatrogenic injury during an ilioinguinal approach to the acetabulum, is typically an anastomotic connection between the obturator vessels and which of the following?
Correct Answer & Explanation
. Inferior epigastric vessels
Explanation
The corona mortis is an anastomosis between the external iliac system (specifically the inferior epigastric vessels) and the obturator vessels. It crosses the superior pubic ramus and is highly vulnerable during anterior pelvic approaches.
Question 735
Topic: Surgical Anatomy & Approaches
A 20-year-old woman sustained the closed injury shown in Figures 49a and 49b in a motor vehicle accident. Examination reveals that this is an isolated injury; however, she has a complete radial nerve palsy. Management should consist of
Correct Answer & Explanation
. splinting for 1 to 2 weeks, followed by a humeral fracture brace.
Explanation
Lacerated radial nerves are associated with open humeral fractures. All open humeral fractures with radial nerve palsy should be managed with radial nerve exploration and skeletal stabilization. Closed humeral fractures with associated radial nerve palsy usually have an intact nerve with neurapraxia. Most of these patients recover without surgical treatment. If the patient has multiple injuries, skeletal stabilization may be indicated to improve mobilization. For an isolated closed humeral fracture with a radial nerve palsy, the treatment of choice is splinting for 1 to 2 weeks, followed by a humeral fracture brace. Ring D, Chin K, Jupiter JB: Radial nerve palsy associated with high-energy humeral shaft fractures. J Hand Surg Am 2004;29:144-147.
Question 736
Topic: Surgical Anatomy & Approaches
A 45-year-old man requires ORIF of a displaced posterior wall acetabular fracture via a Kocher-Langenbeck approach. To minimize iatrogenic injury to the sciatic nerve during retraction, how should the ipsilateral lower extremity be positioned intraoperatively?
Correct Answer & Explanation
. Hip extended and knee flexed
Explanation
During a Kocher-Langenbeck approach, the sciatic nerve is at high risk from retractor tension. Extending the hip and flexing the knee minimizes tension on the nerve, reducing the risk of a stretch injury.
Question 737
Topic: Surgical Anatomy & Approaches
During an ilioinguinal approach for the fixation of an anterior column acetabular fracture, the surgeon operates in the middle window. Which of the following structures defines the medial border of this surgical window?
Correct Answer & Explanation
. Iliopectineal fascia
Explanation
The middle window of the ilioinguinal approach is bordered laterally by the iliopectineal fascia and medially by the external iliac vessels. This window provides access to the pelvic brim, quadrilateral plate, and superior pubic ramus.
Question 738
Topic: Surgical Anatomy & Approaches
During an ilioinguinal approach for an anterior column acetabular fracture, brisk arterial bleeding is encountered near the superior pubic ramus approximately 5 cm from the pubic symphysis. This bleeding is most likely arising from an anastomosis between which of the following vessel pairs?
Correct Answer & Explanation
. Inferior epigastric and internal pudendal vessels
Explanation
The corona mortis is a critical vascular anastomosis between the external iliac (or inferior epigastric) system and the obturator vessels. It is found traversing the superior pubic ramus and is highly vulnerable during anterior pelvic and acetabular approaches.
Question 739
Topic: Surgical Anatomy & Approaches
A 32-year-old man is involved in a high-speed motor vehicle collision and sustains a displaced posterior wall acetabular fracture with a posterior hip dislocation.
Following emergent closed reduction of the hip, CT imaging confirms a large, single-piece posterior wall fragment. Which of the following surgical approaches is most appropriate for definitive fixation?
Correct Answer & Explanation
. Kocher-Langenbeck approach
Explanation
The Kocher-Langenbeck approach is the standard approach for isolated posterior wall and posterior column acetabular fractures. It allows direct visualization and buttress plating of the posterior wall.
Question 740
Topic: Surgical Anatomy & Approaches
When utilizing the ilioinguinal approach for an anterior column acetabular fracture, the surgeon must identify and ligate the 'corona mortis'. This structure represents an anastomosis between the obturator vessels and the:
Correct Answer & Explanation
. External iliac or deep inferior epigastric vessels
Explanation
The corona mortis is an important vascular anastomosis crossing the superior pubic ramus. It connects the obturator vessels with the external iliac or deep inferior epigastric vessels and can cause massive hemorrhage if torn.
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