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1. General Principles & Basic Science MCQs

Practice Set 1 of 789

This practice set contains high-yield board review questions covering key concepts in 1. General Principles & Basic Science. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 1

Topic: 1. General Principles & Basic Science

The sensitivity of the Lachman test is reported to be up to:

. 30%
. 55%
. 78%
. 85%
. 98%

Correct Answer & Explanation

. 98%

Explanation

Physical examination of the knee includes performing a Lachman test, which has a reported sensitivity of up to 98%.

Question 2

Topic: Physiology & Rehabilitation

A 45-year-old bodybuilder feels a sudden snap in the back of his elbow while performing heavy bench presses. He has a palpable gap proximal to the olecranon and marked weakness in active elbow extension against resistance. What is the most common mechanism of this specific tendon rupture?

. Concentric contraction of the triceps against a heavy load
. Eccentric contraction of the triceps with a sudden deceleration force
. Direct blow to the olecranon tip
. Avulsion from a previous occult olecranon fracture
. Spontaneous rupture secondary to fluoroquinolone use

Correct Answer & Explanation

. Eccentric contraction of the triceps with a sudden deceleration force

Explanation

Triceps tendon ruptures typically occur due to an eccentric load on a contracting triceps muscle, such as decelerating a heavy weight or falling onto an outstretched hand. Immediate surgical repair is indicated for complete ruptures to restore extension strength.

Question 3

Topic: Surgical Anatomy & Approaches

During a surgical approach to the radial head, the surgeon decides to use the Kocher interval to access the joint. This interval utilizes the internervous plane between which two muscles?

. Extensor carpi radialis brevis and extensor digitorum communis
. Brachioradialis and brachialis
. Flexor carpi ulnaris and flexor digitorum superficialis
. Anconeus and extensor carpi ulnaris
. Pronator teres and flexor carpi radialis

Correct Answer & Explanation

. Anconeus and extensor carpi ulnaris

Explanation

The Kocher approach to the lateral elbow utilizes the internervous plane between the anconeus (innervated by the radial nerve) and the extensor carpi ulnaris (innervated by the posterior interosseous nerve). This provides safe exposure to the radial head and neck.

Question 4

Topic: Biomechanics & Biomaterials

During medial ulnar collateral ligament (UCL) reconstruction via the docking technique, where is the precise isometric point for the ulnar tunnel placement?

. At the sublime tubercle
. Anterior to the sublime tubercle
. Posterior to the sublime tubercle
. At the coronoid tip
. At the lateral epicondyle

Correct Answer & Explanation

. At the sublime tubercle

Explanation

The anterior bundle of the UCL inserts distally at the sublime tubercle of the anteromedial coronoid. Tunnel placement at this exact location reproduces the native isometric biomechanics of the UCL.

Question 5

Topic: 1. General Principles & Basic Science
The primary collagen type found in the knee meniscus is:
. Type I
. Type II
. Type III
. Type V
. Type VI

Correct Answer & Explanation

. Type I

Explanation

Type I collagen makes up 90% of the collagen in the meniscus. The remainder is made up of types II, III, V, and VI collagen. Type II makes up the majority of collagen in articular cartilage.

Question 6

Topic: 1. General Principles & Basic Science

The transverse intermensical ligament is occasionally the only site of attachment for the:

. Anterior horn lateral meniscus
. Anterior horn medial meniscus
. Posterior horn lateral meniscus
. Posterior horn medial meniscus
. None of the above

Correct Answer & Explanation

. Anterior horn medial meniscus

Explanation

Although the majority of the time the anterior horn of the medial meniscus has a firm bony attachment, the transverse intermeniscal ligament is the only site of anterior attachment in 3% to 14% of cases.

Question 7

Topic: 1. General Principles & Basic Science

Vascularity of the adult meniscus is limited to the:

. Inner 10% to 30%
. Inner 30% to 50%
. Peripheral 10% to 30%
. Peripheral 30% to 50%
. Entire meniscus is vascular

Correct Answer & Explanation

. Peripheral 10% to 30%

Explanation

Studies show that only the peripheral 10% to 25% of the lateral meniscus and 10% to 30% of the medial meniscus is vascular. The vascularity arises from the medial and lateral genicular arteries.

Question 8

Topic: 1. General Principles & Basic Science

Which of the following statements best describes the relationship of humeral head diameter to humeral head thickness:

. Humeral head diameter and humeral head thickness are independent of one another.
. Humeral head diameter and humeral head thickness have a directly proportional linear relationship.
. Humeral head diameter and humeral head thickness have an inversely proportional linear relationship.
. Humeral head diameter and humeral head thickness have a directly proportional logarithmic relationship.
. Humeral head diameter and humeral head thickness have an inversely proportional logarithmic relationship.

Correct Answer & Explanation

. Humeral head diameter and humeral head thickness have a directly proportional linear relationship.

Explanation

Humeral head diameter and humeral head thickness have a directly proportional linear relationship.

Question 9

Topic: 1. General Principles & Basic Science

Recent randomized controlled trials comparing operative repair versus non-operative management with early functional rehabilitation for acute Achilles tendon ruptures most consistently demonstrate which of the following?

. Significantly higher rerupture rates in the non-operative group
. Equivalent rerupture rates with lower wound complications in the non-operative group
. Significantly higher wound complication rates in the non-operative group
. Superior plantarflexion strength in the non-operative group
. Higher deep vein thrombosis (DVT) rates in the operative group

Correct Answer & Explanation

. Equivalent rerupture rates with lower wound complications in the non-operative group

Explanation

Current literature supports that non-operative management combined with early functional rehabilitation yields rerupture rates equivalent to operative repair while avoiding surgical complications like wound breakdown and infection.

Question 10

Topic: Physiology & Rehabilitation

The Alfredson protocol is considered a first-line treatment for non-insertional Achilles tendinopathy. Which of the following biomechanical principles is the primary focus of this rehabilitation protocol?

. Concentric strengthening of the gastrosoleus complex
. Eccentric lengthening of the gastrosoleus under load
. Isometric holds in maximal dorsiflexion
. Isokinetic strengthening at high angular velocities
. Passive static stretching of the plantar fascia

Correct Answer & Explanation

. Eccentric lengthening of the gastrosoleus under load

Explanation

The Alfredson protocol consists of a 12-week regimen of heavy-load eccentric exercises (lengthening contractions under load), which stimulates collagen synthesis and organization to reverse tendinosis.

Question 11

Topic: Physiology & Rehabilitation

Which of the following regimens is recommended for maintenance of cadiorespiratory fitness:

. 30 to 60 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate
. 30 to 60 minutes of exercise 7 days per week at 20% to 50% of maximum heart rate
. 90 to 120 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate
. 30 to 60 minutes of exercise 1 day per week at 60% to 90% of maximum heart rate
. 15 to 20 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate

Correct Answer & Explanation

. 30 to 60 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate

Explanation

Current recommendations for maintenance of cardiorespiratory fitness include 30 to 60 minutes of exercise 3 to 5 days per week at 60% to 90% of maximum heart rate.

Question 12

Topic: 1. General Principles & Basic Science

All of the following muscles act in scapular retraction except:

. Trapezius
. Rhomboideus major
. Rhomboideus minor
. Levator scapulae
. Pectoralis minor

Correct Answer & Explanation

. Pectoralis minor

Explanation

The trapezius, rhomboids, and levator scapulae all provide some degree of scapular retraction. The pectoralis minor is a scapular protractor.

Question 13

Topic: Physiology & Rehabilitation

Muscles at increased risk for injury include:

. Muscles that cross a single joint and act concentrically.
. Muscles that cross a single joint and act eccentrically.
. Muscles that cross two joints and act concentrically.
. Muscles that cross two joints and act eccentrically.
. Muscle injury is independent of the number of joints crossed and type of contraction.

Correct Answer & Explanation

. Muscles that cross two joints and act eccentrically.

Explanation

Muscles that cross two joints and that are acting in an eccentric fashion are at increased risk for injury. Frequently injured muscles also have a high percentage of type II (fast twitch) fibers.

Question 14

Topic: 1. General Principles & Basic Science

Histology 7 days after muscle strain will most likely reveal:

. Inflammatory reaction
. Fibrous tissue replacing the inflammatory reaction
. C omplete muscle regeneration
. No reaction
. Acute hemorrhage

Correct Answer & Explanation

. Fibrous tissue replacing the inflammatory reaction

Explanation

Inflammatory reaction is seen after 2 days. At 1 week, the inflammatory reaction is replaced by fibrous tissue, and some muscle regeneration may be evident. Muscle strains and tears heal through scarring with minimal replacement with normal muscle tissue.

Question 15

Topic: 1. General Principles & Basic Science

The initial treatment after a muscle strain includes:

. Rest, heat, and elevation
. Ice, rest, and aggressive stretching
. Heat, rest, and aggressive stretching
. Ice, elevation, and aggressive stretching
. Ice, rest, and elevation

Correct Answer & Explanation

. Ice, rest, and elevation

Explanation

The usual initial treatment after a muscle strain involves rest, ice, compression, and elevation (RIC E). Although gentle range of motion exercises can be instituted as tolerated, aggressive stretching may cause further hemorrhage and muscle injury.

Question 16

Topic: 1. General Principles & Basic Science

Which of the following are important in prevention of muscle injury:

. Improved muscle endurance
. Inflexibility
. Minimal warm up
. Decreased muscle tone
. Rapid muscle fatigue

Correct Answer & Explanation

. Rapid muscle fatigue

Explanation

Factors that decrease muscle injury include adequate warm up; a strong, flexible muscle; and improved muscle endurance. Fatigued muscles have diminished load to failure, total deformation, and energy to absorption prior to failure.

Question 17

Topic: 1. General Principles & Basic Science

Fatigued muscles are characterized as having:

. Lower propensity for injury
. Greater flexibility
. Diminished energy to absorption
. Less flexibility
. Increased muscle tone

Correct Answer & Explanation

. Diminished energy to absorption

Explanation

Factors that decrease muscle injury include adequate warm up; a strong, flexible muscle; and improved muscle endurance. Fatigued muscles have diminished load to failure, total deformation, and energy to absorption prior to failure.

Question 18

Topic: Physiology & Rehabilitation

During which phase of the gait cycle or knee flexion angle does the iliotibial band experience the maximum friction against the lateral femoral epicondyle?

. Full extension
. 30 degrees of knee flexion
. 60 degrees of knee flexion
. 90 degrees of knee flexion
. 120 degrees of knee flexion

Correct Answer & Explanation

. 30 degrees of knee flexion

Explanation

The IT band rubs against the lateral femoral epicondyle most prominently at approximately 30 degrees of knee flexion. This typically occurs just after foot strike in runners, leading to ITB friction syndrome.

Question 19

Topic: Physiology & Rehabilitation

Which type of muscle contraction generates the greatest peak force and is most commonly implicated in acute muscle strain injuries?

. Concentric
. Eccentric
. Isometric
. Isokinetic
. Plyometric

Correct Answer & Explanation

. Eccentric

Explanation

Eccentric contractions occur when the muscle forcefully lengthens while under tension, generating the greatest peak forces. They are the primary mechanism behind most acute muscle strain injuries, such as hamstring tears during sprinting.

Question 20

Topic: 1. General Principles & Basic Science

Following a total medial meniscectomy, contact stresses in the medial compartment of the knee are estimated to increase by approximately:

. 10-20%
. 40-50%
. 100%
. 200-300%
. Over 500%

Correct Answer & Explanation

. 200-300%

Explanation

The meniscus plays a crucial role in load distribution across the knee joint. A total medial meniscectomy decreases the contact area by roughly 75%, leading to a 200-300% increase in focal contact stresses and accelerating osteoarthritis.

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