1. General Principles & Basic Science MCQs

When evaluating a patient for a suspected acute injury to the thumb metacarpophalangeal (MCP) joint, physical examination includes valgus stress testing in different joint positions. Testing the MCP joint in 30 degrees of flexion primarily isolates which of the following stabilizing structures?

While diagnosing a suspected complete tear of the proper ulnar collateral ligament of the thumb, stress radiography is sometimes utilized. According to established criteria, a complete rupture is strongly suspected if there is an absolute valgus opening greater than what threshold?

A patient presents with an acute hyperextension injury to the thumb MCP joint. Which structure provides the primary static restraint to valgus stress when the thumb MCP joint is in 0 degrees of extension?

A 28-year-old female presents with a lytic, expansile lesion in the distal femur epiphysis extending to the subchondral bone. Biopsy confirms a Giant Cell Tumor of bone. She is started on denosumab therapy preoperatively. What is the precise mechanism of action of this medication?

A 35-year-old female presents with a massive, unresectable recurrent Giant Cell Tumor (GCT) of the sacrum. The multidisciplinary tumor board recommends initiation of denosumab therapy. What is the specific mechanism of action of this medication in treating GCT of bone?

A 34-year-old female presents with a recurrent giant cell tumor of the distal radius that is now deemed unresectable without significant morbidity. Which targeted medical therapy is most appropriate to inhibit the recruitment and activity of the osteoclast-like giant cells?

A full-thickness skin graft is placed on the dorsal hand. During the first 24 to 48 hours postoperatively, how does the graft primarily survive before the establishment of a new blood supply?

Which of the following is the most common cause of split-thickness skin graft failure in upper extremity reconstruction?

After harvesting a split-thickness skin graft (STSG) from the anterolateral thigh, the donor site heals primarily by which mechanism?

What is the primary mechanism of nutrient delivery to a newly applied skin graft during the first 24 to 48 hours post-application?

A 45-year-old male undergoes reconstruction of a volar digital defect using a full-thickness skin graft. During the first 48 hours postoperatively, by which of the following mechanisms does the graft primarily survive?

Which of the following statements accurately characterizes the biomechanical properties of a full-thickness skin graft (FTSG) compared to a split-thickness skin graft (STSG)?

The examiner asks the candidate to describe the general consent process. The candidate refers to GMC guidelines. Which of the following principles is NOT a core component of the informed consent process as outlined in the case?

A 42-year-old male presents with an unstable pelvic ring injury after a fall from a height. The surgeon plans an anterior intrapelvic (modified Stoppa) approach. Which of the following anatomic structures must be carefully identified and ligated to prevent catastrophic hemorrhage near the superior pubic ramus?

A 70-year-old female on long-term alendronate therapy for osteoporosis presents with atraumatic thigh pain. Radiographs reveal a transverse, non-comminuted fracture of the femoral shaft with localized lateral cortical thickening. Which of the following is an expected histologic or biological feature of this specific type of fracture?

A 15-year-old boy presents with a painless, bony prominence on the distal medial aspect of his thigh. Radiographs demonstrate a pedunculated osseous lesion pointing away from the joint line with distinct corticomedullary continuity. What is the histologic composition of the cartilaginous cap covering this lesion?

A 12-year-old female with a family history of multiple bony deformities is diagnosed with Hereditary Multiple Exostoses (HME). Genetic testing is most likely to reveal a mutation affecting which of the following cellular processes?

A 40-year-old male requires an ilioinguinal approach for open reduction and internal fixation of an anterior column acetabular fracture. During the dissection, massive hemorrhage occurs near the superior pubic ramus. The injured vessel is most likely an anastomosis between which two vascular systems?

A 72-year-old female on long-term alendronate therapy sustains a low-energy, transverse subtrochanteric femur fracture with a medial cortical spike. What is the primary cellular mechanism by which bisphosphonates increase the risk of this specific atypical fracture pattern?

During meticulous repair of a germinal matrix laceration in a 28-year-old patient, which of the following suture materials and sizes is most appropriate for optimal anatomical restoration and minimal scarring?