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1. General Principles & Basic Science MCQs

Practice Set 112 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 2221

Topic: 1. General Principles & Basic Science

In a written exam question requiring a comprehensive management plan, you are tight on time. Which section can most effectively be condensed without significantly compromising your overall score, provided other sections are well-detailed?

. Differential diagnosis list.
. Detailed indications for operative intervention.
. The specific steps of the surgical technique (assuming surgery is indicated).
. Potential complications and their prevention.
. Post-operative rehabilitation and follow-up.

Correct Answer & Explanation

. The specific steps of the surgical technique (assuming surgery is indicated).

Explanation

Correct Answer: CWhile all sections are important, if time is severely limited, a highly detailed, step-by-step exposition of the surgical technique can sometimes be condensedifthe candidate has clearly articulated the indications, pre-operative planning, and has a strong grasp of potential complications and post-operative care. Examiners often value the 'what' and 'why' (indications, decision-making, outcomes) more than exhaustive procedural minutiae, assuming competence in technique. However, one must still convey the essence of the chosen procedure. Condensing differential diagnoses or complications would be more detrimental to the score.

Question 2222

Topic: 1. General Principles & Basic Science

During a mock oral board examination, an examiner frequently interrupts your presentation of a patient's history to ask specific questions about isolated lab values. What is the most effective viva tactic to handle these interruptions?

. Politely ask the examiner to let you finish the history before taking questions.
. Stop speaking immediately, listen carefully to the redirection, and answer the specific question asked.
. Ignore the interruption and continue with your planned presentation to maintain flow.
. State that the lab values are irrelevant to the diagnosis and move to physical examination.
. Ask the examiner why the lab values are more important than the history.

Correct Answer & Explanation

. Stop speaking immediately, listen carefully to the redirection, and answer the specific question asked.

Explanation

Examiners often interrupt to guide candidates away from irrelevant details or to test specific knowledge areas. Pausing to listen and directly answering the prompted question demonstrates adaptability and ensures you cover the scoring points the examiner is seeking.

Question 2223

Topic: Biology, Genetics & Bone Healing

In the context of bone grafting for orthopedic nonunions, demineralized bone matrix (DBM) is primarily utilized because it possesses which of the following biological properties?

. Osteoinduction.
. Osteoconduction.
. Osteogenesis.
. Structural mechanical support.
. Angiogenesis.

Correct Answer & Explanation

. Osteoinduction.

Explanation

Demineralized bone matrix (DBM) undergoes an acid extraction process that removes the mineral phase but leaves behind bone morphogenetic proteins (BMPs) and collagen. Therefore, it is primarily an osteoinductive agent, though it has some minimal osteoconductive properties.

Question 2224

Topic: 1. General Principles & Basic Science

During a viva station, the examiner presents a patient's chief complaint and history of present illness, then immediately asks, 'What would you do next?' Which response correctly follows the standard algorithmic approach required in oral exams?

. Order an MRI of the affected joint.
. Discuss the surgical approaches and risks of the procedure.
. Perform a thorough, targeted physical examination of the patient.
. Prescribe a course of physical therapy and NSAIDs.
. Order standard orthogonal radiographs.

Correct Answer & Explanation

. Perform a thorough, targeted physical examination of the patient.

Explanation

Oral board scenarios require strict adherence to the fundamental algorithm of clinical medicine: History -> Physical Examination -> Imaging -> Treatment. Skipping straight to imaging or treatment without requesting the physical examination findings will lose points.

Question 2225

Topic: 1. General Principles & Basic Science

During the ABOS Part II oral examination, an examiner asks a candidate to discuss a case from their list where the patient sustained an iatrogenic nerve injury. Which of the following is the most appropriate viva tactic for the candidate to employ?

. Deflect the blame to the anesthesia team for improper positioning.
. Briefly mention the complication and quickly pivot to a successful case.
. Take responsibility, explain the mechanism of injury, how it was managed, and what was learned.
. Argue that the nerve injury was a pre-existing condition not documented in the chart.
. State that nerve injuries are known complications and require no further explanation.

Correct Answer & Explanation

. Take responsibility, explain the mechanism of injury, how it was managed, and what was learned.

Explanation

Taking responsibility and demonstrating insight is critical in oral board exams. Examiners want to see that the candidate recognizes complications, manages them appropriately, and alters future practice to prevent recurrence.

Question 2226

Topic: 1. General Principles & Basic Science

When asked to discuss the complications of a high tibial osteotomy during an ABOS Part II or oral viva exam, what is the most highly recommended structured approach to present your answer?

. List them alphabetically to show memory recall.
. Organize them by system (cardiac, pulmonary, GI).
. Categorize them temporally into intraoperative, early postoperative, and late postoperative.
. Only mention the most common complication to save time.
. Wait for the examiner to list a complication and then explain its management.

Correct Answer & Explanation

. Categorize them temporally into intraoperative, early postoperative, and late postoperative.

Explanation

Structuring complications chronologically (intraoperative, early, late) provides a logical, comprehensive framework that prevents omission and shows the examiner you have an organized thought process.

Question 2227

Topic: Surgical Anatomy & Approaches

In an oral examination, you are handed an AP pelvis radiograph of a trauma patient. What is the most appropriate first step in your structured response?

. Immediately state the definitive diagnosis.
. Identify the imaging modality, view, and patient skeletal maturity.
. Point out the subtle fracture lines.
. Discuss the planned surgical approach.
. Ask the examiner for a CT scan.

Correct Answer & Explanation

. Identify the imaging modality, view, and patient skeletal maturity.

Explanation

Always begin radiographic interpretation by stating the imaging modality, view, and skeletal maturity. This grounds your answer, buys you time to scan the image, and demonstrates a systematic approach.

Question 2228

Topic: 1. General Principles & Basic Science

During a viva station on basic science, you are asked about the specific molecular pathway of BMP-2 in bone healing, which you cannot recall. What is the most strategic viva tactic to handle this situation?

. Guess a random molecular pathway to avoid looking unknowledgeable.
. Confidently provide incorrect information.
. Admit you do not recall the specific pathway but pivot to discussing the clinical applications and FDA-approved indications of BMP-2.
. Remain completely silent until the examiner provides a hint.
. Ask to skip the station entirely.

Correct Answer & Explanation

. Admit you do not recall the specific pathway but pivot to discussing the clinical applications and FDA-approved indications of BMP-2.

Explanation

Admitting a knowledge gap honestly while immediately pivoting to safe, related clinical knowledge demonstrates maturity. It keeps the exam moving and salvages points.

Question 2229

Topic: Surgical Anatomy & Approaches

An examiner asks you to describe the anterior (Smith-Petersen) approach to the hip. To maximize your score by demonstrating anatomical safety, you must explicitly name the internervous plane. This superficial plane lies between which two muscles?

. Sartorius and tensor fasciae latae
. Rectus femoris and vastus lateralis
. Gluteus medius and minimus
. Pectineus and adductor longus
. Gracilis and adductor magnus

Correct Answer & Explanation

. Sartorius and tensor fasciae latae

Explanation

The superficial internervous plane of the Smith-Petersen approach is between the Sartorius (femoral nerve) and the Tensor Fasciae Latae (superior gluteal nerve). Stating internervous planes is a high-yield viva tactic.

Question 2230

Topic: 1. General Principles & Basic Science

During an ABOS Part II case presentation, you notice you have only 2 minutes left and the examiner is still asking about non-operative modalities for a patient who clearly needed surgery. What is the best viva tactic?

. Interrupt the examiner to forcefully show the postoperative X-rays.
. Elaborate extensively on physical therapy protocols to show thoroughness.
. Concisely summarize the failure of non-operative management and state this led to the indication for your chosen surgical intervention.
. Sit silently until the examiner changes the topic.
. Ask the examiner to skip to the end.

Correct Answer & Explanation

. Concisely summarize the failure of non-operative management and state this led to the indication for your chosen surgical intervention.

Explanation

Politely summarizing the current phase allows you to smoothly bridge to the surgical intervention. This ensures you cover the crucial operative details and post-op outcomes before time expires.

Question 2231

Topic: 1. General Principles & Basic Science

A 48-year-old male patient, similar to the case presented, is being evaluated for surgical management of medial compartment osteoarthritis. He has a varus deformity of 8 degrees, full range of motion, and stable ligaments. However, during the workup, it is discovered that he has a history of rheumatoid arthritis and a large varus thrust with coronal subluxation of 1.5 cm. An AP weightbearing radiograph is shown below.

Considering these additional findings, which of the following is a contraindication for performing a High Tibial Osteotomy (HTO) in this patient?

. Physiological age of 48 years
. Varus deformity of 8 degrees
. History of rheumatoid arthritis
. Full range of motion
. Stable knee ligaments

Correct Answer & Explanation

. History of rheumatoid arthritis

Explanation

Correct Answer: CThe case explicitly lists inflammatory arthropathy, such as rheumatoid arthritis and psoriatic arthropathy, as main contraindications for HTO. The presence of rheumatoid arthritis significantly increases the risk of poor bone healing, disease progression in other compartments, and overall unpredictable outcomes with osteotomy. Additionally, a large varus thrust with coronal subluxation of > 1 cm is also a contraindication, which this patient also exhibits (1.5 cm).A. Physiological age of 48 yearsis well within the acceptable range (< 60 years) for HTO.B. Varus deformity of 8 degreesis within the acceptable range (< 15 degrees) for HTO.D. Full range of motionis a favorable condition for HTO, as it indicates good joint mobility and less stiffness.E. Stable knee ligamentsare a prerequisite for HTO, as ligamentous instability (e.g., incompetent MCL or ACL) is a contraindication.

Question 2232

Topic: 1. General Principles & Basic Science

A 45-year-old male undergoes a closing wedge High Tibial Osteotomy (HTO) for medial compartment osteoarthritis. Postoperatively, he experiences a complication related to the surgical technique. Which of the following complications is specifically associated with closing wedge HTO, as discussed in the case?

The image shows a post-operative radiograph of a closing wedge HTO.

. Late collapse with loss of correction
. Need for bone graft
. Peroneal nerve injury
. Decreased patellar height
. Increased risk of non-union

Correct Answer & Explanation

. Peroneal nerve injury

Explanation

Correct Answer: CThe case specifically mentions that closing wedge osteotomy 'may entail proximal fibular osteotomy or disruption of tibialโ€“fibular joint. It has the risk of peroneal nerve injury'. This is a direct complication associated with the closing wedge technique due to the proximity of the fibula and the common peroneal nerve during the osteotomy and potential fibular shortening or osteotomy.A. Late collapse with loss of correctionis a disadvantage specifically attributed to opening wedge osteotomy in the case.B. Need for bone graftis a disadvantage specifically attributed to opening wedge osteotomy, as the gap created needs to be filled.D. Decreased patellar height (patella baja)is associated with opening wedge osteotomy, whereas closing wedge osteotomy is noted to increase patellar height. Historically, patella baja was associated with lateral closing wedge HTO with cast immobilization, but more recent studies show closing wedge increases patellar height.E. Increased risk of non-unionis not specifically highlighted as a unique complication of closing wedge HTO over opening wedge in the provided text, though it can be a general complication of any osteotomy.

Question 2233

Topic: 1. General Principles & Basic Science

A 62-year-old patient with medial compartment osteoarthritis is being considered for surgical intervention. She has a fixed flexion deformity of 20 degrees and a varus deformity of 10 degrees. Her knee flexion is 85 degrees. Based on the prerequisites for HTO discussed in the case, which of her clinical findings would contraindicate a High Tibial Osteotomy?

. Varus deformity of 10 degrees
. Physiological age of 62 years
. Fixed flexion deformity of 20 degrees
. Knee flexion of 85 degrees
. Medial compartment osteoarthritis

Correct Answer & Explanation

. Fixed flexion deformity of 20 degrees

Explanation

Correct Answer: CThe case lists the prerequisites for HTO, including a fixed flexion deformity of < 15 degrees. This patient has a fixed flexion deformity of 20 degrees, which exceeds this prerequisite and therefore contraindicates HTO.A. Varus deformity of 10 degreesis within the acceptable range (< 15 degrees) for HTO.B. Physiological age of 62 yearsis slightly above the stated prerequisite of < 60 years, but 'physiological age' can be subjective. However, the fixed flexion deformity is a more definitive contraindication based on the strict criteria provided. If the patient was physiologically younger than 60 despite chronological age, this might not be an absolute contraindication, but the fixed flexion deformity is.D. Knee flexion of 85 degreesis just below the prerequisite of > 90 degrees flexion. While close, it could be a relative contraindication, but the fixed flexion deformity is a more direct and absolute contraindication based on the given thresholds.E. Medial compartment osteoarthritisis the indication for HTO, not a contraindication.

Question 2234

Topic: 1. General Principles & Basic Science

A 42-year-old male bricklayer with medial compartment osteoarthritis is undergoing pre-operative planning for a High Tibial Osteotomy (HTO). The initial weightbearing AP radiograph is shown below. Which of the following parameters, if present, would be a contraindication for HTO, as discussed in the case?

The image shows a weightbearing AP radiograph of the left knee.

. Varus deformity of 12 degrees
. Physiological age of 55 years
. Fixed flexion deformity of 10 degrees
. Severe osteoarthritis of the patellofemoral joint
. Ability to flex the knee to 100 degrees

Correct Answer & Explanation

. Severe osteoarthritis of the patellofemoral joint

Explanation

Correct Answer: DThe case lists 'severe OA of medial compartment or lateral compartment/PFJ' as a main contraindication for HTO. If the patient had severe osteoarthritis of the patellofemoral joint, HTO would be contraindicated because it only addresses the tibiofemoral compartments and would not alleviate the patellofemoral pain.A. Varus deformity of 12 degreesis within the acceptable range (< 15 degrees) for HTO.B. Physiological age of 55 yearsis within the acceptable range (< 60 years) for HTO.C. Fixed flexion deformity of 10 degreesis within the acceptable range (< 15 degrees) for HTO.E. Ability to flex the knee to 100 degreesmeets the prerequisite of > 90 degrees flexion for HTO.

Question 2235

Topic: Infection, Pharmacology & VTE

According to the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for the non-operative management of knee osteoarthritis, which of the following treatments has a "Strong" recommendation FOR its use?

. Intra-articular hyaluronic acid injections
. Platelet-rich plasma (PRP) injections
. Lateral wedge insoles
. Oral nonsteroidal anti-inflammatory drugs (NSAIDs)
. Glucosamine and chondroitin sulfate supplementation

Correct Answer & Explanation

. Oral nonsteroidal anti-inflammatory drugs (NSAIDs)

Explanation

Oral NSAIDs, topical NSAIDs, and supervised exercise/weight loss have "Strong" recommendations for treating symptomatic knee OA. Intra-articular hyaluronic acid and glucosamine/chondroitin are explicitly not recommended by current AAOS guidelines.

Question 2236

Topic: Infection, Pharmacology & VTE
According to the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for the non-operative management of knee osteoarthritis, which of the following treatments is strongly recommended against?
. Oral non-steroidal anti-inflammatory drugs (NSAIDs)
. Intra-articular hyaluronic acid injections
. Supervised physical therapy
. Weight loss for patients with a BMI > 25
. Topical NSAIDs

Correct Answer & Explanation

. Intra-articular hyaluronic acid injections

Explanation

The AAOS strongly recommends against the use of intra-articular hyaluronic acid (viscosupplementation) for symptomatic osteoarthritis of the knee due to a lack of clinically significant efficacy in high-quality studies.

Question 2237

Topic: 1. General Principles & Basic Science

In the evaluation of patellar instability, distinguishing between habitual and obligatory dislocations is critical. Which of the following characterizes an obligatory patellar dislocation?

. The patella dislocates every time the knee is flexed, requiring surgical lengthening of the quadriceps.
. The patella dislocates in extension and spontaneously reduces upon knee flexion, often due to a tight iliotibial band or vastus lateralis.
. The patella dislocates only after a traumatic impact to the medial aspect of the knee.
. The patella is permanently dislocated and cannot be reduced closed.
. The patella dislocates during internal rotation of the tibia in full flexion.

Correct Answer & Explanation

. The patella dislocates in extension and spontaneously reduces upon knee flexion, often due to a tight iliotibial band or vastus lateralis.

Explanation

Obligatory patellar dislocation occurs when the patella dislocates in extension and reduces in flexion, commonly associated with tight lateral structures or underlying dysplasia. Habitual dislocation occurs in flexion and is often caused by a short quadriceps mechanism.

Question 2238

Topic: 1. General Principles & Basic Science

According to the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines for the management of osteoarthritis of the knee, which of the following treatments is strongly NOT recommended?

. Oral NSAIDs
. Topical NSAIDs
. Intra-articular corticosteroid injections
. Intra-articular hyaluronic acid injections
. Supervised physical therapy

Correct Answer & Explanation

. Intra-articular hyaluronic acid injections

Explanation

The AAOS strongly recommends against the use of intra-articular hyaluronic acid (viscosupplementation) for patients with symptomatic osteoarthritis of the knee. This is based on multiple high-quality randomized controlled trials demonstrating a lack of clinically significant efficacy compared to placebo.

Question 2239

Topic: Physiology & Rehabilitation

What is the ideal targeted position for an arthrodesis of the first metatarsophalangeal (MTP) joint to optimize postoperative gait?

. Neutral valgus and 20 degrees dorsiflexion
. 10 to 15 degrees valgus and 10 to 15 degrees dorsiflexion relative to the floor
. 20 degrees valgus and neutral dorsiflexion
. 5 degrees varus and 5 degrees plantarflexion
. Neutral valgus and neutral dorsiflexion

Correct Answer & Explanation

. 10 to 15 degrees valgus and 10 to 15 degrees dorsiflexion relative to the floor

Explanation

The optimal position for a first MTP arthrodesis is 10-15 degrees of valgus (to parallel the lesser toes) and 10-15 degrees of dorsiflexion relative to the floor. This allows for normal push-off during the gait cycle and accommodates standard footwear.

Question 2240

Topic: 1. General Principles & Basic Science

A surgeon is planning a complex limb reconstruction for a patient with a post-traumatic angular deformity of the tibia. After drawing the proximal and distal mechanical axes of the deformed bone, they identify the point where these two lines intersect, as depicted in the diagram. What is this critical geometric point called, and what is its immediate significance for surgical planning?

. The Axis of Correction of Angulation (ACA), representing the ideal osteotomy site.
. The Mechanical Axis Deviation (MAD), indicating the magnitude of the deformity.
. The Center of Rotation of Angulation (CORA), which is the geometric apex of the deformity and dictates the transverse bisector line.
. The Joint Line Convergence Angle (JLCA), which defines the intra-articular component of the deformity.
. The Medial Proximal Tibial Angle (MPTA), used to assess proximal tibial alignment.

Correct Answer & Explanation

. The Center of Rotation of Angulation (CORA), which is the geometric apex of the deformity and dictates the transverse bisector line.

Explanation

Correct Answer: CThe diagram clearly illustrates the definition of the Center of Rotation of Angulation (CORA). The text defines the CORA as 'the precise mathematical point where the proximal mechanical axis line and the distal mechanical axis line of a deformed bone intersect.' It is described as the 'true epicenter of the deformity' and a 'non-negotiable step in preoperative planning.' Once identified, the surgeon must draw the transverse bisector line through the CORA, which is the roadmap for hinge placement to achieve pure angular correction.Option A is incorrect because the ACA is the functional hinge point created by hardware, not the anatomical intersection of axes. Option B is incorrect because MAD is a measurement of overall limb alignment, not a point of intersection within a bone. Options D and E are incorrect as JLCA and MPTA are joint orientation angles, not points of intersection for a deformity's apex.

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