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1. General Principles & Basic Science MCQs

Practice Set 2 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 21

Topic: Physiology & Rehabilitation

During a maximum-effort 100-meter sprint lasting approximately 10 seconds, which energy system provides the primary source of ATP?

. Oxidative phosphorylation
. Anaerobic glycolysis
. ATP-CP (Creatine Phosphate) system
. Aerobic lipolysis
. Gluconeogenesis

Correct Answer & Explanation

. ATP-CP (Creatine Phosphate) system

Explanation

The ATP-CP (phosphagen) system is the primary energy source for short, high-intensity bursts of exercise lasting up to 10-15 seconds. Anaerobic glycolysis becomes the dominant source for maximal efforts lasting from 15 seconds up to about 2 minutes.

Question 22

Topic: 1. General Principles & Basic Science

A 24-year-old elite volleyball player complains of insidious onset anterior knee pain exacerbated by jumping. Ultrasound reveals a thickened patellar tendon with hypoechoic areas. Which of the following best describes the underlying histologic pathology?

. Acute neutrophil-mediated inflammation
. Mucoid degeneration with neovascularization
. Granulomatous inflammation with giant cells
. Fibrinoid necrosis of the tendon substance
. Eosinophilic infiltration with collagen hypertrophy

Correct Answer & Explanation

. Mucoid degeneration with neovascularization

Explanation

Patellar tendinopathy (jumper's knee) is fundamentally a degenerative process (tendinosis) rather than an inflammatory one. Histology characteristically shows mucoid degeneration, collagen disorganization, and neovascularization with an absence of inflammatory cells.

Question 23

Topic: Physiology & Rehabilitation

During rehabilitation following an anterior cruciate ligament (ACL) reconstruction, which of the following exercises places the highest amount of strain on the healing ACL graft?

. Closed kinetic chain exercises from 0 to 30 degrees of flexion
. Closed kinetic chain exercises from 60 to 90 degrees of flexion
. Open kinetic chain knee extension from 90 to 60 degrees of flexion
. Open kinetic chain knee extension from 30 to 0 degrees of flexion
. Isometric quadriceps contractions at 90 degrees of flexion

Correct Answer & Explanation

. Open kinetic chain knee extension from 30 to 0 degrees of flexion

Explanation

Open kinetic chain (OKC) knee extension exercises near terminal extension (30 to 0 degrees) produce maximum anterior tibial translation forces, placing the highest strain on an ACL graft. Closed kinetic chain exercises generally provide compressive joint forces that protect the graft.

Question 24

Topic: Physiology & Rehabilitation

Delayed onset muscle soreness (DOMS) typically peaks 24 to 72 hours after unaccustomed exercise. Which of the following types of muscle contraction is most strongly associated with the development of DOMS?

. Isometric
. Isotonic concentric
. Isokinetic concentric
. Eccentric
. Plyometric concentric

Correct Answer & Explanation

. Eccentric

Explanation

DOMS is most closely associated with eccentric muscle contractions, where the muscle lengthens while under tension. This specific type of contraction causes significant microtrauma to muscle fibers and connective tissue, leading to subsequent inflammation and soreness.

Question 25

Topic: 1. General Principles & Basic Science

A 19-year-old soccer player sustains a knee injury resulting in a bucket-handle tear of the medial meniscus. The tear is located in the peripheral 10-20% of the meniscus. From which of the following arteries does this specific region derive its primary blood supply?

. Middle genicular artery
. Superior lateral genicular artery
. Inferior medial genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Inferior medial genicular artery

Explanation

The peripheral 10-30% of the medial meniscus (the red-red zone) receives its blood supply from the capsular branches of the inferior medial and superior medial genicular arteries. The central portion is avascular and relies entirely on synovial fluid diffusion for nutrition.

Question 26

Topic: 1. General Principles & Basic Science

Which of the following best describes the biomechanical consequence of a complete tear of the medial meniscus posterior root?

. Maintained hoop stresses with isolated posterior joint space narrowing
. Equivalent contact pressures to a completely meniscectomized knee
. Increased translation of the medial femoral condyle during extension
. Decreased peak contact pressures in the medial compartment
. Isolated loss of proprioception without altered kinematics

Correct Answer & Explanation

. Equivalent contact pressures to a completely meniscectomized knee

Explanation

A complete tear of the posterior root of the medial meniscus disrupts the meniscal ability to convert axial loads into hoop stresses. Biomechanically, this results in peak articular contact pressures equivalent to a total medial meniscectomy.

Question 27

Topic: Physiology & Rehabilitation

Skeletal muscle fibers can be classified based on their metabolic and contractile properties. Which of the following characteristics is true regarding Type I muscle fibers?

. Fast twitch, high fatigue resistance, anaerobic
. Slow twitch, low fatigue resistance, anaerobic
. Fast twitch, low fatigue resistance, high glycolytic capacity
. Slow twitch, high fatigue resistance, high oxidative capacity
. Fast twitch, intermediate fatigue resistance, high oxidative capacity

Correct Answer & Explanation

. Slow twitch, high fatigue resistance, high oxidative capacity

Explanation

Type I muscle fibers are slow-twitch fibers that rely heavily on oxidative metabolism. They are highly fatigue-resistant and primarily recruited during prolonged endurance activities, such as long-distance running.

Question 28

Topic: Physiology & Rehabilitation

A 30-year-old weightlifter feels a sudden pop in his anterior chest wall while performing a heavy bench press. He has bruising over his anterior axillary fold and weakness in internal rotation. If surgical repair is indicated, where does the ruptured tendon anatomically insert?

. Medial lip of the bicipital groove
. Lateral lip of the bicipital groove
. Coracoid process
. Lesser tuberosity of the humerus
. Sublime tubercle

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

The pectoralis major inserts on the lateral lip of the bicipital groove of the humerus. Ruptures typically occur at the musculotendinous junction or the tendinous insertion during forced eccentric contraction, such as the eccentric phase of a bench press.

Question 29

Topic: 1. General Principles & Basic Science

During arthroscopic meniscus repair, an orthopedic surgeon assesses the vascularity of the tear. The primary blood supply to the peripheral meniscus in an adult originates from which of the following?

. Middle genicular artery
. Superior and inferior medial and lateral genicular arteries
. Direct branches of the popliteal artery
. Sural arteries
. Descending genicular artery

Correct Answer & Explanation

. Superior and inferior medial and lateral genicular arteries

Explanation

The peripheral 10-25% of the meniscus (the red-red zone) is vascularized by a perimeniscal capillary plexus that originates from the superior and inferior medial and lateral genicular arteries. The middle genicular artery supplies the cruciate ligaments.

Question 30

Topic: Biology, Genetics & Bone Healing
Ligament healing typically progresses through inflammatory, proliferative, and remodeling phases. During the remodeling phase of a healing medial collateral ligament (MCL), which critical structural transition occurs?
. Type I collagen is replaced by Type II collagen
. Type II collagen is replaced by Type I collagen
. Type III collagen is replaced by Type I collagen
. Type I collagen is replaced by Type III collagen
. Type III collagen is replaced by Type IV collagen

Correct Answer & Explanation

. Type III collagen is replaced by Type I collagen

Explanation

During the proliferative phase of ligament healing, mechanically weaker Type III collagen is laid down rapidly. In the remodeling phase, this Type III collagen is gradually replaced by stronger, highly organized Type I collagen.

Question 31

Topic: Infection, Pharmacology & VTE

What is the gold standard for diagnosing osteomyelitis?

. Bone biopsy with culture
. MRI
. X-ray
. Blood test (ESR/CRP)
. CT scan

Correct Answer & Explanation

. Bone biopsy with culture

Explanation

Bone biopsy with subsequent histopathological examination and culture is considered the gold standard for confirming the diagnosis of osteomyelitis.

Question 32

Topic: 1. General Principles & Basic Science

What is the primary function of the menisci in the knee joint?

. To produce synovial fluid
. To absorb shock and stabilize the joint
. To connect bone to muscle
. To restrict knee flexion
. To initiate knee extension

Correct Answer & Explanation

. To absorb shock and stabilize the joint

Explanation

The menisci are C-shaped cartilaginous structures that act as shock absorbers, increase the contact area between the femur and tibia, and contribute to knee joint stability.

Question 33

Topic: Infection, Pharmacology & VTE

What is the most common cause of septic arthritis in adults?

. E. coli
. Streptococcus pneumoniae
. Pseudomonas aeruginosa
. Staphylococcus aureus
. Neisseria gonorrhoeae

Correct Answer & Explanation

. Staphylococcus aureus

Explanation

Staphylococcus aureus is the most common causative organism for septic arthritis across all age groups, including adults.

Question 34

Topic: 1. General Principles & Basic Science

Which physical exam maneuver tests for meniscal tears?

. McMurray test
. Lachman test
. Anterior drawer test
. Valgus stress test
. Varus stress test

Correct Answer & Explanation

. McMurray test

Explanation

The McMurray test is a common orthopedic test used to detect meniscal tears, producing an audible click or palpable clunk with knee flexion, extension, and rotation.

Question 35

Topic: Biology, Genetics & Bone Healing

Which vitamin deficiency is associated with rickets in children and osteomalacia in adults?

. Vitamin A
. Vitamin K
. Vitamin C
. Vitamin D
. Vitamin B12

Correct Answer & Explanation

. Vitamin D

Explanation

Vitamin D deficiency leads to impaired mineralization of bone, causing rickets in children (growth plate abnormalities) and osteomalacia in adults (softening of mature bone).

Question 36

Topic: Biology, Genetics & Bone Healing

Which of the following factors increases the risk of developing osteoporosis?

. High calcium intake
. Regular weight-bearing exercise
. Post-menopausal status
. Obesity
. High testosterone levels

Correct Answer & Explanation

. Post-menopausal status

Explanation

Estrogen deficiency after menopause significantly accelerates bone loss, making post-menopausal women highly susceptible to osteoporosis.

Question 37

Topic: Surgical Anatomy & Approaches

Which nerve is at risk during surgical fixation of a proximal fibula fracture?

. Tibial nerve
. Saphenous nerve
. Sural nerve
. Common fibular (peroneal) nerve
. Femoral nerve

Correct Answer & Explanation

. Common fibular (peroneal) nerve

Explanation

The common fibular (peroneal) nerve wraps around the neck of the fibula, making it highly susceptible to injury during fractures or surgical procedures in this region.

Question 38

Topic: 1. General Principles & Basic Science

The fibular collateral ligament (FCL) serves as the primary restraint to varus instability. Its contribution to varus restraint is most pronounced at what degree of knee flexion?

. 0 degrees
. 15 degrees
. 30 degrees
. 60 degrees
. 90 degrees

Correct Answer & Explanation

. 30 degrees

Explanation

The FCL is the primary restraint to varus stress at 30 degrees of knee flexion. At full extension (0 degrees), the posterior cruciate ligament and the posterior capsule act as critical secondary stabilizers.

Question 39

Topic: 1. General Principles & Basic Science

A 24-year-old basketball player presents with chronic patellar tendinopathy (jumpers knee) failing 6 months of eccentric strengthening protocols. What is the characteristic MRI finding confirming this diagnosis?

. Thickening and increased signal at the distal insertion on the tibial tubercle
. Thickening and increased signal at the proximal insertion on the inferior pole of the patella
. Diffuse uniform attenuation of the midsubstance tendon
. Cystic degeneration of the quadriceps tendon insertion
. Intrasubstance tearing of the medial patellofemoral ligament

Correct Answer & Explanation

. Thickening and increased signal at the proximal insertion on the inferior pole of the patella

Explanation

Patellar tendinopathy classically presents on MRI as focal thickening and increased T2 signal at the proximal origin of the patellar tendon, located at the inferior pole of the patella.

Question 40

Topic: 1. General Principles & Basic Science

Meniscal healing potential is highly dependent on its vascular supply. In adults, the well-vascularized zone of the meniscus extends approximately how far from the peripheral capsular attachment?

. 10 to 30 percent of the peripheral meniscal width
. 40 to 50 percent of the peripheral meniscal width
. 60 to 70 percent of the peripheral meniscal width
. The entire meniscus maintains an active blood supply
. Only the posterior root attachments are vascularized

Correct Answer & Explanation

. 10 to 30 percent of the peripheral meniscal width

Explanation

In adults, only the peripheral 10% to 30% of the meniscus (the red-red zone) receives direct blood supply from the perimeniscal capillary plexus, giving this region the highest healing potential for repairs.

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