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1. General Principles & Basic Science MCQs

Practice Set 266 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 5301

Topic: 1. General Principles & Basic Science

A 29-year-old male sustains a posterior hip dislocation. Closed reduction is performed within 4 hours. A post-reduction CT scan demonstrates a 5 mm intra-articular bone fragment and an incongruent hip joint. What is the next most appropriate step in management?

. Skeletal traction for 6 weeks
. Immediate weight bearing as tolerated
. Surgical exploration and removal of the intra-articular fragment
. Repeat closed reduction under general anesthesia
. Observation and repeat radiographs in 2 weeks

Correct Answer & Explanation

. Surgical exploration and removal of the intra-articular fragment

Explanation

An incongruent joint following hip reduction, especially with a retained intra-articular fragment, is an absolute indication for surgical exploration. Failure to remove the fragment leads to rapid articular cartilage destruction.

Question 5302

Topic: Infection, Pharmacology & VTE

An 82-year-old woman with a history of atrial fibrillation sustains an intertrochanteric femur fracture. She takes daily warfarin. Her initial INR in the emergency department is 3.5. Which of the following is the most appropriate method to rapidly reverse her coagulopathy for surgical fixation within 24 hours?

. Hold warfarin for 5 days prior to surgery
. Administer Intravenous Vitamin K and Prothrombin Complex Concentrate (PCC)
. Administer Fresh Frozen Plasma (FFP) alone
. Administer a prophylactic dose of Enoxaparin
. Transfuse one unit of pooled platelets

Correct Answer & Explanation

. Administer Intravenous Vitamin K and Prothrombin Complex Concentrate (PCC)

Explanation

The most rapid and reliable reversal of warfarin-induced coagulopathy for urgent orthopedic trauma surgery is achieved with Prothrombin Complex Concentrate (PCC) and Intravenous Vitamin K.

Question 5303

Topic: 1. General Principles & Basic Science

A 22-year-old rugby player is tackled and sustains a traumatic posterior hip dislocation. Upon evaluation in the emergency department, what is the classic resting position of the affected lower extremity?

. Shortened, abducted, and externally rotated
. Lengthened, abducted, and internally rotated
. Shortened, adducted, and internally rotated
. Shortened, adducted, and externally rotated
. Lengthened, adducted, and internally rotated

Correct Answer & Explanation

. Shortened, adducted, and internally rotated

Explanation

A classic posterior hip dislocation presents with the affected limb shortened, adducted, and internally rotated. In contrast, an anterior hip dislocation typically presents with the limb abducted and externally rotated.

Question 5304

Topic: Physiology & Rehabilitation

A 72-year-old man with cervical spondylosis falls forward, striking his forehead. He presents with profound bilateral upper extremity weakness but retains moderate strength in his lower extremities. Which of the following is true regarding his condition?

. It is characterized by loss of pain and temperature with preserved proprioception.
. Early surgical decompression within 24 hours definitively shows superior functional outcomes.
. The pathognomonic lesion is isolated damage to the anterior spinal artery.
. It typically carries a better prognosis for ambulatory recovery than complete cervical cord injuries.
. Recovery usually occurs in a proximal-to-distal pattern in the upper extremities.

Correct Answer & Explanation

. It typically carries a better prognosis for ambulatory recovery than complete cervical cord injuries.

Explanation

This presentation is classic for Central Cord Syndrome, which disproportionately affects upper extremities. It carries a favorable prognosis for functional ambulation compared to complete injuries, with hand recovery typically being the last to return.

Question 5305

Topic: Infection, Pharmacology & VTE

A 7-year-old girl presents with torticollis 1 week after a pharyngitis infection. CT scan shows C1 rotated on C2 with no anterior displacement. What is the initial treatment of choice for this Fielding Type I rotatory subluxation?

. Emergent posterior C1-C2 fusion
. Halter traction followed by a rigid collar
. Soft collar and NSAIDs with close observation
. Manipulation under anesthesia
. Halo vest immobilization

Correct Answer & Explanation

. Soft collar and NSAIDs with close observation

Explanation

For Grisel syndrome (atlantoaxial rotatory subluxation associated with head/neck infections) presenting acutely (less than 1 week) as Fielding Type I, initial management is a soft collar, NSAIDs, and treatment of the underlying infection.

Question 5306

Topic: Biology, Genetics & Bone Healing

A 75-year-old woman with severe osteoporosis presents with acute back pain following a coughing fit. Radiographs show an acute L2 compression fracture with 20% height loss. She has intact neurology. What is the recommended first-line treatment?

. Kyphoplasty
. Vertebroplasty
. Posterior spinal fusion
. Analgesics, early mobilization, and medical management of osteoporosis
. Prolonged bed rest for 6 weeks

Correct Answer & Explanation

. Analgesics, early mobilization, and medical management of osteoporosis

Explanation

The initial management of an osteoporotic vertebral compression fracture without neurologic deficit is nonoperative, focusing on pain control, early mobilization to prevent deconditioning, and treating the underlying osteoporosis.

Question 5307

Topic: 1. General Principles & Basic Science
A 68-year-old man falls forward, striking his chin and hyperextending his neck. On examination, he has 3/5 motor strength in his upper extremities and 4+/5 strength in his lower extremities. He has patchy sensory deficits in his arms. What is the most likely diagnosis?
. Anterior cord syndrome
. Brown-Sรฉquard syndrome
. Central cord syndrome
. Posterior cord syndrome
. Cruciate paralysis

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically occurs in older individuals with preexisting cervical spondylosis who sustain a hyperextension injury. It is characterized by disproportionately greater motor impairment in the upper extremities compared to the lower extremities.

Question 5308

Topic: 1. General Principles & Basic Science

A 28-year-old woman is involved in a motor vehicle collision. Radiographs and CT scans reveal a unilateral perched facet at C5-C6. What is the primary mechanism of injury for this specific pathology?

. Hyperextension and axial load
. Flexion-distraction with rotation
. Pure axial loading
. Lateral bending and compression
. Hyperextension and rotation

Correct Answer & Explanation

. Flexion-distraction with rotation

Explanation

Unilateral facet dislocations occur via a flexion-distraction mechanism combined with rotation. This leads to disruption of the posterior ligamentous complex and joint capsule on one side.

Question 5309

Topic: 1. General Principles & Basic Science

A unilateral cervical facet dislocation is most commonly produced by which of the following injury mechanisms?

. Flexion-distraction
. Flexion-rotation
. Extension-compression
. Vertical compression
. Lateral bending

Correct Answer & Explanation

. Flexion-rotation

Explanation

Unilateral facet dislocations classically result from a combined flexion and rotation mechanism. In contrast, bilateral facet dislocations are typically caused by a more severe flexion-distraction force.

Question 5310

Topic: Biomechanics & Biomaterials

Following a rigid instrumented lumbar fusion, symptomatic adjacent segment disease most frequently develops at which location relative to the fusion construct?

. One level caudal to the fusion
. One level rostral (cephalad) to the fusion
. Two levels rostral to the fusion
. The sacroiliac joints
. The exact middle segment of the fusion

Correct Answer & Explanation

. One level rostral (cephalad) to the fusion

Explanation

Adjacent segment disease most commonly occurs at the motion segment immediately rostral (cephalad) to a spinal fusion. This is attributed to altered biomechanics, increased lever arm, and concentrated stress at that un-fused level.

Question 5311

Topic: 1. General Principles & Basic Science
A 65-year-old man with preexisting cervical spondylosis sustains a hyperextension injury during a motor vehicle collision. He presents with bilateral upper extremity weakness (3/5) but retains normal motor function (5/5) in his lower extremities. What is the most likely diagnosis?
. Anterior cord syndrome
. Brown-Sรฉquard syndrome
. Central cord syndrome
. Posterior cord syndrome
. Conus medullaris syndrome

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically occurs in older patients with cervical spondylosis following hyperextension injuries. It causes disproportionately greater motor impairment in the upper extremities compared to the lower extremities.

Question 5312

Topic: Biomechanics & Biomaterials

Following a rigid lumbar fusion, adjacent segment degeneration (ASD) most commonly occurs at which specific anatomic level?

. Immediately cranial to the fusion construct
. Immediately caudal to the fusion construct
. Two levels above the fusion construct
. At the level of the fusion mass
. Two levels below the fusion construct

Correct Answer & Explanation

. Immediately cranial to the fusion construct

Explanation

Adjacent segment degeneration most commonly occurs at the level immediately cranial to the fused spinal segment. This is driven by increased biomechanical stress and altered kinematics at the unfused junction.

Question 5313

Topic: 1. General Principles & Basic Science
An elite football player sustains a hyperdorsiflexion injury to his first MTP joint (turf toe). MRI confirms a complete tear of the plantar plate. Which of the following is an absolute indication for surgical repair?
. Grade I sprain with minimal swelling
. A bipartite medial sesamoid
. Retraction of the sesamoids with clinical instability
. Concomitant minor sprain of the LCL of the knee
. Dorsal capsular avulsion

Correct Answer & Explanation

. Retraction of the sesamoids with clinical instability

Explanation

Surgical intervention for turf toe is indicated in Grade III injuries demonstrating gross instability, intra-articular loose bodies, or significant proximal retraction of the sesamoids. Operative repair restores the anatomy of the sesamoid complex and plantar plate.

Question 5314

Topic: 1. General Principles & Basic Science

A wide receiver sustains a severe hyperextension injury to his great toe while being tackled on an artificial surface. MRI confirms a complete tear of the plantar plate. The primary stabilizers of the first metatarsophalangeal joint complex injured in this "turf toe" condition include the insertion of which tendon?

. Flexor hallucis longus
. Abductor hallucis
. Flexor hallucis brevis
. Extensor hallucis brevis
. Tibialis anterior

Correct Answer & Explanation

. Flexor hallucis brevis

Explanation

Turf toe involves a sprain or rupture of the plantar plate of the first MTP joint. The plantar plate complex includes the insertion of the flexor hallucis brevis (FHB) tendon and the associated sesamoids.

Question 5315

Topic: Surgical Anatomy & Approaches



During a midfoot surgical approach for tendon transfer, the surgeon isolates the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendons at the Knot of Henry. What is the precise anatomic relationship between these two tendons at this location?

. The FHL crosses dorsal (deep) to the FDL
. The FHL crosses plantar (superficial) to the FDL
. The FHL runs parallel and medial to the FDL without crossing
. The FDL bifurcates to surround the intact FHL
. The FHL terminates by inserting entirely into the FDL

Correct Answer & Explanation

. The FHL crosses dorsal (deep) to the FDL

Explanation

At the Master Knot of Henry in the plantar midfoot, the flexor hallucis longus (FHL) courses medially and crosses dorsal (deep) to the flexor digitorum longus (FDL) tendon.

Question 5316

Topic: Infection, Pharmacology & VTE

A 55-year-old diabetic patient presents with a swollen, erythematous foot. Radiographs demonstrate bone destruction at the midfoot. MRI shows diffuse marrow edema in the cuboid and cuneiforms. T1-weighted images show complete loss of signal, but contrast-enhanced T2 images show distinct preserved margins of the cuboid and cuneiforms (the "ghost sign"). What is the most likely diagnosis?

. Acute osteomyelitis
. Acute Charcot neuroarthropathy
. Chronic osteomyelitis
. Bone infarction
. Gouty arthropathy

Correct Answer & Explanation

. Acute Charcot neuroarthropathy

Explanation

The "ghost sign" on MRI describes the loss of bony morphology on T1-weighted images that becomes distinctly demarcated again on T2 or post-contrast images. This finding is highly characteristic of acute Charcot neuroarthropathy rather than osteomyelitis, which typically lacks preserved bone margins.

Question 5317

Topic: Infection, Pharmacology & VTE

A 60-year-old diabetic patient presents with a chronic, non-healing plantar foot ulcer beneath the first metatarsal head. Total contact casting (TCC) is being considered for offloading. Which of the following represents an absolute contraindication to the use of a total contact cast?

. Wagner Grade 1 ulcer
. Wagner Grade 2 ulcer
. Active deep infection or osteomyelitis
. History of Charcot neuroarthropathy
. Mild peripheral neuropathy

Correct Answer & Explanation

. Active deep infection or osteomyelitis

Explanation

Total contact casting is the gold standard for offloading non-infected, non-ischemic plantar diabetic foot ulcers. However, it is absolutely contraindicated in the presence of an active deep space infection, osteomyelitis, severe peripheral arterial disease, or highly exudative wounds.

Question 5318

Topic: Surgical Anatomy & Approaches

A 40-year-old female sustains a coronal shear fracture of the distal humerus extending into the trochlea (Dubberley Type 2B). What surgical approach is most appropriate for direct visualization and anterior-to-posterior fixation?

. Posterior approach with olecranon osteotomy
. Medial over-the-top approach
. Extended lateral (Kaplan) approach
. Anterior Henry approach
. Triceps-splitting approach

Correct Answer & Explanation

. Extended lateral (Kaplan) approach

Explanation

Coronal shear fractures involving the capitellum and extending into the trochlea are best managed via an extended lateral approach, often elevating the common extensor origin. This provides excellent visualization of the anterior articular surface for anterior-to-posterior screw fixation.

Question 5319

Topic: 1. General Principles & Basic Science

An 18-year-old male is brought to the emergency department after a motor vehicle collision complaining of chest pain, dysphagia, and shortness of breath. Examination reveals a posterior sternoclavicular joint dislocation. What is the most appropriate management strategy?

. Closed reduction in the emergency department using inline traction
. Closed reduction in the operating room with cardiothoracic surgery available
. Immediate open reduction and internal fixation with a hook plate
. Resection of the medial third of the clavicle
. Figure-of-eight bracing and observation

Correct Answer & Explanation

. Closed reduction in the operating room with cardiothoracic surgery available

Explanation

Posterior sternoclavicular dislocations can compress mediastinal structures, risking life-threatening vascular or tracheal injuries. Reduction must be performed in the OR under general anesthesia with a cardiothoracic surgeon on standby.

Question 5320

Topic: Surgical Anatomy & Approaches

A 30-year-old male presents with a Hahn-Steinthal (Type I) capitellum fracture, characterized by a large osseous fragment involving the subchondral bone. Which surgical approach provides the most direct and appropriate exposure for internal fixation?

. Medial over-the-top approach
. Kocher (lateral) approach between the anconeus and ECU
. Extensile posterior approach with olecranon osteotomy
. Anterior Henry approach
. Dorsal midline approach

Correct Answer & Explanation

. Kocher (lateral) approach between the anconeus and ECU

Explanation

The Kocher approach, utilizing the internervous plane between the anconeus (radial nerve) and the extensor carpi ulnaris (posterior interosseous nerve), provides excellent direct access to the capitellum and lateral column.

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