1. General Principles & Basic Science MCQs

During an ilioinguinal approach for an anterior column acetabular fracture, brisk arterial bleeding is encountered near the superior pubic ramus approximately 5 cm from the pubic symphysis. This bleeding is most likely arising from an anastomosis between which of the following vessel pairs?

A 68-year-old woman on long-term alendronate therapy presents with chronic left thigh pain. Radiographs demonstrate lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region of the femur. Which of the following describes the fundamental pathophysiology of this specific fracture type?

A 32-year-old man is involved in a high-speed motor vehicle collision and sustains a displaced posterior wall acetabular fracture with a posterior hip dislocation.

Following emergent closed reduction of the hip, CT imaging confirms a large, single-piece posterior wall fragment. Which of the following surgical approaches is most appropriate for definitive fixation?

When utilizing the ilioinguinal approach for an anterior column acetabular fracture, the surgeon must identify and ligate the 'corona mortis'. This structure represents an anastomosis between the obturator vessels and the:

A 50-year-old man is brought to the emergency department after a crushing injury to his pelvis.

He has blood at the urethral meatus and a high-riding prostate on digital rectal exam. What is the most appropriate next step in his urologic evaluation?

During the surgical fixation of an anterior column acetabular fracture via an ilioinguinal approach, significant arterial hemorrhage is encountered posterior to the superior pubic ramus. This bleeding is most likely originating from an anastomosis between the obturator vessels and which of the following?

During the surgical management of an anterior column acetabular fracture via the modified Stoppa approach, a retropubic vascular anastomosis is encountered. Injury to this structure, often called the "corona mortis," can cause massive hemorrhage. This structure typically represents an anastomosis between which of the following vessels?

A 68-year-old woman with a 10-year history of alendronate use presents with chronic thigh pain. Radiographs reveal focal lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region. What is the most appropriate prophylactic management?

A 72-year-old woman on long-term alendronate therapy presents with a displaced subtrochanteric fracture of the right femur after a mechanical fall from standing height. She reports a 3-month history of left anterior thigh pain. Left femur radiographs reveal lateral cortical thickening and a transverse radiolucent line. What is the recommended management for the contralateral (left) limb?

A 65-year-old woman on long-term alendronate therapy presents with an atraumatic subtrochanteric femur fracture. Which of the following radiographic features is considered a hallmark of a bisphosphonate-related atypical femur fracture?

A 65-year-old woman, who has been taking alendronate for 12 years, presents with a low-energy transverse subtrochanteric femur fracture. Radiographs show lateral cortical thickening and a medial spike. Following cephalomedullary nailing of the fracture, what is the most appropriate pharmacological recommendation?

A 35-year-old pedestrian is struck by a truck, sustaining a severe crush injury to the right lower extremity with a mangled lower leg. When evaluating the patient for potential amputation versus limb salvage, which of the following is NOT a formal component of the Mangled Extremity Severity Score (MESS)?

A 55-year-old man sustains a severe crush injury to his leg resulting in a mangled extremity. The surgeon is calculating the Mangled Extremity Severity Score (MESS) to help guide the decision between amputation and salvage. Which of the following is NOT a component of the MESS?

A 26-year-old man sustains an anterior shoulder dislocation. After successful closed reduction, he is noted to have weakness with shoulder abduction and decreased sensation over the lateral aspect of the deltoid. Which nerve is most likely injured?

A 32-year-old woman sustains a closed, isolated midshaft humerus fracture. She presents with a wrist drop and inability to extend her metacarpophalangeal joints. What is the most appropriate initial management of her nerve injury?

A 65-year-old woman sustains a volar-displaced distal radius fracture. Which nerve is at greatest risk of iatrogenic injury during a standard Henry (volar) surgical approach for plate osteosynthesis?

A 45-year-old unrestrained driver is involved in a head-on collision and sustains a traumatic posterior hip dislocation. Which of the following physical examination findings is most likely present in the affected lower extremity?

A 28-year-old male suffers a closed, mid-shaft humeral fracture. Neurological examination reveals a wrist drop and inability to extend the metacarpophalangeal joints. The fracture is treated with a functional brace. At 12 weeks, there is no clinical or electromyographic (EMG) evidence of radial nerve recovery. What is the next best step?

A 45-year-old male laborer falls from a height and sustains a completely displaced, closed transverse fracture of the acetabulum with a large posterior wall component. Which surgical approach provides the most direct access to visualize and reduce the posterior wall and posterior column?

A 68-year-old man with known cervical spondylosis falls forward and strikes his chin, resulting in a hyperextension injury of the neck. Examination reveals motor weakness that is significantly worse in his upper extremities than in his lower extremities, along with patchy sensory loss. What is the most likely diagnosis?