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1. General Principles & Basic Science MCQs

Practice Set 306 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 6101

Topic: 1. General Principles & Basic Science

Figures 37a and 37b show the clinical photographs of a 43-year-old patient with type I diabetes mellitus who has a stump ulcer after undergoing successful transtibial amputation 1 year ago. Which of the following is considered the most predictable method of healing the ulcer and preventing recurrent ulceration?

. Refrain from using the prosthesis until the ulcer heals.
. Refrain from using the prosthesis and apply platelet-derived growth factor daily until the ulcer heals.
. Have a prosthetist relieve the area of the anterior-distal tibia to eliminate pressure and allow the ulcer to heal.
. Replace the prosthetic socket liner with a thick silicone liner.
. Perform a wedge resection of the infected tissue, create a soft-tissue envelope with muscle covering the bone, and allow primary healing of the skin.

Correct Answer & Explanation

. Perform a wedge resection of the infected tissue, create a soft-tissue envelope with muscle covering the bone, and allow primary healing of the skin.

Explanation

The ulcer occurred as the result of a mismatch between the shape of the residual limb and the prosthetic socket. With the mismatch, the residual limb pistoned and the tissue failed because of the applied shear forces. The most predictable short- and long-term solution is reconstruction of the residual limb. Refraining from use of the prosthesis will prevent the patient from walking for months. It is unlikely that prosthetic socket modification will allow resolution of this large ulcer.

Question 6102

Topic: 1. General Principles & Basic Science

A 21-year-old soccer player presents with recurrent snapping over the lateral malleolus. Physical examination reveals subluxation of the peroneal tendons with resisted eversion and dorsiflexion. Surgical exploration is planned. Which of the following structures is most likely injured or incompetent in this patient?

. Inferior extensor retinaculum
. Calcaneofibular ligament
. Superior peroneal retinaculum
. Anterior talofibular ligament
. Peroneus tertius tendon

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Recurrent peroneal tendon subluxation is primarily caused by an injury to, or incompetence of, the superior peroneal retinaculum (SPR). Surgical treatment typically involves repair of the SPR and deepening of the fibular groove.

Question 6103

Topic: Surgical Anatomy & Approaches

An orthopaedic surgeon is performing an anterolateral approach for a pilon fracture. The surgical interval is developed between the extensor digitorum longus (EDL) and the extensor hallucis longus (EHL). Which nerve must be identified and protected in this interval?

. Superficial peroneal nerve
. Deep peroneal nerve
. Sural nerve
. Saphenous nerve
. Medial plantar nerve

Correct Answer & Explanation

. Deep peroneal nerve

Explanation

The anterolateral approach to the distal tibia utilizes the internervous plane between the EDL and EHL. The deep peroneal nerve and anterior tibial artery lie between these tendons and must be carefully protected.

Question 6104

Topic: 1. General Principles & Basic Science

A 28-year-old skier sustained a sudden dorsiflexion and inversion injury. She reports a painful popping sensation behind the lateral malleolus. Examination reveals swelling posterior to the fibula and the tendons subluxate anteriorly during resisted eversion. This pathology is associated with failure of which structure?

. Anterior talofibular ligament
. Calcaneofibular ligament
. Inferior extensor retinaculum
. Superior peroneal retinaculum
. Spring ligament

Correct Answer & Explanation

. Superior peroneal retinaculum

Explanation

Peroneal tendon dislocation is caused by an injury to the superior peroneal retinaculum (SPR). It frequently occurs due to forceful dorsiflexion and inversion or sudden contraction of the peroneals.

Question 6105

Topic: 1. General Principles & Basic Science

A 25-year-old weightlifter feels a sudden pop in his anterior axilla while bench pressing. He has ecchymosis and loss of the anterior axillary fold. If surgical repair is chosen, to which anatomical structure should the tendon be reattached?

. The coracoid process
. The lesser tuberosity
. The lateral lip of the bicipital groove
. The medial lip of the bicipital groove
. The clavicle

Correct Answer & Explanation

. The lateral lip of the bicipital groove

Explanation

The pectoralis major tendon normally inserts onto the lateral lip of the bicipital groove of the humerus. Surgical repair of a rupture involves reattaching the tendon to this native footprint.

Question 6106

Topic: Surgical Anatomy & Approaches

A patient with a mid-shaft humeral fracture treated non-operatively in a functional brace develops a new-onset radial nerve palsy 3 weeks post-injury. What is the most appropriate next step in management?

. Immediate surgical exploration and nerve repair
. Continued observation and brace treatment
. Immediate EMG and nerve conduction studies
. Conversion to a long arm cast with wrist drop extension splint
. MRI of the humerus

Correct Answer & Explanation

. Immediate surgical exploration and nerve repair

Explanation

While primary radial nerve palsies with closed humeral fractures are typically observed, a secondary (delayed) radial nerve palsy developing during non-operative management (e.g., bracing or manipulation) is a strong indication for surgical exploration.

Question 6107

Topic: Surgical Anatomy & Approaches

A patient sustains an anterior shoulder dislocation that is reduced in the ER. Post-reduction, there is a large area of numbness over the lateral aspect of the shoulder, and the patient cannot contract the deltoid muscle. Which nerve is most likely injured?

. Musculocutaneous nerve
. Axillary nerve
. Radial nerve
. Suprascapular nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

The axillary nerve is the most commonly injured nerve during an anterior shoulder dislocation. It provides motor innervation to the deltoid and teres minor, and sensory innervation to the lateral shoulder (the badge area).

Question 6108

Topic: 1. General Principles & Basic Science

A 35-year-old male suffers a high-energy dashboard injury, sustaining a posterior sternoclavicular dislocation. What is the most immediate life-threatening complication associated with this specific injury?

. Subclavian artery laceration
. Tracheal compression
. Brachial plexus avulsion
. Pneumothorax
. Esophageal rupture

Correct Answer & Explanation

. Tracheal compression

Explanation

Posterior sternoclavicular dislocations can compress or injure critical mediastinal structures. Tracheal compression causing rapid airway compromise is the most immediate, life-threatening complication, requiring urgent reduction.

Question 6109

Topic: Surgical Anatomy & Approaches

A 30-year-old man sustains a closed, spiral fracture of the distal third of the humeral shaft. Upon presentation in the emergency department, his radial nerve function is completely intact. Following closed reduction and splinting, he immediately exhibits a dense wrist drop and loss of finger extension. What is the most appropriate next step in management?

. Surgical exploration of the radial nerve
. Obtain an MRI of the humerus
. Observation and repeat examination in 2 weeks
. Electromyography (EMG) and nerve conduction studies
. Application of a functional Sarmiento brace

Correct Answer & Explanation

. Surgical exploration of the radial nerve

Explanation

A secondary radial nerve palsy that develops immediately after a closed reduction attempt of a humeral shaft fracture strongly suggests nerve entrapment within the fracture site. This is a classic, absolute indication for urgent surgical exploration and internal fixation.

Question 6110

Topic: Surgical Anatomy & Approaches

A 35-year-old mechanic presents with vague posterior shoulder pain. MRI demonstrates isolated muscle edema and early atrophy isolated to the teres minor muscle. Which anatomic space is most likely compromised?

. Spinoglenoid notch
. Suprascapular notch
. Quadrilateral space
. Triangular interval
. Triangular space

Correct Answer & Explanation

. Quadrilateral space

Explanation

Isolated atrophy of the teres minor is a hallmark of quadrilateral space syndrome. This condition involves compression of the axillary nerve and posterior humeral circumflex artery within the quadrilateral space.

Question 6111

Topic: Physiology & Rehabilitation

A 30-year-old competitive weightlifter sustains an acute pectoralis major tear while bench pressing. Examination reveals loss of the anterior axillary fold. Where do these ruptures most commonly occur?

. Sternal head origin
. Clavicular head origin
. Mid-substance of the muscle belly
. Tendon insertion at the humerus
. Coracoid process attachment

Correct Answer & Explanation

. Tendon insertion at the humerus

Explanation

Pectoralis major ruptures almost exclusively occur at the distal musculotendinous junction or the tendon insertion onto the proximal humerus during maximal eccentric contraction.

Question 6112

Topic: 1. General Principles & Basic Science

A 30-year-old carpenter sustains a sharp volar laceration to his right index finger, resulting in a zone II flexor tendon injury. Following a 4-strand repair, a dynamic early active motion protocol is initiated. What is the primary biological and mechanical benefit of this protocol compared to prolonged static splinting?

. Increases gap formation to stimulate secondary healing
. Decreases the work of flexion by minimizing peritendinous adhesions
. Eliminates the risk of repair rupture
. Inhibits intrinsic healing while promoting extrinsic healing
. Delays vascular ingrowth to prevent hypertrophic scarring

Correct Answer & Explanation

. Decreases the work of flexion by minimizing peritendinous adhesions

Explanation

Early active motion protocols promote intrinsic tendon healing over extrinsic healing, thereby decreasing peritendinous adhesions. This significantly reduces the work of flexion and improves final digit range of motion without unacceptably increasing the rupture rate.

Question 6113

Topic: Surgical Anatomy & Approaches

A 40-year-old man presents with a volar shear fracture of the distal radius (Barton's fracture). The surgeon elects to perform open reduction and internal fixation utilizing the standard volar Henry approach. The internervous plane for this approach is found between which two muscles?

. Flexor carpi radialis and flexor pollicis longus
. Brachioradialis and flexor carpi radialis
. Flexor carpi ulnaris and flexor digitorum superficialis
. Flexor carpi radialis and palmaris longus
. Pronator teres and flexor carpi radialis

Correct Answer & Explanation

. Brachioradialis and flexor carpi radialis

Explanation

The volar Henry approach utilizes the internervous plane between the brachioradialis (innervated by the radial nerve) and the flexor carpi radialis (innervated by the median nerve).

Question 6114

Topic: Surgical Anatomy & Approaches

A 35-year-old cyclist sustains a comminuted midshaft clavicle fracture. Open reduction and internal fixation with superior plating is performed. Postoperatively, the patient notes a well-demarcated area of numbness over the anterior chest wall just inferior to the incision. Which nerve was most likely injured during the surgical exposure?

. Suprascapular nerve
. Spinal accessory nerve
. Supraclavicular nerve
. Phrenic nerve
. Axillary nerve

Correct Answer & Explanation

. Supraclavicular nerve

Explanation

The supraclavicular nerve branches (medial, intermediate, and lateral) course superficially over the clavicle. They are frequently injured or divided during the standard surgical approach for clavicle plating, leading to anterior chest wall numbness.

Question 6115

Topic: Surgical Anatomy & Approaches

A 45-year-old woman presents with elbow pain after a fall. Imaging shown in

reveals a fracture of the capitellum involving the lateral trochlear ridge. Which surgical approach is most appropriate for direct visualization and fixation of this specific fracture pattern?

. Medial over-the-top approach
. Kocher approach
. Kaplan approach
. Extended lateral (column) approach
. Posterior triceps-splitting approach

Correct Answer & Explanation

. Extended lateral (column) approach

Explanation

The extended lateral approach provides excellent exposure of the anterior capitellum and lateral trochlea. It is required for complex coronal shear fractures that extend medially into the trochlea.

Question 6116

Topic: Surgical Anatomy & Approaches

A 55-year-old woman presents with a severely displaced 4-part proximal humerus fracture after a fall. Examination reveals profound weakness in active arm abduction and numbness over the lateral aspect of the shoulder. Which nerve is most likely injured?

. Musculocutaneous nerve
. Suprascapular nerve
. Axillary nerve
. Radial nerve
. Median nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

The axillary nerve is the most commonly injured nerve in proximal humerus fractures and anterior shoulder dislocations. Injury presents as deltoid weakness and sensory deficits over the lateral shoulder (regimental badge area).

Question 6117

Topic: Surgical Anatomy & Approaches

A 5-year-old boy falls from monkey bars and sustains a significantly displaced extension-type supracondylar humerus fracture with posteromedial displacement. Which nerve is at the greatest risk of injury?

. Ulnar nerve
. Radial nerve
. Posterior interosseous nerve
. Musculocutaneous nerve
. Anterior interosseous nerve

Correct Answer & Explanation

. Radial nerve

Explanation

In extension-type supracondylar fractures, posteromedial displacement typically puts the radial nerve at risk as it stretches over the anteriorly displaced proximal fragment. Posterolateral displacement places the anterior interosseous nerve at risk.

Question 6118

Topic: 1. General Principles & Basic Science

A 19-year-old rugby player presents with severe medial chest pain, shortness of breath, and dysphagia after being tackled. Examination reveals a depression at the medial end of the clavicle. What is the most crucial next step in management?

. Discharge with a figure-of-eight brace
. Immediate closed reduction under procedural sedation in the ED without imaging
. CT scan of the chest and urgent closed reduction in the OR with cardiothoracic surgery on standby
. Open reduction and internal fixation with K-wires
. Reassurance and outpatient physical therapy

Correct Answer & Explanation

. CT scan of the chest and urgent closed reduction in the OR with cardiothoracic surgery on standby

Explanation

This patient has a posterior sternoclavicular joint dislocation, a true emergency due to potential compression of the trachea, esophagus, or great vessels. A CT scan confirms the diagnosis, and reduction requires general anesthesia with cardiothoracic standby.

Question 6119

Topic: Surgical Anatomy & Approaches

A 30-year-old man sustains a closed midshaft humerus fracture. Initial examination shows intact radial nerve function. A closed reduction is performed, and a coaptation splint is applied. Immediately after reduction, the patient is unable to extend his wrist or fingers. What is the most appropriate next step?

. Immediate surgical exploration of the radial nerve
. Observation and EMG at 6 weeks
. Change the splint to a functional fracture brace
. Corticosteroid injection into the spiral groove
. Ultrasound-guided nerve block

Correct Answer & Explanation

. Immediate surgical exploration of the radial nerve

Explanation

A secondary radial nerve palsy that occurs immediately after a closed reduction attempt of a closed humeral shaft fracture is an absolute indication for surgical exploration. The nerve may be entrapped in the fracture site.

Question 6120

Topic: 1. General Principles & Basic Science

Following a primary repair of a Zone II flexor digitorum profundus (FDP) laceration in the index finger, which post-operative rehabilitation protocol most reliably decreases adhesion formation while protecting the repair?

. Immediate unrestricted active motion
. Early active motion (place and hold protocol)
. Passive flexion and active extension only (Kleinert protocol)
. Passive motion only (Duran protocol)
. Static splinting in flexion for 6 weeks

Correct Answer & Explanation

. Early active motion (place and hold protocol)

Explanation

Early active motion protocols, such as 'place and hold', have been shown to significantly reduce tendon adhesions and improve ultimate excursion in Zone II repairs, providing superior functional outcomes compared to passive protocols.

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