1. General Principles & Basic Science MCQs

A 35-year-old restrained driver in a motor vehicle collision sustains a traumatic posterior hip dislocation. Following successful closed reduction, the patient exhibits weak ankle dorsiflexion and decreased sensation over the dorsum of the foot. Which nerve division is most commonly injured in this injury pattern?

A 72-year-old female on alendronate for 8 years presents with a transverse, minimally displaced subtrochanteric femur fracture after a ground-level fall. Radiographs of the contralateral asymptomatic femur show lateral cortical thickening and a 'beaked' appearance. What is the most appropriate management?

A 19-year-old football player complains of dyspnea, dysphagia, and right-sided neck pain after being tackled. Examination reveals a palpable depression at the right medial clavicle.

What is the most appropriate management plan?

During open reduction and internal fixation of a volar Barton's fracture, the surgeon decides to use a classic volar Henry approach. Which surgical interval is primarily utilized for this approach?

What is the optimal surgical approach to directly visualize and buttress a posteromedial shear fragment in a bicondylar tibial plateau fracture?

A 42-year-old farmer sustains an open grade IIIB tibia fracture after his leg is caught in a tractor mechanism. Visible soil and organic debris contaminate the wound. What is the most appropriate initial intravenous antibiotic regimen?

A 65-year-old woman presents with vague thigh pain. Radiographs demonstrate an impending subtrochanteric atypical femur fracture characterized by lateral cortical thickening. She has been on alendronate for 10 years. What is the most appropriate initial medical management alongside prophylactic intramedullary nailing?

A 68-year-old female presents with thigh pain and a low-energy subtrochanteric femur fracture. A representative radiograph is shown, demonstrating lateral cortical thickening and a transverse fracture pattern with a medial spike.

Which of the following medications is most strongly associated with this injury pattern?

A 65-year-old female with an 8-year history of alendronate use presents with a 3-month history of progressive thigh pain. Radiographs reveal lateral cortical thickening and an incomplete transverse radiolucent line in the subtrochanteric region of the femur.

What is the most appropriate next step in management?

A 78-year-old female presents with acute, severe mid-back pain after a minor fall. Radiographs show an acute L1 compression fracture with 30% loss of anterior height. Neurologic exam is intact. After 6 weeks of conservative management including bracing and analgesics, she continues to have debilitating pain. What is the most appropriate next step in management?

A 65-year-old man with pre-existing cervical spondylosis presents after a hyperextension injury. He has 2/5 motor strength in his upper extremities and 4/5 motor strength in his lower extremities. Sensory exam shows patchy deficits. What is the most likely diagnosis?

A 75-year-old woman with severe osteoporosis presents with a 2-week history of severe mechanical thoracic back pain. Radiographs show a T7 compression fracture with 30% loss of height. She is neurologically intact. She has failed bracing and opioid analgesia. What is the most appropriate next step in management?

A 55-year-old man with iatrogenic flatback syndrome requires surgical correction. The surgeon plans a single-level procedure to achieve approximately 30 to 35 degrees of sagittal correction. Which of the following osteotomies is most appropriate?

A 72-year-old woman with osteoporosis presents with an acute T12 compression fracture. She has severe pain refractory to 6 weeks of maximal medical management and bracing.

What is the most appropriate next step in management?

A 75-year-old woman with severe osteoporosis presents with an acute, painful T12 compression fracture. She has failed 6 weeks of aggressive conservative management, including bracing and narcotic analgesics. Which of the following is the most appropriate next step?

Examination of a 30-year-old professional singer who has persistent neck and shoulder pain reveals a positive Hoffman's sign and clonus because of anterior C2-3 cord compression. The MRI scan shown in Figure 11a and the cervical CT scan shown in Figure 11b reveal focal anterior cord compression at the C2-3 level. Which of the following surgical approaches would least affect her professional career?

A 45-year-old male undergoes an L4-L5 microdiscectomy. During the procedure, brisk arterial bleeding is encountered from the anterior aspect of the disc space following the use of pituitary rongeurs, and the patient suddenly becomes hypotensive. Which of the following vascular structures was most likely injured?

A 70-year-old man with a known history of severe cervical stenosis is involved in a rear-end motor vehicle collision, resulting in a hyperextension injury. He presents to the ED with 1/5 motor strength in his bilateral upper extremities and 4/5 strength in his lower extremities. Proprioception and perianal sensation are intact. What is the most likely diagnosis?

In the treatment of osteoporotic vertebral compression fractures, which of the following is a known absolute contraindication for balloon kyphoplasty?

A 2-year-old boy has been referred for musculoskeletal evaluation. Examination reveals shortened proximal limbs, hip and knee flexion contractures, an abducted thumb, and ear abnormalities. His parents are concerned about his deformed feet. What is the most common foot deformity associated with this patient's diagnosis?