1. General Principles & Basic Science MCQs

A 28-year-old overhead athlete presents with posterior shoulder pain and deltoid weakness. MRI demonstrates atrophy of the teres minor. Entrapment of the involved nerve occurs in a space bounded laterally by which of the following structures?

A 35-year-old male is undergoing an arthroscopic medial meniscectomy. The surgeon carefully assesses the periphery of the posterior horn to avoid injury to vital structures. Which of the following structures lies immediately posteromedial to the posterior horn of the medial meniscus?

During an open Latarjet procedure, the surgeon identifies the musculocutaneous nerve to protect it during coracoid transfer. Approximately how far distal to the tip of the coracoid does the musculocutaneous nerve typically enter the coracobrachialis?

A 32-year-old bodybuilder sustains a rupture of the pectoralis major tendon while bench-pressing. During surgical repair, the surgeon isolates the two heads of the muscle. Which of the following accurately describes the insertion of the sternal head relative to the clavicular head?

When placing S1 pedicle screws for spinopelvic fixation, bicortical purchase may be desired for increased pull-out strength. If the screw penetrates the anterior sacral cortex at the level of the S1 promontory too medially, which of the following structures is at greatest risk of injury?

A 45-year-old male sustains a posterior knee dislocation. The surgeon is highly concerned about an intimal tear of the popliteal artery. Which of the following anatomic characteristics places the popliteal artery at particularly high risk during knee dislocation?

A 45-year-old male sustains a posterior wall acetabular fracture with a posterior hip dislocation. Reduction is performed in the emergency department. Post-reduction examination reveals a foot drop and inability to extend the great toe. Sensation is decreased over the dorsum of the foot. Which nerve and specific division are most likely injured?

A 68-year-old woman on long-term bisphosphonate therapy presents with progressive thigh pain for several weeks. Radiographs reveal lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region of the right femur. What is the recommended management?

A 28-year-old male sustains a posterior hip dislocation. Closed reduction in the emergency department is unsuccessful. A CT scan reveals a small, incarcerated osteochondral fragment within the acetabular fossa. What is the most appropriate surgical approach for open reduction?

A 45-year-old woman falls on an outstretched hand and sustains a capitellum fracture that extends medially to involve the majority of the trochlea (Dubberley Type 2). Which surgical approach provides the most optimal visualization for anatomic reduction of this complex articular injury?

A 72-year-old woman with a 10-year history of alendronate use presents with vague thigh pain. Radiographs reveal focal lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region of the right femur. Which of the following is the most appropriate management?

During the ilioinguinal approach for an anterior column acetabular fracture, significant hemorrhage is encountered just superior to the superior pubic ramus. This bleeding is most likely originating from an anastomosis between which two vascular systems?

A 40-year-old polytrauma patient arrives at the trauma center with massive bleeding from a pelvic crush injury. According to the CRASH-2 trial, within what timeframe from the time of injury must Tranexamic Acid (TXA) be administered to provide a significant mortality benefit?

A 45-year-old farm worker sustains a traumatic complete amputation of his upper extremity at the mid-humerus level. What is the generally accepted maximum warm ischemia time for a major limb replantation containing significant muscle mass?

A 28-year-old passenger in an MVC sustains a severe dashboard injury resulting in a posterior hip dislocation. Upon reduction, physical examination reveals a dense foot drop, with an inability to actively dorsiflex or evert the ankle. Which specific neural structure is most commonly injured in this scenario?

During an anterior ilioinguinal approach for the fixation of an anterior column acetabular fracture, severe hemorrhage occurs while dissecting near the superior pubic ramus. Which of the following vascular structures is most likely injured?

An 82-year-old female with a history of atrial fibrillation presents with a displaced left femoral neck fracture. She takes apixaban 5 mg twice daily, with her last dose 12 hours ago. Renal function is normal. What is the recommended timing for surgical intervention?

When evaluating a severely injured lower extremity using the Mangled Extremity Severity Score (MESS), which of the following variables contributes most heavily to a higher score predicting amputation?

A 28-year-old female sustains a closed midshaft humerus fracture with an immediate, complete radial nerve palsy. She is managed nonoperatively in a functional brace. At 12 weeks, there is no clinical or electromyographic (EMG) evidence of radial nerve recovery. What is the next most appropriate step in management?

A 70-year-old woman taking alendronate for 8 years presents with severe right thigh pain after a minor trip. Radiographs show a transverse fracture in the subtrochanteric region with lateral cortical thickening and a medial spike. What is the most appropriate management?