1. General Principles & Basic Science MCQs

A 70-year-old woman who has been taking alendronate for 10 years presents with atraumatic thigh pain. Radiographs reveal lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region. What is the primary pathophysiologic mechanism of this fracture?

A 45-year-old man involved in a fall from a roof sustains a posterior hip dislocation. Post-reduction, he is noted to have a complete sciatic nerve palsy. Based on the typical pattern of sciatic nerve injury in posterior hip dislocations, which focal neurologic deficit is most likely to be permanent or severe?

When evaluating a severely traumatized limb for potential amputation versus limb salvage, the Mangled Extremity Severity Score (MESS) is often referenced. Which of the following is NOT a scoring component of the MESS?

Following a multi-level lumbar spinal fusion, adjacent segment disease (ASD) is a recognized complication. Which of the following surgical factors has been shown to most significantly increase the risk of developing symptomatic ASD at the proximal adjacent level?

During a routine L4-L5 microdiscectomy, a 3 mm incidental durotomy occurs with minor cerebrospinal fluid egress. The tear is repaired primarily with a 4-0 nonabsorbable suture, and a Valsalva maneuver confirms a watertight seal. What is the most appropriate postoperative management regarding mobilization?

A patient undergoing halo skeletal fixation complains of new-onset diplopia and lateral gaze palsy on the second day after application. Which cranial nerve is most likely affected by the traction?

A 67-year-old man with known cervical spondylosis presents to the ER after a minor hyperextension injury. He is unable to move his arms but retains functional, albeit weak, motor function in his legs. Perianal sensation is intact. What is the most likely diagnosis?

A 45-year-old male undergoes an Anterior Lumbar Interbody Fusion (ALIF) at L5-S1 for severe degenerative disc disease. Postoperatively, he complains of cloudy urine and notes infertility issues. Iatrogenic injury to which of the following structures is most likely responsible for his symptoms?

During the placement of a halo vest, the anterior pins must be placed in a designated "safe zone" to avoid neurovascular injury. Which two nerves are primarily at risk if the anterior pins are placed too medially?

A 33-year-old male sustains a severe pelvic crush injury resulting in a Denis Zone 3 sacral fracture. Which of the following neurologic complications has the highest incidence in this specific injury zone?

A 65-year-old male sustains a hyperextension injury to his neck, resulting in upper extremity weakness out of proportion to his lower extremities, alongside patchy sensory loss. Which of the following factors predicts the poorest prognosis for his functional neurological recovery?

A 30-year-old male strikes his head on the bottom of a pool while diving. He sustains a C5 flexion teardrop fracture. Examination shows bilateral complete loss of motor function, pain, and temperature sensation below the injury, but proprioception and vibratory sense remain intact. What is his diagnosis and expected prognosis for motor recovery?

A 28-year-old skier sustains an acute inversion injury. He complains of a snapping sensation over the lateral malleolus. Physical exam reveals subluxation of the peroneal tendons over the fibula with resisted dorsiflexion and eversion. What is the primary anatomical lesion?

A 45-year-old male sustains a high-energy closed pilon fracture. A spanning external fixator is placed on the day of injury. When planning definitive open reduction and internal fixation (ORIF), which of the following is the most reliable clinical indicator that the soft tissue envelope is ready for surgery?

A 28-year-old skier reports a painful snapping sensation over the lateral malleolus after a forced dorsiflexion and eversion injury. Examination confirms subluxation of the peroneal tendons with resisted eversion. This condition is primarily caused by an injury to which structure?

A 72-year-old male presents with acute pain and swelling in his dominant hand. He has a history of a cat bite to the dorsum of his hand 24 hours prior. Examination reveals erythema, warmth, and exquisite tenderness, particularly over the MCP joint of the index finger. He has limited range of motion due to pain. Which of the following is the MOST appropriate initial management?

During arthroscopic repair of a Type II SLAP lesion, the surgeon places an anchor in the superior glenoid. If the drill and anchor are placed too far medially and posterosuperiorly, which of the following neurologic structures is at greatest risk of iatrogenic injury?

A 65-year-old woman sustains a 3-part proximal humerus fracture and is managed non-operatively. At her 6-week follow-up, she demonstrates profound weakness in shoulder abduction and reports decreased sensation over the lateral aspect of her shoulder. Injury to which of the following nerves is most likely responsible for her symptoms?

A 32-year-old bodybuilder feels a tearing sensation in his anterior chest wall while bench pressing a heavy weight. Examination reveals loss of the anterior axillary fold and significant ecchymosis. MRI confirms a rupture of the sternocostal head of the pectoralis major muscle. Which of the following describes the anatomic footprint of the sternocostal head at its humeral insertion relative to the clavicular head?