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1. General Principles & Basic Science MCQs

Practice Set 4 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 61

Topic: 1. General Principles & Basic Science
Which of the following is the most commonly reported cause of nontraumatic humeral head osteonecrosis?
. Alcohol abuse
. Corticosteroid therapy
. Gaucher's disease
. Smoking
. Hemoglobinopathies

Correct Answer & Explanation

. Corticosteroid therapy

Explanation

Corticosteroid therapy is the most commonly reported cause of osteonecrosis of the humeral head. Other risk factors include alcohol abuse, hemoglobinopathies, Gaucher's disease, dysbarism, connective tissue disorders, arteritis, vasculitis, hypercoagulability, prior radiation, pregnancy, and pancreatitis.

Question 62

Topic: 1. General Principles & Basic Science

The results of anteromedial tibial tubercle transfer for patellar malalignment are best when patellar lesions are located:

. Distally on the lateral facet
. Proximally on the lateral facet
. Proximally on the medial facet
. Distally on the medial facet
. Proximally on either facet

Correct Answer & Explanation

. Distally on the lateral facet

Explanation

A study revealed that results after tibial tubercle anteromedialization are best if patellar lesions are located distally or laterally. The results were poor when the lesions were located proximally or on the medial facet.

Question 63

Topic: 1. General Principles & Basic Science
The maximal restraint to varus stress provided by the posterolateral structures of the knee is at what degree of knee flexion?
. 0°
. 30°
. 45°
. 60°
. 90°

Correct Answer & Explanation

. 30°

Explanation

Biomechanical studies show that sectioning the posterolateral structures results in increases in varus rotation of the knee from 0° to 30° of knee flexion, with maximal increase observed at 30°.

Question 64

Topic: 1. General Principles & Basic Science

What is the primary function of the anterolateral ligament (ALL) of the knee?

. Primary restraint to anterior tibial translation
. Primary restraint to posterior tibial translation
. Secondary restraint to varus stress
. Secondary restraint to internal tibial rotation
. Primary restraint to valgus stress

Correct Answer & Explanation

. Secondary restraint to internal tibial rotation

Explanation

The anterolateral ligament (ALL) functions as a secondary restraint to internal tibial rotation and heavily influences the pivot-shift phenomenon. It is often reconstructed or augmented in high-risk ACL injuries to restore rotational stability.

Question 65

Topic: Surgical Anatomy & Approaches

During an arthroscopic SLAP repair, careful anchor placement in the superior glenoid is required to avoid injury to which nerve?

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

Correct Answer & Explanation

. Suprascapular nerve

Explanation

The suprascapular nerve courses through the spinoglenoid notch, typically 1 to 2 cm medial to the posterosuperior glenoid rim. Deep drilling or aberrant anchor placement at the 11 to 1 o'clock position puts this nerve at significant risk.

Question 66

Topic: Surgical Anatomy & Approaches

Which of the following nerves is most commonly injured in an acute anterior-inferior shoulder dislocation?

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

Correct Answer & Explanation

. Axillary nerve

Explanation

The axillary nerve is the most commonly injured nerve in anterior-inferior shoulder dislocations due to its anatomical course directly inferior to the glenohumeral joint and around the surgical neck of the humerus.

Question 67

Topic: 1. General Principles & Basic Science

Regarding the vascular supply and healing potential of the menisci, which anatomical zone has the highest intrinsic capacity for healing following a surgical repair?

. Red-red zone
. Red-white zone
. White-white zone
. Anterior horn apex
. Inner free margin

Correct Answer & Explanation

. Red-red zone

Explanation

The peripheral 10% to 30% of the meniscus (the red-red zone) has a rich vascular supply derived from the perimeniscal capillary plexus, giving it the highest potential for healing after repair.

Question 68

Topic: 1. General Principles & Basic Science

A medial meniscus posterior root tear is strongly associated with which of the following biomechanical consequences in the knee joint?

. Decreased contact pressure in the medial compartment
. Increased lateral compartment anterior translation
. Loss of hoop stresses leading to meniscal extrusion
. Increased lateral patellofemoral tracking
. Spontaneous functional regeneration of the root

Correct Answer & Explanation

. Loss of hoop stresses leading to meniscal extrusion

Explanation

A posterior root tear functionally unanchors the meniscus, destroying its ability to convert axial loads into hoop stresses. This leads to meniscal extrusion and medial compartment cartilage loads equivalent to a total meniscectomy.

Question 69

Topic: 1. General Principles & Basic Science

Ligaments and joint capsule are primarily composed of collagen. What is the predominant type of collagen in these structures:

. Type I
. Type II
. Type V
. Type VI
. Type IX

Correct Answer & Explanation

. Type I

Explanation

As thermal modification of soft tissue becomes a common procedure, orthopedic surgeons must have an understanding of collagen. Type I collagen predominates in ligaments, joint capsule, bone, tendon, meniscus, annulus of intervertebral disks, and skin. Type II collagen predominates in articular cartilage and nucleus pulposus of intervertebral disks. Type V collagen is found in small amounts in articular cartilage, as is types VI and IX.

Question 70

Topic: 1. General Principles & Basic Science

A football player sustains a direct helmet blow to the iliac crest, presenting with severe pain, swelling, and inability to bear weight. Radiographs are negative. Which of the following muscles is most commonly injured in this "hip pointer" contusion?

. Gluteus maximus
. Rectus femoris
. Tensor fasciae latae
. External oblique
. Iliacus

Correct Answer & Explanation

. External oblique

Explanation

A "hip pointer" is a contusion of the iliac crest and/or the associated muscular insertions. It most commonly affects the external and internal obliques and the transverse abdominis muscles.

Question 71

Topic: Surgical Anatomy & Approaches

Which physical examination finding is most specific for diagnosing piriformis syndrome in an athlete with buttock pain and sciatica?

. Pain exacerbated by active external rotation and passive internal rotation of the hip
. A positive straight leg raise test at 30 degrees
. Weakness of the quadriceps muscle
. Decreased patellar reflex
. Pain localized strictly to the posterior superior iliac spine

Correct Answer & Explanation

. Pain exacerbated by active external rotation and passive internal rotation of the hip

Explanation

Piriformis syndrome involves sciatic nerve compression by the piriformis muscle. Pain is typically provoked by stretching the muscle (passive internal rotation) or by active contraction (resisted external rotation).

Question 72

Topic: Surgical Anatomy & Approaches

An athlete undergoes arthroscopic release for recalcitrant internal snapping hip syndrome. During the release at the level of the joint capsule, which structure is at greatest risk of iatrogenic injury?

. Femoral nerve
. Sciatic nerve
. Lateral femoral cutaneous nerve
. Obturator nerve
. Superior gluteal nerve

Correct Answer & Explanation

. Femoral nerve

Explanation

The femoral nerve lies immediately medial to the iliopsoas muscle belly. When performing an endoscopic release of the iliopsoas tendon at the joint level, care must be taken to stay on the tendinous portion to avoid nerve injury.

Question 73

Topic: Infection, Pharmacology & VTE

A 20-year-old soccer player developed myositis ossificans in the vastus intermedius following a contusion 6 weeks ago. Radiographs show immature, fluffy ossification. What is the most appropriate management?

. Immediate surgical excision of the mass
. Radiation therapy to halt progression
. Rest, NSAIDs, and gentle active range of motion until the lesion matures
. Aggressive passive stretching under anesthesia
. Local injection of corticosteroids directly into the mass

Correct Answer & Explanation

. Rest, NSAIDs, and gentle active range of motion until the lesion matures

Explanation

Early surgical excision of myositis ossificans is contraindicated due to a high risk of recurrence. The mass should be allowed to mature over 6 to 12 months with conservative management before considering excision.

Question 74

Topic: 1. General Principles & Basic Science

A 24-year-old rugby player developed myositis ossificans after a severe thigh contusion 6 weeks ago. He is being considered for surgical excision due to persistent pain and restricted knee flexion. Which imaging finding best indicates that the lesion is safe for excision?

. Bone scan showing intense focal uptake
. MRI showing extensive surrounding edema
. Peripheral maturation and a sharply circumscribed mass on CT scan
. Ultrasound demonstrating a central anechoic fluid collection
. Radiographs showing a faint, ill-defined cloud-like radiopacity

Correct Answer & Explanation

. Peripheral maturation and a sharply circumscribed mass on CT scan

Explanation

Surgical excision of myositis ossificans should only be performed after the lesion has fully matured, typically 6-12 months post-injury. CT scanning best demonstrates this maturation, characterized by peripheral ossification and a sharply circumscribed border, reducing the risk of recurrence.

Question 75

Topic: 1. General Principles & Basic Science

A 35-year-old female presents with chronic deep gluteal pain that worsens with long strides. MRI demonstrates narrowing of the ischiofemoral space. Which muscle is typically compressed and shows edema or atrophy in this condition?

. Obturator internus
. Piriformis
. Quadratus femoris
. Gluteus minimus
. Gemellus superior

Correct Answer & Explanation

. Quadratus femoris

Explanation

Ischiofemoral impingement syndrome is characterized by a narrowed space between the lesser trochanter and the ischial tuberosity. This anatomical narrowing compresses the quadratus femoris muscle, leading to edema, fatty replacement, and deep gluteal pain.

Question 76

Topic: Surgical Anatomy & Approaches

Which of the following clinical tests is most specific for diagnosing piriformis syndrome in an athlete?

. FADIR test
. FAIR test
. Ober test
. Thomas test
. Ely test

Correct Answer & Explanation

. FAIR test

Explanation

The FAIR test (Flexion, Adduction, Internal Rotation) stretches the piriformis muscle, compressing the sciatic nerve and reproducing the radicular symptoms characteristic of piriformis syndrome.

Question 77

Topic: 1. General Principles & Basic Science

A 45-year-old female presents with lateral hip pain and a positive Trendelenburg sign. MRI shows a high-grade tear of the gluteus medius tendon at its insertion. Which facet of the greater trochanter is the primary insertion site for the gluteus medius?

. Anterior facet
. Lateral facet
. Posterior facet
. Lesser trochanter
. Quadrate tubercle

Correct Answer & Explanation

. Lateral facet

Explanation

The gluteus medius primarily inserts onto the lateral and superoposterior facets of the greater trochanter. The gluteus minimus inserts on the anterior facet.

Question 78

Topic: Surgical Anatomy & Approaches

A football player sustained a direct blow to the iliac crest, termed a 'hip pointer'. He now complains of altered sensation over the gluteal region and lateral hip. Which nerve is most susceptible to injury in this direct contusion?

. Obturator nerve
. Femoral nerve
. Pudendal nerve
. Iliohypogastric nerve
. Sciatic nerve

Correct Answer & Explanation

. Iliohypogastric nerve

Explanation

A hip pointer is a contusion to the iliac crest. The iliohypogastric nerve and superior cluneal nerves cross the iliac crest and are susceptible to crush injury, leading to sensory deficits.

Question 79

Topic: 1. General Principles & Basic Science

A 28-year-old professional hockey player is diagnosed with an acute grade II strain of the adductor longus. Which of the following is the most appropriate initial management?

. Immediate surgical repair
. Corticosteroid injection
. Platelet-rich plasma injection
. Rest, ice, and gentle active range of motion
. Spica casting for 4 weeks

Correct Answer & Explanation

. Rest, ice, and gentle active range of motion

Explanation

Most adductor longus strains, including grade II partial tears, are managed non-operatively with a brief period of rest, ice, and early functional rehabilitation, yielding high return-to-play rates.

Question 80

Topic: Infection, Pharmacology & VTE

A 22-year-old football player sustains a severe thigh contusion. Three weeks later, he presents with worsening pain and decreased knee flexion. Radiographs show calcification in the anterior thigh. What is the most appropriate initial management?

. Immediate surgical excision of the calcification
. Indomethacin and gentle active range of motion
. Aggressive passive stretching under anesthesia
. Extracorporeal shockwave therapy
. Corticosteroid injection into the calcified mass

Correct Answer & Explanation

. Indomethacin and gentle active range of motion

Explanation

Myositis ossificans traumatica is best managed non-operatively initially with NSAIDs (such as indomethacin) and gentle active range of motion. Early surgical excision is contraindicated as it exacerbates the inflammatory process and leads to high rates of recurrence.

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