1. General Principles & Basic Science MCQs

During an ilioinguinal approach to the acetabulum, the surgeon develops three distinct surgical windows. When working in the middle window to access the pelvic brim and quadrilateral surface, which of the following neurovascular structures is primarily mobilized and at highest risk?

During a posterior (Kocher-Langenbeck) approach to the hip, the short external rotators are detached to expose the posterior capsule. The deep branch of the medial femoral circumflex artery (MFCA), the primary blood supply to the femoral head, is at risk. Where does the main terminal branch of the MFCA lie in relation to the short external rotators?

A 35-year-old male requires autologous bone grafting for a recalcitrant tibial nonunion. A posterolateral approach to the tibia is chosen to avoid the compromised anteromedial soft tissue envelope. During this approach, the correct internervous plane is developed between the lateral gastrocnemius, soleus, and flexor hallucis longus posteriorly, and which of the following muscles anteriorly?

A 45-year-old male sustains an anterior column and quadrilateral plate fracture of the acetabulum. The surgeon selects the modified Stoppa approach for reduction and fixation. During the initial dissection, a significant anastomotic vessel (corona mortis) is identified crossing the superior pubic ramus. This vessel typically connects the external iliac or inferior epigastric system to which of the following?

A surgeon is performing an anterior (Smith-Petersen) approach to the hip for an open reduction of a slipped capital femoral epiphysis. After utilizing the superficial interval, the deep internervous plane is developed. Which two muscles form this deep internervous plane?

A surgeon is utilizing the volar (Henry) approach to the proximal radius for open reduction and internal fixation of a highly comminuted radial shaft fracture. During the initial superficial dissection, the surgeon develops the internervous plane between the brachioradialis and the pronator teres. Which of the following vascular structures must be identified and typically ligated to safely mobilize the brachioradialis laterally and expose the underlying supinator?

A 45-year-old male undergoes open reduction and internal fixation of an anterior column acetabular fracture via an ilioinguinal approach. During dissection along the superior pubic ramus, brisk arterial bleeding is encountered approximately 6 centimeters from the pubic symphysis. This bleeding is most likely originating from an anastomotic vessel that connects which two vascular systems?

During an ilioinguinal approach for an anterior column acetabular fracture, the surgeon is exposing the posterior aspect of the superior pubic ramus. Massive hemorrhage is suddenly encountered. This bleeding is most likely due to an anomalous vascular connection between which two vessels?

A 55-year-old woman undergoes a minimally invasive lateral transpsoas approach to the lumbar spine (LLIF) for an L4-L5 degenerative spondylolisthesis. Postoperatively, she experiences profound weakness in knee extension and numbness over the anterior aspect of her thigh. Which of the following nerves was most likely injured, and what is its normal anatomical location relative to the psoas major muscle at the L4-L5 disc level?

A 45-year-old female is undergoing a periacetabular osteotomy (PAO) via the anterior (Smith-Petersen) approach to the hip. The surgeon develops the superficial interval between the sartorius and the tensor fasciae latae. During this dissection, a significant vascular structure crossing the operative field must be identified and ligated to prevent hemorrhagic complications. Which of the following vessels is this?

A 32-year-old male sustains a distal-third oblique humerus fracture (Holstein-Lewis type). A posterior approach to the humerus is chosen for open reduction and internal fixation. To safely mobilize the radial nerve, the surgeon tracks it from the posterior compartment to the anterior compartment. At what approximate distance proximal to the lateral epicondyle does the radial nerve pierce the lateral intermuscular septum?

A 40-year-old male undergoes open reduction and internal fixation for a displaced anterior column acetabular fracture via the ilioinguinal approach. During dissection posterior to the superior pubic ramus, heavy arterial bleeding is encountered. This bleeding is most likely originating from an aberrant vascular connection between the external iliac system and which of the following arteries?

A 24-year-old competitive weightlifter presents with vague posterior shoulder pain and weakness in external rotation. MRI reveals isolated denervation edema and early atrophy of the teres minor. Examination demonstrates diminished pinprick sensation over the lateral deltoid. Entrapment of the affected nerve is most likely occurring in an anatomic space bounded superiorly by which of the following structures?

A senior resident is utilizing the anterolateral (Watson-Jones) approach to the hip for a total hip arthroplasty. The superficial surgical interval is developed between the tensor fasciae latae and the gluteus medius. What is the true internervous plane utilized in this superficial dissection?

During a posterolateral approach to the hip for a total hip arthroplasty, the surgeon splits the gluteus maximus in line with its fibers. To access the short external rotators, which of the following nerves must be identified and protected as it courses anterior to the piriformis in normal anatomy, but can pierce the piriformis muscle in up to 15% of patients?

During an ilioinguinal approach for an anterior column acetabular fracture, significant hemorrhage is encountered behind the superior pubic ramus, approximately 5-6 cm from the pubic symphysis. Which of the following anatomical variants is the most likely source of the bleeding?

A 32-year-old bodybuilder presents with poorly localized posterior shoulder pain and numbness over the lateral aspect of the deltoid. Examination reveals weakness in external rotation and abduction. An MRI shows an isolated paralabral cyst compressing a nerve within a space bordered superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the surgical neck of the humerus. Which of the following vessels accompanies the affected nerve in this space?

A surgeon is performing a posterolateral approach (Kocher) to the radial head for a comminuted fracture in a 40-year-old woman. To minimize the risk of iatrogenic injury to the posterior interosseous nerve (PIN), the forearm should be held in which position, and the PIN is located within which muscle?

A 30-year-old rock climber presents with a 'bowstringing' deformity of his right ring finger following a sudden pop while gripping a small hold. Examination reveals pain and loss of mechanical advantage during finger flexion. Rupture of which two annular pulleys is most likely responsible for clinical bowstringing of the flexor tendons?

A 28-year-old overhead athlete presents with posterior shoulder pain and weakness in external rotation and abduction. An MRI shows an isolated paralabral cyst compressing the nerve within the quadrangular space. Which of the following describes the boundaries of the space where the compression occurs?