1. General Principles & Basic Science MCQs

A 45-year-old woman is undergoing total hip arthroplasty via a posterior approach. The surgeon identifies the piriformis tendon and prepares to release it. According to the Beaton and Anson classification, what is the most common anatomical relationship between the sciatic nerve and the piriformis muscle?

During an ilioinguinal approach for open reduction and internal fixation of an anterior column acetabular fracture, the surgeon dissects along the posterior aspect of the superior pubic ramus. Sudden, brisk arterial hemorrhage occurs. This is most likely due to an injury to the 'corona mortis', which is an anastomotic vessel connecting the obturator system with which of the following?

A surgeon is utilizing a standard deltopectoral approach for open reduction and internal fixation of a 3-part proximal humerus fracture. If extending the incision laterally into the deltoid muscle is required, the surgeon must be highly cautious of the axillary nerve. The main trunk of the axillary nerve typically courses along the deep surface of the deltoid at approximately what distance distal to the lateral edge of the acromion?

During a total hip arthroplasty via the anterior (Smith-Petersen) approach, the surgeon exploits an internervous plane to access the hip joint while minimizing denervation. Which two nerves supply the muscles that define the superficial surgical interval of this approach?

During an ilioinguinal approach for the internal fixation of an anterior column acetabular fracture, significant hemorrhage is encountered while dissecting over the posterior aspect of the superior pubic ramus. Which of the following is the most likely source of this bleeding?

During a deltopectoral approach for a total shoulder arthroplasty, the cephalic vein is identified. Which of the following correctly describes its anatomical relationship and the recommended method of retraction during this approach?

During an ilioinguinal approach for an anterior column acetabular fracture, the surgeon encounters massive, pulsatile hemorrhage while exposing the superior pubic ramus. This bleeding most likely originates from an anomalous vascular connection (corona mortis) bridging which two vascular systems?

In performing an inside-out repair of the posterior horn of the medial meniscus, a postero-medial approach is often utilized to retrieve needles safely. To prevent iatrogenic nerve injury, the surgeon must be aware of the anatomic course of the saphenous nerve. At the level of the medial joint line, the main trunk of the saphenous nerve is typically located between which two tendons?

A 28-year-old hockey player undergoes hip arthroscopy for a symptomatic CAM-type femoroacetabular impingement and a focal anterosuperior labral tear. The anterolateral (AL) portal is established first under fluoroscopic guidance. To safely establish the mid-anterior (MAP) portal, the surgeon must remain lateral to the sagittal plane of the anterior superior iliac spine (ASIS). Deviating medial to this plane primarily increases the risk of injury to which of the following structures?

During an open subpectoral biceps tenodesis, the surgeon creates a cortical window in the bicipital groove just distal to the transverse humeral ligament. However, due to extensive fraying of the long head of the biceps tendon, the incision and deep dissection are extended further distally along the humeral shaft. If medial retractors are placed too aggressively deep to the conjoined tendon and biceps muscle belly during this distal extension, which neurovascular structure is at greatest risk of iatrogenic injury?

A 50-year-old female experiences a sudden "pop" in the posterior aspect of her knee while descending stairs. She is diagnosed with a complete medial meniscus posterior root tear with 3 mm of extrusion on MRI. Biomechanically, what is the direct consequence of leaving this tear untreated compared to the native knee?

A 32-year-old competitive weightlifter feels a sudden tearing sensation and 'pop' in his anterior axilla while performing a one-rep max bench press. Physical examination reveals an asymmetrical loss of the anterior axillary fold, significant ecchymosis, and weakness in internal rotation and adduction. An MRI confirms a complete rupture of the pectoralis major tendon. During an open surgical repair, the surgeon must accurately reattach the tendon to its anatomic footprint. Which of the following accurately describes the insertion of the sternal head of the pectoralis major relative to the clavicular head?

During an open subpectoral biceps tenodesis, the conjoint tendon is retracted medially to optimize exposure of the bicipital groove and pectoralis major tendon. Overzealous medial retraction of the conjoint tendon is most likely to result in injury to which of the following nerves?

A 30-year-old competitive weightlifter feels a sudden "pop" and tearing sensation in his anterior axilla while performing a heavy bench press. He presents with extensive ecchymosis and loss of the anterior axillary fold. MRI confirms a complete, full-thickness rupture of the pectoralis major tendon at its insertion. Which of the following best describes the anatomic orientation of the pectoralis major tendon at its insertion onto the humerus?

A 19-year-old collegiate wrestler sustains an anterior shoulder dislocation. After successful closed reduction, he complains of numbness over the lateral deltoid and demonstrates weakness with shoulder abduction. Electromyography (EMG) confirms an isolated neurapraxia. What is the expected anatomic distance of the affected nerve from the inferior border of the glenoid at the 6 o'clock position?

A 45-year-old woman presents with acute onset medial knee pain after a deep knee flexion maneuver. She felt a "pop" in her knee. MRI demonstrates a medial meniscus posterior root tear and a 2 mm extrusion of the medial meniscus on coronal sequences. Which of the following biomechanical consequences is most likely if this injury is treated nonoperatively?

A 55-year-old woman experiences a sudden onset of posterior medial knee pain while descending stairs. An MRI confirms a complete posterior root tear of the medial meniscus with 4 mm of medial meniscal extrusion. Biomechanically, what is the direct consequence of this specific tear pattern if left untreated?

A 28-year-old male weightlifter presents with a tearing sensation in his anterior chest wall while performing a heavy bench press. Examination reveals ecchymosis over the anterior axillary fold and a palpable defect. If surgical repair is planned, which portion of the pectoralis major tendon is most commonly ruptured and where does it normally insert?

A 30-year-old male powerlifter feels a tearing sensation in his anterior chest wall while performing a heavy bench press. Clinical examination reveals a palpable defect over the anterior axillary fold and weakness with adduction and internal rotation. During surgical repair, the surgeon isolates the torn sternal head of the pectoralis major. Which of the following accurately describes the native anatomic insertion of the sternal head relative to the clavicular head?

A 26-year-old male ice hockey player presents with deep anterior groin pain exacerbated by hip flexion and internal rotation. Radiographs demonstrate an alpha angle of 65 degrees and no crossover sign. Arthroscopy is planned. During hip arthroscopy, establishing the anterior portal places which of the following structures at greatest risk?