Menu

1. General Principles & Basic Science MCQs

Practice Set 420 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 8381

Topic: Surgical Anatomy & Approaches

A 35-year-old man presents with vague posterior shoulder pain and numbness over the lateral deltoid. An MRI of the shoulder demonstrates isolated atrophy of the teres minor. Which of the following structures is most likely compressed?

. Radial nerve and profunda brachii artery
. Suprascapular nerve and artery
. Axillary nerve and posterior circumflex humeral artery
. Musculocutaneous nerve and anterior circumflex humeral artery
. Thoracodorsal nerve and artery

Correct Answer & Explanation

. Axillary nerve and posterior circumflex humeral artery

Explanation

Quadrilateral space syndrome is caused by compression of the axillary nerve and posterior circumflex humeral artery. It classically leads to isolated teres minor atrophy and lateral shoulder paresthesia.

Question 8382

Topic: Physiology & Rehabilitation

A 28-year-old male weightlifter presents with acute right shoulder pain after a heavy bench press. Examination reveals ecchymosis over the anterior axillary fold and a palpable defect. Loss of contour is most apparent when the patient presses his hands together.

Which of the following is true regarding this injury?

. The clavicular head is most commonly ruptured.
. The sternocostal head ruptures, which normally inserts lateral to the bicipital groove.
. Nonoperative management yields equal strength outcomes in athletes.
. The injury most commonly involves avulsion from the coracoid process.
. Surgical repair is ideally performed 6 months post-injury.

Correct Answer & Explanation

. The sternocostal head ruptures, which normally inserts lateral to the bicipital groove.

Explanation

Pectoralis major ruptures usually occur at the musculotendinous junction or tendinous insertion of the sternocostal head during eccentric contraction. The pectoralis major inserts onto the lateral lip of the bicipital groove.

Question 8383

Topic: 1. General Principles & Basic Science

A 30-year-old competitive weightlifter feels a sudden pop in his anterior axillary fold while performing a heavy bench press. Examination reveals bruising and a loss of the anterior axillary contour. Surgical repair is planned. Where is the anatomical footprint of the torn structure?

. Lateral lip of the bicipital groove
. Medial lip of the bicipital groove
. Coracoid process
. Lesser tuberosity
. Greater tuberosity

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

The pectoralis major muscle inserts onto the lateral lip of the bicipital groove. Ruptures most commonly occur at the sternocostal head insertion during eccentric loading and are best treated with early surgical repair in active patients.

Question 8384

Topic: 1. General Principles & Basic Science

A 32-year-old competitive weightlifter feels a pop in his anterior axilla while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. Operative exploration is planned. Where should the surgeon expect to find the native insertion of the ruptured tendon?

. Medial lip of the bicipital groove
. Lateral lip of the bicipital groove
. Floor of the bicipital groove
. Lesser tuberosity
. Coracoid process

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

The pectoralis major tendon inserts onto the lateral lip of the bicipital groove. Ruptures typically occur at or near this tendinous insertion during eccentric loading, such as the descent phase of a bench press.

Question 8385

Topic: 1. General Principles & Basic Science

A 32-year-old weightlifter felt a sudden tearing sensation in his anterior axilla while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. Surgical exploration is planned for a complete tear of the sternal head of the pectoralis major. Where does the sternal head normally insert on the humerus relative to the clavicular head?

. Proximal and deep
. Proximal and superficial
. Distal and deep
. Distal and superficial
. Directly medial and on the same plane

Correct Answer & Explanation

. Proximal and deep

Explanation

The pectoralis major tendon twists 180 degrees before inserting on the lateral lip of the bicipital groove. Due to this twist, the inferiorly originating sternal head inserts proximal and deep to the superiorly originating clavicular head.

Question 8386

Topic: 1. General Principles & Basic Science

An 18-year-old male presents to the emergency department after a high-speed motor vehicle collision. He complains of left medial clavicle pain, dysphagia, and mild dyspnea. Examination reveals a palpable void at the left sternoclavicular joint. After plain radiographs, what is the most appropriate next step in management?

. Closed reduction in the emergency department with conscious sedation
. Discharging the patient in a figure-of-eight sling with outpatient follow-up
. Immediate open reduction and internal fixation by an orthopedic surgeon alone
. Computed tomography (CT) angiogram of the chest and cardiothoracic surgery consultation
. Magnetic resonance imaging (MRI) of the brachial plexus

Correct Answer & Explanation

. Computed tomography (CT) angiogram of the chest and cardiothoracic surgery consultation

Explanation

Posterior sternoclavicular dislocations can cause life-threatening compression of mediastinal structures, including the trachea, esophagus, and great vessels. A CT angiogram is essential to evaluate for retrosternal injury, and thoracic surgery backup is required during reduction due to the high risk of catastrophic hemorrhage.

Question 8387

Topic: Surgical Anatomy & Approaches

During a Latarjet procedure, the coracoid process is transferred to the anterior glenoid. Which nerve is at greatest risk of injury during the coracoid preparation and transfer of the conjoined tendon?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis 5-8 cm distal to the coracoid process. It is tethered to the conjoined tendon and is at significant risk during retraction and transfer in a Latarjet procedure.

Question 8388

Topic: Physiology & Rehabilitation

A 30-year-old weightlifter feels a sudden "pop" in his axilla while performing a heavy bench press. He presents with extensive ecchymosis over the anterior axillary fold. He will most likely demonstrate marked weakness in which of the following shoulder motions?

. Adduction and internal rotation
. Abduction and external rotation
. Forward flexion and internal rotation
. Extension and external rotation
. Adduction and external rotation

Correct Answer & Explanation

. Adduction and internal rotation

Explanation

The pectoralis major acts primarily as an adductor and internal rotator of the humerus. Ruptures typically occur during eccentric contraction, such as the descent phase of a bench press, resulting in weakness in these specific motions.

Question 8389

Topic: 1. General Principles & Basic Science

A 19-year-old football player sustains a posterior sternoclavicular dislocation during a pile-up. He presents with shortness of breath and difficulty swallowing. What is the most immediate life-threatening complication that must be ruled out?

. Brachial plexus avulsion
. Pneumothorax
. Tracheal compression
. Aortic aneurysm rupture
. Subclavian vein thrombosis

Correct Answer & Explanation

. Tracheal compression

Explanation

Posterior sternoclavicular dislocations can compress critical mediastinal structures. Tracheal compression resulting in airway compromise is an immediate, life-threatening emergency requiring prompt reduction.

Question 8390

Topic: Surgical Anatomy & Approaches

A 32-year-old overhead athlete presents with poorly localized posterior shoulder pain and paresthesias over the lateral deltoid. Angiography demonstrates occlusion of the posterior circumflex humeral artery with the arm in abduction and external rotation. Which nerve is most likely compressed?

. Radial nerve
. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Long thoracic nerve

Correct Answer & Explanation

. Axillary nerve

Explanation

Quadrilateral space syndrome involves the compression of the axillary nerve and posterior circumflex humeral artery within the quadrilateral space. It is often caused by fibrous bands or hypertrophy of the adjacent teres minor muscle.

Question 8391

Topic: Surgical Anatomy & Approaches

A 32-year-old professional volleyball player presents with poorly localized posterior shoulder pain and paresthesias over the lateral deltoid. An MRI demonstrates isolated atrophy of the teres minor muscle. Which of the following structures is most likely being compressed?

. Suprascapular nerve in the spinoglenoid notch
. Axillary nerve in the quadrilateral space
. Radial nerve in the triangular interval
. Circumflex scapular artery in the triangular space
. Long thoracic nerve at the first rib

Correct Answer & Explanation

. Axillary nerve in the quadrilateral space

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and posterior humeral circumflex artery. It typically presents with localized teres minor atrophy, as the anterior branch of the axillary nerve supplying the deltoid may be spared.

Question 8392

Topic: 1. General Principles & Basic Science

A 19-year-old male is brought to the emergency department after a motor vehicle accident. He has severe pain over his medial clavicle, shortness of breath, and dysphagia. Radiographs and a CT scan confirm a posterior sternoclavicular dislocation. What is the most appropriate management?

. Immediate closed reduction in the emergency department using traction and extension
. Closed reduction in the operating room with a cardiothoracic surgeon on standby
. Figure-of-eight bracing and observation
. Open reduction and internal fixation with Kirschner wires
. Resection of the medial clavicle

Correct Answer & Explanation

. Closed reduction in the operating room with a cardiothoracic surgeon on standby

Explanation

Posterior sternoclavicular dislocations can compress vital mediastinal structures. Due to the high risk of catastrophic vascular injury during manipulation, reduction must be performed in the operating room with cardiothoracic surgery available.

Question 8393

Topic: 1. General Principles & Basic Science

A 32-year-old male bodybuilder presents with an acute tearing sensation in his anterior chest and axilla while performing a heavy bench press. Examination reveals an asymmetric chest wall and a palpable defect in the axillary fold. If surgical repair is planned, which anatomical structure represents the most common site of failure in this injury?

. Sternocostal head at the humeral insertion
. Clavicular head at the musculotendinous junction
. Muscle belly of the sternocostal head
. Clavicular head at the sternal origin
. Coracoid insertion of the short head of the biceps

Correct Answer & Explanation

. Sternocostal head at the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur at the insertion of the sternocostal head onto the humerus. This typically occurs during maximal eccentric loading, such as the descent phase of a bench press.

Question 8394

Topic: Surgical Anatomy & Approaches

A 35-year-old man presents with vague posterior shoulder pain and numbness over the lateral aspect of the deltoid. MRI of the shoulder demonstrates isolated atrophy and fatty infiltration of the teres minor muscle. Which of the following structures is most likely compressed?

. Suprascapular nerve
. Axillary nerve and posterior circumflex humeral artery
. Radial nerve and profunda brachii artery
. Musculocutaneous nerve
. Spinal accessory nerve

Correct Answer & Explanation

. Axillary nerve and posterior circumflex humeral artery

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and the posterior circumflex humeral artery. It classically presents with teres minor atrophy, deltoid weakness, and lateral shoulder paresthesias.

Question 8395

Topic: Physiology & Rehabilitation

A 32-year-old male bodybuilder felt a pop in his anterior chest while performing a heavy bench press. He has bruising over the anterior axillary fold and weakness in internal rotation and adduction. Which segment of the pectoralis major is most commonly injured in this mechanism?

. Clavicular head at the muscle belly
. Sternal head at the muscle belly
. Sternal head at the humeral insertion
. Clavicular head at the humeral insertion
. Costal head at the sternoclavicular joint

Correct Answer & Explanation

. Sternal head at the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur at the humeral insertion (tendon avulsion) during eccentric contraction, such as bench pressing. The sternal head is tightest in the extended and abducted position, making it most vulnerable to rupture.

Question 8396

Topic: 1. General Principles & Basic Science

A 32-year-old bodybuilder feels a 'pop' and develops severe pain in the anterior axillary fold while performing a heavy bench press. Examination reveals loss of the normal axillary contour. If operative repair is undertaken, the torn tendon should be reattached to which of the following anatomic locations?

. Medial lip of the bicipital groove
. Lateral lip of the bicipital groove
. Coracoid process
. Lesser tuberosity
. Conjoined tendon

Correct Answer & Explanation

. Lateral lip of the bicipital groove

Explanation

Pectoralis major ruptures commonly occur during eccentric loading. The sternal head of the pectoralis major tendon anatomically inserts onto the lateral lip of the bicipital groove, which is the surgical target for repair.

Question 8397

Topic: Surgical Anatomy & Approaches

A 40-year-old male presents with vague posterior shoulder pain and weakness in external rotation. An MRI demonstrates fatty infiltration and atrophy isolated to the teres minor muscle. Which structure is most likely compressed?

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

Correct Answer & Explanation

. Axillary nerve

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and posterior humeral circumflex artery. This typically results in isolated atrophy of the teres minor, though the deltoid may also be affected.

Question 8398

Topic: 1. General Principles & Basic Science

A 35-year-old bodybuilder tears his pectoralis major tendon while bench pressing. Operative repair is planned. Which of the following accurately describes the normal anatomic insertion of the sternal head relative to the clavicular head on the humerus?

. Anterior and distal
. Posterior and proximal
. Anterior and proximal
. Posterior and distal
. Medial and coplanar

Correct Answer & Explanation

. Posterior and proximal

Explanation

The pectoralis major tendon undergoes a 180-degree twist before inserting on the humerus. This twisting causes the sternal (inferior) head to insert posterior (deep) and proximal (superior) relative to the clavicular head.

Question 8399

Topic: Surgical Anatomy & Approaches

A 24-year-old male undergoes a Latarjet procedure. Postoperatively, he exhibits profound weakness in elbow flexion and supination, along with numbness over the lateral forearm. Which nerve was most likely injured by vigorous retractor placement deep to the conjoined tendon?

. Axillary nerve
. Musculocutaneous nerve
. Radial nerve
. Median nerve
. Ulnar nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve enters the coracobrachialis approximately 3-8 cm distal to the coracoid tip. Vigorous medial retraction of the conjoined tendon during the Latarjet procedure places this nerve at high risk for a traction neuropathy.

Question 8400

Topic: 1. General Principles & Basic Science

A 30-year-old weightlifter feels a sharp pop in his anterior axilla while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. What is the recommended management for an acute complete tear at the humeral insertion?

. Nonoperative management with a sling
. Immediate repair using suture anchors or cortical button
. Delayed surgical repair after 6 months
. Excision of the torn tendon end
. Pectoralis minor tendon transfer

Correct Answer & Explanation

. Immediate repair using suture anchors or cortical button

Explanation

Acute operative repair of completely ruptured pectoralis major tendons at the humeral insertion yields significantly better strength, cosmesis, and functional outcomes compared to nonoperative management in young active individuals.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page