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1. General Principles & Basic Science MCQs

Practice Set 440 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 8781

Topic: 1. General Principles & Basic Science

When applying a halo vest in an adult patient, the anterior pins must be placed carefully to avoid nerve injury. Which of the following nerves is at greatest risk if the anterior pins are placed too medially?

. Supraorbital nerve
. Supratrochlear nerve
. Facial nerve (temporal branch)
. Auriculotemporal nerve
. Greater occipital nerve

Correct Answer & Explanation

. Supratrochlear nerve

Explanation

The supratrochlear and supraorbital nerves exit superior to the orbit. Anterior halo pins should be placed in the safe zone lateral to the middle two-thirds of the orbit to avoid injuring the supraorbital and supratrochlear nerves.

Question 8782

Topic: 1. General Principles & Basic Science

A 40-year-old runner presents with chronic heel pain, worse with the first steps in the morning. After 12 months of conservative treatment, he elects for a partial plantar fascia release. To minimize the risk of lateral column pain and arch collapse, the release should be limited to:

. The lateral one-third of the plantar fascia
. The medial one-third of the plantar fascia
. The central band only
. The medial and central bands entirely
. The abductor hallucis fascia only

Correct Answer & Explanation

. The medial one-third of the plantar fascia

Explanation

Surgical release of the plantar fascia should be strictly limited to the medial one-third to one-half of the fascia. Releasing more than this significantly increases the risk of lateral column overload, cuboid syndrome, and longitudinal arch collapse.

Question 8783

Topic: 1. General Principles & Basic Science

A 36-year-old runner presents with lateral retromalleolar pain and swelling that worsens with activity. Clinical exam reveals tenderness along the posterior aspect of the fibula. An MRI is shown in the provided image.

Assuming the image shows a longitudinal split tear of the peroneus brevis, what is the most likely pathomechanism?

. Repetitive forced dorsiflexion and extreme eversion
. Hypertrophy of the os peroneum causing friction
. Subluxation of the peroneus brevis tendon over a shallow fibular groove
. Hypertrophy of the superior peroneal retinaculum compressing the tendon
. Ischemic necrosis due to impingement from the sural nerve

Correct Answer & Explanation

. Subluxation of the peroneus brevis tendon over a shallow fibular groove

Explanation

Peroneus brevis tears (often longitudinal or "split" tears) frequently occur due to subluxation over a shallow or convex fibular retromalleolar groove. This subluxation creates a mechanical shearing force between the tendon and the fibula.

Question 8784

Topic: 1. General Principles & Basic Science

A wide receiver injures his great toe while being tackled on an artificial turf field. MRI confirms a complete tear of the plantar plate and sesamoid complex of the first metatarsophalangeal (MTP) joint. What is the most common mechanism of this injury?

. Forced hyperflexion
. Forced hyperextension
. Axial loading
. Valgus impaction
. Varus stress

Correct Answer & Explanation

. Forced hyperextension

Explanation

Classic 'turf toe' is caused by an acute, forced hyperextension of the first MTP joint, leading to sprain or rupture of the plantar capsuloligamentous complex. It is highly associated with flexible artificial turf and lightweight athletic footwear.

Question 8785

Topic: Infection, Pharmacology & VTE

A diabetic patient presents with a chronic plantar ulcer under the first metatarsal head. There is no systemic toxicity. Which clinical finding has the highest positive predictive value for underlying osteomyelitis?

. Erythema extending 2 cm from the ulcer margins
. An elevated erythrocyte sedimentation rate (ESR) > 40 mm/hr
. A positive probe-to-bone test
. Periosteal reaction on plain radiographs
. An elevated C-reactive protein (CRP)

Correct Answer & Explanation

. A positive probe-to-bone test

Explanation

A positive probe-to-bone test (feeling a hard, gritty surface) in the presence of a chronic diabetic foot ulcer is highly predictive of underlying osteomyelitis, often confirming the diagnosis without the immediate need for an MRI.

Question 8786

Topic: 1. General Principles & Basic Science

A 22-year-old collegiate football player sustains a forceful hyper-dorsiflexion injury to his great toe. Examination reveals marked tenderness plantar to the first MTP joint and profound weakness with active plantar flexion of the hallux. What structure is most likely disrupted?

. Extensor hallucis brevis tendon
. Flexor hallucis longus tendon
. Plantar plate and sesamoid complex
. Medial collateral ligament of the MTP joint
. Adductor hallucis tendon

Correct Answer & Explanation

. Plantar plate and sesamoid complex

Explanation

Turf toe is a severe sprain or complete tear of the plantar plate and capsuloligamentous complex of the first MTP joint. Loss of push-off strength directly implicates compromise of the sesamoid-plantar plate mechanism.

Question 8787

Topic: 1. General Principles & Basic Science

A 35-year-old male bodybuilder feels a pop in his anterior chest while performing a heavy bench press. He has bruising and a palpable defect medially on the humerus. MRI confirms a complete tear of the pectoralis major tendon at its insertion. Which head of the pectoralis major typically tears first, and where does it insert relative to the other head?

. Sternal head; inserts posterior and superior to the clavicular head
. Sternal head; inserts anterior and inferior to the clavicular head
. Clavicular head; inserts posterior and superior to the sternal head
. Clavicular head; inserts anterior and inferior to the sternal head
. Sternal head; inserts directly medial to the clavicular head

Correct Answer & Explanation

. Sternal head; inserts posterior and superior to the clavicular head

Explanation

The sternal head of the pectoralis major is placed under the most tension during extreme extension and external rotation (bench press) and typically tears first. The tendon twists 180 degrees, causing the sternal head to insert posterior and superior to the clavicular head.

Question 8788

Topic: 1. General Principles & Basic Science

A 19-year-old football player sustains a posterior sternoclavicular dislocation after being tackled. He complains of mild difficulty swallowing. What is the most appropriate initial management step?

. Immediate open reduction via a cardiothoracic approach
. Closed reduction in the operating room with cardiothoracic surgery backup
. Discharge with a figure-of-eight sling and outpatient follow-up
. CT angiogram followed by conservative management if vessels are intact
. Application of a spica cast

Correct Answer & Explanation

. Closed reduction in the operating room with cardiothoracic surgery backup

Explanation

Posterior sternoclavicular dislocations can compress vital mediastinal structures such as the trachea, esophagus, or great vessels. Urgent closed reduction in the OR under general anesthesia with cardiothoracic surgery on standby is the standard of care.

Question 8789

Topic: 1. General Principles & Basic Science

A 28-year-old weightlifter feels a "pop" and burning pain in his anterior axillary fold while performing a heavy bench press. Exam reveals loss of the anterior axillary contour and weakness in internal rotation. Which portion of the pectoralis major is most commonly ruptured in this scenario?

. Clavicular head
. Sternal head
. Costal head
. Abdominal head
. Coracoid insertion

Correct Answer & Explanation

. Sternal head

Explanation

Pectoralis major ruptures during bench pressing typically involve the sternocostal head, which is placed under maximum tension at the bottom of the lift. The clavicular head often remains intact.

Question 8790

Topic: Surgical Anatomy & Approaches



A 45-year-old manual laborer undergoes an open subpectoral biceps tenodesis. In the recovery room, the patient complains of numbness over the lateral aspect of his forearm and profound weakness in elbow flexion. Which of the following nerves was most likely injured during the procedure?

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

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

The musculocutaneous nerve is at risk during a subpectoral biceps tenodesis, particularly if retractors are placed too medially under the conjoined tendon. Injury results in biceps/brachialis weakness and numbness in the lateral antebrachial cutaneous nerve distribution.

Question 8791

Topic: 1. General Principles & Basic Science

A 32-year-old bodybuilder feels a 'pop' in his anterior axilla while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. MRI confirms a complete rupture of the pectoralis major tendon at its humeral insertion. Which of the following accurately describes the anatomy of this tendon?

. The clavicular head inserts proximal to the sternal head.
. The sternal head twists 180 degrees and inserts proximal and deep to the clavicular head.
. The tendon inserts on the medial lip of the bicipital groove.
. The clavicular head twists 180 degrees before inserting.
. The entire tendon inserts deep to the long head of the biceps.

Correct Answer & Explanation

. The sternal head twists 180 degrees and inserts proximal and deep to the clavicular head.

Explanation

The pectoralis major tendon undergoes a 180-degree twist before inserting onto the lateral lip of the bicipital groove. The sternal head twists such that its fibers insert proximal and deep to the untwisted clavicular head fibers.

Question 8792

Topic: Surgical Anatomy & Approaches

A 35-year-old man sustained a highly comminuted proximal humerus fracture and is scheduled for operative fixation. Postoperatively, he is noted to have a sensory deficit over the lateral aspect of his shoulder and weakness in external rotation.

Which space did the likely injured nerve pass through to innervate the affected muscle?

. Triangular space
. Triangular interval
. Quadrilateral space
. Spinoglenoid notch
. Suprascapular notch

Correct Answer & Explanation

. Quadrilateral space

Explanation

The patient has an axillary nerve injury, causing lateral shoulder numbness and weakness of the teres minor (external rotation) and deltoid. The axillary nerve passes through the quadrilateral space along with the posterior circumflex humeral artery.

Question 8793

Topic: Surgical Anatomy & Approaches

A 28-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness. MRI reveals isolated atrophy of the teres minor. The entrapped nerve is located in a quadrilateral space bounded superiorly by which anatomic structure?

. Teres major
. Teres minor
. Long head of the triceps
. Humeral shaft

Correct Answer & Explanation

. Teres minor

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery. The space is bounded superiorly by the teres minor, inferiorly by the teres major, medially by the long head of the triceps, and laterally by the humeral shaft.

Question 8794

Topic: 1. General Principles & Basic Science

A 29-year-old competitive weightlifter feels a pop in his anterior chest wall while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in adduction. Where does the most common pattern of this muscular rupture occur?

. Clavicular head at the muscle belly
. Sternal head at the musculotendinous junction
. Sternal head at the humeral insertion
. Clavicular head at the clavicular origin

Correct Answer & Explanation

. Sternal head at the humeral insertion

Explanation

Pectoralis major ruptures typically occur in weightlifters (e.g., bench press) and most commonly involve the avulsion of the sternal head from its humeral insertion. Surgical repair is indicated for young, active patients to restore full strength.

Question 8795

Topic: Surgical Anatomy & Approaches

A 28-year-old weightlifter presents with isolated wasting of the infraspinatus muscle and weakness in external rotation. An MRI reveals a paralabral cyst. Where is the most likely location of the cyst and the associated nerve compression?

. Suprascapular notch compressing the suprascapular nerve
. Spinoglenoid notch compressing the suprascapular nerve
. Quadrilateral space compressing the axillary nerve
. Triangular interval compressing the radial nerve
. Triangular space compressing the subscapular nerve

Correct Answer & Explanation

. Spinoglenoid notch compressing the suprascapular nerve

Explanation

Compression of the suprascapular nerve at the spinoglenoid notch typically causes isolated infraspinatus weakness and atrophy, as the motor branches to the supraspinatus have already departed the nerve proximal to this level.

Question 8796

Topic: 1. General Principles & Basic Science

A 32-year-old bodybuilder feels a pop in his anterior axilla while bench pressing. Examination reveals loss of the anterior axillary fold and weakness in internal rotation and adduction. Which portion of the pectoralis major is most commonly ruptured and what is its anatomic insertion?

. Clavicular head, inserting proximal to the sternal head
. Sternal head, inserting proximal to the clavicular head
. Clavicular head, inserting deep to the sternal head
. Sternal head, inserting deep to the clavicular head
. Sternal head, inserting lateral to the clavicular head

Correct Answer & Explanation

. Sternal head, inserting deep to the clavicular head

Explanation

The sternal head of the pectoralis major most commonly ruptures. Due to the 180-degree twist of the tendon, the sternal head inserts deep and superior to the clavicular head on the lateral lip of the bicipital groove.

Question 8797

Topic: Surgical Anatomy & Approaches

A 35-year-old overhead athlete complains of posterior shoulder pain and numbness over the lateral deltoid. MRI shows isolated teres minor atrophy. Which vascular structure is most likely compressed along with the involved nerve?

. Suprascapular artery
. Posterior humeral circumflex artery
. Anterior humeral circumflex artery
. Thoracoacromial artery
. Circumflex scapular artery

Correct Answer & Explanation

. Posterior humeral circumflex artery

Explanation

Quadrilateral space syndrome involves compression of the axillary nerve and the posterior humeral circumflex artery, leading to lateral shoulder numbness and teres minor atrophy.

Question 8798

Topic: Surgical Anatomy & Approaches

During a deltopectoral approach to the shoulder, how far distal to the lateral acromion does the axillary nerve typically traverse the deep surface of the deltoid muscle?

. 1 to 2 cm
. 5 to 7 cm
. 9 to 11 cm
. 12 to 14 cm
. 15 to 17 cm

Correct Answer & Explanation

. 5 to 7 cm

Explanation

The axillary nerve generally crosses the deep surface of the deltoid approximately 5 to 7 cm distal to the lateral edge of the acromion. Care must be taken to avoid retractors or dissection that risks injury in this zone.

Question 8799

Topic: 1. General Principles & Basic Science

A 19-year-old football player presents with a closed posterior sternoclavicular joint dislocation following a direct blow. He complains of mild difficulty swallowing. What is the most appropriate next step in management?

. Immediate closed reduction in the emergency department
. Observation with a sling
. CT scan of the chest and reduction with cardiothoracic surgery backup
. Open reduction and internal fixation with K-wires
. MRI of the brachial plexus

Correct Answer & Explanation

. CT scan of the chest and reduction with cardiothoracic surgery backup

Explanation

Posterior sternoclavicular dislocations can compress critical mediastinal structures. A CT scan evaluates the great vessels, and reduction should be performed in the OR with cardiothoracic surgery available due to the risk of catastrophic vascular injury.

Question 8800

Topic: 1. General Principles & Basic Science

A 32-year-old bodybuilder feels a "pop" in his axilla while performing a heavy bench press. Examination reveals an asymmetric chest wall and weakness in internal rotation and adduction. MRI confirms a complete pectoralis major rupture. Which of the following statements regarding the relevant anatomy and injury pattern is correct?

. The clavicular head is most commonly injured first.
. The sternal head inserts proximal and deep to the clavicular head on the humerus.
. The sternal head inserts distal and superficial to the clavicular head on the humerus.
. Tears most commonly occur at the musculotendinous junction in this demographic.
. The primary insertion is on the lesser tuberosity of the humerus.

Correct Answer & Explanation

. The sternal head inserts proximal and deep to the clavicular head on the humerus.

Explanation

The sternal head of the pectoralis major crosses beneath the clavicular head to insert proximally and deep on the lateral lip of the bicipital groove. This deep, lower portion is under maximum stretch during a bench press and typically tears first.

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