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1. General Principles & Basic Science MCQs

Practice Set 494 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 9861

Topic: Surgical Anatomy & Approaches

Which of the following correctly describes the anatomical relationship of the neurovascular bundles in the fingers relative to the flexor tendons?

. The neurovascular bundles lie volar to the flexor tendons.
. The neurovascular bundles lie dorsal to the flexor tendons.
. The neurovascular bundles lie immediately radial and ulnar to the flexor tendons.
. The neurovascular bundles intertwine within the substance of the flexor tendons.
. The neurovascular bundles are located only on the dorsal aspect of the fingers.

Correct Answer & Explanation

. The neurovascular bundles lie immediately radial and ulnar to the flexor tendons.

Explanation

The digital neurovascular bundles (composed of the digital artery, nerve, and vein) run on the radial and ulnar sides of the flexor tendon sheath and phalanges within the finger. They are located just volar to the sagittal mid-axial line, making them vulnerable during surgical approaches or direct trauma. They do not lie volar or dorsal to the tendons in a consistent manner relative to the entire finger, nor do they intertwine with the tendons. They are not only dorsal.

Question 9862

Topic: Biomechanics & Biomaterials

Which type of suture material is generally preferred for core sutures in FDP repair due to its strength and knot security?

. Chromic gut.
. Plain gut.
. Non-absorbable monofilament (e.g., Prolene, Ethilon).
. Absorbable braided (e.g., Vicryl, Dexon).
. Stainless steel wire.

Correct Answer & Explanation

. Non-absorbable monofilament (e.g., Prolene, Ethilon).

Explanation

Non-absorbable monofilament sutures, such as polypropylene (Prolene) or nylon (Ethilon), are generally preferred for core sutures in flexor tendon repairs. They provide excellent tensile strength, maintain their integrity long enough for tendon healing, have good knot security, and their monofilament nature minimizes tissue drag and infection risk. Absorbable sutures do not provide long-term strength. Gut sutures are rapidly absorbed and have low strength. Stainless steel wire is generally not used for core sutures in the hand due to stiffness and potential for fatigue failure or pull-out.

Question 9863

Topic: 1. General Principles & Basic Science

A patient is 6 months post-operative from FDP repair. He has recovered excellent passive range of motion but complains of persistent weakness and fatigue with grip, especially during repetitive tasks. What is the most appropriate next step in his rehabilitation?

. Rigid immobilization for an additional 4 weeks to allow for further healing.
. Referral for surgical re-exploration due to suspected re-rupture.
. Initiate a progressive strengthening and endurance program.
. Prescribe oral corticosteroids to reduce inflammation.
. Recommend immediate return to full unrestricted activity.

Correct Answer & Explanation

. Initiate a progressive strengthening and endurance program.

Explanation

At 6 months post-op, with good passive range of motion but persistent weakness and fatigue, the patient is ready for a focused progressive strengthening and endurance program. The tendon is well-healed by this point, and the focus shifts from protection and early motion to regaining full strength, power, and endurance for functional activities. Immobilization would lead to further stiffness and deconditioning. Re-rupture would present with loss of active motion. Corticosteroids are not indicated. Immediate unrestricted activity without strengthening may risk re-injury or poor functional return.

Question 9864

Topic: 1. General Principles & Basic Science

When advising a patient on post-operative care following FDP repair, what is the typical recommended duration for avoiding heavy gripping and lifting activities?

. 2-3 weeks.
. 4-6 weeks.
. 8-10 weeks.
. 3-4 months.
. 6 months to 1 year.

Correct Answer & Explanation

. 3-4 months.

Explanation

While light activities and protected active motion begin early, heavy gripping and lifting activities are typically restricted for a period of 3-4 months (12-16 weeks) following flexor tendon repair. This timeframe allows for adequate tensile strength development in the healing tendon. Premature engagement in strenuous activities risks re-rupture. Tendon healing is a slow process, with tensile strength gradually increasing over several months.

Question 9865

Topic: Surgical Anatomy & Approaches

What is the standard surgical approach for open reduction internal fixation of an olecranon fracture?

. Anteromedial approach
. Lateral Kocher approach
. Posterior approach
. Anterior approach
. Medial approach

Correct Answer & Explanation

. Posterior approach

Explanation

The standard surgical approach for olecranon fractures is a posterior approach (C). This allows direct access to the olecranon, triceps tendon, and articular surface while carefully protecting the ulnar nerve, which is usually identified and mobilized medially.

Question 9866

Topic: Biology, Genetics & Bone Healing

When planning surgical fixation of a both bones forearm fracture, what is the ideal timing for operation to minimize complications such as infection and non-union in a hemodynamically stable patient with a closed fracture?

. Within 6 hours of injury.
. Within 12 hours of injury.
. Within 24 hours of injury.
. Within 3-5 days of injury, after soft tissue swelling subsides.
. Within 7-10 days of injury, allowing for callus formation.

Correct Answer & Explanation

. Within 24 hours of injury.

Explanation

For closed diaphyseal forearm fractures in adults, surgical fixation (ORIF) is considered an urgent, but not emergent, procedure. It is ideally performed within 24-48 hours (Option C). This 'golden period' allows for optimal surgical conditions before significant soft tissue swelling or early callus formation complicates reduction, while also minimizing the risk of delayed union or non-union associated with prolonged conservative management in an adult. Waiting 3-5 days (Option D) or 7-10 days (Option E) may allow for swelling to subside but risks increasing difficulty of reduction due to early callus and fibrosis.

Question 9867

Topic: Infection, Pharmacology & VTE

What is the primary goal of anatomical reduction and rigid internal fixation in adult both bones forearm fractures?

. Facilitate early weight-bearing.
. Minimize operative time.
. Promote secondary bone healing.
. Restore full pronation and supination.
. Prevent osteomyelitis.

Correct Answer & Explanation

. Restore full pronation and supination.

Explanation

The primary goal of anatomical reduction and rigid internal fixation in adult diaphyseal forearm fractures is to restore full pronation and supination (Option D). The forearm requires precise anatomical alignment to allow for the complex coupled motion of the radius and ulna around each other. Any significant malreduction, especially rotational, will severely compromise this function. Rigid fixation also aims for primary bone healing, and while minimizing operative time and preventing osteomyelitis are important surgical considerations, they are not theprimary goalfor functional outcome. Early weight-bearing (Option A) is not typically a goal for forearm fractures.

Question 9868

Topic: Surgical Anatomy & Approaches

Regarding plate placement for diaphyseal forearm fractures, which statement is most accurate?

. The radius is ideally plated on its dorsal surface, and the ulna on its volar surface.
. Both radius and ulna are ideally plated on their dorsal surfaces.
. Both radius and ulna are ideally plated on their volar surfaces.
. The radius is ideally plated on its volar surface, and the ulna on its dorsal or medial surface.
. The plating surface depends solely on the fracture obliquity.

Correct Answer & Explanation

. The radius is ideally plated on its volar surface, and the ulna on its dorsal or medial surface.

Explanation

For the radius, the volar surface (anterior, Henry approach) is generally preferred (Option D) due to less soft tissue stripping and avoiding the posterior interosseous nerve. For the ulna, the subcutaneous dorsal surface (posterior) or the medial surface (which is also relatively subcutaneous) is preferred due to ease of access and minimal muscle dissection. Therefore, Option D, 'The radius is ideally plated on its volar surface, and the ulna on its dorsal or medial surface,' is the most accurate statement, representing optimal surgical approaches and minimizing complications.

Question 9869

Topic: Biology, Genetics & Bone Healing

What is the earliest reliable radiographic sign of healing in a both bones forearm fracture treated with rigid internal fixation?

. Loss of fracture line visibility.
. Formation of periosteal callus.
. Bridging callus across the fracture gap.
. Cortical remodeling at the fracture site.
. Re-establishment of intramedullary continuity.

Correct Answer & Explanation

. Loss of fracture line visibility.

Explanation

With rigid internal fixation (e.g., compression plating), primary bone healing is aimed for, which involves minimal to no visible callus. The earliest radiographic sign of healing is often the gradual blurring and eventual loss of visibility of the fracture line (Option A) as cortical continuity is re-established directly. Periosteal callus (Option B) and bridging callus (Option C) are features of secondary bone healing, which occurs if fixation is not absolutely rigid or if there is a gap. Cortical remodeling (Option D) and re-establishment of intramedullary continuity (Option E) occur later.

Question 9870

Topic: Surgical Anatomy & Approaches

Which surgical approach for the ulna shaft is generally considered the safest and most direct, minimizing neurovascular risk?

. Anterior approach.
. Posterior (dorsal) subcutaneous approach.
. Medial approach.
. Lateral approach.
. Anteromedial approach.

Correct Answer & Explanation

. Posterior (dorsal) subcutaneous approach.

Explanation

The posterior (dorsal) subcutaneous approach (Option B) to the ulna shaft is generally considered the safest and most direct because the ulna is largely subcutaneous along its posterior border. This approach requires minimal muscle dissection, thereby reducing the risk of injury to neurovascular structures, which are typically located volarly or deep in the forearm. The anterior and medial approaches involve more muscle dissection and potential risks to vessels and nerves.

Question 9871

Topic: 1. General Principles & Basic Science

In a patient with a refracture of the radius through a previous screw hole after plate removal, what is the most important prophylactic measure to consider during the initial plate removal?

. Early physiotherapy immediately after removal.
. Re-drilling and grafting of screw holes.
. Extended period of immobilization after removal.
. Avoiding strenuous activity for 6 weeks post-removal.
. Using larger screws for initial fixation.

Correct Answer & Explanation

. Avoiding strenuous activity for 6 weeks post-removal.

Explanation

Refracture through screw holes after plate removal is a known complication due to stress risers. The most important prophylactic measure is to protect the limb from strenuous activity for an adequate period (typically 6 weeks, Option D) post-removal, allowing the screw holes to remodel and regain strength. While extended immobilization (C) might reduce risk, it leads to stiffness. Re-drilling and grafting (B) are not standard. Early physio (A) would increase risk. Larger screws (E) are for initial fixation strength, not refracture prevention after removal.

Question 9872

Topic: Surgical Anatomy & Approaches

Which artery is at highest risk of injury during the surgical approach to a distal radial shaft fracture via the Henry (anterior) approach?

. Ulnar artery.
. Posterior interosseous artery.
. Anterior interosseous artery.
. Radial artery.
. Brachial artery.

Correct Answer & Explanation

. Radial artery.

Explanation

The radial artery (Option D) lies in close proximity to the distal radial shaft and is directly within the surgical field of the Henry (anterior) approach. It must be carefully identified and retracted, typically ulnarward, to prevent iatrogenic injury. The ulnar artery (A), posterior interosseous artery (B), and anterior interosseous artery (C) are typically not in the direct field for a distal radial approach. The brachial artery (E) is much more proximal.

Question 9873

Topic: 1. General Principles & Basic Science

In an acute lunate dislocation, the interval between the lunate and the scaphoid on an AP radiograph is often widened. What is the typical measurement that indicates significant scapholunate dissociation?

. < 1 mm
. 1-2 mm
. 2-3 mm
. > 3 mm
. No widening is expected

Correct Answer & Explanation

. > 3 mm

Explanation

A scapholunate interval (SL gap) greater than 3 mm on an AP radiograph is generally considered indicative of significant scapholunate dissociation, often referred to as the 'Terry Thomas sign.' Normal is typically 2 mm or less, though some consider 3 mm borderline. A dynamic study, like a clenched-fist view, can accentuate a subtle widening.

Question 9874

Topic: Infection, Pharmacology & VTE

A patient presents with a 'fight bite' over the dorsal aspect of the fifth MCP joint. During surgical exploration, purulent material is found tracking along the extensor digitorum communis tendon into the wrist. This finding is indicative of:

. A. Isolated cellulitis
. B. Septic arthritis of the MCP joint
. C. Tenosynovitis of the extensor tendon sheath
. D. Osteomyelitis of the fifth metacarpal head
. E. Localized abscess formation

Correct Answer & Explanation

. C. Tenosynovitis of the extensor tendon sheath

Explanation

Purulent material tracking along the extensor digitorum communis tendon into the wrist is a classic sign of extensor tenosynovitis. While other pathologies like septic arthritis and osteomyelitis can coexist or develop from tenosynovitis, the direct observation of pus within the tendon sheath extending proximally confirms tenosynovitis. Cellulitis (A) is a superficial soft tissue infection. Septic arthritis (B) involves the joint space. Osteomyelitis (D) involves bone infection. A localized abscess (E) would be a circumscribed collection of pus, but its extension along a tendon sheath points specifically to tenosynovitis.

Question 9875

Topic: Infection, Pharmacology & VTE

What is the typical duration of intravenous antibiotic therapy for established septic arthritis of the MCP joint secondary to a human bite, assuming no osteomyelitis is present?

. A. 24-48 hours, followed by oral antibiotics for 5 days.
. B. 3-5 days, followed by oral antibiotics for 1-2 weeks.
. C. 7-10 days, followed by oral antibiotics for 2-4 weeks.
. D. 4-6 weeks of intravenous antibiotics only.
. E. 6-8 weeks of combined intravenous and oral antibiotics.

Correct Answer & Explanation

. C. 7-10 days, followed by oral antibiotics for 2-4 weeks.

Explanation

For established septic arthritis without associated osteomyelitis, the typical duration involves initial intravenous antibiotics for 7-10 days, followed by a transition to oral antibiotics for an additional 2-4 weeks, for a total course of 3-4 weeks. The exact duration may vary based on clinical response, pathogen, and host factors. Shorter courses (A, B) are often insufficient for deep-seated joint infections. Prolonged IV antibiotics for 4-6 weeks (D) or 6-8 weeks (E) are more typical for osteomyelitis, not isolated septic arthritis.

Question 9876

Topic: Infection, Pharmacology & VTE

Which of the following physical examination findings is most indicative of septic arthritis of an MCP joint in a patient with a suspected fight bite?

. A. Pain localized to the skin laceration with normal range of motion.
. B. Warmth and erythema extending to the forearm.
. C. Significant pain with passive range of motion of the affected MCP joint.
. D. Paresthesias in the digit distal to the wound.
. E. Visible pus exuding from the wound without joint involvement.

Correct Answer & Explanation

. C. Significant pain with passive range of motion of the affected MCP joint.

Explanation

Significant pain with passive range of motion (PROM) of the affected joint is a classic and highly sensitive sign of septic arthritis. Any attempt to move the joint will stretch the inflamed and distended joint capsule, causing severe pain. Pain localized to the skin (A) suggests superficial involvement. Warmth and erythema extending to the forearm (B) indicate cellulitis/lymphangitis, which may or may not involve the joint. Paresthesias (D) suggest nerve injury, not primarily septic arthritis. Visible pus (E) from the wound suggests infection but does not specifically localize it to the joint unless it is directly from within the joint space.

Question 9877

Topic: Infection, Pharmacology & VTE

What is the primary role of an MRI in the acute evaluation of a complicated fight bite injury to the hand?

. A. To definitively identify bacterial species present in the wound.
. B. To assess the extent of soft tissue edema and inflammation only.
. C. To detect early osteomyelitis, tenosynovitis, or joint capsule violation not clear on plain radiographs.
. D. To guide placement of external fixators for unstable fractures.
. E. To measure nerve conduction velocity for suspected nerve injury.

Correct Answer & Explanation

. C. To detect early osteomyelitis, tenosynovitis, or joint capsule violation not clear on plain radiographs.

Explanation

MRI is highly sensitive for detecting early osteomyelitis, tenosynovitis, and joint capsule violations, as well as foreign bodies not visible on X-ray, and delineating fluid collections (abscesses). While plain radiographs are initial, MRI provides superior soft tissue and bone marrow detail when deep infection or complex involvement is suspected but not definitively clear from clinical exam and X-rays. It does not identify bacterial species (A) or measure nerve conduction (E). While it shows edema (B), its utility extends far beyond that. External fixator guidance (D) is not its primary role in the acute phase of an infection.

Question 9878

Topic: Infection, Pharmacology & VTE

Which of the following is considered a poor prognostic indicator in a fight bite injury to the hand?

. A. Young patient age.
. B. Injury sustained over the index finger MCP joint.
. C. Delayed presentation (>24 hours) with signs of deep infection.
. D. Superficial laceration without joint involvement.
. E. Absence of associated fracture.

Correct Answer & Explanation

. C. Delayed presentation (>24 hours) with signs of deep infection.

Explanation

Delayed presentation (>24 hours) coupled with signs of deep infection (e.g., septic arthritis, osteomyelitis, tenosynovitis) is a significant poor prognostic indicator for fight bite injuries. The longer the infection is allowed to progress without definitive treatment, the greater the risk of irreversible joint damage, functional loss, and limb-threatening complications. Young age (A) is generally a good prognostic indicator. The location (B) is common but not inherently prognostic. Superficial wounds (D) and absence of fracture (E) are typically associated with better outcomes.

Question 9879

Topic: 1. General Principles & Basic Science

When considering tetanus prophylaxis for a patient with a human bite wound, which of the following is true?

. A. Tetanus immunoglobulin (TIG) is always given for human bite wounds.
. B. Tetanus toxoid is indicated if the last dose was more than 10 years ago.
. C. Both Tetanus toxoid and TIG are given if the patient's immunization status is unknown or incomplete and the wound is dirty/deep.
. D. Tetanus prophylaxis is not necessary for human bite wounds, only animal bites.
. E. Tetanus toxoid booster is given only if the wound shows signs of infection.

Correct Answer & Explanation

. C. Both Tetanus toxoid and TIG are given if the patient's immunization status is unknown or incomplete and the wound is dirty/deep.

Explanation

Tetanus prophylaxis guidelines are based on the patient's immunization history and the wound characteristics. For human bite wounds, which are considered contaminated and often deep, if the patient has an unknown or incomplete immunization status (less than 3 doses of tetanus toxoid), both tetanus toxoid (vaccine) and tetanus immunoglobulin (TIG) are indicated. If the patient has received 3 or more doses, a booster shot of tetanus toxoid is given if the last dose was more than 5 years ago for dirty/deep wounds, or more than 10 years for clean/minor wounds. TIG is not always given (A). Tetanus prophylaxis is definitely necessary for human bites (D). Tetanus toxoid booster should be given based on immunization status and wound characteristics, not just signs of infection (E).

Question 9880

Topic: Infection, Pharmacology & VTE

What is the approximate time window after which a human bite wound to the hand is generally considered 'late presentation' and carries a significantly higher risk of complications?

. A. 3 hours
. B. 6 hours
. C. 12 hours
. D. 24 hours
. E. 48 hours

Correct Answer & Explanation

. D. 24 hours

Explanation

While there isn't an absolute universal cutoff, a human bite wound presenting after 24 hours is generally considered a 'late presentation' and carries a significantly higher risk of developing deep-seated infections such as septic arthritis, tenosynovitis, or osteomyelitis. The longer the delay, the more established the bacterial inoculation and proliferation. Prompt evaluation and management within the first few hours are crucial for optimal outcomes. Some sources suggest 6-12 hours as a critical window for primary closure consideration, but 24 hours is more universally accepted for increased complication risk.

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