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1. General Principles & Basic Science MCQs

Practice Set 5 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 81

Topic: Physiology & Rehabilitation

A 55-year-old female presents with refractory lateral hip pain. She walks with a distinct Trendelenburg gait. An MRI reveals a full-thickness tear of the gluteus medius tendon at its insertion on the greater trochanter with fatty atrophy. What physical exam finding is most likely present?

. Positive FADIR test
. Positive FABER test
. Weakness with resisted hip abduction
. Weakness with resisted hip adduction
. Positive straight leg raise

Correct Answer & Explanation

. Weakness with resisted hip abduction

Explanation

Gluteus medius tears present as recalcitrant greater trochanteric pain syndrome accompanied by a positive Trendelenburg sign. Patients exhibit profound weakness with resisted hip abduction in the lateral decubitus position.

Question 82

Topic: Physiology & Rehabilitation

A hockey player sustains an acute grade II strain of the adductor longus muscle. He is prescribed a phased physical therapy program. During the remodeling phase, which type of exercise is most effective for promoting tissue healing and preventing recurrence?

. Maximal isometric contractions
. Aggressive passive stretching
. Eccentric strengthening exercises
. Plyometric jumping
. Continuous passive motion

Correct Answer & Explanation

. Eccentric strengthening exercises

Explanation

Eccentric strengthening exercises are critical in the rehabilitation of muscle strains, including the adductors and hamstrings. They promote proper collagen alignment, increase muscle fascicle length, and significantly reduce recurrence rates.

Question 83

Topic: 1. General Principles & Basic Science

Following acute lateral traumatic patellar dislocation, the surgical procedure that most closely reconstructs the injured structure is:

. Arthroscopic lateral release
. Vastus medialis obliquus advancement
. Medial patellofemoral ligament reconstruction
. Medial patellotibial ligament reconstruction
. Tibial tubercle transfer

Correct Answer & Explanation

. Medial patellofemoral ligament reconstruction

Explanation

The medial patellofemoral ligament is the primary restraint to lateral subluxation of the patella. The other structures contribute less substantially to patellofemoral stability. In the majority of cases of acute traumatic patellar dislocation, the medial patellofemoral ligament is disrupted.

Question 84

Topic: 1. General Principles & Basic Science

An arthroscopic photo (Slide) looking from the posterior portal at the anterior inferior aspect of the glenoid is presented. What is the proper treatment in this case based on the finding:

. Debridement
. Biceps tenotomy
. Open repair
. Arthroscopic repair
. No treatment necessary

Correct Answer & Explanation

. No treatment necessary

Explanation

The photo shows normal anterior inferior labrum; therefore, no treatment is necessary for this structure.

Question 85

Topic: 1. General Principles & Basic Science
Muscle contusions are clinically graded according to:
. Offending activity
. Objective swelling
. Pain as determined by analog pain scale
. The degree of myositis ossificans
. Range of motion of the adjacent joint

Correct Answer & Explanation

. Range of motion of the adjacent joint

Explanation

Muscle contusions are graded according to the range of motion of the adjacent joint. Mild muscle contusion: two-thirds normal range of motion. Moderate muscle contusion: one-third to two-thirds normal range of motion. Severe muscle contusions: less than one-third normal range of motion. The offending activity does not determine the grade of injury. Although swelling is variable, it is not the final determinant of grading. Pain is variable and unreliable in classifying muscle contusion. Although myositis ossificans is more often a result of more severe contusions, it is a later and infrequent finding.

Question 86

Topic: 1. General Principles & Basic Science

The treatment protocol found to hasten recovery after quadriceps contusion is:

. Extension protocol
. Flexion protocol
. Immobilization
. Aggressive stretching protocol
. Nonweight bearing protocol

Correct Answer & Explanation

. Flexion protocol

Explanation

An initial period of rest with the knee in flexion followed by rehabilitation focusing on regaining knee flexion has resulted in reduced morbidity and faster return to full activity. Extension protocols are associated with resultant longer recovery times. Immobilization is not associated with early recovery. Aggressive stretching increases morbidity and the formation of myositis ossificans. Nonweight bearing has not demonstrated decreased recovery times.

Question 87

Topic: 1. General Principles & Basic Science

A 30-year-old male felt a tearing sensation in his anterior axillary fold while performing a heavy bench press. Examination reveals loss of the anterior axillary fold contour and weakness in internal rotation. Which portion of the pectoralis major is most commonly ruptured during this activity?

. Clavicular head at the muscle belly
. Sternocostal head at the humeral insertion
. Clavicular head at the humeral insertion
. Sternocostal head at the sternal origin

Correct Answer & Explanation

. Sternocostal head at the humeral insertion

Explanation

Pectoralis major ruptures most commonly occur at the humeral insertion. The sternocostal head is placed under maximal tension during the eccentric phase of a bench press, making it the most frequently torn segment.

Question 88

Topic: 1. General Principles & Basic Science

A 24-year-old soccer player undergoes an isolated medial meniscal repair. Which of the following zones of the meniscus has the best healing potential?

. Red-red zone
. Red-white zone
. White-white zone
. Anterior horn
. Posterior horn

Correct Answer & Explanation

. Red-red zone

Explanation

The red-red zone (peripheral 3mm) has the best vascularity and thus the highest healing potential for meniscal repairs. The inner white-white zone is avascular.

Question 89

Topic: 1. General Principles & Basic Science
The posterior cruciate ligament sustains from 85% to 100% of the load of a posterior directed force at 90° of flexion. Which fibers of the ligament are responsible for this?
. Anterolateral bundle
. Anteromedial bundle
. Posteromedial bundle
. Posterolateral bundle
. Anterolateral and posteromedial equally

Correct Answer & Explanation

. Anterolateral bundle

Explanation

The posterior cruciate ligament is the primary restraint to posterior tibial translation, sustaining the majority of force across the knee at 90° of flexion. The PCL has two functional components, an anterolateral portion, and a posteromedial portion. These two "bundles" are named according to their insertions. The anterolateral bundle is tight in flexion and is biomechanically superior to the posteromedial bundle. For this reason, "one bundle techniques" attempt to reproduce the anterolateral bundle.

Question 90

Topic: 1. General Principles & Basic Science

The most common location for a meniscal cyst is:

. Middle third of the lateral meniscus
. Middle third of the medial meniscus
. Posterior horn of the lateral meniscus
. Anterior horn of the lateral meniscus
. Anterior horn of the medial meniscus

Correct Answer & Explanation

. Middle third of the lateral meniscus

Explanation

Mensical cysts are rather uncommon and occur most frequently in the middle third of the lateral meniscus. They are less common in the medial meniscus, where they tend to occur in the posterior horn. They are often associated with horizontal, cleavage type tears of the meniscus. Lateral cysts tend to be smaller and are localized to the joint line, where medial cysts can be large and may dissect through the capsule.

Question 91

Topic: Biology, Genetics & Bone Healing

A 68-year-old woman on long-term alendronate therapy presents with sudden onset thigh pain after a minor trip. Radiographs show a transverse fracture in the subtrochanteric region with lateral cortical thickening. This fracture pattern is primarily attributed to which cellular mechanism?

. Hyperactive osteoblast function
. Suppression of osteoclastic bone resorption
. Overexpression of parathyroid hormone
. Deficiency in type I collagen synthesis
. Malignant transformation of osteocytes

Correct Answer & Explanation

. Suppression of osteoclastic bone resorption

Explanation

Bisphosphonates inhibit osteoclast function, severely suppressing bone turnover and impairing the physiological repair of microdamage. Over years of therapy, this leads to the accumulation of microfractures on the tension side (lateral cortex) of the femur, eventually resulting in an atypical complete fracture.

Question 92

Topic: Biomechanics & Biomaterials

During a total hip arthroplasty, the surgeon opts to use a highly cross-linked polyethylene liner to reduce wear rates. What is the primary mechanism by which cross-linking improves the tribological properties of the polyethylene?

. Increasing the overall crystalline content of the polymer
. Inducing free radicals to break down weak polymer chains
. Exposing the material to ethylene oxide to harden the surface
. Using irradiation to create covalent bonds between adjacent polymer chains
. Melting the polyethylene at temperatures above 200 degrees Celsius to eliminate wear debris

Correct Answer & Explanation

. Using irradiation to create covalent bonds between adjacent polymer chains

Explanation

Highly cross-linked polyethylene is manufactured using gamma or electron beam irradiation, which breaks polymer chains to create free radicals that subsequently form covalent bonds between adjacent chains. This cross-linking significantly reduces volumetric wear in total joint arthroplasty.

Question 93

Topic: Biology, Genetics & Bone Healing

A 45-year-old woman presents with an unresectable recurrence of a giant cell tumor of the sacrum. She is started on denosumab therapy. What is the specific mechanism of action of this medication?

. Inhibits vascular endothelial growth factor (VEGF)
. Binds to the RANK ligand (RANKL) preventing it from activating the RANK receptor
. Stimulates osteoblast production of unmineralized osteoid
. Directly induces apoptosis in mature osteoclasts
. Inhibits the mammalian target of rapamycin (mTOR) pathway

Correct Answer & Explanation

. Binds to the RANK ligand (RANKL) preventing it from activating the RANK receptor

Explanation

Denosumab is a fully human monoclonal antibody that binds directly to RANKL, preventing its interaction with the RANK receptor on osteoclast precursors. This prevents osteoclast formation, function, and survival, severely inhibiting the bone resorption characteristic of giant cell tumors.

Question 94

Topic: Biology, Genetics & Bone Healing

A 65-year-old woman is prescribed alendronate after a dual-energy X-ray absorptiometry (DEXA) scan reveals a T-score of -2.7 in her lumbar spine. Which of the following describes the primary molecular target of this bisphosphonate therapy?

. Inhibition of osteoblast apoptosis
. Stimulation of the Wnt/beta-catenin signaling pathway
. Inhibition of the farnesyl pyrophosphate synthase enzyme
. Binding to RANKL to prevent osteoclast activation
. Direct enhancement of intestinal calcium absorption

Correct Answer & Explanation

. Inhibition of the farnesyl pyrophosphate synthase enzyme

Explanation

Nitrogen-containing bisphosphonates (such as alendronate) inhibit the farnesyl pyrophosphate synthase enzyme within the mevalonate pathway. This disruption prevents the prenylation of small GTPases in osteoclasts, leading to impaired osteoclast function and enhanced apoptosis.

Question 95

Topic: 1. General Principles & Basic Science

Following a Zone II flexor tendon repair of the index finger, a patient is started on an early active mobilization protocol. What is the primary biomechanical rationale for incorporating early active motion compared to passive-only protocols?

. It decreases the work of flexion by limiting peritendinous adhesions
. It prevents gap formation by completely offloading the repair site
. It increases collagen cross-linking by decreasing local blood flow
. It shifts the repair to an intramembranous healing pathway
. It relies entirely on the intrinsic healing capacity of the epitenon

Correct Answer & Explanation

. It decreases the work of flexion by limiting peritendinous adhesions

Explanation

Early active motion protocols promote tendon gliding and limit restrictive peritendinous adhesions, effectively decreasing the work of flexion. Controlled stress also stimulates intrinsic healing and improves longitudinal collagen alignment.

Question 96

Topic: Biology, Genetics & Bone Healing

A tibial shaft fracture is treated with absolute stability using a properly tensioned compression plate. Which of the following best describes the primary mode of bone healing expected in this scenario?

. Endochondral ossification with a large cartilaginous callus
. Intramembranous ossification via cutting cones without visible callus
. A combination of endochondral and intramembranous ossification
. Fibrous tissue formation followed by direct mineralization
. Appositional bone growth from the periosteum alone

Correct Answer & Explanation

. Intramembranous ossification via cutting cones without visible callus

Explanation

Absolute stability minimizes interfragmentary strain and allows for primary bone healing. This occurs via Haversian remodeling (cutting cones) directly across the fracture site, which skips the cartilaginous phase and forms no visible callus.

Question 97

Topic: 1. General Principles & Basic Science

Patellar tendinitis:

. Is most frequently diagnosed in patients over 40 years old.
. Occurs at the superior pole of the patella.
. Frequently has consistent radiographic changes that are pathognomonic to the condition.
. Leads to fibrinoid necrosis and mucinous degeneration in the deep fibers of the tendon origin at the inferior pole of the patella.
. Occurs at the insertion of the patellar tendon into the tibia.

Correct Answer & Explanation

. Leads to fibrinoid necrosis and mucinous degeneration in the deep fibers of the tendon origin at the inferior pole of the patella.

Explanation

The deep fibers of the patellar tendon are less elastic and more susceptible to stresses that create the micro-traumatic damage. This repetitive stress leads to the focal degeneration and chronic inflammation.C orrect Answer: Leads to fibrinoid necrosis and mucinous degeneration in the deep fibers of the tendon origin at the inferior pole of the patella.

Question 98

Topic: 1. General Principles & Basic Science
During arthroscopic repair of the lateral meniscus using an "outside-in technique," the most important way to prevent damage to the peroneal nerve is to:
. Fully extend the leg during the repair
. Keep the knee flexed at least to 90° while performing the repair
. Make a large incision to identify the nerve
. Repair of the lateral meniscus should be done only with intra-articular arrows to prevent injury to the peroneal nerve
. Repair of the lateral meniscus should be done only with an inside-out technique to prevent injury to the peroneal nerve

Correct Answer & Explanation

. Keep the knee flexed at least to 90° while performing the repair

Explanation

The most important consideration in arthroscopic repair of the lateral meniscus is to avoid injuring the peroneal nerve. This is done best by using an outside-in technique and flexing the knee to 90° while passing the needles. With flexion of the knee, the peroneal nerve falls posterior to the joint line. It is important to remember to keep the needles anterior to the biceps.

Question 99

Topic: Biomechanics & Biomaterials

A medial meniscus posterior root tear alters knee biomechanics by causing which of the following?

. Decreased peak contact pressure in the medial compartment
. Increased radial stresses within the lateral meniscus
. Biomechanical equivalence to a total medial meniscectomy
. Posterior subluxation of the tibia relative to the femur
. Decreased anterior-posterior translation of the femur

Correct Answer & Explanation

. Biomechanical equivalence to a total medial meniscectomy

Explanation

A posterior root tear disrupts the ability of the meniscus to convert axial loads into hoop stresses. Biomechanically, this results in peak contact pressures equivalent to a total meniscectomy.

Question 100

Topic: Biology, Genetics & Bone Healing
During the proliferative phase of rotator cuff tendon healing after repair, which collagen type initially predominates before tissue remodeling occurs?
. Type I collagen
. Type II collagen
. Type III collagen
. Type IV collagen
. Type X collagen

Correct Answer & Explanation

. Type III collagen

Explanation

Tendon healing involves a proliferative phase characterized by the rapid deposition of Type III collagen. During the subsequent remodeling phase, this is gradually replaced by stronger, highly organized Type I collagen.

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