Practice Set 559 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.
During harvest of a hamstring autograft, the pes anserinus is exposed via an anteromedial tibial incision. From anterior to posterior, what is the correct order of the tendinous insertions?
. Sartorius, Gracilis, Semitendinosus
On an axial MRI of the distal third of the thigh, multiple hamstring muscles are visualized. Which of these muscles is uniquely innervated by the common peroneal division of the sciatic nerve?
. Long head of biceps femoris
The deltopectoral approach utilizes a true internervous plane to access the anterior shoulder. What are the respective innervations of the two muscles that define this plane?
. Axillary nerve and medial/lateral pectoral nerves
A 68-year-old female with an 8-year history of alendronate therapy complains of dull right thigh pain. Radiographs reveal lateral cortical thickening and a transverse radiolucent line in the subtrochanteric region of the right femur, but no complete fracture. What is the most appropriate management?
. Discharge with NSAIDs and physical therapy
A 40-year-old male presents with persistent pain 8 months after a midshaft tibial fracture treated in a cast. Radiographs show a prominent 'elephant foot' callus formation but a persistent radiolucent line across the fracture gap. The site is mobile on exam. What is the primary underlying cause, and the treatment of choice?
. Poor biological potential; requires autologous bone grafting
A 45-year-old male sustains an anterior column and anterior wall acetabular fracture. An ilioinguinal approach is planned. During the exposure, the surgeon identifies a vascular structure passing over the superior pubic ramus connecting the external iliac and obturator systems. This structure is known as the corona mortis. What is the approximate incidence of this vascular variant?
. 5-10%
A 29-year-old industrial worker suffers a complete traumatic amputation of his dominant index finger. The amputated part is recovered. To maximize the chance of successful replantation, how should the amputated part be transported?
. Submerged directly in normal saline at room temperature
During an ilioinguinal approach for the fixation of an anterior column acetabulum fracture, massive hemorrhage is encountered when dissecting over the superior pubic ramus.
Which of the following vascular structures is most likely injured?
. An anomalous anastomosis between the internal pudendal and superior gluteal arteries
In evaluating a severe lower extremity crush injury for potential amputation, the Mangled Extremity Severity Score (MESS) is calculated. Which of the following components can contribute the highest possible number of points to the MESS score?
. Patient age over 50 years
The CRASH-2 trial demonstrated a significant reduction in mortality in bleeding trauma patients treated with tranexamic acid (TXA). To achieve this mortality benefit, TXA must be administered within what maximum timeframe from the time of injury?
. 1 hour
A patient is brought to the emergency department following an industrial explosion. Which of the following injuries is classified as a 'primary' blast injury?
. Penetrating shrapnel wounds to the lower extremities
During the surgical management of a complex lower extremity trauma, a pneumatic tourniquet is applied to minimize blood loss. To prevent irreversible ischemic damage to the muscles and nerves, what is the maximum recommended continuous inflation time before the tourniquet must be released for a 'breathing' period?
. 60 minutes
A massively bleeding trauma patient undergoes a rapid thromboelastography (TEG) assay. The results show a significantly prolonged R-time (reaction time) with normal K-time, normal alpha angle, and normal maximum amplitude. Which of the following is the most appropriate targeted therapy based on this specific TEG abnormality?
. Platelet transfusion
Based on the CRASH-2 trial regarding the use of Tranexamic Acid (TXA) in bleeding trauma patients, which of the following statements is true regarding its administration?
. TXA administration should be delayed until the patient reaches the operating room.
The Lower Extremity Assessment Project (LEAP) was a large multicenter prospective study comparing amputation to limb salvage for severe lower extremity trauma. Which of the following was a major conclusion of the LEAP study?
. Limb salvage patients had significantly better functional outcomes at 2 years compared to amputation patients.
According to the classic principles described by Godina for the management of complex open extremity injuries requiring free tissue transfer, timing of the flap coverage is most predictive of flap failure and infection. What was the optimal time frame originally recommended by Godina for free flap coverage?
. Within 24 hours of injury
Bone morphogenetic proteins (BMPs) are utilized in orthopedic trauma to promote fracture healing. Through which of the following mechanisms do BMP-2 and BMP-7 primarily exert their osteoinductive effects?
. Inhibition of osteoclast activity via the RANKL pathway
A pneumatic tourniquet is routinely used in orthopedic extremity trauma surgery. What is the generally accepted maximum safe continuous tourniquet inflation time before the risk of irreversible muscle damage and nerve injury significantly increases?
. 60 minutes
. Aspirin was non-inferior to LMWH in preventing fatal and non-fatal pulmonary embolisms.
A 28-year-old male sustains a closed, mid-shaft humerus fracture and presents with an isolated radial nerve palsy on initial examination. The fracture is treated with a functional Sarmiento brace. At what time point is surgical exploration of the radial nerve most definitively indicated if there is no clinical or electromyographic (EMG) evidence of recovery?
. 3 to 4 weeks