1. General Principles & Basic Science MCQs

During a TKA for a severe varus deformity, the surgeon proceeds with a sequential medial release. After releasing the deep medial collateral ligament (MCL) and posteromedial capsule, the knee remains tight medially in flexion. Which structure, serving as the primary restraint to valgus stress at 90 degrees of flexion, must be addressed next?

Tranexamic acid (TXA) is routinely utilized in total joint arthroplasty to reduce blood loss and transfusion requirements. What is the specific pharmacological mechanism of action of TXA?

A 30-year-old weightlifter feels a sudden 'pop' in his anterior chest while performing a heavy bench press. Examination reveals ecchymosis over the anterior arm and loss of the normal contour of the anterior axillary fold. If surgical repair is undertaken, which anatomic portion of the injured structure is most commonly found to be ruptured?

A 24-year-old sustains an anterior shoulder dislocation. After closed reduction, he has numbness over the lateral deltoid and cannot actively contract the muscle. At 3 weeks post-injury, he has no clinical improvement, and an EMG demonstrates fibrillation potentials in the deltoid and teres minor. What is the most appropriate management?

A 29-year-old elite tennis player presents with vague posterior shoulder pain and early fatigue. Examination reveals isolated atrophy of the teres minor. MR angiography demonstrates focal occlusion of the posterior circumflex humeral artery when the shoulder is positioned in abduction and external rotation. This pathology involves compression within a space bound superiorly by which structure?

A 40-year-old weightlifter feels a sudden 'pop' in his anterior chest while performing a heavy bench press. Examination reveals loss of the anterior axillary fold and weakness in internal rotation. During surgical repair, an understanding of the pectoralis major footprint is critical. Which statement is correct regarding its insertion?

A 65-year-old female presents with bilateral thigh pain. Radiographs reveal thickened lateral cortices of the proximal femur with a transverse radiolucent line and a medial spike. Which medication is most strongly associated with this fracture pattern?

A 22-year-old male driver involved in a high-speed dashboard collision sustains a posterior hip dislocation. Which specific nerve injury is most frequently associated with this mechanism?

A 35-year-old male motorcyclist is thrown from his bike, sustaining a complete brachial plexus avulsion and laterally displaced scapula (scapulothoracic dissociation). Which vascular structure is most commonly injured in this specific injury pattern?

A 25-year-old male sustains a low-velocity gunshot wound to the distal thigh. Radiographs show a retained bullet entirely contained within the knee joint capsule. What is the most appropriate next step in management?

A 32-year-old male sustains a posterior wall acetabular fracture with a posterior hip dislocation. Following closed reduction, he is noted to have a new-onset foot drop. Which component of the sciatic nerve is most commonly injured, and what is its anatomic relation at the greater sciatic notch?

A 35-year-old male sustains a posterior wall acetabular fracture with an associated posterior hip dislocation. Post-reduction, he is unable to dorsiflex his foot or extend his toes. Which specific nerve division is most likely injured?

During the modified Henry approach for volar plating of a distal radius fracture, the surgeon develops the interval between the flexor carpi radialis (FCR) and the radial artery. Retraction of which muscle exposes the pronator quadratus?

A 28-year-old male presents with a traumatic posterior hip dislocation following a dashboard injury. The hip is reduced in the emergency department 4 hours post-injury. Post-reduction examination reveals new weakness in ankle dorsiflexion and decreased sensation over the dorsal foot. Which nerve division is most likely injured?

A 48-year-old male falls from a ladder, sustaining a severely comminuted intra-articular distal tibia (pilon) fracture. A bridging external fixator is applied on the day of injury. What clinical sign primarily determines the optimal timing for definitive open reduction and internal fixation?

During the surgical repair of a complete pectoralis major rupture in a weightlifter, the surgeon must anatomically restore the footprint. What is the anatomic relationship of the sternal head footprint relative to the clavicular head footprint on the humerus?

A 28-year-old volleyball player complains of vague posterior shoulder pain and numbness over the lateral deltoid. MRI confirms Quadrilateral Space Syndrome causing compression of the axillary nerve and posterior humeral circumflex artery. Which of the following structures forms the inferior border of this anatomic space?

A 45-year-old active male sustains a medial meniscus posterior root tear. Biomechanically, what is the consequence of leaving this tear unrepaired compared to a completely meniscectomized knee?

A 24-year-old volleyball player is scheduled for surgical debridement of recalcitrant proximal patellar tendinopathy (Jumper's knee). Where is the classic pathological lesion located in this condition?

A 45-year-old female presents with acute posterior knee pain after deep flexion. MRI shows a medial meniscus posterior root tear with 3 mm of extrusion. What is the primary biomechanical consequence of leaving this unrepaired?