1. General Principles & Basic Science MCQs

A 55-year-old woman presents with a painful, translucent mass over the dorsum of her right index finger DIP joint. Radiographs confirm severe osteoarthritis with a prominent dorsal osteophyte. What is the most critical surgical step to minimize the recurrence of this mass after excision?

When utilizing an anterolateral surgical approach for the open reduction and internal fixation of a severe pilon fracture, which of the following neurologic structures is at greatest risk of iatrogenic injury?

A 28-year-old rugby player presents with an inability to actively flex the distal interphalangeal (DIP) joint of his ring finger after grabbing an opponent's jersey. The flexor digitorum profundus (FDP) tendon has retracted into the palm. Within what timeframe must this injury ideally be repaired to avoid tendon necrosis and fixed retraction?

A 60-year-old woman complains of a painful bump on the dorsal aspect of her index finger DIP joint. Examination reveals a translucent nodule and grooving of the adjacent nail bed. Which of the following is the most critical surgical step to prevent recurrence if operative excision is chosen?

A 22-year-old athlete sustains a rotational ankle injury. Radiographs show a fracture of the proximal third of the fibula and widening of the medial clear space. What structure is highly at risk during surgical approach or from the injury itself in this specific fracture pattern?

A 58-year-old woman presents with severe hand pain. Radiographs demonstrate central erosions of the PIP and DIP joints with a characteristic 'gull-wing' appearance. Rheumatoid factor and anti-CCP antibodies are negative. What cytokine is most strongly implicated in the pathogenesis of the cartilage destruction in this condition?

A 65-year-old female with advanced osteoarthritis of her right middle finger DIP joint presents with a painful, transilluminating dorsal nodule over the joint and grooving of her fingernail. Aspiration and corticosteroid injection have failed. She is scheduled for surgical excision. To minimize the risk of recurrence, which of the following steps is most critical during the surgical procedure?

A 45-year-old male presents with a 3-day history of pain, swelling, and redness over the dorsum of his hand following a fight. He has a small, punctate wound over the third MCP joint. X-rays show no fracture or foreign body. Examination reveals significant swelling, warmth, and exquisite pain with any movement of the third MCP joint. Which of the following is the most appropriate next step in management?

Which antibiotic regimen is considered first-line empiric therapy for a human bite infection involving the hand, pending culture results?

Which of the following is an absolute indication for surgical exploration and debridement of a human bite wound to the hand?

A 28-year-old male presents with a severe human bite wound to the hand. He has a documented anaphylactic allergy to penicillin. Which of the following antibiotic regimens is most appropriate to cover Eikenella corrodens and other oral flora?

During surgical exploration of a human bite wound over the small finger MCP joint, the joint capsule appears intact when the fingers are held in full extension. Which of the following maneuvers is critical to avoid missing an intra-articular penetration?

When evaluating a patient with a suspected scapholunate ligament tear, understanding the intrinsic ligamentous anatomy is crucial. Which region of the scapholunate interosseous ligament is biomechanically the strongest and most important for resisting translation?

Following meticulous surgical irrigation and debridement of a human bite wound with intra-articular extension into the 4th MCP joint, what is the most appropriate management of the soft tissue envelope?

Which of the following best explains why human clenched-fist injuries frequently result in delayed presentation of septic arthritis that is difficult to visually assess upon initial emergency department evaluation?

A 25-year-old male presents with a human bite wound over the fourth MCP joint. The decision is made to take the patient to the operating room for formal irrigation and debridement. Which of the following describes the most appropriate surgical incision to adequately explore the joint and extensor mechanism?

During open reduction and internal fixation of a medial malleolus fracture, a longitudinal incision is made directly over the medial malleolus. Which neurological structure is most at risk of injury during the superficial dissection in this area?

A 25-year-old male suffers a severe crush injury to his leg after an industrial accident. On arrival at the ED, his BP is 100/60 mmHg, HR 110 bpm. Labs show K+ 6.2 mEq/L, Cr 2.5 mg/dL, and a significant myoglobinuria. What is the most immediate life-threatening electrolyte abnormality to address?