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1. General Principles & Basic Science MCQs

Practice Set 9 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 161

Topic: 1. General Principles & Basic Science

A 28-year-old marathon runner presents with lateral knee pain. Examination reveals a positive Noble compression test, with pain maximal at 30 degrees of knee flexion. The pathogenesis of this condition is most commonly related to friction of the iliotibial band against which underlying anatomic structure?

. Gerdy's tubercle
. Fibular head
. Lateral femoral epicondyle
. Lateral meniscus
. Popliteus hiatus

Correct Answer & Explanation

. Lateral femoral epicondyle

Explanation

Iliotibial band friction syndrome (ITBFS) is caused by the IT band snapping or rubbing repetitively over the prominent lateral femoral epicondyle. This friction is maximal at approximately 30 degrees of knee flexion.

Question 162

Topic: Biomechanics & Biomaterials

A 45-year-old male undergoes arthroscopy for a medial meniscal tear. Biomechanically, an unrepaired posterior root tear of the medial meniscus most closely approximates the tibiofemoral contact pressures seen in which of the following conditions?

. Intact meniscus
. Partial meniscectomy
. Total meniscectomy
. Discoid meniscus
. Meniscal cyst

Correct Answer & Explanation

. Total meniscectomy

Explanation

A posterior root tear disrupts the hoop stresses of the meniscus, causing it to extrude. This results in altered biomechanics and peak contact pressures that are essentially equivalent to a total meniscectomy.

Question 163

Topic: 1. General Principles & Basic Science

The superficial medial collateral ligament (sMCL) is the primary restraint to valgus stress at the knee. At what degree of knee flexion does the sMCL provide the highest percentage of this restraining force?

. 0 degrees
. 25 degrees
. 60 degrees
. 90 degrees
. 120 degrees

Correct Answer & Explanation

. 25 degrees

Explanation

The sMCL is the primary restraint to valgus stress, providing nearly 80% of the restraining force at 25-30 degrees of knee flexion, as the posteromedial capsule is relaxed in this position.

Question 164

Topic: 1. General Principles & Basic Science

The blood supply to the meniscus is critical in determining its healing potential following surgical repair. Which vascular structures primarily supply the peripheral 10-25% ("red-red" zone) of the menisci?

. Middle geniculate artery
. Medial and lateral inferior geniculate arteries
. Popliteal artery directly
. Descending genicular artery
. Sural arteries

Correct Answer & Explanation

. Medial and lateral inferior geniculate arteries

Explanation

The medial and lateral inferior geniculate arteries form the peripheral capillary plexus that supplies the peripheral 10-25% of the meniscus, making this "red-red" zone amenable to biological healing.

Question 165

Topic: 1. General Principles & Basic Science

Which layer of healthy articular cartilage contains the highest concentration of water and features collagen fibrils strictly oriented parallel to the joint surface to resist shear forces?

. Superficial (tangential) zone
. Middle (transitional) zone
. Deep (radial) zone
. Calcified zone
. Tidemark

Correct Answer & Explanation

. Superficial (tangential) zone

Explanation

The superficial (tangential) zone of articular cartilage has the highest water content and lowest proteoglycan content. Its collagen fibers run parallel to the surface to provide immense resistance to shear stress.

Question 166

Topic: 1. General Principles & Basic Science

During an inside-out meniscal repair of the posterior horn of the medial meniscus, which neurovascular structure is at greatest risk of iatrogenic injury if proper retractor placement is not maintained?

. Saphenous nerve
. Common peroneal nerve
. Popliteal artery
. Sural nerve
. Tibial nerve

Correct Answer & Explanation

. Saphenous nerve

Explanation

The saphenous nerve and vein are at greatest risk during an inside-out repair of the medial meniscus. A posteromedial incision and retractor are required to protect them.

Question 167

Topic: 1. General Principles & Basic Science

The posterior oblique ligament (POL) of the knee acts as a primary secondary restraint to which of the following kinematic forces?

. Valgus and internal rotation near full extension
. Varus and external rotation at 30 degrees of flexion
. Posterior translation at 90 degrees of flexion
. Anterior translation in full extension
. Internal rotation at 90 degrees of flexion

Correct Answer & Explanation

. Valgus and internal rotation near full extension

Explanation

The POL is a thickening of the posteromedial capsule. It becomes tight in extension and serves as a primary restraint to internal rotation and a secondary restraint to valgus stress near full extension.

Question 168

Topic: 1. General Principles & Basic Science

When performing an inside-out meniscal repair for a lateral meniscus middle-third tear, caution must be exercised to avoid injury to which of the following neurovascular structures?

. Sural nerve
. Saphenous nerve
. Common peroneal nerve
. Tibial nerve
. Popliteal artery

Correct Answer & Explanation

. Common peroneal nerve

Explanation

During a lateral inside-out meniscal repair, the common peroneal nerve is at greatest risk as it courses around the fibular neck. Medial inside-out repairs place the saphenous nerve at risk.

Question 169

Topic: 1. General Principles & Basic Science

A 16-year-old female basketball player sustains a non-contact twisting knee injury resulting in an ACL rupture. Which of the following anatomic risk factors is most strongly associated with her injury?

. Increased intercondylar notch width index
. Decreased posterior tibial slope
. Increased Q-angle
. Decreased intercondylar notch width index
. Patella baja

Correct Answer & Explanation

. Decreased intercondylar notch width index

Explanation

A decreased intercondylar notch width index (a narrow notch) is a well-established anatomical risk factor for ACL tears. Increased posterior tibial slope is also a known risk factor.

Question 170

Topic: 1. General Principles & Basic Science

The anterolateral ligament (ALL) of the knee, which originates near the lateral epicondyle and inserts on the proximal tibia, is recognized for its primary biomechanical role as a restraint to:

. Posterior tibial translation
. Internal tibial rotation
. External tibial rotation
. Varus stress
. Valgus stress

Correct Answer & Explanation

. Internal tibial rotation

Explanation

The anterolateral ligament (ALL) is an important secondary stabilizer of the knee. It primarily acts as a restraint to internal tibial rotation, particularly at higher angles of knee flexion.

Question 171

Topic: Infection, Pharmacology & VTE

Which of the following medial collateral ligament (MCL) injury patterns has the poorest healing potential and is most likely to require surgical repair rather than non-operative management?

. Proximal femoral avulsion
. Midsubstance tear
. Distal tibial avulsion with the superficial MCL flipped superficial to the pes anserinus
. Partial articular-sided tear
. Tear isolated to the deep MCL

Correct Answer & Explanation

. Distal tibial avulsion with the superficial MCL flipped superficial to the pes anserinus

Explanation

A distal avulsion of the superficial MCL where the ligament flips superficial to the pes anserinus tendons creates a 'Stener-like' lesion of the knee. This prevents apposition of the torn ends, necessitating surgical repair.

Question 172

Topic: 1. General Principles & Basic Science
A 14-year-old male presents with chronic anterior knee pain. Radiographs reveal a bipartite patella. According to the Saupe classification, which type of bipartite patella is most common?
. Type I (inferior pole)
. Type II (lateral margin)
. Type III (superolateral pole)
. Type IV (medial margin)
. Type V (central)

Correct Answer & Explanation

. Type III (superolateral pole)

Explanation

The Type III bipartite patella, located at the superolateral pole, is the most common variant, accounting for approximately 75% of cases. It is also the type most frequently associated with symptoms.

Question 173

Topic: 1. General Principles & Basic Science

A 25-year-old runner complains of lateral knee pain that is worst at 30 degrees of knee flexion, leading to a diagnosis of Iliotibial Band (ITB) Syndrome. The ITB passes relative to the lateral femoral epicondyle in what manner during range of motion?

. Anterior to the epicondyle in extension and posterior in flexion
. Posterior to the epicondyle in extension and anterior in flexion
. It remains anterior at all times
. It remains posterior at all times
. Directly over the epicondyle at 90 degrees of flexion

Correct Answer & Explanation

. Posterior to the epicondyle in extension and anterior in flexion

Explanation

The ITB glides anterior to the lateral femoral epicondyle during full extension and moves posterior to it during knee flexion. Friction occurs primarily at around 30 degrees of flexion as it crosses the epicondyle.

Question 174

Topic: 1. General Principles & Basic Science

Regarding the vascular supply of the adult meniscus, which of the following statements is most accurate?

. The entire meniscus remains highly vascularized throughout life
. The inner one-third is primarily vascularized by the middle genicular artery
. Only the peripheral 10-25% is vascularized by branches of the genicular arteries
. The popliteal artery directly supplies the anterior meniscal horns
. The meniscus receives its primary blood supply from the underlying subchondral bone

Correct Answer & Explanation

. Only the peripheral 10-25% is vascularized by branches of the genicular arteries

Explanation

In the adult knee, the meniscus is largely avascular. Blood supply is limited to the peripheral 10% to 25% (the red-red zone), which receives branches from the medial and lateral genicular arteries.

Question 175

Topic: Biology, Genetics & Bone Healing
Schmorl's nodes may be seen on radiographic studies in all of the following disorders except:
. Spina bifida
. Scheuermann's kyphosis
. Degenerative disk disease
. Trauma
. Osteoporosis

Correct Answer & Explanation

. Spina bifida

Explanation

Schmorl's nodes are seen in association with several disorders including Scheuermann's kyphosis, degenerative disk disease, trauma, and osteoporosis. Schmorl's nodes are not commonly seen in patients with spina bifida.

Question 176

Topic: Infection, Pharmacology & VTE

Which of the following is a contraindication to kyphoplasty:

. Local osteomyelitis
. Osteoblastic lesions
. Sepsis
. Bleeding diathesis
. All of the above

Correct Answer & Explanation

. All of the above

Explanation

It is important to properly evaluate a patient prior to any surgical procedure. If a patient presents with osteomyelitis, osteoblastic lesions, sepsis, or bleeding diathesis, then surgery should be postponed until the underlying condition is corrected.

Question 177

Topic: 1. General Principles & Basic Science

Occipitocervical fusion is indicated in all of the following situations except:

. Diseased C 1-C 2 facet joints
. C 1-C 2 instability with decompressive laminectomy
. C 1-C 2 instability with intact posterior arch of the atlas
. C 1-C 2 instability with fractured posterior arch of the atlas
. Atlanto-occipital instability

Correct Answer & Explanation

. C 1-C 2 instability with intact posterior arch of the atlas

Explanation

An unstable C 1-C 2 segment, with intact posterior elements, may be treated via a C 1-C 2 fusion. If decompression is necessary or the posterior elements at C 1-C 2 are involved, then extension to the occiput may be necessary.

Question 178

Topic: 1. General Principles & Basic Science

Approximately what percentage of individuals with rheumatoid arthritis will develop basilar invagination:

. 1%
. 3%
. 5%
. 10%
. 20%

Correct Answer & Explanation

. 10%

Explanation

As per Sandhu and researchers, approximately 11% of patients with rheumatoid arthritis will eventually develop basilar invagination.

Question 179

Topic: 1. General Principles & Basic Science

A 30-year-old man underwent an anterior lumbar discectomy and fusion at L4-L5 and L5-S1 through an anterior retroperitoneal approach 1 month ago. He now reports that he is unable to obtain and maintain an erection. The most likely cause of this condition is:

. Disruption of the sympathetic nerves during anterior lumbar exposure
. Traction on the parasympathetic nerve at the L4-L5 level
. Not related to the surgical dissection
. Injury to the pudendal nerves in the anterior sacral region during dissection at the L5-S1 level
. Sexual dysfunction secondary to retrograde ejaculation

Correct Answer & Explanation

. Not related to the surgical dissection

Explanation

Sexual dysfunction is a common condition after extensive anterior lumbar surgical dissection. Erectile dysfunction is often nonorganic but may be related to parasympathetic injury. The parasympathetic nerves are deep in the pelvis at the level of S2-S3 and S3-S4 and are not usually involved in the surgical field for anterior L4-L5 and L5-S1 procedures. Retrograde ejaculation is the result of injury to the sympathetic chain on the anterior surface of the major vessels crossing the L4-L5 level and at the L5-S1 interspace. Erectile function and orgasm are not affected by sympathetic injury. The pudendal nerve is primarily a somatic nerve and is not located in the surgical field.

Question 180

Topic: 1. General Principles & Basic Science

Which of the following variables is the most reliable predictor of poor outcome following arthroscopic debridement of an arthritic knee:

. Presence of mechanical symptoms
. Outerbridge grade IV chondromalacia
. Varus malalignment
. Patient age
. Duration of symptoms

Correct Answer & Explanation

. Varus malalignment

Explanation

The presence of mechanical symptoms is a reliable predictor of successful outcome. Age has not been shown to reliably predict outcome following knee debridement. Although a prolonged duration of symptoms correlates with poor outcome, the presence of varus malalignment has a far more dismal prognosis.

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