Multiple Choice Questions
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53. With a right-sided anterior cervical spine approach, the structure at increased risk is the:
A) Recurrent laryngeal nerve
B) Superior laryngeal nerve
C) Hypoglossal nerve
D) Thoracic duct
52. The triceps tendon insertion has two well-defined components.
The triceps proper inserts:
A) Directly onto the posterior 40% of the olecranon
B) On to the anconeous muscle
C) On to the entirety of the olecranon tip
D) On to the anterior aspect of the olecranon
E) None of the above
51. Dynamic muscular stabilizers of the shoulder play an important role in stability.
Which of the following is the most important dynamic stabilizer?
A) The rotator cuff
B) The labrum
C) The coracobrachialis
D) The latissimus dorsi
E) The biceps brachii
50. Using the three layer description of the medial structures of the knee, the medial patellofemoral ligament is described as being within the:
A) First layer
B) Second layer
C) Third layer
D) All three layers
E) The medial patellofemoral ligament does not exist.
46. A magnetic resonance image of a patient’s right shoulder is shown.
The structure marked by the arrows is innervated by which of the following structures?
A) Musculocutaneous nerve
B) Branch of the posterior cord of the brachial plexus
C) Branch of the lateral cord of the brachial plexus
D) Branch of the medial cord of the brachial plexus
E) Branch of the superior trunk of the brachial plexus
45. With regard to the meniscofemoral ligaments, the ligament of Humphrey runs ___ to the posterior cruciate ligament (PCL) and the ligament of Wrisberg runs _____ to the PCL.
A) Posterior, anterior
B) Anterior, posterior
C) Anterior, anterior
D) Posterior, posterior
E) Medial, lateral
44. Which of the following describes the correct relationship between the suprascapular nerve and the suprascapular vessels as they pass through the suprascapular notch:
A) The suprascapular nerve, artery, and vein all pass below the transverse scapular ligament.
B) The suprascapular nerve, artery, and vein all pass superficially to the transverse scapular ligament.
C) The suprascapular nerve passes superficially to the transverse scapular ligament while the artery and vein pass deep
D) The suprascapular nerve and artery pass deep to the transverse scapular ligament while the suprascapular vein passes superficially to it.
E) The suprascapular nerve passes deep to the transverse scapular ligament while the suprascapular artery and vein pass above it.
43. The primary restraint to anterior translation of the abducted and externally rotated glenohumeral joint is the:
A) Coracohumeral ligament
B) Superior glenohumeral ligament
C) Middle glenohumeral ligament
D) Inferior glenohumeral ligament
E) Subscapularis muscle
42. Which of the following anatomic landmarks of the knee represents the contact area between the lateral femoral condyle and the anterior horn of the lateral meniscus when the knee is in full extension:
A) Outerbridge’s ridge
B) Blumensatt’s line
C) Notch of Grant
D) David’s point
E) Sulcus terminalis
41. In a congruent patellofemoral joint, the patella centers within the trochlear groove by what degree of flexion:
A) 5° to 10°
B) 10° to 15°
C) 15° to 20°
D) 20° to 25°
E) 25° to 30°
40. Weight training that employs a constant velocity and variable resistance is referred to as:
39. Which of the following statements is true regarding the effect of anabolic-androgenic steroid on immobilized skeletal muscle:
A) Steroid administration has no effect on immobilized muscle.
B) Steroid administration leads to muscle hypertrophy only in conjunction with strength training.
C) When compared to controls, steroid administration leads to increased muscle mass but not increased contractile force.
D) When compared to controls, steroid administration leads to increased contractile force but not muscle mass.
E) When compared to controls, steroid administration leads to both increased contractile force and muscle mass.
38. A foot is maximally dorsiflexed during this point of the gait cycle:
C) Toe off
E) First one-third of stance
37 .The protein neurofibromin normally acts in which of the following ways:
A) Inhibits fibroblast growth factor
B) Promotes proteoglycan assembly
C) Down regulates Ras protein
D) Causes nerve cells to divide
E) Promotes tumor formation
36. Which of the following mechanisms of biphosphonate action occurs when a biphosphonate is used to treat osteoporosis:
A) Increasing calcium absorption in the intestines
B) Decreasing urinary excretion of calcium
C) Stimulating osteoblast precursors
D) Binding to hydroxyapatite crystals
E) Increasing phosphate reabsorption in the kidney
35. Osteoclasts have receptors for which of the following:
A) 1,25 dihydroxyvitamin D3
B) Parathyroid hormone
D) Receptor activator of nuclear factor –kB
34. Parathyroid hormone inhibits the production of:
B) 1,25 dihydroxyvitamin D3 production
D) Kidney 1 alpha-hydroxylase
E) Receptor activator of nuclear factor –kB ligand (RANKL)
33. Which of the following proteins or hormones assists in the transport of calcium in the kidney against chemical and electrical gradients:
D) Parathyroid hormone
E) Vitamin D3
32. Osteoprotegerin (OPG) has which of the following functions or effects:
A) Inhibits osteoclast apoptosis
B) Inhibits osteoclast formation
C) Activates osteoclast precursors
D) Induces hypercalcemia
E) Binds to receptor activator of nuclear factor –kB ligand (RANKL)
31. Which of the following proteins binds to osteoclast precursor cells and positively effects their final differentiation into osteoclasts:
A) Receptor activator of nuclear factor-kappa B (RANK)
C) Bone morphogenetic protein 7
D) Core binding factor alpha 1 (Cbfa1)
D) Parathyroid hormone related protein (PTHrP)
30. Which of the following musculoskeletal complications may occur in patients taking fluoroquinolones, such as ciprofloxacin:
C) Joint laxity
D) Tendon ruptures
29. The skin over the umbilicus is innervated by which of the following levels:
28. The extensor hallucis longus muscle is innervated by which of the following nerve roots:
27. The skin of the proximal one-third of the anterior thigh just distal to the inguinal ligament is innervated by which of the following sensory segmental levels:
26. The skin on the medial aspect of the leg and great toe is innervated by which of the following nerve roots:
25. Which of the following statements is true concerning the vascularity at a fracture site
A) Periosteal blood vessels are capable of supplying the endosteal region.
B) Fracture site blood flow peaks at 2 weeks.
C) Reamed intramedullary rods do not significantly interrupt endosteal blood supply.
D) In animal studies, blood flow is greater at 120 days in plated vs. rodded tibias.
E) In animal studies, blood flow is greater at 42 days in rodded vs. plated tibias.
24. A 25-year-old soccer player sustained a closed tibia fracture when his planted leg was struck by another player. Which of the following would be the most common fracture pattern and mechanism:
A) Short spiral fracture — torsion
B) Oblique fracture — uneven bending
C) Transverse fracture — pure bending
D) Oblique fracture with a butterfly fragment — bending and compression
E) Segmental fracture — four-point bending
23. The net effect of 1,25 dihydroxyvitamin D3 on the calcium and phosphate concentration of the extracellular fluid and serum is:
A) Increased calcium, increased phosphate
B) Increased calcium, decreased phosphate
C) Decreased calcium, decreased phosphate
D) Increased calcium, no effect on phosphate
E) Transient decrease in serum calcium
22. Which of the following serum levels is the best indicator of body stores of Vitamin D3:
B) 1,25 dihydroxyvitamin D3
c) 25 hydroxyvitamin D3
D) 24,25 dihydroxyvitamin D3
E) Parathyroid hormone levels
21. Which of the following cells have receptors for parathyroid hormone:
D) Mast cells
20. Which of the following areas of the osteoclast is responsible for attachment to the bone surface prior to the bone resorption process:
A) Golgi apparatus
C) Clear zone
D) Ruffled border
E) Secretory vesicles
19. Which of the following is characteristic of an active osteoclast:
A) A large amount of rough endoplasmic reticulum
B) Paucity of intracellular smooth vesicles
C) Ruffled border adjacent to the bone surface
D) Few mitochondria
E) Low acid phosphatase activity
18. A genetic mutation accounts for the manifestations of achondroplasia. Which of the following proteins has a genetic mutation that has been linked to achondroplasia:
A) Fibroblast growth factor (FGF) receptor 3
B) Type I collagen
D) Type II collagen
E) Cartilage oligomeric matrix protein (COMP)
17. The tidemark in articular cartilage separates which of the following two zones:
A) The superficial tangential zone and the middle zone
B) The middle zone and the deep zone
C) The superficial zone and the deep zone
D) The deep zone and the calcified zone
E) The calcified cartilage zone and the subchondral bone zone
16. Following a traumatic nerve injury, in which time period would a physician find denervation activity with fibrillation and positive sharp waves in the affected muscles:
A) Immediately following the injury
B) 7 to 10 days following injury
C) 2 to 5 weeks following injury
D) 6 to 8 weeks following injury
E) 12 weeks following injury
15. Which of the following terms is used to describe a localized conduction block in a peripheral nerve in which the nerve is intact and full recovery is expected:
A) First-degree injury (neuropraxia)
B) Second-degree (axonotmesis)
14. Enchondral ossification is responsible for mineralization in all of the following conditions except:
A) Callus formation during fracture healing
B) Heterotopic bone formation
C) Cartilage degeneration is osteoarthritis
D) Embryonic long bone development
E) Perichondrial bone formation
13. The most common location of a chordoma is:
A) Cervical vertebra
B) Thoracic vertebra
C) Lumbar vertebra
D) Sacrococcygeal region
E) Spheno-occipital region
12. Which of the following processes may produce cystic bone erosions in the cortex on both sides of a joint:
A) Septic Arthritis
B) Synovial chondormatosis
C) Pigmented villonodular synovitis
11. What is the most likely complication following treatment of the humeral shaft fracture shown in the figure attached?
B) Shoulder pain
D) Elbow injury
E) Radial nerve injury
10. Bleeding is encountered while developing the internervous plane between the tensor fascia lata and the sartorius during the anterior approach to the hip. The most likely cause is injury to what artery?
A) Ascending branch of the lateral femoral circumf ex
B) Superior gluteal
D) Profunda femoris
E) Medial femoral circumfl ex
9. The anatomy of the sciatic nerve as it exits the pelvis is best described as exiting through the:
A) greater sciatic notch and passing between the inferior gemellus and the obturator externus.
B) greater sciatic notch and passing between the piriformis and the superior gemellus.
C) obturator foramen and passing between the obturator internus and the obturator externus.
D) lesser sciatic notch and passing between the piriformis and the superior gemellus.
E) lesser sciatic notch and passing between the superior gemellus and the inferior gemellus.
8. Through a retroperitoneal approach to the L4-5 disk, what structure must be ligated to safely mobilize the common iliac vessels toward the midline laterally and gain exposure?
A) Obturator vein
B) Iliolumbar vein
C) External iliac vein
D) Middle sacral artery
E) Hypogastric artery
7. What structure is located at the tip of the arrow in the figure attached?
A) Left L3 nerve root
B) Right L3 nerve root
C) Right L4 segmental artery
D) Right L4 nerve root
E) Left lateral disk herniation
6. What structure is most at risk for injury from a retractor against the tracheoesophageal junction during an ant. approach to the cervical spine?
C) Superior laryngeal nerve
D) Recurrent laryngeal nerve
E) Sympathetic chain
5. When harvesting an iliac crest bone graft from the post. approach, what anatomic structure is at greatest risk for injury if a Cobb elevator is directed too caudal?
A) Sciatic nerve
B) Cluneal nerves
C) Inferior gluteal artery
D) Superior gluteal artery
E) Sacroiliac joint
4. The single most important treatment in preventing acute renal failure following crush injury is:
A) maintenance of an alkaline urine (pH > 6) to prevent cast formation
B) maintenance of adequate urine output with mannitol
C) vigourous intravenous fluid replacement
D) administration of xanthine oxidase inhibitors to prevent hyperuricemia
E) emergent dialysis to remove myoglobin from the circulation
3. A 28 years old man was involved in a motorbike road traffic accident sustaining head injury resulting in a coma and hip fracture.
Indomethacin is indicated here to prevent which complication?
A) Non union
C) Vascular compromise
D) Pressure ulcers
E) Heterotopic ossification
2. Number of hits during taper assembly can influence taper seating mechanisms.
Which of the statement is true regarding single hit versus three hits?
A) One-hit assembled tapers exhibit more contact pressure and total seating of the head taper
B) Three-hits assembled tapers provide superior taper seating
C) Three-hits assembled tapers leads to increased plastic strain
D) One-hit imparts low impulse that is insufficient to seat the modular taper
E) It does not make a difference if you hit once or multiple times to sit the modular taper
1. All of the statements regarding the atypical femur fracture due to bisphosphonate therapy are true EXCEPT :
A) Fracture is located along femoral diaphysis from distal to the lesser trochanter to proximal to supracondylar ridge
B) Fracture is sustained with minimal or no trauma
C) Complete fracture extends through both cortices
D) The fracture line originates at the lateral cortex and is usually transeverse
E) The incomplete fracture can involve either the medial or lateral cortex