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ORTHOPEDIC MCQS ONLINE BANK OITE 97

ORTHOPEDIC MCQS ONLINE BANK OITE 97

  • 97.1 A 55-year-old woman reports a spontaneous onset of severe pain in her ribs. AP
  • and lateral chest radiographs show severe osteopenia, two rib fractures, and
  • three vertebral compression fractures. Laboratory studies show a hemoglobin
  • level of 9.0 g/dL and a monoclonal spike on serum protein electrophoresis.
  • Which of the following imaging studies would be most helpful in establishing
  • the diagnosis?
  • 1- Skeletal survey
  • 2- Technetium bone scan
  • 3- Bone density determination
  • 4- MRI scan of the thoracic spine
  • 5- CT scan of the chest and abdomen

 

  • Question 97.1
  • Answer = 1
  • Reference(s)
  • Kyle RA: Multiple myeloma: Review of 869 cases. Mayo Clin Proc 1975;50:29-40. Sim FH, Frassica FJ: Metastatic bone disease and myeloma, in Evarts CM (ed): Surgery of the Musculoskeletal System, ed 2. New York, NY, Churchill Livingstone, 1990, pp 5019-5053. Frassica FJ, Frassica DA, Sim FH: Myeloma of bone, in Stauffer RN (ed): Advances in Orthopaedics. St Louis, MO, CV Mosby 1994;2:357-377.

 

  • 97.2 Figure 1 shows a current AP radiograph of the elbow of a 12-year-old high
  • school pitcher who has pain and restricted motion, especially in extension.
  • Physical therapy has failed to relieve the symptoms. Treatment should now
  • include
  • 1- continued physiotherapy.
  • 2- manipulation under anesthesia.
  • 3- debridement with osteochondral allograft replacement of the defect.
  • 4- arthroscopy and possible open debridement.
  • 5- arthroscopy, bone graft, and arthroscopic fixation of the fragment.
  • Figure 1

 

  • Question 97.2
  • Answer = 4
  • Reference(s)
  • Shaughnessy WJ, Blanco AJ: Osteochondritis dissecans, in Morrey BF (ed): The Elbow and Its Disorders, ed 2. Philadelphia, PA, WB Saunders, 1993, pp 282-287.

 

  • 97.3 What is the most common metastatic carcinoma to the hand?
  • 1- Lung
  • 2- Renal
  • 3- Breast
  • 4- Thyroid
  • 5- Prostate

 

  • Question 97.3
  • Answer = 1
  • Reference(s)
  • Kann SE, Jacquemin J, Stern PJ: Simulators of hand infections, in Springfield D (ed): Instructional Course Lectures 46. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 69-82.

 

  • 97.4 An otherwise healthy 45-year-old man has an intraosseous low-grade
  • chondrosarcoma of the distal femur with no dedifferentiation or metastatic
  • disease. Treatment should consist of
  • 1- surgical resection only.
  • 2- radiation therapy only.
  • 3- radiation therapy and surgical resection.
  • 4- chemotherapy only.
  • 5- chemotherapy and surgical resection.

 

  • Question 97.4
  • Answer = 1
  • Reference(s)
  • Bauer HC, Brosjo O, Kreicbergs A, et al: Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities: 80 patients followed for 2 - 25 years. Acta Orthop Scand 1995;66:283-288. Mankin HJ, Springfield DS, Rosenberg AE, et al: Chondrosarcoma of bone, in Evarts CM (ed): Surgery of the Musculoskeletal System, ed 2. New York, NY, Churchill Livingstone, 1990, pp 4895-4928.

 

  • 97.5 The postulated mode of action of capsaicin (pepper) cream in producing
  • analgesia can be best described as
  • 1- demyelination of nociceptive afferents.
  • 2- neuropeptide depletion in unmyelinated C fibers.
  • 3- lowered threshold of larger diameter A-beta fibers.
  • 4- selective membrane stabilization of A-delta fibers.
  • 5- increased lateral inhibition in second order neurons.

 

  • Question 97.5
  • Answer = 2
  • Reference(s)
  • Physicians' Desk Reference. Montvale, NJ, Medical Economics Co, 1996, p 1056.

 

  • 97.6 Polymerase chain reaction is a technique for
  • 1- sequencing DNA aminobuds.
  • 2- measuring RNA levels in cells.
  • 3- amplifying specific DNA sequences.
  • 4- identifying specific DNA sequences.
  • 5- determining the ploidy of a tumor.

 

  • Question 97.6
  • Answer = 3
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 219-276. Alberts B, Bray D, Lewis J, et al (eds): Molecular Biology of the Cell, ed 2. New York, NY, Garland Publishing, 1989.

 

  • 97.7 Figure 2 shows the lateral radiograph of the left hindfoot and ankle of a patient
  • who fell 10 feet and landed on his left foot. The most predictable advantage of
  • open reduction and internal fixation compared with closed management without
  • reduction is
  • 1- an earlier return to function.
  • 2- decreased subtalar arthrosis.
  • 3- increased ankle dorsiflexion.
  • 4- increased subtalar range of motion.
  • 5- restoration of height and width of the heel.
  • Figure 2

 

  • Question 97.7
  • Answer = 5
  • Reference(s)
  • Eastwood DM, Maxwell-Armstrong CA, Atkins RM: Fracture of the lateral malleolus with talar tilt: Primarily a calcaneal fracture not an ankle injury. Injury 1993;24:109-112.

 

  • 97.8 In a fatigue test, the maximum stress under which the material will not fail,
  • regardless of how many loading cycles are applied, is defined as the
  • 1- yield stress.
  • 2- failure stress.
  • 3- critical stress.
  • 4- elastic limit.
  • 5- endurance limit.

 

  • Question 97.8
  • Answer = 5
  • Reference(s)
  • Chao EYS, Aro HT: Biomechanics of fracture fixation, in Mow VC, Hayes WC (eds): Basic Orthopaedic Biomechanics. New York, NY, Raven Press, 1991.

 

  • 97.9 A 65-year-old man has aseptic loosening of a cemented acetabular component
  • with a well-fixed femoral component. The medial wall and acetabular rim are
  • intact. Treatment for acetabular revision should include
  • 1- an oversized bipolar component.
  • 2- a cemented metal-backed acetabular component.
  • 3- a cemented all-polyethylene acetabular component.
  • 4- a cementless acetabular component with screw fixation.
  • 5- a protrusio ring with a cemented all-polyethylene component.

 

  • Question 97.9
  • Answer = 4
  • Reference(s)
  • Petrera P, Rubash HE: Revision total hip arthroplasty: The acetabular component. J Am Acad Orthop Sur- 1995;3:15-21.

 

  • 97.10 What is the most appropriate biomechanical fixation method/device for a
  • reverse oblique intertrochanteric fracture?
  • 1- Ender pins
  • 2- Sliding hip screw
  • 3- 95-degree fixed angle device
  • 4- Cerclage wire with interfragmentary fixation
  • 5- Medial displacement osteotomy with sliding hip screw

 

  • Question 97.10
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 379-388. Kyle RF, Gustilo RB, Premer RF: Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg 1979;61A:216-221. Levy RN, Capozzi JD, Mont MA: Intertrochanteric hip fractures, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1992, vol 2, pp 1443-1484.

 

  • 97.11 A patient has a fractured acetabulum associated with injury to the sciatic nerve
  • that results in loss of function in the peroneal nerve distribution. Three days
  • later, open reduction and internal fixation of the fracture is performed without
  • incident. Postoperatively, the patient's neurologic status is unchanged;
  • however, the treating physician notices that there is inadequate documentation
  • in the medical record regarding the patient's preoperative neurologic deficit.
  • Concerned that the traumatic nerve injury could be erroneously attributed to
  • the surgical procedure, the physician decides to immediately add further
  • documentation to the medical record. The proper procedure for making this
  • correction is to
  • 1- completely erase the original note and make the necessary corrections.
  • 2- make a note providing clarification in the margin next to the original
  • entry.
  • 3- remove the original entry sheet from the chart and replace it with the
  • corrected information.
  • 4- make no changes to the chart until notification of a professional liability
  • claim is received.
  • 5- place the correct information after the most recent chart entry, explain the
  • change, and date and initial it.

 

  • Question 97.11
  • Answer = 5
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 21-24. Committee on Professional Liability (ed): Managing Orthopaedic Malpractice Risk. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 21-24.

 

  • 97.12 In a cemented total hip arthroplasty, use of a cobalt-chromium alloy for the
  • femoral stem is preferred over a titanium alloy because the cobalt-chromium
  • alloy
  • 1- is more flexible.
  • 2- requires less bone preparation.
  • 3- bonds to cement better than titanium.
  • 4- is easier to machine and manufacture.
  • 5- generates less particulate metal debris.

 

  • Question 97.12
  • Answer = 5
  • Reference(s)
  • Friedman RJ, Black J, Galante JO, et al: Current concepts in orthopaedic biomaterials and implant fixation, in Schafer M (ed): Instructional Course Lectures 43. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 233-255.

 

  • 97.13 What type of prosthesis produces the most predictable results in patients who
  • have had a prior patellectomy?
  • 1- Fixed-hinged
  • 2- Rotating hinge
  • 3- Unicompartmental
  • 4- Cruciate retaining
  • 5- Posteriorly constrained

 

  • Question 97.13
  • Answer = 5
  • Reference(s)
  • Paletta GA Jr, Laskin RS: Total knee arthroplasty after a previous patellectomy. J Bone Joint Sur- 1995;77A:1708-1712. Larson KR, Cracchiolo A III, Dorey FJ, et al: Total knee arthroplasty in patients after patellectomy. Clin Orthop 1991;264:243-254.

 

  • 97.14 Figure 3 shows the MRI scan of a patient with known metastatic breast
  • carcinoma who has low back pain and bilateral leg pain. The arrow is pointing
  • to
  • 1- epidural fat.
  • 2- an epidural tumor.
  • 3- a herniated disk.
  • 4- a ligamentum flavum.
  • 5- a lateral facet capsule.
  • Figure 3

 

  • Question 97.14
  • Answer = 2
  • Reference(s)
  • White AH (ed): Spine Care Diagnosis and Conservative Treatment. St Louis, MO, CV Mosby, 1995, vol 1, pp 171-175.

 

  • 97.15 Posterolateral rotatory elbow instability is caused by a deficiency of which of
  • the following ligaments?
  • 1- Annular
  • 2- Ulnar part of the lateral collateral
  • 3- Anterior band of the medial collateral
  • 4- Posterior band of the medial collateral
  • 5- Transverse band of the medial collateral

 

  • Question 97.15
  • Answer = 2
  • Reference(s)
  • O'Driscoll SW, Bell DF, Money BF: Posterolateral rotatory instability of the elbow. J Bone Joint Surg 1991;73A:440-446. Nestor BJ, O'Driscoll SW, Morrey BF: Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Sur- 1992;74A:1235-1241.

 

  • 97.16 Figure 4a shows a pigmented lesion on
  • the right side of the neck of a 41-year-old
  • man. The patient's history reveals that he
  • had multiple bone lesions during
  • childhood and juvenile-onset diabetes
  • mellitus. Figures 4b and 4c show
  • radiographs of his knee and leg. What is
  • the most likely
  • diagnosis?
  • 1- 2-Ollier's disease
  • 2- Neurofibromatosis
  • 3- McCune-Albright
  • syndrome
  • 4- Multiple hereditary
  • exostoses
  • 5- Multiple nonossifying
  • fibromas
  • A
  • B
  • C
  • Figures 4

 

  • Question 97.16
  • Answer = 3
  • Reference(s)
  • Stanton RP, Montgomery BE: Fibrous dysplasia. Orthopedics 1996;19:679-685. Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 367-377.

 

  • 97.17 Figure 5a shows the radiograph
  • of a 22-year-old man 3 years
  • after undergoing reduction and
  • fixation for a fracture of the
  • radius and ulna with two plates
  • secured with 4.5 mm screws. A
  • postoperative radiograph after
  • plate removal is shown in
  • Figure 5b. Which of the
  • following factors increases the
  • risk of refracture?
  • 1- Young age
  • 2- Incomplete healing
  • 3- Use of a large plate
  • 4- Bony overgrowth around the plate
  • 5- Insufficient amount of time between
  • fracture and plate removal
  • A
  • B
  • Figures 5

 

  • Question 97.17
  • Answer = 3
  • Reference(s)
  • Rumball K, Finnegan M: Refractures after forearm plate removal. J Orthop Trauma 1990;4:124-129. Chapman MW, Gordon JE, Zissimos AG: Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg 1989;71A:159-169. Hidaka S, Gustilo RB: Refracture of bones of the forearm after plate removal. J Bone Joint Sur- 1984;66A:1241-1243.

 

  • 97.18 The most commonly used parameter to estimate trunk muscle contractive force
  • potential is the
  • 1- length of the muscle.
  • 2- moment arm of the muscle.
  • 3- total volume of the muscle.
  • 4- physiologic cross-sectional area.
  • 5- distribution of slow and fast twitching fibers.

 

  • Question 97.18
  • Answer = 4
  • Reference(s)
  • An KN, Chao EYS, Kaufman KR: Analysis of muscle and joint loads, in Mow VC, Hayes WC (eds): Basic Orthopaedic Biomechanics. New York, NY, Raven Press, 1991.

 

  • 97.19 What is an effective way to control knee hyperextension in midstance in an
  • ambulatory patient with spastic diplegia?
  • 1- Perform daily quadriceps stretching.
  • 2- Lengthen the hamstrings at the pelvis origin.
  • 3- Use an ankle-foot orthosis to control the ground reaction force.
  • 4- Perform selective rhizotomy involving lumbar levels 2, 3, and 4.
  • 5- Transfer the vastus medialis obliquus to the hamstring laterally.

 

  • Question 97.19
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 29-40.

 

  • 97.20 A 42-year-old health care professional has had knee pain for the past 2 months.
  • An MRI scan of the knee reveals a large effusion with loculations and synovial
  • thickening, and results of an open biopsy and culture are consistent with
  • tuberculosis. Sensitivity tests show no resistance to antibiotics. Following
  • debridement and synovectomy, appropriate antibiotic therapy should include
  • 1- rifampin and pyridoxine. rifampin and
  • 2- ethambutol hydrochloride.
  • 3- isoniazid.
  • 4- isoniazid and pyridoxine.
  • 5- isoniazid, rifampin, pyrazinamide, and pyridoxine.

 

  • Question 97.20
  • Answer = 5
  • Reference(s)
  • Watts HG, Lifeso RM: Tuberculosis of bones and joints. J Bone Joint Surg 1996;78A:288-298.

 

  • 97.21 A college football player twists his knee when he attempts to tackle an
  • oncoming player. Examination reveals no medial lateral laxity or jointline
  • tenderness. The anterior and posterior drawer tests and pivot shift results are
  • negative; however, the Lachman test result is positive. What is the most likely
  • diagnosis?
  • 1- Minor knee sprain
  • 2- Medial collateral ligament injury
  • 3- Lateral collateral ligament injury
  • 4- Anterior cruciate ligament injury
  • 5- Posterior cruciate ligament injury

 

  • Question 97.21
  • Answer = 4
  • Reference(s)
  • Tor g JS, Conrad W, Kalen V: Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 1976;4:84-93.

 

  • 97.22 A college basketball player has had foot pain for the past 3 months that is
  • worse at the conclusion of a game or practice. Radiographs show an incomplete
  • fracture of the fifth metatarsal at the proximal metaphyseal-diaphyseal junction.
  • Treatment should consist of
  • 1- external bone stimulation and immobilization in a short leg cast.
  • 2- immobilization in a short leg cast with no weightbearing for 6 weeks.
  • 3- open reduction and internal fixation and an immediate bone graft.
  • 4- open reduction and internal fixation with an A-O compression plate.
  • 5- open reduction and internal fixation with an intramedullary cancellous
  • screw.

 

  • Question 97.22
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 89-101. Yost JG, Ellfeldt HJ: Basketball injuries, in Nicholas JA, Hershman EB (eds): The Lower Extremity and Spine in Sports Medicine. St Louis, MO, CV Mosby, 1986, pp 1459-1462.

 

  • 97.23 A 10-year-old boy has had intermittent pain in his right groin and proximal
  • thigh for the past 6 months. Figures 6a and 6b show plain radiographs of the hip.
  • Figure 6c shows an axial proton density MRI scan through the lesion, and
  • Figure 6d shows representative tissue biopsy specimens at low power. What is
  • the most likely diagnosis?
  • 1- Chondroblastoma
  • 2- Ewing's sarcoma
  • 3- Giant cell tumor
  • 4- Simple bone cyst
  • 5- Aneurysmal bone cyst
  • Go to next slide
  • for remaining
  • figures and
  • answer link
  • A
  • B
  • Figures 6

 

  • Question 97.23
  • Figures 6
  • D
  • C

 

  • Question 97.23
  • Answer = 5
  • Reference(s)
  • Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 382-390. Vergel De Dios AM, Bond JR, Shives TC, et al: Aneurysmal bone cyst: A clinicopathologic study of 238 cases. Cancer 1992;69:2921-2931. Kransdorf MJ, Sweet DE: Aneurysmal bone cyst: Concept, controversy, clinical presentation, and imaging. Am J Roentgenol 1995;164:573-580.

 

  • 97.24 After reduction and internal fixation of the fibula fracture, the posterior
  • fragment of a trimalleolar fracture should be reduced and fixed if it involves
  • more than 25% of the plafond and is
  • 1- comminuted.
  • 2- more than 3 cm in proximal to distal length.
  • 3- displaced in any plane.
  • 4- displaced more than 2 mm.
  • 5- associated with a tear of the deltoid ligament.

 

  • Question 97.24
  • Answer = 4
  • Reference(s)
  • Russell TA, Taylor JC: Subtrochanteric fractures of the femur, in Browner BD, Jupiter JB, Levin AM, et al (eds): Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1992, vol 2, pp 1485-1524. Bucholz RW, Lippot FG III, Wenger DR, et al: Orthopaedic Decision Making. Philadelphia, PA, BC Decker, 1984, p 80.

 

  • 97.25 A 28-year-old man has had symptoms of lateral epicondylitis for 3 weeks.
  • Initial management should include
  • 1- corticosteroid injection.
  • 2- isometric strengthening exercises.
  • 3- surgical release of the extensor carpi radialis brevis origin.
  • 4- nonsteroidal anti-inflammatory medication and a short arm cast.
  • 5- nonsteroidal anti-inflammatory medication, ice, and activity modification.

 

  • Question 97.25
  • Answer = 5
  • Reference(s)
  • Nirschl RP: Muscle and tendon trauma: Tennis elbow, in Morrey BF (ed): The Elbow and Its Disorders. Philadelphia, PA, WB Saunders, 1993, pp 537-552.

 

  • 97.26 A 40-year-old woman sustains multiple fractures as a result of being pushed
  • down the stairs at home. Which of the patient's family members is most likely
  • to be responsible for the injury?
  • 1- Mother
  • 2- Father
  • 3- Spouse
  • 4- 15-year-old son
  • 5- 15-year-old daughter

 

  • Question 97.26
  • Answer = 3
  • Reference(s)
  • Diagnostic and treatment guidelines on domestic violence. Am Med Assoc, March 1992.

 

  • 97.27 Viscoelastic behavior of a musculoskeletal structure is a function of what aspect
  • of the material?
  • 1- Toughness
  • 2- Endurance limit
  • 3- Internal friction
  • 4- Tensile strength
  • 5- Modulus of elasticity

 

  • Question 97.27
  • Answer = 3
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American American Academy of Orthopaedic Surgeons, 1994, pp 397-446.

 

  • 97.28 Figures 7a and 7b show the wound and radiograph
  • of a 44-year-old man who underwent plating for a
  • closed fracture of his tibia 7 months ago. The
  • wound has been draining for 4 months, and cultures
  • are positive for Staphylococcus aureus. In addition
  • to antibiotics, metal removal, and debridement,
  • treatment should include
  • 1- electrical stimulation and casting.
  • 2- soft-tissue coverage and replating with a bone graft.
  • 3- bone grafting, soft-tissue coverage, and application
  • of a cast.
  • 4- external fixation, staged soft-tissue coverage, and
  • bone grafting.
  • 5- intramedullary rodding, staged soft-tissue coverage,
  • and bone grafting.
  • A
  • B
  • Figures 7

 

  • Question 97.28
  • Answer = 4
  • Reference(s)
  • Patzakis MJ: Management of osteomyelitis, in Operative Orthopaedics. Philadelphia, PA, JB Lippincott, 1993, p 3335.

 

  • 97.29 An 11-year-old girl has had intermittent pain in her left hip after activity and an
  • occasional limp after falling off her bicycle 3 weeks ago. The radiograph shown
  • in Figure 8 was obtained 2 weeks after the injury. The patient reports pain in the
  • hip region that is worse with activity; however, she cannot identify where the
  • pain is localized. She has no fever or night pain. Examination shows normal
  • range of motion and no limp, although she has some pain in the left groin and
  • buttock with internal rotation of the left hip. There is no tenderness about the
  • hip, and the knee examination is normal. Which of the following diagnostic
  • studies should be
  • obtained next?
  • 1- CT scan of both hips
  • 2- MRI scan of both hips
  • 3- Bone scan of both hips
  • 4- Frog lateral view of both hips
  • 5- CBC and erythrocyte
  • sedimentation rate
  • Figure 8

 

  • Question 97.29
  • Answer = 4
  • Reference(s)
  • Kehl DK: Slipped capital femoral epiphysis, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 993-1022. Tachdjian MO: Pediatric Orthopaedics, ed 2. Philadelphia, PA, WB Saunders, 1990, p 1028.

 

  • 97.30 What structure is shown at the tip of the arrow in Figure 9?
  • 1- L5, S1 disk
  • 2- L4 pedicle
  • 3- L4 nerve root
  • 4- L5 nerve root
  • 5- L5 segmental vertebral artery
  • Figure 9

 

  • Question 97.30
  • Answer = 4
  • Reference(s)
  • Anderson JE: Grant's Atlas of Anatomy, ed 8. Baltimore, MD, Williams & Wilkins, 1983.

 

  • 97.31 What is a unique physiologic characteristic of immature articular cartilage?
  • 1- Type II collagen production
  • 2- Glycosaminoglycan synthesis
  • 3- Link protein message expression
  • 4- Nutrition from the synovial cavity
  • 5- Existence of a stem cell population

 

  • Question 97.31
  • Answer = 5
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 1-44.

 

  • 97.32 Figures l0a and 10b show radiographs of a
  • 27-year-old woman who sustained an
  • injury to her left, nondominant forearm as
  • a result of a motor vehicle accident. Under
  • anesthesia, it is noted that the distal
  • radioulnar joint is unstable but reducible in
  • supination. Treatment should include
  • 1- closed reduction, followed by splint
  • immobilization with the limb in supination.
  • 2- closed reduction and external fixation of the
  • radius, followed by splint immobilization with
  • the limb in supination.
  • 3- open reduction and external fixation of the
  • radius, with fixation of the radioulnar joint.
  • 4-open reduction and internal plate fixation of the
  • radius, with fixation of the distal radioulnar \
  • joint.
  • 5- open reduction and internal plate fixation of the
  • radius, with immobilization of the distal
  • radioulnar joint in supination.
  • A
  • B
  • Figures 10

 

  • Question 97.32
  • Answer = 5
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 57-65. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 269-281.

 

  • 97.33 Torsional rigidity of a long bone fracture under internal or external fixation is
  • determined by
  • 1- bone rotation versus torque applied.
  • 2- bone deflection versus bending moment applied.
  • 3- axial displacement at the fracture gap.
  • 4- maximum shear stress on the bone surface.
  • 5- normal and shear stresses at the fracture gap.

 

  • Question 97.33
  • Answer = 1
  • Reference(s)
  • Chao EYS, Aro HT: Biomechanics of fracture fixation, in Mow VC, Hayes WC (eds): Basic Orthopaedic Biomechanics. New York, NY, Raven Press, 1991.

 

  • 97.34 When visualizing an MRI cross-sectional scan of the wrist, the ulnar artery
  • bears what relationship to the ulnar nerve?
  • 1- Directly deep
  • 2- Directly superficial
  • 3- Deep and ulnar
  • 4- Superficial and radial
  • 5- At the same level and ulnar

 

  • Question 97.34
  • Answer = 4
  • Reference(s)
  • Barrett CP, Anderson LD, Holder LE, et al: Primer of sectional anatomy with MRI and CT correlation, ed 2. Baltimore, MD, Williams & Wilkins, 1990, pp 119-120. Hagens GV, Romrell LJ, Ross MH, et al: The visible human body: An atlas of sectional anatomy. Part II: Upper extremity. Philadelphia, PA, Lea & Febiger, 1991, pp 52-55.

 

  • 97.35 A 60-year-old woman has pain along the medial aspect of the ankle.
  • Examination reveals pain along the posterior tibial tendon with normal single
  • toe raise. Despite undergoing conservative treatment consisting of nonsteroidal
  • anti-inflammatory medication, physical therapy, and cast immobilization for 8
  • weeks, she continues to have pain. What is the next appropriate step in
  • management?
  • 1- Steroid injection
  • 2- Subtalar joint arthrodesis
  • 3- Synovectomy of the posterior tibial tendon
  • 4- Reconstruction of the posterior tibial tendon
  • 5- Anterior tibial tendon transfer and calcaneal cuboid arthrodesis

 

  • Question 97.35
  • Answer = 3
  • Reference(s)
  • Mann RA, Thompson FM: Rupture of the posterior tibial tendon causing flat foot: Surgical treatment. J Bone Joint Surg 1985;67A:556-561. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 269-282.

 

  • 97.36 A normal lower extremity has a valgus angulation at the knee when measured
  • 1- along the mechanical axis.
  • 2- between the mechanical axis of the femur and tibia.
  • 3- between the mechanical and anatomic axes of the tibia.
  • 4- between the anatomical axis of the femur and tibia.
  • 5- between the mechanical axis of the femur and the anatomical axis of the tibia.

 

  • Question 97.36
  • Answer = 4
  • Reference(s)
  • Haussen AD, Chao EYS: High tibial osteotomy, in Fu FH, Warner CD, Vince KG (eds): Knee Surgery. Baltimore, MD, Williams & Wilkins, 1994, pp 1121-1169.

 

  • 97.37 The incidence of vascular injury after an anterior knee dislocation is
  • 1- less than 5%.
  • 2- 10% to 25%.
  • 3- 30% to 50%.
  • 4- 60% to 80%.
  • 5- greater than 95%.

 

  • Question 97.37
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 463-480.

 

  • 97.38 A 72-year-old woman has an irreparable massive rotator cuff tear and
  • symptomatic glenohumeral arthritis. What procedure will most likely yield the
  • best long-term clinical result?
  • 1- Arthrodesis
  • 2- Hemiarthroplasty
  • 3- Resection arthroplasty
  • 4- Total shoulder arthroplasty
  • 5- Acromioplasty and debridement

 

  • Question 97.38
  • Answer = 2
  • Reference(s)
  • Amtz CT, Jackins S, Matsen FA III: Prosthetic replacement of the shoulder for the treatment of defects in the rotator cuff and the surface of the glenohumeral joint. J Bone Joint Surg 1993;75A:485-491.

 

  • 97.39 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.40 A 45-year-old man sustains an injury to
  • his pelvic ring as a result of a motor
  • vehicle accident. Radiographs are shown
  • in Figures 11a through 11c, and a CT scan
  • is shown in Figure 11d. Examination
  • reveals that he is hemodynamically stable
  • and has no associated injuries.
  • Management should include
  • 1- anterior sacroiliac plate fixation.
  • 2- anterior fixation of the pubic symphysis.
  • 3- posterior fixation of the left sacroiliac joint.
  • 4- early mobilization and weightbearing without
  • internal fixation.
  • 5- combined anterior fixation to the pubic
  • symphysis and posterior fixation of the left
  • sacroiliac joint.
  • A
  • B
  • Figures 11
  • Go to next slide for remaining figures and answer link

 

  • Question 97.40 Figures 11
  • D
  • C

 

  • Question 97.40
  • Answer = 2
  • Reference(s)
  • Tile M: Classification, in Tile M (ed): Fractures of the Pelvis and Acetabulum, ed 2. Baltimore, MD, Williams and Wilkins, 1995, pp 66-101. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 241-248. Tile M: Fractures of the pelvis and acetabulum, in Schatzker J, Tile M (eds): The Rationale of Operative Fracture Care. Berlin, Germany, Springer-Verlag, 1987, pp 133-172.

 

  • 97.41 Radiographs of a 24-year-old man who
  • sustained an open tibial fracture 11
  • months ago are shown in Figures 12a
  • and 12b. Examination shows an
  • anteromedial draining wound over the
  • mid-tibia. Which of the following
  • methods will most accurately identify
  • the pathologic microorganisms?
  • 1- Swab culture of the sinus tract
  • 2- Operative sampling of the sinus tract
  • 3- Operative sampling of the posterolateral
  • sequestrum
  • 4- Operative sampling of deep specimens from
  • multiple foci
  • 5- Needle aspiration of the distal tibial
  • metaphyseal abscess
  • A
  • B
  • Figures 12

 

  • Question 97.41
  • Answer = 4
  • Reference(s)
  • Perry CR, Pearson RL, Miller GA: Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis. J Bone Joint Surg 1991;73A:745-749. Patzakis MJ, Wilkins J, Kumar J, et al: Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones: A prospective study. J Bone Joint Surg 1994;76A:664-666.

 

  • 97.42 Which of the following conditions has the highest rate of malignant change?
  • 1- Ollier's disease
  • 2- Enchondromatosis
  • 3- Maffucci’s syndrome
  • 4- Multiple exostoses
  • 5- Solitary osteochondroma

 

  • Question 97.42
  • Answer = 3
  • Reference(s)
  • Schwartz HS, Zimmerman NB, Simon MA, et al: The malignant potential of enchondromatosis. J Bone Joint Surg 1987;69A:269-274.

 

  • 97.43 A 37-year-old man who sustained a type IIIB open fracture of the middle third of
  • the tibia after a severe crush injury has significant contusions and some necrosis
  • of the posterior muscles. Treatment consists of debridement and external
  • fixation. Which of the following muscle flaps should be used for soft-tissue
  • coverage of the exposed anteromedial tibia?
  • 1- Soleus
  • 2- Fasciocutaneous
  • 3- Medial gastrocnemius
  • 4- Lateral gastrocnemius
  • 5- Free vascularized muscle

 

  • Question 97.43
  • Answer = 5
  • Reference(s)
  • Neale HW, Stern PJ, Kreilein JG, et al: Complications of muscle-flap transposition for traumatic defects of the leg. Plast Reconstr Sur- 1983;72:512-517. Frymoyer JW (ed): Orthopaedic Knowledge Update 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 579-592.

 

  • 97.44 A previously active 36-year-old woman who fractured her right ankle 10 years
  • ago and was treated with 6 weeks of cast immobilization now has had pain and
  • swelling for the past year and is no longer able to play tennis or jog.
  • Examination shows swelling and a 10-degree loss of dorsiflexion when
  • compared with the normal, contralateral ankle. Radiographs show shortening of
  • the fibula, widening of the ankle mortise, lateral tilt of the talus, and slight
  • narrowing of the tibiotalar joint space. Treatment should include
  • 1- ankle fusion.
  • 2- osteotomy of the fibula.
  • 3- deltoid ligament reconstruction.
  • 4- a custom-made plastic shoe insert.
  • 5- nonsteroidal anti-inflammatory drug therapy.

 

  • Question 97.44
  • Answer = 2
  • Reference(s)
  • Michelson JD: Fractures about the ankle. J Bone Joint Surg 1995;77A:142-152. Marti RK, Raaymakers EL, Nolte PA: Malunited ankle fractures: The late results of reconstruction. J Bone Joint Surg 1990;72B:709-713. Yablon IG, Leach RE: Reconstruction of malunited fractures of the lateral malleolus. J Bone Joint Surg 1989;71A:521-527.

 

  • 97.45 Which of the following proteins is a cell-wall pump that functions to eliminate
  • natural toxins and some chemotherapeutic agents from the cytoplasm into the
  • extracellular environment, and allows both normal and neoplastic cells to
  • develop resistance to chemotherapeutic agents?
  • 1- Interleukin 2
  • 2- P-glycoprotein
  • 3- Parathyroid hormone
  • 4- Platelet-derived growth factor
  • 5- Transforming growth factor beta

 

  • Question 97.45
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 219-276. Baldini N, Scotlandi K, Barbanti-Brodano G, et al: Expression of P-glycoprotein in high grade osteosarcomas in relation to clinical outcome. N En.,1 J Med 1995;333:1380-1385. Takeshita H, Gebhardt MC, Springfield DS, et al: Experimental models for the study of drug resistance in osteosarcoma: P-glycoprotein-positive, murine osteosarcoma cell lines. J Bone Joint Sur- 1996;78A:366-375.

 

  • 97.46 A 9-year-old boy has an abnormal gait that has become progressively worse for
  • the past 2 years. Examination reveals high arches in both feet, an irregular and
  • unsteady gait, and difficulty walking in a straight line. Reflexes are absent in
  • both knees and ankles, but a positive Babinski's sign is present. He also has
  • scoliosis and slurred speech. This child should also be evaluated for
  • 1- hip dysplasia.
  • 2- cardiomyopathy.
  • 3- aortic dilation.
  • 4- pseudohypertrophy.
  • 5- cervical spine anomalies.

 

  • Question 97.46
  • Answer = 2
  • Reference(s)
  • Shapiro F, Specht L: The diagnosis and orthopaedic treatment of childhood spinal muscular atrophy, peripheral neuropathy, Freidreich ataxia, and arthrogryposis. J Bone Joint Surg 1993;75A:1699-1714.

 

  • 97.47 What two nerves, other than the femoral nerve, innervate the muscles that
  • contribute tendons to the pes anserinus?
  • 1- Sural and sciatic
  • 2- Tibial and peroneal
  • 3- Saphenous and tibial
  • 4- Saphenous and sciatic
  • 5- Sciatic and obturator

 

  • Question 97.47
  • Answer = 5
  • Reference(s)
  • Hollinshead WH: Textbook of Anatomy. New York, NY, Harper & Row, 1974, p 606.

 

  • 97.48 A 3-year-old child refuses to walk, has restricted, painful hip motion, and a
  • temperature of 100.4°F (38°C) after being treated with antibiotics for the past 5
  • days for an upper respiratory infection and otitis media. Laboratory studies show
  • an erythrocyte sedimentation rate of 50 mm/hr and a peripheral WBC of
  • 9,000/mm3 with 70% polys and 2% bands. An ultrasound of the hip shows a
  • mild to moderate effusion, and aspiration of the hip yields 1 1/2 mL of cloudy
  • fluid with a WBC of 50,000/mm3. No organisms are seen on the Gram stain.
  • Management should consist of
  • 1- open arthrotomy and drainage.
  • 2- antibiotics and a repeat aspiration in 24 hours.
  • 3- observation and a repeat aspiration in 24 hours.
  • 4- bed rest with a spica cast.
  • 5- bed rest, observation, and anti-inflammatory medication.

 

  • Question 97.48
  • Answer = 1
  • Reference(s)
  • Morrissy RT: Bone and joint sepsis, in Mornssy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 579-625.

 

  • 97.49 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.50 A 21-year-old man has had increasing hip
  • pain primarily during weightlifting
  • exercises. AP and oblique radiographs of
  • his hip are shown in Figures 13a and 13b.
  • A CT scan of the hip is shown in Figure
  • 13c and a T2-weighted coronal MRI scan
  • is shown in Figure 13d. Low- and high-
  • power photomicrographs of the biopsy
  • material are shown in Figures 13e and
  • 13f. What is the most likely diagnosis?
  • 1- Chondroblastoma
  • 2- Giant cell tumor
  • 3- Unicameral bone cyst
  • 4- Aneurysmal bone cyst
  • 5- Hyperparathyroidism
  • Go to next slide for remaining figures and
  • answer link
  • Figures 13
  • A
  • B

 

  • back to question 97.50
  • D
  • Figures 13
  • C
  • E
  • F

 

  • Question 97.50
  • Answer = 4
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 420-430.

 

  • 97.51 A patient who underwent a successful posterior stabilized total knee
  • arthroplasty, 9 months ago reports an audible clunk with increasing pain and
  • disability as he extends the knee from 45 to 30 degrees of flexion. Surgical
  • treatment should now consist of
  • 1- patellectomy
  • 2- open patellectomy
  • 3- patellar component revision
  • 4- extensor mechanism realign
  • 5- excision of a soft-tissue lesion.

 

  • Question 97.51
  • Answer = 5
  • Reference(s)
  • Vernace JV, Rothman RH, Booth RE Jr, et al: Arthroscopic management of the patellar clunk syndrome following posterior stabilized total knee arthroplasty. J Arthroplasty 1989;4:179-182. Hozack WJ, Rothman RH, Booth RE Jr, et al: The patellar clunk syndrome: A complication of posterior stabilized total knee arthroplasty. Clin Orthop 1989;241:203-208.

 

  • 97.52 What is the most significant factor leading to nonunion when a halo vest is used
  • to treat a type II fracture at the base of the odontoid?
  • 1- Diabetes
  • 2- Osteoporosis
  • 3- Extension injury
  • 4- Age older than 65 years
  • 5- Displacement more than 5 mm

 

  • Question 97.52
  • Answer = 5
  • Reference(s)
  • Clark W: Fracture of the dens: A multi-center study. J Bone Joint Surg 1985;67A:1340-1348.

 

  • 97.53 An 8-year-old boy with diplegic cerebral palsy has spastic ankle equinus that
  • interferes with gait. A posterior polypropylene "leaf-spring" ankle-foot orthosis
  • is prescribed. The purpose of the device is to
  • 1- strengthen the ankle muscles.
  • 2- prevent ankle dorsiflexion in midstance.
  • 3- reduce excessive equinus in swing phase.
  • 4- release stored energy during third rocker.
  • 5- permanently correct the shortened Achilles tendon.

 

  • Question 97.53
  • Answer = 3
  • Reference(s)
  • Ounpuu S, Bell KJ, Davis RB III, et al: An evaluation of the posterior leaf spring orthosis using joint kinematics and kinetics. J Pediatr Orthop 1996;16:378-384.

 

  • 97.54 Radiographs of a 45-year-old man who
  • has pain in his left shoulder 11 days after
  • being admitted to the neurology
  • department for an uncontrolled seizure
  • disorder are shown in Figures 14a and
  • 14b. Examination will most likely reveal
  • 1- limited internal rotation and fullness beneath
  • the coracoid.
  • 2- limited internal rotation and abduction with the
  • humeral head palpable posterior to the
  • acromion.
  • 3- restriction of all range of motion in the
  • shoulder with normal shoulder contours.
  • 4- the shoulder locked in internal rotation and a
  • prominent coracoid process.
  • 5- the shoulder held in abduction with marked
  • restriction of adduction and a palpable gap
  • beneath the acromion.
  • A
  • B
  • Figures 14

 

  • Question 97.54
  • Answer = 4
  • Reference(s)
  • Keppler P, Holz U, Thielemann FW, et al: Locked posterior dislocation of the shoulder: Treatment using rotational osteotomy of the humerus. J Orthop Trauma 1994;8:286-292. Hawkins RJ, Neer CS II, Pianta RM, et al: Locked posterior dislocation of the shoulder. J Bone Joint Surg 1987;69A:9-18. Rowe CR, Zarins B: Chronic unreduced dislocations of the shoulder. J Bone Joint Surg 1982;64A:494-505.

 

  • 97.55 Parathyroid hormone-related protein and its receptor are implicated in
  • 1- rickets.
  • 2- Stickler syndrome.
  • 3- hypochondroplasia.
  • 4- metaphyseal dysplasia.
  • 5- osteogenesis imperfecta.

 

  • Question 97.55
  • Answer = 4
  • Reference(s)
  • Schipani E, Kruse K, Juppner H: A constitutively active mutant PTH-PTHrP receptor in Jansen-type metaphyseal chondrodysplasia. Science 1995;268:98-100.

 

  • 97.56 An orthopaedic surgeon is most likely to be sued by a patient for which of the
  • following reasons?
  • 1- An unexpected result of treatment
  • 2- Excessive waiting time in the physician's office
  • 3- A delay in healing or prolonged recovery time
  • 4- A treatment fee in excess of the allowance by an insurer
  • 5- Poor communication with the patient's primary care physician

 

  • Question 97.56
  • Answer = 1
  • Reference(s)
  • Committee on Professional Liability (ed): Managing Orthopaedic Malpractice Risk. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, p 5.

 

  • 97.57 What nerve must be retracted during a recession of the gastrocnemius
  • aponeurosis?
  • 1- Tibial
  • 2- Saphenous
  • 3- Deep peroneal
  • 4- superficial peroneal
  • 5- Medial sural cutaneous

 

  • Question 97.57
  • Answer = 5
  • Reference(s)
  • Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 1. Philadelphia, PA, JB Lippincott, 1984, pp 443-467. Sage FP: Cerebral palsy, in Crenshaw AH (ed): Campbell's Operative Orthopaedics, ed 8. St Louis, MO, Mosby Year-Book, 1992, pp 2287-2382.

 

  • 97.58 What deformity of the great toe is most likely to occur if both sesamoids are
  • removed?
  • 1- Floppy toe
  • 2- Cock-up toe
  • 3- Hallux varus
  • 4- Hallux valgus
  • 5- Hallux rigidus

 

  • Question 97.58
  • Answer = 2
  • Reference(s)
  • Mann RA, Coughlin MJ: Adult hallux valgus and associated conditions, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, CV Mosby, 1993, vol 1, pp 167-295. Shereff MJ: Excision hallux sesamoids, in Shereff MJ (ed): Atlas of Foot and Ankle Surgery. Philadelphia, PA, WB Saunders, 1993, pp 70-75.

 

  • 97.59 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.60 Figure 15 shows the radiograph of a 6-year-
  • old girl who sustained a fracture after falling
  • from the top of the monkey bars. Treatment
  • should consist of
  • 1- open reduction and internal fixation
  • 2- open reduction, epiphysiodesis, and internal fixation
  • 3- application of a long leg cast with the foot in a
  • neutral position
  • 4- closed reduction and percutaneous pin fixation
  • 5- closed reduction and application of a short leg cast
  • with the foot in an equinus position
  • Figure 15

 

  • Question 97.60
  • Answer = 1
  • Reference(s)
  • Tachdjian MO: Pediatric Orthopaedics, ed 2. Philadelphia, PA, WB Saunders, 1990, p 333.

 

  • 97.61 A 38-year-old woman who sustained multiple blunt injuries, including a
  • unilateral lateral compression injury to the pelvic ring as a result of a motor
  • vehicle accident, is awake, alert, and normotensive; however, she has a
  • decreased pulse pressure, a pulse of 110/min and a urine output of 20 mL/hr. She
  • responds to an initial fluid bolus; however, after the fluids are slowed, perfusion
  • begins to deteriorate. An increase in fluids and blood administration is instituted.
  • To evaluate the abdomen as a potential bleeding source, management should
  • include
  • 1- obtaining a CT scan of the abdomen.
  • 2- obtaining lateral decubitus radiographs of the abdomen.
  • 3- obtaining a cross-table lateral radiograph of the abdomen.
  • 4- performing an exploratory laparotomy.
  • 5-performing a supraumbilical diagnostic peritoneal lavage.

 

  • Question 97.61
  • Answer = 5
  • Reference(s)
  • Initial assessment and management, in Alexander RH, Proctor HJ (eds): Advanced Trauma Life Support: Program for Physicians, ed 5. Chicago, IL, American College of Surgeons, 1993, pp 17-46.
  • Abdominal trauma, in Alexander RH, Proctor HJ (eds): Advanced Trauma Life Support: Program for Physicians, ed 5. Chicago, IL, American College of Surgeons, 1993, pp 141-154. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 217-225.

 

  • 97.62 A bifid (high division) of the median nerve at the wrist is usually associated
  • with
  • 1- a persistent median artery.
  • 2- an all median-innervated hand.
  • 3- an absent palmar cutaneous branch.
  • 4- proximal take off of the motor branch.
  • 5- an incomplete superficial palmar arch.

 

  • Question 97.62
  • Answer = 1
  • Reference(s)
  • Lanz U: Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg 1977;2:44-53.

 

  • 97.63 A 35-year-old construction worker has left leg pain and difficulty walking on
  • the left foot. Examination is normal except for decreased sensation to the lateral
  • border of the left foot, the inability to walk on the toes of the left foot, and a
  • positive stretch test producing left heel and lateral foot pain. A standard MRI
  • scan shows a large herniated nucleus pulposus on the left side at L5-S 1. The
  • gait abnormality is most likely due to
  • 1- cauda equina syndrome.
  • 2- L5 radiculopathy and gastrocnemius soleus denervation.
  • 3- L5 radiculopathy and extensor hallucis longus weakness.
  • 4- S1 radiculopathy and gastrocnemius soleus denervation.
  • 5- S1 radiculopathy and extensor hallucis longus weakness.

 

  • Question 97.63
  • Answer = 4
  • Reference(s)
  • Frymoyer JW (ed): Orthopaedic Knowledge Update 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 491-501.

 

  • 97.64 An 18-year-old woman has a closed femoral shaft fracture and facial trauma.
  • Cervical spine radiographs are normal. Because of moderate facial edema,
  • internal fixation of the femur is delayed. Two days later, the patient is noted to
  • have mental confusion and dyspnea. The lungs are clear to auscultation with
  • normal breath sounds. Vital signs are pulse, 100/min; respiration, 35/min; blood
  • pressure, 140/95 mm Hg. Arterial blood gases are p02,70; PC02,45. The pH
  • was 7.35. The most likely diagnosis is
  • 1- occult head injury.
  • 2- pulmonary embolism.
  • 3- spontaneous pneumothorax.
  • 4- fat embolism.
  • 5- upper airway obstruction.

 

  • Question 97.64
  • Answer = 4
  • Reference(s)
  • Guide to the Ethical Practice of Orthopaedic Surgery, ed 2. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1992, pp 40-43.

 

  • 97.65 Which of the following factors most heavily influences a patient's perception of
  • results after undergoing a total hip arthroplasty?
  • 1- Pain relief
  • 2- Walking ability
  • 3- Hip range of motion
  • 4- General improvement in health
  • 5- Patient-physician relationship

 

  • Question 97.65
  • Answer = 1
  • Reference(s)
  • Lieberman JR, Dorey F, Shekelle P, et al: Differences between patients' and physicians‘ evaluations of outcome after total hip arthroplasty. J Bone Joint Surg 1996;78A:835-838.

 

  • 97.66 A new surgical procedure is described for treating symptomatic osteochondritis
  • dissecans. Results of clinical trials at 1 year are better than no treatment, but no
  • long-term studies are available. A patient with a large osteochondrotic defect
  • asks about this treatment, but you have not previously performed the procedure.
  • As his physician, you should
  • 1- decline to perform the procedure until 10-year follow-up data are available.
  • 2- do whatever the patient requests, even if you have reservations about efficacy.
  • 3- agree to perform the procedure only if the patient is entered into a clinical trial.
  • 4- agree to perform the procedure if it is technically within your competence, and you
  • and the patient each feel it is the best alternative.
  • 5- convince the patient to undergo the procedure if you feel it is worthwhile, but avoid
  • confusing the patient with information about the lack of long-term follow-up data.

 

  • Question 97.66
  • Answer = 4
  • Reference(s)
  • Guide to the Ethical Practice of Orthopaedic Surgery, ed 2. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1992, p 18.

 

  • 97.67 A 12-year-old girl has had painful, unilateral toe walking for the
  • past 12 months. Examination shows that her foot is fixed in
  • equinus, and she has exquisite point tenderness over the proximal
  • and medial aspect of the medial gastrocnemius muscle. A lateral
  • radiograph of the knee is shown in Figure 16a, and a T2- weighted
  • axial MRI scan of the proximal leg is shown in Figure 16b. A
  • photomicrograph of biopsy material is shown in Figure 16c. What
  • is the most likely diagnosis?
  • 1- Rhabdomyosarcoma
  • 2- Nodular fasciitis
  • 3- Heterotopic ossification
  • 4- Soft-tissue hemangioma
  • 5- Soft-tissue Ewing's sarcoma
  • A
  • B
  • Figures 16
  • C

 

  • Question 97.67
  • Answer = 4
  • Reference(s)
  • Enzinger F, Weiss S (eds): Soft Tissue Tumors, ed 3. St. Louis, MO, CV Mosby, 1995, pp 605-609.

 

  • 97.68 A 57-year-old woman who sustained a minimally displaced fracture of the
  • distal radius is unable to fully extend her thumb 3 months after the injury. What
  • is the best treatment?
  • 1- Intercalated tendon graft of the extensor pollicis longus
  • 2- Transfer of the brachioradialis to the extensor pollicis longus
  • 3- Transfer of the flexor carpi ulnaris to the extensor pollicis longus
  • 4- Transfer of the flexor digitorum sublimis of the ring finger to the extensor pollicis
  • longus
  • 5- Transfer of the extensor digitorum communis of the index finger to the extensor
  • pollicis longus

 

  • Question 97.68
  • Answer = 1
  • Reference(s)
  • Littler JW: The finger extensor mechanism. Surg Clin North Am 1967;47:415-432. Littler JW: The digital extensor flexor system, in Converse JM (ed): Reconstructive Surgery. Philadelphia, PA, WB Saunders, 1977, vol 6, pp 3166-3183.

 

  • 97.69 Figures 17a and 17b show the radiographs of a 13-year-old girl who has had a bump on
  • her left thigh for the past 6 months, but no constitutional symptoms and no pain except
  • with sport activities. The bump has not increased in size in 6 months, but she reports that
  • she did not feel it before 6 months ago. Examination reveals a palpable, fixed, hard, 4 x 4 cm mass on the left lateral thigh.
  • Range of motion in the knee and
  • hip is full. There is no erythema,
  • but palpation is uncomfortable.
  • What is the most likely
  • diagnosis?
  • 1- Osteoblastoma
  • 2- Osteochondroma
  • 3- Osteogenic sarcoma
  • 4- Chondrosarcoma
  • 5- Parosteal osteogenic sarcoma
  • A
  • B
  • Figures 17

 

  • Question 97.69
  • Answer = 2
  • Reference(s)
  • Tachdjian MO: Pediatric Orthopaedics, ed 2. Philadelphia, PA, WB Saunders, 1990, pp 1163-1173.

 

  • 97.70 Figure 18 shows the MRI scan of a 72-year-old woman who has intractable
  • pain in the back and leg that has been unresponsive to conservative treatment.
  • What is the best surgical treatment at L4-5?
  • 1- Bilateral microdiskectomy
  • 2- Posterior decompression
  • 3- Posterior decompression and
  • posterolateral fusion
  • 4- Posterolateral intertransverse
  • fusion
  • 5- Anterior diskectomy and
  • fusion with allograft and
  • internal fixation
  • Figure 18

 

  • Question 97.70
  • Answer = 3
  • Reference(s)
  • Bradford D: Operative treatment: Adults, in Weinstein JN, Wiesel SW (eds): The Lumbar Spine. Philadelphia, PA, WB Saunders, 1990, pp 539-542.

 

  • 97.71 A 12-year-old girl has a Ewing's sarcoma of the proximal fibula with no
  • metastatic disease or neurovascular involvement. Treatment should include
  • 1- radiation therapy.
  • 2- chemotherapy.
  • 3- surgical resection.
  • 4- radiation therapy and surgical resection.
  • 5- chemotherapy and surgical resection.

 

  • Question 97.71
  • Answer = 5
  • Reference(s)
  • Toni A, Neff JR, Sudanese A, et al: The role of surgical therapy in patients with nonmetastatic Ewing's sarcoma of the limbs. Clin Orthop 1993;286:225-240. Wilkins RM, Pritchard DJ, Burgert EO Jr, et al: Ewing's sarcoma of bone: Experience with 140 patients. Cancer 1986;58:2551-2555.

 

  • 97.72 Which of the following methods is most effective in improving the fatigue
  • strength of polymethylmethacrylate?
  • 1- Porosity reduction
  • 2- Viscosity reduction
  • 3- Chilling the monomer
  • 4- Addition of antibiotics
  • 5- Addition of radiopacifiers

 

  • Question 97.72
  • Answer = 1
  • Reference(s)
  • Davies JP, Jasty M, O'Connor DO, et al: The effect of centrifuging bone cement. J Bone Joint Surg 1989;71B:39-42. Chan KH, Ahmed AM: Polymethylmethacrylate, in Morrey BF (ed): Joint Replacement Arthroplasty. New York, NY, Churchill Livingstone, 1991, pp 23-36.

 

  • 97.73 Figure 19 shows the radiograph of an active 70-year-old woman who had
  • surgery 25 years ago for a painful bunion. She has pain with weightbearing and
  • a prominent screwhead. Conservative management has failed. The best
  • surgical option is screw removal and
  • 1- fascial arthroplasty.
  • 2- silicone implant
  • arthroplasty.
  • 3- a shortening osteotomy.
  • 4- a basal chevron
  • realignment osteotomy.
  • 5- a metatarsophalangeal
  • joint arthrodesis.
  • Figures 19

 

  • Question 97.73
  • Answer = 5
  • Reference(s)
  • Alexander U: Arthrodesis of the metatarsophalangeal and interphalangeal joints of the hallux, in Myerson MM (ed): Current Therapy in Foot and Ankle Surgery. St Louis, MO, Mosby, 1993, pp 81-83. Coughlin MJ, Mann RA: Arthrodesis of the first metatarsophalangeal joint as salvage for the failed Keller procedure. J Bone Joint Surg 1987;69A:68-75.

 

  • 97.74 A 25-year-old woman who has multiple injuries, including closed femoral and
  • tibial shaft fractures, is initially awake and alert, but during resuscitation she
  • becomes somnolent. A chest radiograph shows three rib fractures on the right
  • side, and an AP view of the pelvis shows a 3-cm pubic diastasis. She has a
  • systolic blood pressure of 220 mm Hg and a pulse rate of 38/min. Treatment
  • should include
  • 1- pelvic angiography.
  • 2- diagnostic peritoneal lavage.
  • 3- emergency CT scan of the head and a neurosurgical consultation.
  • 4- administration of 2 L of crystalloid and blood type and crossmatching.
  • 5- insertion of a chest tube in the midclavicular line of the second intercostal space.

 

  • Question 97.74
  • Answer = 3
  • Reference(s)
  • Head Trauma, in Alexander RH, Proctor HJ (eds): Advanced Trauma Life Support: Program for Physicians, ed 5. Chicago, IL, American College of Surgeons, 1993, pp 159-190.

 

  • 97.75 A 4-year-old child who has a
  • history of several fractures of the
  • right femur and tibia now has
  • acute pain in the right tibia.
  • Current radiographs of the femur
  • and tibia are shown in Figures 20a
  • through 20d. There is a family
  • history of fracture difficulties, but
  • no physical characteristics of
  • neurofibromatosis. Management
  • should include
  • 1- a long leg brace with a free knee and
  • ankle.
  • 2- a long leg brace with a fixed knee and
  • free ankle.
  • 3- open reduction and plate fixation of
  • the tibia fracture.
  • 4- femoral and tibial osteotomies with
  • fine wire external fixation.
  • 5- multiple realignment osteotomies and
  • intramedullary fixation of the femur
  • and tibia.
  • A
  • B
  • Figures 20
  • Go to next slide for remaining figures and answer link

 

  • back to question 97.75
  • Figures 20
  • D
  • C

 

  • Question 97.75
  • Answer = 5
  • Reference(s)
  • Lang- Stevenson AJ, Sharrard WJ: Intramedullary rodding with Bailey-Dubow extensible rods in osteogenesis imperfecta: An interim report of results and complications. J Bone Joint Surg 1984;66B:227-232. Marafioti RL, Westin GW: Elongating intramedullary rods in the treatment of osteogenesis imperfecta. J Bone Joint Surg 1977;59A:467-472.

 

  • 97.76 A 10-year-old boy who is in the 20th percentile for height has a waddling gait.
  • Examination reveals a 15-degree scoliosis and frontal bossing, and radiographs
  • show bilateral coxa vara and a widened symphysis pubis. Results of the
  • neurologic examination are normal. What is the most likely diagnosis?
  • 1- Rickets
  • 2- Achondroplasia
  • 3- Cleidocranial dysplasia
  • 4- Developmental coxa vara
  • 5- Metaphyseal chondrodysplasia

 

  • Question 97.76
  • Answer = 3
  • Reference(s)
  • Richie MF, Johnson CE Il: Management of developmental coxa vara in cleidocranial dysostosis. Orthopaedics 1989;12:1001-1004. Bassett GS: The osteochondrodysplasias, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 203-254.

 

  • 97.77 As a third-year orthopaedic resident you are in surgery with an attending
  • surgeon treating a patient who has a grossly contaminated open tibia fracture.
  • As the case proceeds, it becomes apparent to you and other operating room staff
  • that the attending surgeon has recently consumed alcohol and his judgment is
  • impaired. You disagree with the wound management insisted on by the
  • attending surgeon. At this point, you should
  • 1- take over the treatment and call the Chief of Service.
  • 2- refuse to proceed as directed and leave the operating room.
  • 3- proceed as directed but also administer high doses of antibiotics.
  • 4- proceed as directed and report the physician to the Chief of Service.
  • 5- proceed as directed and write a note in the chart that you disagree with the
  • management of the patient.

 

  • Question 97.77
  • Answer = 1
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, p 35.

 

  • 97.78 Force is a vector because it
  • 1- produces potential energy.
  • 2- has direction and magnitude.
  • 3- causes rotation and translation.
  • 4- cannot be added or subtracted.
  • 5- can only be analyzed graphically.

 

  • Question 97.78
  • Answer = 2
  • Reference(s)
  • Chao EYS, Aro HT: Biomechanics of fracture fixation, in Mow VC, Hayes WC (eds): Basic Orthopaedic Biomechanics. New York, NY, Raven Press, 1991.

 

  • 97.79 Figure 21 shows the radiograph of an 18-month-old infant. What is the most
  • appropriate surgical procedure for reconstruction of the thumb?
  • 1- Tendon rebalancing
  • 2- Proximal phalanx osteotomy and lengthening
  • 3- Opening wedge osteotomy of the delta phalanx
  • 4- Closing wedge osteotomy of the delta phalanx
  • 5- Total excision of the delta phalanx and
  • soft-tissue reconstruction

 

  • Question 97.79
  • Answer = 5
  • Reference(s)
  • Lister GD: The Hand: Diagnosis and Indication, ed 3. New York, NY, Churchill Livingstone, 1993, pp 459-512.

 

  • 97.80 Figures 22a and 22b show plain radiographs of a 33-year-old man who has had
  • progressive pain in his nondominant left shoulder for the past 5 months. A proton density
  • MRI scan is shown in Figure 22c, and histologic materials from the solid portion of the
  • lesion are shown in Figures 22d and 22e. What is the most likely diagnosis?
  • 1- Enchondroma
  • 2- Giant cell tumor
  • 3- Chondroblastoma
  • 4- Chondromyxoid fibroma
  • 5- Clear cell chondrosarcoma
  • A
  • B
  • Figures 22
  • Go to next slide for remaining figures and answer link

 

  • Figures 22
  • D
  • C
  • E
  • back to question 97.80

 

  • Question 97.80
  • Answer = 5
  • Reference(s)
  • Gilbert TJ, Goswitz JJ, Griffiths H: Radiologic case study: Clear-cell chondrosarcoma. Orthopaedics 1995;18:407. Kumar R, David R, Cierney G III: Clear cell Chondrosarcoma. Radiology 1985;154:45-48. Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 71-108.

 

  • 97.81 A 200-lb, 52-year-old male construction worker is evaluated for surgical
  • correction of medial unicompartmental arthritis of the knee that has become
  • increasingly symptomatic for the past 3 years. Range of motion in his knee is 5
  • degrees to 120 degrees. Long leg radiographs show a mechanical axis that
  • measures 5 degrees varus. Surgical treatment should consist of
  • 1- high tibial osteotomy.
  • 2- total knee replacement.
  • 3- distal femoral osteotomy.
  • 4- unicompartmental arthroplasty.
  • 5- arthroscopic debridement of the medial. compartment.

 

  • Question 97.81
  • Answer = 1
  • Reference(s)
  • Gill T, Schemitsch EH, Brick GW, et al: Revision total knee arthroplasty after failed unicompartmental knee arthroplasty or high tibial osteotomy. Clin Orthop 1995;321:10-18. Matthews L, Goldstein S, Malvitz T: Proximal tibial osteotomy. Clin Orthop 1988;229:193-200.

 

  • 97.82 What is the best method of skeletal stabilization for a 23-year-old man who
  • sustains a comminuted diaphyseal femoral fracture as a result of a low-velocity
  • gunshot?
  • 1- Plate fixation
  • 2- External fixation
  • 3- Flexible intramedullary nailing
  • 4- Intramedullary nailing with static interlocking
  • 5- Traction and delayed fixation dependent on the status of the wound

 

  • Question 97.82
  • Answer = 4
  • Reference(s)
  • Bergman M, Tornetta P, Kerina M, et al: Femur fractures caused by gunshots: Treatment by immediate reamed intramedullary nailing. J Trauma 1993;34:783-785. Nowotarski P, Brumback RJ: Immediate interlocking nailing of fractures of the femur caused by low- to mid-velocity gunshots. J Orthop Trauma 1994;8:134-141.

 

  • 97.83 Figures 23a and 23b show
  • radiographs of a 52-year-old man
  • with diabetes who has had purulent
  • drainage from the medial side of his
  • right great toe for 3 weeks. He was
  • recently started on insulin.
  • Examination reveals a good dorsalis
  • pedis pulse but poor sensation from
  • the malleoli to the toes. Treatment
  • should consist of
  • 1- amputation of the great toe.
  • 2- bone culture and 6 weeks of IV
  • antibiotics.
  • 3- joint aspiration and 2 weeks of IV
  • antibiotics.
  • 4- excision interphalangeal arthroplasty.
  • 5- excision of infected bone and
  • interphalangeal joint arthrodesis.
  • A
  • B
  • Figures 23

 

  • Question 97.83
  • Answer = 1
  • Reference(s)
  • Penn I: Infections in the diabetic foot, in Samarco GJ (ed): The Foot in Diabetes. Philadelphia, PA, Lea & Febiger, 1991, pp 109-121. Wagner FW: The dysvascular foot: A system for diagnosis and treatment. Foot Ankle 1981, pp 66-122.

 

  • 97.84 Which of the following factors has been shown to increase the risk of
  • neurovascular injury after insertion of an uncemented acetabular component?
  • 1- Vertical cup
  • 2- Posterior acetabular screws
  • 3- Anterior acetabular screws
  • 4- Cups greater than 70 mm in diameter
  • 5- Medialization of the cup to the floor of the true acetabulum

 

  • Question 97.84
  • Answer = 3
  • Reference(s)
  • Wasielewski RC, Cooperstein LA, Kruger MP, et al: Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg 1990;72A:501-508

 

  • 97.85 The elastic modulus of polymethylmethacrylate is closest to that of
  • 1- titanium.
  • 2- carbon fiber.
  • 3- polyethylene.
  • 4- hydroxyapatite.
  • 5- cancellous bone.

 

  • Question 97.85
  • Answer = 5
  • Reference(s)
  • Chan KH, Ahmed AM: Polymethylmethacrylate, in Money BF (ed): Joint Replacement Arthroplasty. New York, NY, Churchill Livingstone, 1991, pp 22-36. Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 43-47.

 

  • 97.86 Treatment of a transverse femoral shaft fracture at the tip of a well-fixed total
  • hip stem should consist of
  • 1- retrograde intramedullary fixation.
  • 2- roller traction, followed by cast bracing.
  • 3- plate fixation with or without an allograft strut.
  • 4- a cemented revision femoral long stem prosthesis.
  • 5- an uncemented revision femoral long stem prosthesis.

 

  • Question 97.86
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389-426. Montijo H, Ebert FR, Lennox DA: Treatment of proximal femur fractures associated with total hip arthroplasty. J Arthroplasty 1989;4:115-123.

 

  • 97.87 A 38-year-old construction worker with no history of trauma has had a painful
  • swelling in the hypothenar eminence of his dominant hand for the past 4 weeks.
  • He also reports numbness in the two ulnar digits and cold intolerance. Which of
  • the following studies is most useful for diagnosis?
  • 1- CT scan
  • 2- Bone scan
  • 3- Arteriogram
  • 4- Doppler ultrasound
  • 5- Electrodiagnostic study

 

  • Question 97.87
  • Answer = 3
  • Reference(s)
  • Koman LA, Urbaniak JR: Ulnar artery insufficiency: A guide to treatment. J Hand Surg 1981;6A:16-24.

 

  • 97.88 Initial radiographs of a 56-year-old
  • man who sustained a closed fracture
  • of the distal tibia in a motor vehicle
  • accident are shown in Figures 24a
  • and 24b. Figure 24c shows a clinical
  • photograph of the injured foot and
  • ankle in the operating room 8 days
  • later. The chances of surgical wound
  • complications are most likely to be
  • minimized by
  • 1- avoiding plate fixation of the distal tibia.
  • 2- keeping the incisions spread by more than
  • 7 cm.
  • 3- using low-profile malleable plates.
  • 4- using a "pilon" fracture incision and a femoral
  • distractor.
  • 5- using a topical antibiotic cream and delaying
  • surgery for 3 to 5 more days.
  • A
  • B
  • Figures 24
  • C

 

  • Question 97.88
  • Answer = 1
  • Reference(s)
  • Bonar SK, Marsh JL: Tibial plafond fractures: Changing principles of treatment. J Am Acad Orthop Surg 1994;2:297-305. Teeny SM, Wiss DA: Open reduction and internal fixation of tibial plafond fractures: Variables contributing to poor results and complications. Clin Orthop 1993;292:108-117. McFerran MA, Smith SW, Boulas HJ, et al: Complications encountered in the treatment of pilon fractures. J Orthop Trauma 1992;6:195-200.

 

  • 97.89 A 14-year-old boy has a 4-month history of aching pain in the distal thigh. Examination
  • reveals a mass in the distal thigh. Figure 25a shows a plain radiograph, Figures 25b and
  • 25c show MRI images, Figure 25d shows a bone scan, and Figure 25e shows a CT scan of
  • the chest. The most likely diagnosis and Musculoskeletal Tumor Society (Enneking) stage
  • is
  • 1- osteosarcoma, stage IIB.
  • 2- osteosarcoma, stage III.
  • 3- parosteal osteosarcoma, stage IIB.
  • 4- periosteal osteosarcoma, stage IIB.
  • 5- periosteal osteosarcoma, stage III.
  • A
  • B
  • Figures 25
  • Go to next slide for remaining
  • figures and answer link

 

  • Go to next slide for last
  • figure and answer link
  • back to question 97.89
  • Figures 25
  • D
  • C

 

  • Figure 25 E
  • back to previous images for question 97.89

 

  • Question 97.89
  • Answer = 2
  • Reference(s)
  • Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 143-184. Nelson TE, Enneking WF: Staging of bone and soft-tissue sarcomas revisited, in Stauffer RN (ed): Advances in Operative Orthopaedics. St Louis, MO, Mosby Year-Book, 1994, vol 2, pp 379-391.

 

  • 97.90 Which of the following structures, in addition to the piriformis, pass through the
  • greater sciatic foramen?
  • 1- Sciatic nerve and obturator internus
  • 2- Sciatic nerve and superior gluteal artery
  • 3- Sciatic nerve and gemellus superior
  • 4- Obturator internus and gemellus superior
  • 5- Superior gluteal artery and gemellus superior

 

  • Question 97.90
  • Answer = 2
  • Reference(s)
  • Anderson JE: Gluteal region and the back of the thigh, bony and ligamentous parts of gluteal region: Obturator muscles from behind, in Grant's Atlas of Anatomy, ed 7. Baltimore, MD, Williams & Wilkins, 1993, pp 4-34, 4-36, and 4-37. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 382-392.

 

  • 97.91 A 21-year-old basketball player sustains a knee injury while decelerating and
  • pivoting for the ball and hemarthrosis develops immediately after the injury.
  • Examination shows a large effusion and 2+ Lachman's test result. If an MRI
  • scan were to be performed immediately, the most common location(s) of an
  • osteochondral injury would be the
  • 1- tibial spine.
  • 2- medial tibial plateau.
  • 3- medial femoral condyle and the medial tibial plateau.
  • 4- lateral femoral condyle and the medial tibial plateau.
  • 5- lateral femoral condyle and the lateral tibial plateau.

 

  • Question 97.91
  • Answer = 5
  • Reference(s)
  • Vellet AD, Marks PH, Fowler PJ, et al: Occult posttraumatic osteochondral lesions of the knee: Prevalence, classification, and short-term sequelae evaluated with MR imaging. Radiology 1991;178:271-276. Speer KP, Spritzer CE, Bassett FH III, et al: Osseous injury associated with acute tears of the anterior cruciate ligament. Am J Sports Med 1992;20:382-389.

 

  • 97.92 Which of the following muscles can be used to protect the sciatic nerve during a
  • posterior approach to the hip?
  • 1- Gluteus minimus
  • 2- Gluteus medius
  • 3- Gluteus maximus
  • 4- Adductor magnus
  • 5- Short external rotators

 

  • Question 97.92
  • Answer = 5
  • Reference(s)
  • Anderson JE: Muscles of the gluteal region and back of thigh: Adductor magnus from behind, in Grant's Atlas of Anatomy, ed 7. Baltimore, MD, Williams & Wilkins, 1993, pp 4-32. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 376-382.

 

  • 97.93 A 78-year-old man has had a chronic symptomatic anterior dislocation of his
  • dominant right shoulder for the past 2 years. Treatment should include
  • 1- arthrodesis.
  • 2- resection arthroplasty.
  • 3- open reduction and stabilization.
  • 4- closed reduction and physical therapy.
  • 5- nonconstrained total shoulder arthroplasty.

 

  • Question 97.93
  • Answer = 5
  • Reference(s)
  • Flatow EL, Miller SR, Neer CS: Chronic anterior dislocation of the shoulder. J Shoulder Elbow Sur- 1993;2:2-10.

 

  • 97.94 Figure 26 shows an oblique coronal proton density MRI scan of a 40-year-old
  • man with shoulder pain. What is the most significant finding?
  • 1- Full-thickness subscapularis tendon tear
  • 2- Full-thickness supraspinatus tendon tear
  • 3- Partial-thickness subscapularis tendon tear
  • 4- Partial-thickness supraspinatus tendon tear
  • 5- A ganglion cyst of the supraspinatus tendon
  • Figure 26

 

  • Question 97.94
  • Answer = 2
  • Reference(s)
  • Miniaci A, Dowdy PA, Willits KR, et al: Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder. Am J Sports Med 1995;23:142-145. Zlatkin MB: MRI of the Shoulder. New York, NY, Raven Press, 1991.

 

  • 97.95 Figures 27a and 27b show the radiographs of an otherwise healthy 6-month-old infant
  • who has been treated with serial casting since birth for a foot deformity. There has been
  • no change in the foot position over the past month of casting. Management should now
  • consist of
  • 1- split transfer of the anterior tibial tendon.
  • 2- surgical release of the residual deformities.
  • 3- use of an ankle-foot orthosis to prevent further deformity.
  • 4- continued serial casting with
  • the knee in an extended
  • position.
  • 5- continued serial casting with
  • dorsiflexion under the first
  • metatarsal.
  • A
  • B
  • Figures 27

 

  • Question 97.95
  • Answer = 2
  • Reference(s)
  • Tachdjian MO: Pediatric Orthopaedics, ed 2. Philadelphia, PA, WB Saunders, 1990, pp 2428-2541.

 

  • 97.96 Examination of a 27-year-old man who injured his knee playing soccer shows
  • full range of motion, no jointline tenderness, negative Lachman and anterior
  • drawer test results, but a positive grade I posterior drawer test result.
  • Radiographs and signs of posterolateral instability are negative. Initial
  • management should consist of
  • 1- primary posterior cruciate ligament repair.
  • 2- rehabilitation, with emphasis on quadriceps strengthening.
  • 3- rehabilitation, with emphasis on hamstring strengthening.
  • 4- reconstruction of the posterior cruciate ligament using an autogenous patellar tendon. 5- reconstruction of the posterior cruciate ligament using an autogenous hamstring
  • tendon.

 

  • Question 97.96
  • Answer = 2
  • Reference(s)
  • Fowler PJ, Messieh SS: Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 1987;15:553-557. Frymoyer JW (ed): Orthopaedic Knowledge Update 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 593-602.

 

  • 97.97 What type of displaced proximal humerus fracture would most likely require
  • immediate treatment with a hemiarthroplasty?
  • 1- Two-part
  • 2- Three-part
  • 3- Head-splitting
  • 4- Two-part fracture-dislocation
  • 5- Three-part fracture-dislocation

 

  • Question 97.97
  • Answer = 3
  • Reference(s)
  • Bigliani LU: Fractures of the proximal humerus, in Rockwood CA, Matsen FA (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1990, pp 278-334. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 217-232.

 

  • 97.98 Figure 28 shows an axial CT scan through the body and posterior elements of
  • L5 in a young man with low back pain. What is the radiographic diagnosis?
  • 1- Spondylolysis
  • 2- Osteoid sarcoma
  • 3- Acute facet fracture
  • 4- Dysplastic spondylolisthesis
  • 5- Congenital failure of posterior element formation
  • Figure 28

 

  • Question 97.98
  • Answer = 1
  • Reference(s)
  • Wiltse LL, Rothman SL: Spondylolisthesis: Classification, diagnosis, and natural history. Semin Spine Surg 1993;5:264-280. Heithoff KB, Herzog RJ: Computed tomography (CT) and enhanced CT of the spine, in Frymoyer JW (ed): The Adult Spine. New York, NY, Raven Press, 1991, pp 335-401.

 

  • 97.99 What is the main disadvantage of using aluminum in the fabrication of
  • orthoses?
  • 1- Too rigid
  • 2- Limited availability
  • 3- Lower endurance limit
  • 4- High strength-to-weight ratio
  • 5- Too heavy for upper extremity applications

 

  • Question 97.99
  • Answer = 3
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 447-486.

 

  • 97.100 A 56-year-old man who has a 2-year history of a progressive peripheral
  • neuropathy has symmetric motor and sensory deficits in the lower extremities
  • that are worse distally. Plain radiographs of the spine and pelvis show multiple
  • small sclerotic lesions in the pubic rami, left and right ilia, and the lumbosacral
  • spine. Serum protein immunoelectrophoresis shows a monoclonal spike. What
  • is the most likely diagnosis?
  • 1- Metastatic lung cancer
  • 2- Metastatic prostate cancer
  • 3- Osteosclerotic myeloma
  • 4- Non-Hodgkin's lymphoma
  • 5- Primary hyperparathyroidism

 

  • Question 97.100
  • Answer = 3
  • Reference(s)
  • Kelly JJ Jr, Kyle RA, Miles JM, et al: Osteosclerotic myeloma and peripheral neuropathy. Neurology 1983;33:202-210. Frassica FJ, Frassica DA, Sim FH: Myeloma of bone, in Stauffer RN (ed): Advances in Operative Orthopaedics. St Louis, MO, Mosby Year-Book, 1994, vol 2, pp 357-377.

 

  • 97.101 A 52 year old woman has thumb basilar arthritis and ipsilateral carpal tunnel
  • syndrome. Conservative treatment consists of a custom orthosis and
  • nonsteroidal anti-inflammatory medication. The orthotic prescription should
  • read
  • 1- hand-based thumb spica splint, IP free.
  • 2- hand-based thumb spica splint, to base of nail.
  • 3- forearm-based thumb spica splint, IP free.
  • 4- forearm-based thumb spica splint, to base of nail.
  • 5- radial gutter wrist support splint, neutral.

 

  • Question 97.101
  • Answer = 3
  • Reference(s)
  • Weiss ND, Gordon L, Bloom T, et al: Position of the wrist associated with the lowest carpal-tunnel pressure: Implications for splint design. J Bone Joint Surg 1995;77:1695-1699. Malick MH: Manual on Static Hand Splinting, ed 5. Pittsburgh, PA, AREN-Publications, 1985, p 97.

 

  • 97.102 A 35-year-old drill press operator lacerated her index finger over the dorsum
  • of the proximal interphalangeal joint on a piece of sheet metal 6 months ago.
  • Initial treatment included irrigation, debridement, and application of a splint
  • for 6 weeks. She has returned to work; however, she is dissatisfied with finger
  • mobility. She has a 30-degree arc of active and passive motion at the proximal
  • interphalangeal joint and full metacarpophalangeal and distal interphalangeal
  • motion. Management should consist of
  • 1- serial casting.
  • 2- a passive joint mobilization program.
  • 3- dorsal proximal interphalangeal joint capsulotomy.
  • 4- extensor tenolysis.
  • 5- extensor tenolysis and dorsal proximal interphalangeal joint capsulotomy.

 

  • Question 97.102
  • Answer = 5
  • Reference(s)
  • Guelmi K, Sokolow C, Mitz V, et al: Dorsal tenolysis and arthrolysis of the proximal interphalangeal joint. Ann ChirMain Memb Super 1992;11:307-312. Creighton JJ, Steichen JB: Complications in phalangeal and metacarpal fracture management: Results of extensor tenolysis. Hand Clin 1994;10:111-116.

 

  • 97.103 While performing a wrist fusion using a dorsally applied plate, the surgeon
  • notes that supination is limited after application of the plate. Intraoperative
  • radiographs show evidence of significant ulnocarpal abutment between the
  • distal ulna and the triquetrum. What is the next step in the procedure?
  • 1- Ulnar shortening
  • 2- Resection of the triquetrum
  • 3- Radial lengthening and bone graft
  • 4- Darrach resection of the distal ulna
  • 5- Hemiresection arthroplasty of the distal radioulnar joint

 

  • Question 97.103
  • Answer = 2
  • Reference(s)
  • Zachary SV, Stern PJ: Complications following AO/ASIF wrist arthrodesis. J Hand Surg 1995;20A:339-344.

 

  • 97.104 A 26-year-old cashier sustained a transverse extra-articular fracture of the proximal phalangeal base
  • of the small finger 10 months ago. Treatment consisted of closed reduction and 5 weeks of
  • immobilization in an ulnar gutter splint. Figure 29a shows active extension, and Figure 29b shows
  • active flexion of the small finger. Figure 29c shows passive flexion of the small finger. There is 20
  • degrees of active flexion in the distal interphalangeal joint with blocking. Radiographs show a well-
  • healed fracture in satisfactory alignment. Treatment should now include
  • 1- a free tendon graft.
  • 2- a dorsal interphalangeal joint capsulotomy.
  • 3- staged tendon reconstruction with a silicone rod.
  • 4- sublimis and profundus tenolysis.
  • 5- sublimis tenodesis and distal interphalangeal joint fusion.
  • A
  • B
  • Figures 29
  • C

 

  • Question 97.104
  • Answer = 4
  • Reference(s)
  • Strickland JW: Flexor tenolysis. Hand Clin 1985;1:121-132. Schneider LH: Tenolysis and capsulectomy after hand fractures. Clin Orthop 1996;327:72-78.

 

  • 97.105 For the fracture shown in Figures 30a and 30b, the greatest mechanical rigidity
  • is obtained using which of the following fixation techniques?
  • 1- A Y-plate extending onto the medial and lateral column
  • 2- A medial column 3.5-mm plate and lateral tension band wiring
  • 3- A lateral contoured buttress plate and medial
  • interfragmentary 4.5-mm screw
  • 4- Two 3.5-mm reconstruction plates, one placed
  • medially and one placed posterolaterally
  • 5- Two 1/3 tubular plates,
  • one placed
  • posteromedially
  • and one placed
  • posterolaterally
  • A
  • B
  • Figures 30

 

  • Question 97.105
  • Answer = 4
  • Reference(s)
  • Helfet DL, Schmeling GJ: Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop 1993;292:26-36. Schemitsch EH, Tencer AF, Henley MB: Biomechanical evaluation of methods of internal fixation of the distal humerus. J Orthop Trauma 1994;8:468-475. Helfet DL, Hotchkiss RN: Internal fixation of the distal humerus: A biomechanical comparison of methods. J Orthop Trauma 1990;4:260-264.

 

  • 97.106 Figure 31 shows the radiographs of a 3-year-old boy with bowlegs. A family
  • history notes bowlegs in his grandfather and his mother is of short stature. His
  • dietary history is normal. The bowing was first noted when he started to walk
  • and has gradually increased. Laboratory studies are most likely to show normal
  • parathyroid hormone and
  • 1- normal serum calcium, phosphorus, and
  • alkaline phosphatase levels.
  • 2- normal serum calcium, low serum phosphorus,
  • and increased alkaline phosphatase levels.
  • 3- elevated serum calcium, low serum phosphorus,
  • and normal alkaline phosphatase levels.
  • 4- elevated serum calcium, low serum phosphorus,
  • and increased alkaline phosphatase levels.
  • 5- elevated serum calcium, normal serum
  • phosphorus, and increased alkaline
  • phosphatase levels.
  • Figure 31

 

  • Question 97.106
  • Answer = 2
  • Reference(s)
  • Mankin HJ: Metabolic bone disease, in Jackson DW (ed): Instructional Course Lectures 44. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 3-29. Ferris B, Walker C, Jackson A, et al: The orthopedic management of hypophosphatemic rickets. J Pediatr Orthop 1991;11:367-373.

 

  • 97.107 When performing an anterolateral (Watson-Jones) approach to the hip, the
  • appropriate muscular interval is between the
  • 1- gluteus medius and piriformis
  • 2- gluteus medius and gluteus minimus
  • 3- gluteus medius and gluteus maximus
  • 4- tensor fascia lata and rectus femoris tensor
  • 5- fascia lata and gluteus medius

 

  • Question 97.107
  • Answer = 5
  • Reference(s)
  • Anderson JE: Muscles of the gluteal region and back of the thigh, in Grant's Atlas of Anatomy. Baltimore, MD, Williams & Wilkins, 1993, pp 4-31. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 352-357.

 

  • 97.108 What is the most common clinical sign of pulmonary embolism following
  • total hip arthroplasty?
  • 1- Fever
  • 2- Tachypnea
  • 3- Tachycardia
  • 4- Pleural rub
  • 5- Edema and tenderness of the leg

 

  • Question 97.108
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 487-517.

 

  • 97.109 Malignant melanoma of the foot is most commonly located on the
  • 1- toe web space
  • 2- dorsal surface
  • 3- plantar surface
  • 4- subungual space of the great toe
  • 5- subungual space of the lesser toe

 

  • Question 97.109
  • Answer = 3
  • Reference(s)
  • Fortin PT, Freiberg AA, Rees R, et al: Malignant melanoma of the foot and ankle. J Bone Joint Surg 1995;77A:1396-1403.

 

  • 97.110 Immediate postoperative management after repair of a large rotator cuff tear
  • should include
  • 1- limited, passive range of mot,
  • 2- full, active shoulder range of motion exercises
  • 3- active range of motion exercises and resistive exercises
  • 4- protection in a sling for 3 weeks, but no motion exercises. protection in an abduction 5- pillow for 3 week, but no motion exercises

 

  • Question 97.110
  • Answer = 1
  • Reference(s)
  • Kavas EH, Iannotti JP: Failed repair of the rotator cuff: Evaluation and treatment of complications. J Bone Joint Surg 1997;79A:784-793.

 

  • 97.111 Which of the following factors is responsible for the largest proportional
  • increase in the cost of total hip arthroplasty from 1980 to 1990?
  • 1- Surgeon fees
  • 2- Cost of the prosthesis
  • 3- Operating room charges
  • 4- Physician fees other than the surgeon
  • 5- Charges other than the operating room

 

  • Question 97.111
  • Answer = 2
  • Reference(s)
  • Barber TC, Healy WL: The hospital cost of total hip arthroplasty: A comparison between 1981 and 1990. J Bone Joint Sur- 1993;75A:321-325.

 

  • 97.112 Which of the following terms best describes most chondrosarcomas at initial
  • presentation?
  • 1- Metastatic
  • 2- Low-grade, intracompartmental
  • 3- Low-grade, extracompartmental
  • 4- High-grade, intracompartmental
  • 5- High-grade, extracompartmental

 

  • Question 97.112
  • Answer = 2
  • Reference(s)
  • Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106-120. Nelson TE, Enneking WF: Staging of bone and soft-tissue sarcomas revisited, in Stauffer RN (ed): Advances in Operative Orthopedics. St Louis, MO, Mosby Year-Book, 1994, vol 2, pp 379-391.

 

  • 97.113 In which of the following anatomic sites will a patient with an early central
  • cord syndrome resulting from a cervical fracture-dislocation have more
  • neurologic dysfunction?
  • 1- Central torso
  • 2- Bowel and bladder
  • 3- Upper extremities
  • 4- Lower extremities
  • 5- Sympathetic nervous system

 

  • Question 97.113
  • Answer = 3
  • Reference(s)
  • Stauffer ES: Diagnosis and prognosis of acute cervical spinal cord injury. Clin Orthop 1975;112:9-15. Bosch A, Stauffer ES, Nickel VL: Incomplete traumatic quadriplegia: A ten-year review. JAMA 1971;216:473-478.

 

  • 97.114 Which of the following imaging studies is considered the most specific
  • technique for diagnosing a recurrent disk herniation?
  • 1- Myelogram
  • 2- MRI scan
  • 3- MRI scan with gadolinium
  • 4- CT scan with IV contrast
  • 5- CT scan with intrathecal contrast

 

  • Question 97.114
  • Answer = 3
  • Reference(s)
  • Vanderburgh DF,.Kelly WM: Radiologic assessment of discogenic disease of the spine. Neurosurg Clin North Am 1993;4:13-33. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 609-623. Hueftle MG, Modic MT, Ross JS, et al: Lumbar spine: Postoperative MR imaging with Gd-DTPA. Radiology 1988;167:817-824.

 

  • 97.115 Ruffled borders and resorption pits (Howship's Lacunae) are histologic
  • features associated with which of the following cell types?
  • 1- Osteocytes
  • 2- Osteoclasts
  • 3- Osteoblasts
  • 4- Fibroblasts
  • 5- Chondroblasts

 

  • Question 97.115
  • Answer = 2
  • Reference(s)
  • Athanasou NA, Quinn J, Bulstrode CJ: Resorption of bone by inflammatory cells derived from the joint capsule of hip arthroplasties. J Bone Joint Surg 1992;74B:57-62. Athanasou NA: Cellular biology of bone-resorbing cells. J Bone Joint Surg 1996;78A:1096-1112.

 

  • 97.116 Joint motion is maintained at a constant velocity under changing resistance in
  • which of the following exercises?
  • 1- Isotonic
  • 2- Isometric
  • 3- Isokinetic
  • 4- Eccentric
  • 5- Co-contraction

 

  • Question 97.116
  • Answer = 3
  • Reference(s)
  • Cahalan TD, Johnson ME, Liu S, et al: Quantitative measurement of hip strength in different age groups. Clin Orthop 1989;246:136-145.

 

  • 97.117 The quadratus femoris is detached from the femur during a posterolateral
  • approach to the hip, and profuse arterial bleeding is encountered. The bleeding
  • is most likely from a branch of what artery?
  • 1- Obturator
  • 2- Profunda femoris
  • 3- First perforating
  • 4- Medial femoral circumflex
  • 5- Lateral femoral circumflex

 

  • Question 97.117
  • Answer = 4
  • Reference(s)
  • Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 301-356.

 

  • 97.118 When an anterior approach to the cervical spine is being performed, many
  • surgeons prefer the left-sided approach to the right-sided approach because on
  • the left side the recurrent laryngeal nerve is
  • 1- larger.
  • 2- more consistent in location.
  • 3- entirely within the carotid sheath.
  • 4- well protected by the strap muscles of the neck.
  • 5- located between the longus colli and the esophagus.

 

  • Question 97.118
  • Answer = 2
  • Reference(s)
  • Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 1. Philadelphia, PA, JB Lippincott, 1984, pp 265-269.

 

  • 97.119 Figure 32 shows the radiograph of an 8-year-old boy
  • who has pain in his shoulder after throwing a ball.,
  • Management at this time should include
  • 1- a sling.
  • 2- a biopsy.
  • 3- bone grafting.
  • 4- en bloc resection.
  • 5- administration of an intralesional steroid.
  • Figure 32

 

  • Question 97.119
  • Answer = 1
  • Reference(s)
  • Springfield DS: Bone and soft tissue tumors, in Morrissy RT, Weinstein SL (eds): Lovell & Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, vol 1, pp 423-467.

 

  • 97.120 An 18-year-old active duty soldier sustains a 6-cm segmental loss to the tibial
  • diaphysis from an antipersonnel mine. Treatment consists of a fine wire circular
  • external fixator with bone transport, and the immediate postoperative course is
  • uneventful. The patient is given instructions in advancing the frame during a
  • convalescent leave. A radiograph taken 5 weeks postoperatively shows a gain
  • of 4.5 cm and a radiolucent linear area transversely through the middle of the
  • regenerate bone. This finding is most likely the result of
  • 1- a fracture.
  • 2- a pin tract infection.
  • 3- advancing the frame too fast.
  • 4- advancing the frame too slowly.
  • 5- infection within the regenerate.

 

  • Question 97.120
  • Answer = 3
  • Reference(s)
  • Green S: The Ilizarov Method, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 543-570.

 

  • 97.121 A patient undergoes anatomic reduction and stable fixation of a spiral distal
  • fibula fracture that is 4.5 cm above the joint. With which of the following
  • concomitant injuries is the patient most likely to benefit from placement of a
  • syndesmosis screw?
  • 1- Deltoid ligament rupture
  • 2- Wagstaffe's avulsion fracture
  • 3- Rupture of the anterior inferior tibiofibular ligament
  • 4- Oblique medial malleolus fracture that has been reduced and stabilized
  • 5- Transverse medial malleolus fracture that has been reduced and stabilized

 

  • Question 97.121
  • Answer = 1
  • Reference(s)
  • Solari J, Benjamin J, Wilson J, et al: Ankle mortise stability in Weber C fractures: Indications for syndesmotic fixation. J Orthop Trauma 1991;5:190-195.

 

  • 97.122 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.123 A 36-year-old woman who has had intermittent pain in her knee for the past 8
  • months reports that over the last 2 months the pain has increased in frequency
  • and intensity. Laboratory studies show that the CBC and erythrocyte sedimentation rate are within normal
  • limits. AP and lateral radiographs
  • are shown in Figures 33a and 33b.
  • Low- and high-power
  • photomicrographs of the biopsy
  • specimen are shown in Figures 33c
  • and 33d. What is the most likely
  • diagnosis?
  • 1- Lymphoma
  • 2- Osteomyelitis
  • 3- Unicameral bone cyst
  • 4- Aneurysmal bone cyst
  • 5- Eosinophilic granuloma
  • A
  • B
  • Figures 33
  • Go to next slide for remaining figures and answer link

 

  • Figures 33
  • D
  • C
  • back to question 97.123

 

  • Question 97.123
  • Answer = 2
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 448-452.

 

  • 97.124 What structure is most commonly injured when the anterior bolts are placed
  • through a halo fixation device?
  • 1- Frontal sinus
  • 2- Ethmoid sinus
  • 3- Temporal artery
  • 4- Supraorbital nerve
  • 5- Superior rectus muscle

 

  • Question 97.124
  • Answer = 4
  • Reference(s)
  • Garfin SR, Botte MJ, Waters RL, et al: Complications in the use of the halo fixation device. J Bone Joint Surg 1986;68A:320-325.

 

  • 97.125 When an orthopaedic surgeon who works for and is paid by an HMO discusses
  • proposed treatments with a patient, the surgeon should
  • 1- discuss all reasonable treatment options.
  • 2- discuss only the proposed treatment to be done.
  • 3- discuss only the options that are cost-effective and outcome-proven.
  • 4- have the patient and two witnesses sign a transcript of the discussion.
  • 5- refer the patient to the medical administrator for covered treatment options.

 

  • Question 97.125
  • Answer = 1
  • Reference(s)
  • The Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993.

 

  • 97.126 What cell type is implicated as the origin for the mediators of bone resorption
  • and osteolysis about both uncemented and cemented total hip arthroplasty?
  • 1- Fibroblast
  • 2- Macrophage
  • 3- Plasma cell
  • 4- T-lymphocyte
  • 5- B-lymphocyte

 

  • Question 97.126
  • Answer = 2
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389-426. Horowitz SM, Doty SB, Lane JM, et al: Studies of the mechanism by which the mechanical failure of polymethylmethacrylate leads to bone resorption. J Bone Joint Surg 1993;75A:802-813.

 

  • 97.127 A claim must be made within what time period to be covered by an occurrence
  • professional liability insurance policy in effect a the time the injury occurred?
  • 1- Prior to physician's retirement
  • 2- Up to 1 year after the incident occurred
  • 3- Up to 3 years after the incident occurred
  • 4- Up to 7 years after the incident occurred
  • 5- There are no time restrictions

 

  • Question 97.127
  • Answer = 2
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993.

 

  • 97.128 Figures 34a through 34c show a bone scan, MRI
  • scan, and CT scan of a 16-year old boy who has had
  • upper thoracic pain for the past 6 months. The pain
  • does not radiate into the extremities, although it does
  • awaken him at night. His neurologic examination is
  • normal, and plain radiographs show no abnormality.
  • What is the most likely diagnosis?
  • 1- Osteosarcoma
  • 2- Osteoblastoma
  • 3- Giant cell tumor
  • 4- Old trauma with sclerotic healing
  • 5- Encapsulated nonossifying fibroma
  • A
  • B
  • Figures 34
  • C

 

  • Question 97.128
  • Answer = 2
  • Reference(s)
  • Lewis MM: Musculoskeletal Oncology: A multidisciplinary Approach. Philadelphia, PA, WB Saunders, 1992.

 

  • 97.129 A 17-year-old boy who runs cross country has a 6-week history of bilateral
  • deep anterior medial leg pain that persists for 2 to 3 hours after running.
  • Examination shows no pain with palpation, and radiographs are normal. Which
  • of the following tests will best confirm a diagnosis?
  • 1- CT scan
  • 2- MRI scan
  • 3- Gallium bone scan
  • 4- Stereoroentgenography
  • 5- Preexercise and postexercise compartment measurements

 

  • Question 97.129
  • Answer = 5
  • Reference(s)
  • Mubarak SJ: Compartment Syndromes and Volkmann's Contracture. Philadelphia, PA, WB Saunders, 1991, pp 214-217. Bray AW, et al: Chronic exercise induced compartment pressure elevation measured with miniaturized fluid pressure monitor. Am J Sports Med 1988;16:610-615.

 

  • 97.130 Surgical treatment of the femoral window used to remove cement in a revision
  • hip arthroplasty should consist of
  • 1- plugging the defect with polymethylmethacrylate.
  • 2- bridging the window with a femoral strut allograft.
  • 3- plating and bone grafting the window prophylactically.
  • 4- inserting a retrograde intramedullary nail to span the defect.
  • 5- spanning the defect with a prosthesis by at least two cortical diameters.

 

  • Question 97.130
  • Answer = 5
  • Reference(s)
  • Klein AH, Rubash HE: Femoral windows in revision total hip arthroplasty. Clin Orthop 1993;291:164-170.

 

  • 97.131 A 35-year-old man has multi-system blunt injuries as a result of a 15-foot fall.
  • During the resuscitation phase of acute management, the patient is stabilized
  • and radiographs are ordered. Which of the following radiographic views
  • should be selected at this phase of the patient's care?
  • 1- Cervical spine
  • 2- Cervical spine and AP chest
  • 3- Cervical spine, AP chest, and supine abdomen
  • 4- Cervical spine, AP chest, and AP pelvis
  • 5- Cervical spine, AP chest, and cross-table lateral thoracolumbar spine

 

  • Question 97.131
  • Answer = 4
  • Reference(s)
  • Initial assessment and management, in Alexander RH, Proctor HJ (eds): Advanced Trauma Life Support: Program for Physicians, ed 5. American College of Surgeons, 1993, pp 17-46.

 

  • 97.132 Examination of a 10-year-old girl who has a Salter type II fracture of the
  • proximal humeral metaphysis reveals that the fracture is angulated 40 degrees
  • (apex lateral) and displaced 30%. There are no other injuries. Treatment should
  • consist of
  • 1- open reduction and internal fixation.
  • 2- immobilization in a sling and swathe.
  • 3- closed reduction and percutaneous pin fixation.
  • 4- closed reduction followed by application of an abduction shoulder spica cast.
  • 5- olecranon pin traction for 2 weeks, followed by application of a shoulder spica cast.

 

  • Question 97.132
  • Answer = 2
  • Reference(s)
  • Baxter MP, Wiley JJ: Fractures of the proximal humeral epiphysis: Their influence on humeral growth. J Bone Joint Surg 1986;68B:570-573.

 

  • 97.133 What biomechanical considerations enter into the pathophysiology of the
  • condition shown in Figure 35?
  • 1- Early joint motion initiates joint deformation.
  • 2- Laxity of the cruciate ligaments allows tibial
  • subluxation.
  • 3- Static compressive loads adversely affect
  • physeal cartilage.
  • 4- Static compressive loads adversely affect
  • articular cartilage.
  • 5- Hypertrophic bone on the compressive side
  • further impinges on the growth plate.
  • Figure 35

 

  • Question 97.133
  • Answer = 3
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 185-217.

 

  • 97.134 A 14-year-old boy undergoes excisional biopsy of a 3-cm mass over the lateral
  • aspect of the proximal forearm. No imaging studies were obtained prior to the
  • biopsy. A photomicrograph of the biopsy specimen is shown in Figure 36.
  • What is the most likely diagnosis?
  • 1- Desmoid tumor
  • 2- Rhabdomyosarcoma
  • 3- Synovial sarcoma
  • 4- Nodular fasciitis
  • 5- Proliferative fasciitis
  • Figure 36

 

  • Question 97.134
  • Answer = 3
  • Reference(s)
  • Enzinger F, Weiss S (eds): Soft Tissue Tumors, ed 3. St Louis, MO, CV Mosby, 1995, pp 757-786.

 

  • 97.135 A 13-year-old boy has had intermittent pain in both hips for several years and
  • limited motion that has recently become more noticeable. Examination reveals
  • sparse blond hair and facial dysmorphic features, but no other functional
  • impairment. A radiograph of the pelvis is shown in Figure 37a, radiographs of
  • the spine are shown in Figures 37b and 37c, and a radiograph of the hand is
  • shown in Figure 37d. What is the most likely diagnosis?
  • 1- Meyer dysplasia
  • 2- Spondyloepiphyseal
  • dysplasia
  • 3- Multiple epiphyseal
  • dysplasia
  • 4- Trichorhinophalangeal
  • syndrome
  • 5- Legg-Calve-Perthes
  • disease in residual stage
  • Go to next slide for remaining figures and answer link
  • Figure 37
  • A

 

  • Go to next slide for last figure and answer link
  • B
  • C
  • Figures 37
  • 97.135

 

  • back to figures and question
  • D
  • Figures 37
  • 97.135

 

  • Question 97.135
  • Answer = 4
  • Reference(s)
  • Smith's Recognizable Patterns of Human Malformations, ed 5. Philadelphia, PA, WB Saunders, 1988, pp 250-251. Wynn-Davis R, Hall CM, Apley AG: Atlas of Skeletal Dysplasia. London, England, Churchill Livingstone, 1985, pp 629-637.

 

  • 97.136 When should risk management begin in a hospital setting?
  • 1- At discharge from the hospital
  • 2- At the completion of a procedure
  • 3- At the physician's first encounter with a patient
  • 4- When a patient files a formal complaint
  • 5- When a patient initiates legal action against a physician

 

  • Question 97.136
  • Answer = 3
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A Primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 31-32.

 

  • 97.137 Which of the following conditions best characterizes hypermobile pes planus?
  • 1- Hindfoot varus
  • 2- Forefoot adduction
  • 3- Talonavicular instability
  • 4- Lack of supination at push-off
  • 5- Difficulty abducting the forefoot at push-off

 

  • Question 97.137
  • Answer = 4
  • Reference(s)
  • Bordelon RL: Surgical and Conservative Foot Care. Thorofare, NJ, Slack, Inc, 1988, pp 65-87. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 1-19.

 

  • 97.138 Figure 38 shows an axial cat of the L4-5 disk space. Physical findings
  • expected in this patient would be weakness of the
  • 1- left quadriceps and depressed left knee jerk.
  • 2- right quadriceps and depressed right knee jerk.
  • 3- right gastrocsoleus muscle and absent right ankle jerk.
  • 4- left extensor hallucis longus and numbness of the little toe.
  • 5- right extensor hallucis longus and numbness of the right big toe.

 

  • Question 97.138
  • Answer = 5
  • Reference(s)
  • Heithoff KB: Computed tomography and plain film diagnosis of the lumbar spine, in Weinstein JL, Wiesel SW (eds): The Lumbar Spine. Philadelphia, PA, WB Saunders, 1990, pp 283-318.

 

  • 97.139 A 56- year old man has had a
  • slowly enlarging soft tissue
  • mass in his left thigh for the past
  • 6 months. Plain radiographs
  • show only a soft-tissue shadow
  • with no mineralization or
  • obvious bony involvement. The
  • proton density MRI scar shown
  • in Figures 39a and 39b show a
  • coronal view and axial view,
  • respectively, of the thigh. At this
  • time management should include
  • 1- excisional biopsy
  • 2- incisional biopsy
  • 3- resection with a wide margin
  • 4- a repeat MRI scan in 3 months
  • 5- a repeat clinical examination
  • in 3 months
  • A
  • B
  • Figures 39

 

  • Question 97.139
  • Answer = 2
  • Reference(s)
  • Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of Musculoskeletal sarcoma. Clin Orthop 1980;153:106-120. Nelson TE, Enneking WF: Staging of bone and soft-tissue sarcomas revisited, in Stauffer RN (ed): Advances in Operative Orthopaedics. St Louis, MO, Mosby Year-Book, 1994, vol 2, pp 379-391.

 

  • 97.140 A 10-year-old boy of Mediterranean ancestry whose height is in the 25th
  • percentile sustains a fracture of the distal femur following a mild fall.
  • Radiographs reveal an impacted fracture of the distal femur, as well in both
  • femora and the pelvis. Laboratory studies show a hemoglobin level of 7
  • mg/dL. A complete hematologic evaluation is likely to reveal
  • 1- hemoglobin S and C
  • 2- hemoglobin S chains only
  • 3- no hematologic abnormalities
  • 4- increased total iron-binding capacity
  • 5- absence of or severely deficient beta globulin

 

  • Question 97.140
  • Answer = 5
  • Reference(s)
  • Dines DM, Canale VC, Arnold WD: Fractures in thalassemia. J Bone Joint Surg 1976;58A:662-666.

 

  • 97.141 A 42-year-old woman has had progressive difficulty walking for the past 4
  • months. An MRI scan reveals a large T10-T11 disk herniation with
  • significant compression of the spinal cord. Which of the following signs
  • would be most suggestive of spinal cord compression?
  • 1- Clonus
  • 2- Weakness
  • 3- Hyporeflexia
  • 4- Flaccid paralysis
  • 5- Positive Hoffman's sign

 

  • Question 97.141
  • Answer = 1
  • Reference(s)
  • Dietz DD Jr, Fessler FG: Thoracic disc herniations, in Hadley MN, Sonntag VK (eds): Neurosurgery Clinics of North America, Philadelphia, PA, WB Saunders, 1993, pp 75-90. Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 603-607.

 

  • 97.142 A 72-year-old man has persistent drainage following a total knee arthro
  • performed 3 weeks ago. A knee aspirate shows moderate polymorphonuclear
  • leukocytes and Gram-positive cocci in clusters. Management should include
  • 1- one-stage exchange arthroplasty
  • 2- two-stage exchange arthroplasty
  • 3- local wound care and oral antibiotics
  • 4- oral antibiotics with reexamination in a few days
  • 5- irrigation, debridement, and retention of the components

 

  • Question 97.142
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 149-161.

 

  • 97.143 Which of the following analyses must be performed to ensure that the sample
  • size of an experiment is sufficient to draw statistical conclusions?
  • 1- Student's t-test
  • 2- Repeatability test
  • 3- Power analysis
  • 4- Variance analysis
  • 5- Multivariate analysis

 

  • Question 97.143
  • Answer = 3
  • Reference(s)
  • Maxwell SE, Delaney HD: Designing Experiments and Analyzing Data. Belmont, CA, Wadsworth Publishing Co, 1990, pp 113-116.

 

  • 97.144 Which of the following is the treatment of choice for a neurologically intact
  • patient with the C2 fracture shown on the lateral radiograph in Figure 40?
  • 1- Application of a halo brace
  • 2- Application of a rigid orthosis
  • 3- Screw fixation across the fracture
  • 4- Posterior wiring and a halo brace
  • 5- Posterior wiring and a rigid orthosis
  • Figure 40

 

  • Question 97.144
  • Answer = 1
  • Reference(s)
  • Eismont FJ, Garfin SR, Abitbol JJ: Thoracic & upper lumbar spine injuries, in Browner BD, Jupiter JB, Levine AM, et al: Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 729-803.

 

  • 97.145 What is the mechanism of injury for the L1 injury shown in Figure 41?
  • 1- Translation
  • 2- Distraction
  • 3- Axial rotation
  • 4- Flexion
  • 5- Flexion-distraction
  • Figure 41

 

  • Question 97.145
  • Answer = 5
  • Reference(s)
  • Eismont FJ, Garfin SR, Abitbol JJ: Thoracic & upper lumbar spine injuries, in Browner BD, Jupiter JB, Levine AM, et al: Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 729-803.

 

  • 97.146 What is the most likely cause of heel pain in an athletic 12-year-old boy?
  • 1- Tarsal coalition
  • 2- Reiter's syndrome
  • 3- Calcaneal apophysitis
  • 4- Calcaneal osteomyelitis
  • 5- Calcaneal stress fracture

 

  • Question 97.146
  • Answer = 3
  • Reference(s)
  • Micheli LJ, Ireland ML: Prevention and management of calcaneal apophysitis in children: An overuse syndrome. J Pediatr Orthop 1987;7:34-38.

 

  • 97.147 A 25-year old man sustains multiple injuries, including a pelvic ring
  • disruption, in a motor vehicle accident. He is hemodynamically stable.
  • Attempts to pass a urinary catheter are unsuccessful. What diagnostic test
  • should be obtained next?
  • 1- CT scan
  • 2- Cystogram
  • 3- Urinalysis
  • 4- Excretory urogram
  • 5- Retrograde urethrogram

 

  • Question 97.147
  • Answer = 5
  • Reference(s)
  • Abdominal trauma, in Alexander RH, Proctor HJ (eds): ATLS Program for Physicians, ed 5. Chicago, IL, American College of Surgeons, 1993, pp 141-154. Colapinto V: Trauma to the pelvis: Urethral injury. Clin Orthop 1980;151:46-55.

 

  • 97.148 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.149 A 45-year-old man who has pain in his wrist and elbow underwent resection of
  • the radial head for a comminuted fracture 8 years ago. Four years ago, a
  • modified Darrach distal ulna resection of the same arm was performed for wrist
  • pain, but with no relief of symptoms. Two years ago additional ulna was
  • resected. He has instability and pain with ballottement of the distal ulna, as well
  • as pain and snapping with forearm rotation. Treatment should now consist of
  • 1- ulnar shortening
  • 2- creation of a one bone forearm (radioulnar syntosis).
  • 3- distal radioulnar joint stabilization using the flexor carpi ulnaris
  • 4- distal radioulnar joint fusion with proximal ulnar pseudoarthrosis (Sauve-Kapandji).
  • 5- implantation of a radial head replacement and distal radioulnar joint stabilization

 

  • Question 97.149
  • Answer = 2
  • Reference(s)
  • Richards RR: Chronic disorders of the forearm: J Bone Joint Sur- 1996;78A:916-930.

 

  • 97.150 A 22-year-old woman sustains multiple injuries, including a femoral shaft
  • fracture, when she is struck by an automobile. The fracture is 15 cm proximal
  • to the knee joint and has a 10-cm open wound directly over it. Management of
  • the fracture should include administration of antibiotics and surgical
  • debridement, in addition to
  • 1- external fixation.
  • 2- plate fixation and bone grafting.
  • 3- immediate closed intramedullary nailing.
  • 4- closed reduction and balanced skeletal traction.
  • 5- delayed primary closure and delayed intramedullary nailing.

 

  • Question 97.150
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 427-436. Lhowe DW, Hansen ST: Immediate nailing of open fractures of the femoral shaft. J Bone Joint Surg 1988;70A:812-820. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 127-136.

 

  • 97.151 A middle-aged man has pain at the base of the first and second metatarsals, a
  • dorsal prominence, and degenerative changes of the first and second
  • tarsometatarsal joints. Treatment should include surgical removal of the
  • exostosis and
  • 1- tendon transfer.
  • 2- nerve decompression.
  • 3- first metatarsal osteotomy.
  • 4- tarsometatarsal arthrodesis.
  • 5- realignment of the metatarsals.

 

  • Question 97.151
  • Answer = 4
  • Reference(s)
  • Shereff MJ: Arthrodesis of the tarsometatarsal and associated joints, in Shereff MJ (ed): Atlas of Foot and Ankle Surgery. Philadelphia, PA, WB Saunders, 1993, pp 191-193. Myerson MM: Tarsometatarsal arthrodesis, in Myerson MM (ed): Current Therapy in Foot and Ankle Surgery. St Louis, MO, Mosby, 1993, pp 97-100.

 

  • 97.152 When using the posterior surgical approach to the hip, extending the incision
  • too far proximally through the gluteus maximus muscle may result in
  • significant injury to which of the following structures?
  • 1- Sciatic nerve
  • 2- Inferior gluteal nerve
  • 3- Inferior gluteal artery
  • 4- Superior gluteal nerve
  • 5- Superior gluteal artery

 

  • Question 97.152
  • Answer = 2
  • Reference(s)
  • Surgical approaches to the acetabulum, in Letournel E, Judet R (eds): Fractures of the Acetabulum, ed 2. New York, NY, Springer-Verlag, 1993, pp 363-397.

 

  • 97.153 A 35-year-old man sustains a closed Galeazzi fracture-dislocation and a fry: of
  • the ulnar styloid process as a result of a high-speed motor vehicle accident The
  • radius fracture is anatomically fixed with a plate; however, the ulnar head
  • remains dislocated. What structure is most likely responsible for preventing
  • reduction?
  • 1- Radioulnar capsule
  • 2- Pronator quadratus
  • 3- Flexor carpi ulnaris
  • 4- Extensor carpi ulnaris
  • 5- Triangular fibrocartilage complex

 

  • Question 97.153
  • Answer = 4
  • Reference(s)
  • Hanel DP, Scheid DK: Irreducible fracture-dislocation of the distal radioulnar joint secondary to entrapment of the extensor carpi ulnaris tendon. Clin Orthop 1988;234:56-60. Bruckner JD, Alexander AH, Lichtman DM: Acute dislocations of the distal radioulnar joint. J Bone Joint Surg 1995;77A:958-968.

 

  • 97.154 A patient has had residual pain along the lateral hindfoot following an
  • inversion sprain 4 months ago. Examination reveals tenderness over the origin
  • of the extensor digitorum brevis muscle. There is pain with subtalar inversion;
  • however, there is no pain with ankle movement and no ankle instability is
  • noted. Plain stress radiographs of the ankle are normal, and an MRI scan of
  • the ankle ligaments is normal. What is the most likely diagnosis?
  • 1- Residual ankle synovitis
  • 2- Peroneal tendon subluxation
  • 3- Functional ankle instability
  • 4- Osteochondral talar fracture
  • 5- Subtalar instability and sinus tarsi syndrome

 

  • Question 97.154
  • Answer = 5
  • Reference(s)
  • Klein MA, Spreitzer AM: MR imaging of the tarsal sinus and canal: Normal anatomy, pathologic findings, and features of the sinus tarsi syndrome. Radiology 1993;186:233-240. Meyer JM, Lagier R: Post-traumatic sinus tarsi syndrome: An anatomical and radiologic study. Acta Orthop Scand 1977;48:121-128. Brantigan JW, Pedeogana LR, Lippert FG: Instability of the subtalar joint: Diagnosis by stress tomography in three cases. J Bone Joint Sur- 1977;59A:321-324.

 

  • 97.155 Management of medial scapular winging emphasizes strengthening of the
  • 1- trapezius
  • 2- rhomboids.
  • 3- subscapularis.
  • 4- latissimus dorsi.
  • 5- serratus anterior

 

  • Question 97.155
  • Answer = 5
  • Reference(s)
  • Kuhn JE, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surg 1995 ;3:319-325.

 

  • 97.156 The principal weapon in defending any claim of medical negligence is the
  • 1- surgeon
  • 2- deposition
  • 3- expert witness
  • 4- medical record
  • 5- defense attorney

 

  • Question 97.156
  • Answer = 4
  • Reference(s)
  • Committee on Professional Liability (ed): Managing Orthopaedic Malpractice Risk, Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 5-7.

 

  • 97.157 Which of the following medications acts as an antagonist to warfarin?
  • 1- Rifampin
  • 2- Phenytoin
  • 3- Cimetidine
  • 4- Cefamandole
  • 5- Trimethoprim

 

  • Question 97.157
  • Answer = 1
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 487-517.

 

  • 97.158 A 2-year-old boy with Larsen's syndrome was seen at the age of 15 months for
  • untreated clubfoot, dislocations of the knees and radial heads, and a cervical
  • kyphosis of 45 degrees. He is able to move all extremities. History reveals that
  • he sat independently at 10 months; however, he is not yet pulling to stand, and
  • there has been no improvement in motor milestones. Initial treatment should
  • consist of
  • 1- anterior cervical fusion.
  • 2- posterior cervical fusion.
  • 3- open reduction of the dislocated knees.
  • 4- correction of the clubfoot by complete subtalar release.
  • 5- reduction of the radial head and annular ligament reconstruction.

 

  • Question 97.158
  • Answer = 2
  • Reference(s)
  • Johnson CE II, Birch JG, Daniels JL: Cervical kyphosis in patients who have Larsen syndrome. J Bone Joint Surg 1996;78A:538-545.

 

  • 97.159 Examination of a construction worker who received an accidental electrical
  • shock while on the job reveals that he is awake, alert, and holding his arm
  • tightly against the chest and holding his forearm tightly to the front of the
  • trunk. External rotation and abduction are severely limited and painful. Which
  • of the following injuries best accounts for these findings?
  • 1- Luxatio erecta
  • 2- Anterior dislocation of the glenohumeral joint
  • 3- Superior dislocation of the glenohumeral joint
  • 4- Posterior dislocation of the glenohumeral joint
  • 5- Greater tuberosity fracture of the proximal humerus

 

  • Question 97.159
  • Answer = 4
  • Reference(s)
  • Neer CS II, Rockwood CA Jr: Fractures and dislocations of the shoulder, in Rockwood CA, Green DP (eds): Fractures in Adults, ed 2. Philadelphia, PA, JB Lippincott, 1984, pp 675-985.

 

  • 97.160 What is the most common clinical indicator of reflex sympathetic dystrophy of
  • the knee?
  • 1- Effusion
  • 2- Muscle atrophy
  • 3- Atrophic hair changes
  • 4- Disproportionate pain
  • 5- Decreased range of motion

 

  • Question 97.160
  • Answer = 4
  • Reference(s)
  • O'Brien SJ, Ngeow J, Gibney MA, et al: Reflex sympathetic dystrophy of the knee: Causes, diagnosis, and treatment. Am J Sports Med 1995;23:655-659. Cooper DE, DeLee JC, Ramamurthy S: Reflex sympathetic dystrophy of the knee: Treatment using continuous epidural anesthesia. J Bone Joint Surg 1989;71 A:365-369.

 

  • 97.161 Which of the following tests is most useful for detecting infection in the work-
  • up of a painful joint arthroplasty?
  • 1- Indium scan
  • 2- Hip aspiration
  • 3- Plain radiograph
  • 4- Three-phase bone imaging
  • 5- Erythrocyte sedimentation rate

 

  • Question 97.161
  • Answer = 2
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, pp 389-426.

 

  • 97.162 A 14-year-old boy who has myelodysplasia with a neurologic level at L4-5
  • now has swelling and redness around the ankle joint after he decided to walk
  • without an orthosis or crutches. These findings are most likely due to
  • 1- calcaneal fracture.
  • 2- acute fracture.
  • 3- acute osteomyelitis.
  • 4- acute joint infection.
  • 5- acute ankle synovitis.

 

  • Question 97.162
  • Answer = 2
  • Reference(s)
  • Linseth RE: Myelomeningocele, in Drennen JC (ed): The Child's Foot and Ankle. New York, NY, Raven Press, 1992, p 275.

 

  • 97.163 Figure 42 shows a photograph of a 30-year-old man who has had a slowly
  • growing mass at the level of the proximal interphalangeal joint of his middle
  • finger for the past 5 years. Radiographs show a soft-tissue mass without bony
  • or articular abnormalities. The biopsy specimen shows giant cell tumor of the
  • tendon sheath. Treatment should include
  • 1- ray amputation.
  • 2- wide excision.
  • 3- marginal excision.
  • 4- excision and low-dose external
  • beam radiation therapy.
  • 5- excision and high-dose external
  • beam radiation therapy.
  • Figure 42

 

  • Question 97.163
  • Answer = 3
  • Reference(s)
  • Moore JR, Weiland AJ, Curtis RM: Localized nodular tenosynovitis: Experience with 115 cases. J Hand Surg 1984;9:412-417.

 

  • 97.164 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.165 Figures 44a and 44b show the plain radiographs of
  • a 12-year-old boy who has had left medial knee
  • pain for the past 4 months. Figure 44c shows
  • representative histologic material. What is the most
  • likely diagnosis?
  • 1- Enchondroma
  • 2- Osteoblastoma
  • 3- Giant cell tumor
  • 4- Chondroblastoma
  • 5- Osteochondritis dissecans
  • A
  • B
  • Figures 44
  • C

 

  • Question 97.165
  • Answer = 4
  • Reference(s)
  • Turcotte RE, Kurt AM, Sim FH, et al: Chondroblastoma. Hum Pathol 1993;24:944-949. Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 47-58.

 

  • 97.166 The clinical photograph of the hand of a 72-year-old woman who sustained a
  • laceration of the flexor pollicis longus in her thumb is shown in Figure 45. She
  • cannot actively flex the interphalangeal joint. Which pulley, in addition to the
  • oblique pulley, has been lacerated?
  • 1- A-1
  • 2- A-2
  • 3- A-3
  • 4- A-4
  • 5- A-5
  • Figure 45

 

  • Question 97.166
  • Answer = 2
  • Reference(s)
  • Doyle JR, Blythe WF: Anatomy of the flexor tendon sheath and pulleys of the thumb. J Hand Surg 1977;2:149-151.

 

  • 97.167 Which of the following nerves is most commonly at risk for injury during
  • resection of a calcaneonavicular tarsal coalition?
  • 1- Saphenous
  • 2- Lateral plantar
  • 3- Lateral branch of the deep peroneal
  • 4- Medial plantar .
  • 5- Medial branch of the deep peroneal

 

  • Question 97.167
  • Answer = 3
  • Reference(s)
  • Hollinshead WH, Rosse C: Textbook of Anatomy. Hagerstown, MD, Harper & Row, 1985, pp 424-425. Bordelon RL: Flatfoot in children and young adults, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby Year-Book, 1993, pp 717-756.

 

  • 97.168 Bending stiffness of an external fixation frame will be decreased by
  • 1- changing to a hybrid frame.
  • 2- axially dynamizing the frame.
  • 3- increasing patient weightbearing.
  • 4- increasing the frame-bone distance.
  • 5- adding another pin close to the fracture site.

 

  • Question 97.168
  • Answer = 4
  • Reference(s)
  • Behrens F: General theory and principles of external fixation. Clin Orthop 1989;241:15-23. Nepola JV: External fixation, in Rockwood CA Jr, Bucholz RW, Green DP, et al (eds): Fractures in Adults, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 229-259.

 

  • 97.169 A newborn with low lumbar level spina bifida has convex pes valgus. The first
  • ray cannot be made colinear with the talus, even with forced plantar flexion.
  • Management should include
  • 1- serial casting
  • 2- primary talectomy before walking age
  • 3- soft shoes, with no manipulation or surgery
  • 4- performing subtalar arthrodesis at age 6 years
  • 5- surgical realignment and appropriate tenotomies before walking age.

 

  • Question 97.169
  • Answer = 5
  • Reference(s)
  • Seimon LP: Surgical correction of congenital vertical talus under the age of 2 years. J Pediatr Orthop 1987;7:405-411. Lindseth RE: Myelomeningocele, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, vol 1, pp 503-536.

 

  • 97.170 The functional expectations of a patient with C6 quadriplegia include
  • 1- functional thumb pinch.
  • 2- functional wrist flexion.
  • 3- functional grip strength.
  • 4- manual wheelchair locomotion.
  • 5- independent transfers without aids.

 

  • Question 97.170
  • Answer = 4
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 683-687

 

  • 97.171 Figure 46 shows an axial MRI view of the L3-4 disk space with pathology that
  • is best described as
  • 1- a left facet cyst.
  • 2- an aortic aneurysm.
  • 3- central spinal stenosis.
  • 4- central disk herniation.
  • 5- left foraminal disk herniation.

 

  • Question 97.171
  • Answer = 5
  • Reference(s)
  • Hirthoff KB: Computed tomography and plain film diagram of the lumbar spine, in The Lumbar Spine. Philadelphia, PA, WB Saunders, 1990, pp 304-318.

 

  • 97.172 A 60-year-old woman has persistent well localized
  • pain over the proximal tibia following total knee
  • arthroplasty. Examination reveals that the
  • proximal tibia feels significantly warmer than the
  • opposite side. Range of motion in the knee is
  • similar to that in the opposite side, and there is no
  • effusion. An radiograph of the tibia is shown in
  • Figure 47a, a technetium bone scan of knees is
  • shown in Figure 47b, and a CT scan through the
  • area of the tibia with increased uptake is shown in
  • Figure 47c. What is the most likely diagnosis?
  • 1- Lymphoma
  • 2- Osteomyelitis
  • 3- Paget's disease
  • 4- Stress fracture
  • 5- Metastatic carcinoma
  • A
  • B
  • Figures 47
  • C

 

  • Question 97.172
  • Answer = 3
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 193-207.

 

  • 97.173 A 9-year-old boy sustains a closed fracture of the distal radius as a result of a
  • fall. Examination reveals that the radius is completely displaced and shortened
  • 1 cm. The patient is placed under sedation and regional anesthesia in the
  • emergency department, and two attempts at reduction are made. The radius
  • cannot be anatomically reduced; there is bayonet apposition with complete
  • correction of angulation and rotation and 5 mm of shortening. Treatment
  • should now consist of
  • 1- cast application.
  • 2- percutaneous pin fixation.
  • 3- open reduction and casting.
  • 4- open reduction and plate fixation.
  • 5- open reduction and intramedullary fixation.

 

  • Question 97.173
  • Answer = 1
  • Reference(s)
  • Chambers HC: Fractures of the radius and ulna, in Rockwood CA, Wilkins RE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, p 487.

 

  • 97.174 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.175 Amputation of the lower extremity in adults is most commonly associated
  • with which of the following conditions?
  • 1- Tumor
  • 2- Trauma
  • 3- Infection
  • 4- Congenital malformation
  • 5- Peripheral vascular disease

 

  • Question 97.175
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 697-704.

 

  • 97.176 A 28-year-old man with sickle cell anemia has debilitating bilateral hip pain.
  • A plain radiograph of the more symptomatic hip is shown in Figure 48. The
  • contralateral hip has a similar appearance. Treatment of the symptomatic hip
  • should include
  • 1- hip arthrodesis
  • 2- total hip replacement
  • 3- excision arthroplasty
  • 4- bipolar hemiarthroplasty
  • 5- intertrochanteric osteotomy
  • Figure 48

 

  • Question 97.176
  • Answer = 2
  • Reference(s)
  • Acurio MT, Friedman RJ: Hip arthroplasty in patients with sickle-cell hemoglobinopathy. J Bone Joint Sur- 1992;74B:367-371. Moran MC, Huo MH, Garvin KL, et al: Total hip arthroplasty in sickle cell hemoglobinopathy. Clin Orthop 1993;294:140-148.

 

  • 97.177 A 45-year old woman who has had increasing foot pain for the past 9 months
  • has tenderness over the region of the cuboid. Oblique and lateral radiographs
  • are shown in Figures 49a and 49b. Low- and high-power photomicrographs are
  • shown in Figures 49c and 49d. What is the most likely diagnosis?
  • 1- Chondroblastoma
  • 2- Giant cell tumor
  • 3- Unicameral bone cyst
  • 4- Aneurysmal bone cyst
  • 5- Metastatic carcinoma
  • Figures 49
  • Go to next slide
  • for remaining
  • figures and
  • answer link
  • A
  • B

 

  • C
  • D
  • Figures 49 97.177

 

  • Question 97.177
  • Answer = 1
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 52-67.

 

  • 97.178 The carotid tubercle is located at which of the following levels?
  • 1- C3
  • 2- C4
  • 3- C5
  • 4- C6
  • 5- C7

 

  • Question 97.178
  • Answer = 4
  • Reference(s)
  • Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 1. Philadelphia, PA, JB Lippincott, 1984, pp 265-269.

 

  • 97.179 Which of the following radiographic findings is the most likely indication that
  • child abuse has occurred?
  • 1- Growth plate injury
  • 2- Healing spiral tibia fracture
  • 3- Isolated acute spiral femur fracture
  • 4- Fracture with abundant periosteal new bone formation
  • 5- Multiple fractures in various stages of healing

 

  • Question 97.179
  • Answer = 5
  • Reference(s)
  • Kempe CH, Silverman RN, Steele VF, et al: The Battered-Child Syndrome. JAMA 1962;181:17-24.

 

  • 97.180 A 40-year-old man who is 6'8" and weighs 250 lb has progressive pain in the
  • knee that is localized to the lateral aspect of the joint with weightbearing and
  • stressful activities. Despite conservative treatment, the pain continues to be
  • disabling. A plain radiograph is shown in Figure 50a, and a 30-degree flexed
  • knee view is shown in Figure 50b. A full-length AP radiograph shows a valgus
  • deformity measuring 17 degrees. Surgical treatment should include
  • 1- knee arthrodesis.
  • 2- a total knee arthroplasty.
  • 3- a distal femoral varus
  • osteotomy.
  • 4- a proximal tibial varus
  • osteotomy.
  • 5- a lateral unicompartmental
  • arthroplasty.
  • A
  • B
  • Figures 50

 

  • Question 97.180
  • Answer = 3
  • Reference(s)
  • Edgerton BC, Mariani EM, Morrey BF: Distal femoral varus osteotomy for painful genu valgum: A five-to-eleven year follow-up study. Clin Orthop 1993;288:263-269. Healy WL, Anglen JO, Wasilewski SA, et al: Distal femoral varus osteotomy. J Bone Joint Surg 1988;70A:102-109.

 

  • 97.181 Radiographs of a 35-year-old man who has a
  • closed midshaft fracture as a result of a blow to the
  • subcutaneous border of the ulna are shown in
  • Figures 51a and 51b. Examination reveals no
  • tenderness in the wrist or elbow, and radiographs
  • of the wrist and elbow are normal. Management
  • should consist of
  • 1- open reduction and plate fixation.
  • 2- closed reduction and percutaneous intramedullary
  • nailing.
  • 3- closed reduction and application of a long arm cast for
  • 6 weeks.
  • 4- a short arm functional brace after 10 days of casting.
  • 5- application of a long arm cast for 6 weeks.
  • A
  • B
  • Figures 51

 

  • Question 97.181
  • Answer = 4
  • Reference(s)
  • Gebuhr P, Holmich P, Orsnes T, et al: Isolated ulnar shaft fractures: Comparison of treatment by a functional brace and long-arm cast. J Bone Joint Surg 1992;74B:757-759. Ostermann PA, Ekkernkamp A, Henry SL, et al: Bracing of stable shaft fractures of the ulna. J Orthop Trauma 1994;8:245-248.

 

  • 97.182 A 12-year-old child with L5 level myelodysplasia has progressive scoliosis. At
  • age 8 years the curve measured 5 degrees, at age 10 years the curve measured
  • 8 degrees, and at age 12 years the curve measured 28 degrees as measured
  • from T5 to T12. The curve is convex to the right. The right hip is located, the
  • left hip is mildly subluxated, but abduction of the left hip is limited to 0
  • degrees. Initial management should include
  • 1- an MRI scan of the spine.
  • 2- observation for progression.
  • 3- adductor release of the left hip.
  • 4- valgus osteotomy of the left hip.
  • 5- posterior spinal fusion and instrumentation.

 

  • Question 97.182
  • Answer = 1
  • Reference(s)
  • Lindseth RE: Myelomeningocele, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 503-536.

 

  • 97.183 Which of the following structures pass through the quadrangular space about
  • the shoulder?
  • 1- Radial nerve and the axillary nerve
  • 2- Radial nerve and the suprascapular nerve
  • 3- Posterior humeral circumflex artery and the radial nerve
  • 4- Posterior humeral circumflex artery and the axillary nerve
  • 5- Posterior humeral circumflex artery and the circumflex scapular artery

 

  • Question 97.183
  • Answer = 4
  • Reference(s)
  • Anderson JE: Muscles of the posterior shoulder, in Grant's Atlas of Anatomy. Baltimore, MD, Williams & Wilkins, 1993, pp 6-39. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 1. Philadelphia, PA, JB Lippincott, 1994, pp 66-75.

 

  • 97.184 A 65-year-old man has a chronic draining sinus and a chronic patellar tendon
  • rupture with no active extension following a cemented total knee arthroplasty 3
  • years ago. A culture of the joint fluid grows resistant enterococcus. Treatment
  • should consist of
  • 1- arthrodesis.
  • 2- resection arthroplasty.
  • 3- one-stage primary exchange arthroplasty.
  • 4- two-stage exchange arthroplasty.
  • 5- operative debridement with patellar tendon reconstruction.

 

  • Question 97.184
  • Answer = 1
  • Reference(s)
  • Callaghan JJ, Dennis DA, Paprosky WG, et al (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 297-300.

 

  • 97.185 A 12-year-old boy sustains a closed Salter type II fracture of the proximal
  • tibial physis as a result of being hit by a car 1 hour ago. The metaphyseal
  • segment is displaced posteriorly by 100%. No distal pulses are found by
  • Doppler, and no other skeletal injuries are noted. Initial management should
  • consist of
  • 1- an angiogram.
  • 2- closed reduction of the fracture.
  • 3- application of an external fixator.
  • 4- fasciotomy of all four compartments.
  • 5- direct open exploration of the popliteal trunk at the fracture site.

 

  • Question 97.185
  • Answer = 2
  • Reference(s)
  • Burkhart SS, Peterson HA: Fractures of the proximal tibial epiphysis. J Bone Joint Surg 1979;61A:996-1002.

 

  • 97.186 A 55-year-old man with metastatic prostate cancer has a painful lesion of the
  • midshaft of the humerus in which approximately 75% of the cortex is
  • involved. Management should consist of
  • 1- an incisional biopsy.
  • 2- a humeral cuff and sling.
  • 3- closed interlocking nailing.
  • 4- radiation therapy to the humerus.
  • 5- plate fixation with bone grafting.

 

  • Question 97.186
  • Answer = 3
  • Reference(s)
  • Redmond BJ, Biermann JS, Blasier RB: Interlocking intramedullary nailing of pathological fractures of the shaft of the humerus. J Bone Joint Surg 1996;78A:891-896.

 

  • 97.187 The change in strain of a material under a constant load that occurs with time
  • is defined as
  • 1- creep.
  • 2- relaxation.
  • 3- energy dissipation.
  • 4- plastic deformation.
  • 5- elastic deformation.

 

  • Question 97.187
  • Answer = 1
  • Reference(s)
  • Chao EYS, Aro HT: Biomechanics of fracture fixation, in Mow VC, Hayes WC (eds): Basic Orthopaedic Biomechanics. New York, NY, Raven Press, 1991.

 

  • 97.188 A 12-year-old girl has a left thoracic scoliosis of 46 degrees and a kyphosis of
  • 65 degrees. Vertebrae in the region of the curve show some scalloping of the
  • bodies and widening of the foramina. She has subcutaneous nodules in several
  • areas, as well as freckles in her axillae. Management for the spinal deformity
  • should include
  • 1- a Milwaukee brace.
  • 2- a syringopleural shunt.
  • 3- posterior spinal fusion and instrumentation.
  • 4- laminectomy and removal of the foraminal lesions.
  • 5- anterior and posterior spinal fusion and instrumentation.

 

  • Question 97.188
  • Answer = 5
  • Reference(s)
  • Betz RR, Iorio R, Lombardi AV, et al: Scoliosis surgery in neurofibromatosis. Clin Orthop 1989;245:53-56.

 

  • 97.189 Figure 52 shows an MRI scan of a 9-year-old girl who
  • has a 20-degree right thoracic scoliosis, an angle of
  • trunk rotation of 9 degrees, and absent abdominal
  • reflexes. A chest radiograph obtained 6 months earlier
  • revealed no scoliosis. Management should include
  • 1- performing a biopsy of the lesion.
  • 2- evaluation by a neurosurgeon.
  • 3- observation for progression of the curve with repeat radiographs in 2 months.
  • 4- application of a nighttime thoracolumbosacral orthosis.
  • 5- application of a full-time thoracolumbosacral orthosis.
  • Figure 52

 

  • Question 97.189
  • Answer = 2
  • Reference(s)
  • Gurr K, Taylor TK, Stobo K: Syringomyelia and scoliosis in childhood and adolescence. J Bone Joint Surg 1989;70B:159.

 

  • 97.190 A 55-year old woman who has had severe pain in her arm for the past 4 months
  • reports that she felt a sudden snap in her arm after trying to open a tight jar lid.
  • An AP radiograph of the humerus is shown in Figure 53a. A high-power
  • photomicrograph of the biopsy specimen is shown in Figure 55b. What is the
  • most likely diagnosis?
  • 1- Lymphoma
  • 2- Multiple myeloma
  • 3- Hyperparathyroidism
  • 4- Metastatic bone disease
  • 5- Mesenchymal chondrosarcoma
  • A
  • B
  • Figures 53

 

  • Question 97.190
  • Answer = 4
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 408-413.

 

  • 97.191 A 22-year old football player sustains a hyperflexion injury to the knee, reports
  • feeling a "pop," and is then unable to bear weight. A hemarthrosis develops
  • within 1 hour. Which of the following ligaments has most likely been
  • damaged?
  • 1- Medial collateral
  • 2- Posterolateral complex
  • 3- Posterior cruciate
  • 4- Anterior cruciate
  • 5- Anterior and posterior cruciate

 

  • Question 97.191
  • Answer = 3
  • Reference(s)
  • Fowler PJ, Messieh SS: Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 1987;15:553-557. Miller MD, Hamer CD, Koshiwaguchi S: Acute posterior cruciate ligament injuries, in Fu FH, Hamer CD, Vince KG (eds): Knee Surgery. Baltimore, MD, Williams and Wilkins, 1994, vol 1, pp 749-767.

 

  • 97.192 A 21-year-old woman has had anterior knee pain for the past 4 weeks that
  • worsens when she descends stairs and squats. Examination shows patellar
  • apprehension and medial facet tenderness; however, there is minimal effusion,
  • full range of motion, no jointline tenderness, and stable ligaments. Treatment
  • should include
  • 1- lateral retinacular release.
  • 2- patellar tendon realignment
  • 3- arthroscopic debridement of chondromalacia
  • 4- short arc open chain quadriceps exercises.
  • 5- short arc closed chain quadriceps exercises.

 

  • Question 97.192
  • Answer = 5
  • Reference(s)
  • Irrgang JJ: Rehabilitation for non-operative and operative management of knee injuries, in Fu FH, Hamer CD, Vince KG (eds): Knee Surgery. Baltimore, MD, Williams and Wilkins, 1994, vol 1, pp 485-502.

 

  • 97.193 A 30-year-old soccer player has pain and swelling 4 hours after being kicked
  • in the anterior compartment of the leg. Which of the following physical
  • findings best indicates increased compartment pressure?
  • 1- Anterior compartment tenderness
  • 2- Pain with active ankle dorsiflexion
  • 3- Pain with passive flexion of the toes
  • 4- Pain with passive extension of the toes
  • 5- Decreased sensation on the dorsum of the foot

 

  • Question 97.193
  • Answer = 3
  • Reference(s)
  • Whitesides T, Heckman J: Compartment syndrome update and diagnosis. J Am Acad Orthop Sur- 1996;4:209-218.

 

  • 97.194 Cadaver studies show that alteration in joint kinematics following posterior
  • cruciate ligament sectioning leads to
  • 1- increased contact pressures in all three compartments of the knee.
  • 2- increased contact pressures in the medial and patellofemoral compartments.
  • 3- increased contact pressures in the lateral and patellofemoral compartments.
  • 4- decreased contact pressure in the patellofemoral compartment, but increased contact
  • pressure in the medial compartment.
  • 5- decreased contact pressure in the patellofemoral compartment, but increased contact
  • pressure in the lateral compartment.

 

  • Question 97.194
  • Answer = 2
  • Reference(s)
  • Skyhar MJ, Warren RF, Ortiz GJ, et al: The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee. J Bone Joint Surg 1993;75A:694-69.

 

  • 97.195 A 10-month-old infant with achondroplasia recently began to sit
  • independently, but the parents note a bulge in the lower spine. Radiographs
  • show a kyphosis of 35 degrees from T12 to L2. Management should consist of
  • 1- observation.
  • 2- a hyperextension spica cast.
  • 3- a thoracolumbosacral orthosis.
  • 4- in situ posterior spinal fusion.
  • 5- anterior and posterior spinal fusion.

 

  • Question 97.195
  • Answer = 1
  • Reference(s)
  • Herring JA, Winter RB: Kyphosis in an achondroplastic dwarf. J Pediatr Orthop 1983;3:250-252.

 

  • 97.196 Figures 54a and 54b show the radiographs of an 8-year-old boy who has a swollen, very
  • painful knee after falling off his bicycle. Figure 54c shows the lateral radiograph obtained
  • with the knee in extension after aspiration of 45 mL of bloody fluid from the knee.
  • Management should now include
  • 1- excision of the fragment. 3- surgical reduction and internal fixation.
  • 2- a second attempt at closed reduction. 4- maintenance of the cast in extension for 6 weeks.
  • 5- application of a cylinder cast in 30 degrees of flexion.
  • A
  • B
  • Figures 54
  • C

 

  • Question 97.196
  • Answer = 3
  • Reference(s)
  • Meyer MH, McKeever FM: Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg 1970;52A:1677-1684. Zariczny B: Avulsion fracture of the tibial eminence: Treatment by open reduction and pinning. J Bone Joint Surg 1977;59A:1111-1114.

 

  • 97.197 Radiographs of a 30-year-old woman who has pain in her right wrist are shown
  • in Figure 55. What is the most likely diagnosis?
  • 1- Septic arthropathy
  • 2- Charcot arthropathy
  • 3- Traumatic arthropathy
  • 4- Crystalline arthropathy
  • 5- Juvenile rheumatoid arthritis
  • Figure 55

 

  • Question 97.197
  • Answer = 5
  • Reference(s)
  • Reed MH, Wilmot DM: The radiology of juvenile rheumatoid arthritis: A review of the English language literature. J Rheumatol Suppl 1991;31:2-22. Ansell B, Kent PA: Radiological changes in juvenile chronic polyarthritis. Skeletal Radiol 1977;1:129-144.

 

  • 97.198 What anatomic structure is the primary restraint to shoulder dislocation when
  • the arm is held in shoulder abduction and external rotation?
  • 1- Glenoid labrum
  • 2- Subscapularis muscle
  • 3- Inferior glenohumeral ligament
  • 4- Middle glenohumeral ligament
  • 5- Superior glenohumeral ligament

 

  • Question 97.198
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 233-243. Speer KP, Deng X, Borrero S, et al: Biomechanical evaluation of a simulated Bankart lesion. J Bone Joint Surg 1994;76A:1819-1826. Turkel SJ, Panio MW, Marshall JL, et al: Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J Bone Joint Surg 1981;63A:1208-1217.

 

  • 97.199 A patient who sustains a closed crushing injury to the hand must undergo a
  • complete release of all hand compartments. Excluding the digits, how many
  • compartments must be released?
  • 1- 4
  • 2- 6
  • 3- 8
  • 4- 10
  • 5- 12

 

  • Question 97.199
  • Answer = 4
  • Reference(s)
  • Rowland SA: Fasciotomy: The treatment of compartment syndrome, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingstone, vol 1, p 670. Botte MJ, Gelberman RH: Compartment syndrome and Volkmann's contracture, in Peimer CA (ed): Surgery of the Hand and Upper Extremity, vol 2. New York, NY, McGraw Hill, 1996, pp 1539-1558.

 

  • 97.200 A young adult with a severe ankle sprain was treated with a short leg cast for 6
  • weeks. Figures 56a and 56b show radiographs obtained after cast removal that
  • reveal a previously undiagnosed calcaneus fracture. Examination shows a very
  • warm, painful, and stiff foot
  • and ankle with hyperesthesia.
  • Treatment should include
  • 1- phonophoresis
  • 2- continued casting.
  • 3- oral corticosteroids.
  • 4- talocalcaneal arthrodesis.
  • 5- aggressive range of motion
  • A
  • B
  • Figures 56

 

  • Question 97.200
  • Answer = 5
  • Reference(s)
  • Geissler WB, Tsao AK, Hughes JL: Fractures and injuries of the ankle, in Rockwood CA, Green DP, Heckman JD, et al (eds): Fractures in Adults, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, vol 2, pp 2201-2266. Schutzer SF, Gossling HR: Current concepts review: The treatment of reflex sympathetic dystrophy syndrome. J Bone Joint Surg 1984;66A:625-629.

 

  • 97.201 A 3 l -year-old woman has had instability of the right ankle for the past 10
  • years. Stress radiographs show asymmetrical anterior drawer translation,
  • excess lateral opening, and a unilateral os subfibulare on the affected side. In
  • this patient, the os subfibulare represents
  • 1- supernumerary bone.
  • 2- an unfused accessory ossification center.
  • 3- a nonunion of an avulsion fracture of the talus.
  • 4- a nonunion of an avulsion fracture of the fibula

 

  • Question 97.201
  • Answer = 4
  • Reference(s)
  • Berg EE: The symptomatic os subfibulare: Avulsion fracture of the fibula associated with recurrent instability of the ankle. J Bone Joint Surg 1991;73A:1251-1254.

 

  • 97.202 What is the main disadvantage of using stainless steel in the fabrication of
  • orthoses?
  • 1- Weight
  • 2- Cost
  • 3- Rigidity
  • 4- Availability
  • 5- Manufacturing difficulty

 

  • Question 97.202
  • Answer = 1
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 447-486.

 

  • 97.203 A 57-year-old man under workers' compensation underwent a carpal tunnel
  • release 1 year ago and has not returned to work because of numbness and pain.
  • His job requires him to use a rivet gun. The previous carpal tunnel release was
  • performed through a standard incision. Electromyogram and nerve conduction
  • studies are normal; however, conservative treatment, including splinting,
  • stretching exercises, and a steroid injection has failed. Two-point discrimination
  • measures 5 mm in each digit. Management at this time should include
  • 1- observation and possible job retraining.
  • 2- internal neurolysis and coverage of the nerve with silicone sheeting.
  • 3- iontophoresis, fluids therapy, and transcutaneous nerve stimulation.
  • 4- surgical decompression through a standard approach.
  • 5- surgical decompression and coverage of the nerve with a hypothenar fat flap.

 

  • Question 97.203
  • Answer = 1
  • Reference(s)
  • Cobb TK, Amadio PC, Leatherwood DF, et al: Outcome of reoperation for carpal tunnel syndrome. J Hand Surg 1996;21A:347-356.

 

  • 97.204 Management of lateral scapular winging emphasizes strengthening of the
  • 1- deltoid.
  • 2- trapezius.
  • 3- subscapularis.
  • 4- latissimus dorsi.
  • 5- serratus anterior.

 

  • Question 97.204
  • Answer = 2
  • Reference(s)
  • Kuhn JE, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surg 1995;3:319-325.

 

  • 97.205 Which of the following margins is achieved in a hip disarticulation performed
  • as surgical treatment of a Musculoskeletal Tumor Society (Enneking) type IIA
  • distal femoral osteogenic sarcoma?
  • 1- Wide
  • 2- Radical
  • 3- Marginal
  • 4- Intralesional
  • 5- Wide-contaminated

 

  • Question 97.205
  • Answer = 2
  • Reference(s)
  • Enneking WF: Principles of Musculoskeletal Oncologic Surgery, in Evarts CM (ed): Surgery of the Musculoskeletal System, ed 2. New York, NY, Churchill Livingstone, 1990, pp 4647-4669.

 

  • 97.206 Which of the following studies is the most sensitive monitor of the course of
  • infection in children with acute hematogenous osteomyelitis?
  • 1- WBC
  • 2- C-reactive protein
  • 3- Serial bone scans
  • 4- Serial blood cultures
  • 5- Erythrocyte sedimentation rate

 

  • Question 97.206
  • Answer = 2
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 149-161.

 

  • 97.207 Palpable jointline cysts in the knee are most commonly associated with
  • 1- Baker's cyst.
  • 2- medial meniscus tears
  • 3- lateral meniscus tears.
  • 4- congenital discoid lateral meniscus
  • 5- anterior cruciate ligament and meniscal tears

 

  • Question 97.207
  • Answer = 3
  • Reference(s)
  • Ciccotti MG, Shields CL Jr, El Attrache NS: Meniscectomy, in Fu FH, Hamer CD, Vince KG (eds): Knee Surgery. Baltimore, MD, Williams and Wilkins, 1994, vol 1, pp 591-613.

 

  • 97.208 When a short intramedullary hip fixation device is used instead of a
  • compression hip screw for internal fixation of intertrochanteric fractures of
  • the femur, there is an increased risk of which of the following complications?
  • 1- Hardware failure
  • 2- Fracture nonunion
  • 3- Femoral shaft fracture
  • 4- Intraoperative bleeding
  • 5- Varus fracture malposition

 

  • Question 97.208
  • Answer = 3
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 121-126. Bridle SH, Patel AD, Bircher M, et al: Fixation of intertrochanteric fractures of the femur: A randomized prospective comparison of the gamma nail and the dynamic hip screw. J Bone Joint Surg 1991;73B:330-334.

 

  • 97.209 An asymptomatic 10-year-old child has a grade II isthmic spondylolisthesis
  • with a 35% slip and a slip angle of -10 degrees (10 degrees of lumbosacral
  • lordosis). The iliac crests are Risser 0. The neurologic examination is normal,
  • and straight leg raising is possible to 80 degrees. Management should consist
  • of
  • 1- observation.
  • 2- application of an antilordotic brace.
  • 3- in situ posterior L5 to S1 fusion.
  • 4- in situ posterior fusion with instrumentation.
  • 5- posterior fusion with reduction and instrumentation.

 

  • Question 97.209
  • Answer = 1
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 633-638. Lonstein JE: Spondylolysis and spondylolisthesis, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 717-738.

 

  • 97.210 Which of the following findings on physical examination best indicates
  • isolated posterolateral instability of the knee?
  • 1- Reverse pivot shift
  • 2- Positive Lachman test result
  • 3- Positive quadriceps active test result
  • 4- Increased external rotation of the foot relative to the contralateral side at 30 degrees
  • of knee flexion only
  • 5- Increased external rotation of the foot relative to the contralateral side at both 30 and
  • 90 degrees of knee flexion

 

  • Question 97.210
  • Answer = 4
  • Reference(s)
  • Veltri DM, Warren RF: Posterolateral instability of the knee. J Bone Joint Surg 1994;76A:460-472. Veltri DM, Warren RF: Isolated and combined PCL injuries. J Am Acad Orthop Surg 1993;1:67-75. Gollehon DL, Torzilli PA, Warren RF: The role of posterolateral and cruciate ligaments in the stability of the human knee: A biomechanical study. J Bone Joint Surg 1987;69A:233-242.

 

  • 97.211 What is the best treatment for a patient with a recent diagnosis of symptomatic
  • adhesive capsulitis?
  • 1- Shoulder hemiarthroplasty
  • 2- Arthroscopic debridement
  • 3- Open release of the shoulder
  • 4- Closed manipulation of the shoulder
  • 5- Physical therapy and nonsteroidal anti-inflammatory medications

 

  • Question 97.211
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 245-257. Ozaki J, Nakagawa Y, Sakurai G, et al: Recalcitrant chronic adhesive capsulitis of the shoulder: Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. J Bone Joint Surg 1989;71A:1511-1515.

 

  • 97.212 An asymptomatic 14-year-old girl with scoliosis has a right thoracic curve
  • measuring 38 degrees from T5 to T12, and trunk rotation measuring 7 degrees
  • by inclinometer. The neurologic examination is normal. The iliac crests are
  • Risser 4, she has a bone age of 16 years, and menarche began at age 11 years.
  • Management should consist of
  • 1- exercises.
  • 2- observation.
  • 3- application of a thoracolumbosacral orthosis or a Milwaukee brace.
  • 4- posterior spinal fusion and instrumentation.
  • 5- anterior and posterior spinal fusion and posterior instrumentation.

 

  • Question 97.212
  • Answer = 2
  • Reference(s)
  • Lonstein JE: Scoliosis, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 625-685.

 

  • 97.213 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.214 Which of the following factors constitutes a contraindication to
  • unicompartmental knee arthroplasty?
  • 1- Weight of less than 180 lb
  • 2- Varus deformity of 5 degrees
  • 3- Valgus deformity of the knee
  • 4- Absent anterior cruciate ligament
  • 5- Osteonecrosis of the medial femoral condyle

 

  • Question 97.214
  • Answer = 4
  • Reference(s)
  • Scott RD, Cobb AG, McQueary FG, et al: Unicompartmental knee arthroplasty: Eight-to twelve-year follow-up evaluation with survivorship analysis. Clin Orthop 1991;271:96-100. Kozinn SC, Scott R: Unicondylar knee arthroplasty. J Bone Joint Surg 1989;71A:145 -150.

 

  • 97.215 In peer-reviewed scientific journals, all co-authors of a submitted paper must
  • sign an affidavit because it
  • 1- verifies the co-author's existence and affiliation.
  • 2- obtains permission from all the authors for publicity needs.
  • 3- makes a file of the investigators for future journal paper reviewers.
  • 4- ensures each co-author's identity and qualification.
  • 5- ensures that each author has read the paper and agrees with its content.

 

  • Question 97.215
  • Answer = 5
  • Reference(s)
  • Honor in Science. Research Triangle Park, NC, Sigma Xi, The Scientific Research Society, 1991.

 

  • 97.216 Six hours after sustaining a painful traumatic subungual hematoma involving
  • the entire nail head, a 22-year-old woman undergoes decompression of the
  • hematoma. Management should now include
  • 1- reexamination in 24 to 48 hours.
  • 2- IV antibiotics and a dorsal splint.
  • 3- nail removal and nail bed repair.
  • 4- nail removal and marsupialization of the nail bed.
  • 5- oral antibiotics, a narcotic analgesic, and a dorsal splint.

 

  • Question 97.216
  • Answer = 3
  • Reference(s)
  • Zook EG, Brown RE: The Perionychium, in Green D (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingstone, 1993, pp 1283-1314.

 

  • 97.217 Conservative management of recurrent unidirectional posterior shoulder
  • instability emphasizes strengthening of the
  • 1- deltoid.
  • 2- trapezius.
  • 3- infraspinatus.
  • 4- pectoralis major.
  • 5- latissimus dorsi.

 

  • Question 97.217
  • Answer = 3
  • Reference(s)
  • Fronek J, Warren RF, Bowen M: Posterior subluxation of the glenohumeral joint. J Bone Joint Surg 1989;71A:205-216.

 

  • 97.218 A 29-year-old man has severe pain in his back as a result of a fall. Examination shows ecchymosis
  • and a palpable step-off at the thoracolumbar junction with marked tenderness. He is neurologically
  • intact. AP and lateral radiographs of the lumbar spine and an axial CT scan of L1 are shown in
  • Figures 57a through 57c. Results of the examination, radiographs, and CT scan indicate which of the
  • following injuries?
  • 1- Bilateral pars fractures at L1
  • 2- Bilateral laminar fractures at L1
  • 3- Horizontal fracture through the spinous process, laminae, and pedicles
  • 4- Disruption of the interspinous and
  • supraspinous ligaments and the
  • ligamentum flavum
  • 5- Disruption of the anterior
  • longitudinal ligament and posterior
  • longitudinal ligament
  • A
  • B
  • Figures 57
  • C

 

  • Question 97.218
  • Answer = 4
  • Reference(s)
  • Bohlman HH, Ducker TB: Spine and spinal cord injuries, in Rothman RH, Simeone FA (eds): The Spine. Philadelphia, PA, WB Saunders, 1992, pp 1047-1068. McAfee PC, Yuan HA, Fredrickson BE, et al: The value of computed tomography in thoracolumbar fractures: An analysis of one-hundred consecutive cases and a new classification. J Bone Joint Surg 1983;65A:461-473.

 

  • 97.219 A 35-year-old man has had increasing pain in
  • the knee for the past 4 months. An AP
  • radiograph of the knee is shown in Figure 58a,
  • and low- and high-power photomicrographs of
  • the biopsy specimen are shown in Figures 58b
  • and 58c. What is the most likely diagnosis?
  • 1- Osteosarcoma
  • 2- Chondroblastoma
  • 3- Giant cell tumor
  • 4- Aneurysmal bone cyst
  • 5- Desmoplastic fibroma
  • A
  • B
  • Figures 58
  • C

 

  • Question 97.219
  • Answer = 3
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 119-140.

 

  • 97.220 A 15-year-old girl has had pain and swelling over the carpal canal and thenar
  • eminence of her nondominant hand and subjective numbness in the median
  • nerve distribution for the past 18 months. An MRI scan is shown in Figure 59a.
  • The carpal tunnel is exposed, and a nerve biopsy specimen is shown in Figure
  • 59b. Management should include
  • 1- no further treatment.
  • 2- wide resection and reconstruction.
  • 3- administration of dapsone.
  • 4- administration of amphotericin B.
  • 5- administration of ethambutol hydrochloride and rifampin.
  • A
  • B
  • Figures 59

 

  • Question 97.220
  • Answer = 1
  • Reference(s)
  • Warhold LG, Urban MA, Bora FW, et al: Lipofibromatous hamartomas of the median nerve. J Hand Surg 1993;18A:1032-1037. Amadio PC, Reiman HM, Dobyns JH: Lipofibromatous hamartoma of nerve. J Hand Surg 1988;13A:67-75.

 

  • 97.221 What is the most likely long-term result when a bulk structural allograft is
  • used in conjunction with an uncemented acetabular component for acetabular
  • deficiency?
  • 1- Deep infection
  • 2- HIV transmission
  • 3- Full incorporation of the graft
  • 4- Component failure secondary to graft resorption
  • 5- Significant ingrowth of the component into the allograft

 

  • Question 97.221
  • Answer = 4
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 389-426. Hooten JP Jr, Engh CA Jr, Engh CA: Failure of structural acetabular allografts in cementless revision hip arthroplasty. J Bone Joint Surg 1994;76B:419-422.

 

  • 97.222 Figures 60a and 60b show the radiographs of the ankle and distal leg of an 1-
  • year-old girl after she twisted her ankle while playing soccer. She has no
  • history of ankle or leg pain. Examination reveals localized swelling and
  • tenderness over the lateral ankle, and the tibia is not tender. The bone lesion
  • identified in the tibia most likely is
  • 1- osteoblastoma.
  • 2- osteoid osteoma.
  • 3- ossifying fibroma.
  • 4- fibrous dysplasia.
  • 5- nonossifying fibroma.
  • A
  • B
  • Figures 60

 

  • Question 97.222
  • Answer = 5
  • Reference(s)
  • Bertoni F, Calderoni P, Bacchim P, et al: Benign fibrous histiocytoma of bone. J Bone Joint Surg 1986;68A:1225-1230. Unni KK: Dahlin's Bone Tumors: General Aspects and Data on 11,087 Cases, ed 4. Philadelphia, PA, JB Lippincott, 1996, pp 360-365.

 

  • 97.223 A 25-year-old man sustains the ring avulsion injury shown in Figure 61. The
  • flexor tendons and central slip of the extensor mechanism are intact, and there
  • are no fractures. Treatment of the ring finger should include
  • 1- revascularization with appropriate vein and/or artery repair.
  • 2- amputation at the level of the metacarpophalangeal joint.
  • 3- amputation at the level of the proximal interphalangeal joint.
  • 4- ray amputation with deep transverse metacarpal ligament repair.
  • 5- ray amputation with small to ring metacarpal transposition.
  • Figure 61

 

  • Question 97.223
  • Answer = 1
  • Reference(s)
  • Urbaniak JR, Evans JP, Bright DS: Microvascular management of ring avulsion injuries. J Hand Surg 1981;6A:25-30.

 

  • 97.224 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.225 Figure 63 shows a pelvis radiograph of a 4-year-old boy of normal intelligence
  • who has spastic diplegia and severe scissoring when trying to walk. He has
  • excellent head control and is able to sit with his hands supporting his trunk.
  • Examination shows hyperreflexia and clonus in the lower extremities but near
  • normal function in the upper extremities. Management should include
  • 1- bilateral obturator neurectomies.
  • 2- bilateral innominate osteotomies.
  • 3- bilateral hip-knee-foot-ankle orthoses.
  • 4- bilateral proximal femoral varus rotation
  • osteotomies.
  • 5- an abductor cushion for sleeping and a pommel
  • for the wheelchair.
  • Figure 63

 

  • Question 97.225
  • Answer = 4
  • Reference(s)
  • Tylkowski CM, Rosenthal RK, Simon SR: Proximal femoral osteotomy in cerebral palsy. Clin Orthop 1980;151:183-192. Hoffer MM, Stein GA, Koffman M, et al: Femoral varus-derotation osteotomy in spastic cerebral palsy. J Bone Joint Surg 1985;67A:1229-1235.

 

  • 97.226 Which of the following nerves or neural structures is at risk of laceration
  • during excision of the posterior prominence of the calcaneus through a lateral
  • approach?
  • 1- Saphenous
  • 2- Deep peroneal
  • 3- Superficial peroneal
  • 4- Lateral dorsal cutaneous
  • 5- Lateral calcaneal branch of the sural

 

  • Question 97.226
  • Answer = 5
  • Reference(s)
  • Sarrafian K: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. Philadelphia, PA, JB Lippincott, 1983, p 313. Lawrence SJ, Botte MJ: The sural nerve in the foot and ankle: An anatomic study with clinical and surgical implications. Foot Ankle Int 1994;15:490-494.

 

  • 97.227 An 80-year-old man has had increasing hip pain and difficulty ambulating for
  • the past 6 months. An oblique radiograph of the hip is shown in Figure 64a,
  • and a technetium bone scan is shown in Figure 64b. Low- and high-power
  • photomicrographs are shown in Figures 64c and 64d. What is the most likely
  • diagnosis?
  • 1- Paget's sarcoma
  • 2- Paget's disease
  • 3- Fibrous dysplasia
  • 4- Hyperparathyroidism
  • 5- Metastatic carcinoma
  • A
  • B
  • Figures 64
  • Go to next slide
  • for remaining
  • figures and
  • answer link

 

  • Figures 64
  • 97.227
  • D
  • C

 

  • Question 97.227
  • Answer = 2
  • Reference(s)
  • Dahlin DC, Unni KK: General aspects and data on 8,452 cases, ed 4. Springfield, IL, Charles Thomas, 1986, pp 457-459.

 

  • 97.228 Which of the following terms best describes most osteosarcomas at the time of
  • diagnosis?
  • 1- Metastatic
  • 2- Low-grade, intracompartmental
  • 3- Low-grade, extracompartmental
  • 4- High-grade, intracompartmental
  • 5- High-grade, extracompartmental

 

  • Question 97.228
  • Answer = 5
  • Reference(s)
  • Enneking WT, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106-120. Nelson TE, Enneking WF: Staging of bone and soft-tissue sarcomas revisited, in Stauffer RN (ed): Advances in Operative Orthopedics. St Louis, MO, Mosby Year-Book, 1994, vol 2, pp 379-391.

 

  • 97.229 A 6-year-old child who has had increasing fever, pain in the knee, and
  • difficulty with weightbearing for the past 2 days currently has a temperature of
  • 103.1°F (39.5°C). Examination shows mild restriction of knee motion and
  • tenderness over the distal femur. A plain radiograph is negative; however, a
  • bone scan is positive for increased uptake over the distal medial femoral
  • metaphysis. Before administering antibiotics, management should include
  • 1- blood cultures and bone aspiration.
  • 2- an open biopsy of the distal femur.
  • 3- an open biopsy of the distal femur and bone debridement.
  • 4- an NMI scan, blood cultures, and aspiration of the knee joint.
  • 5- an ultrasound of the knee and distal femur, with ultrasound-guided aspiration of the
  • knee joint.

 

  • Question 97.229
  • Answer = 1
  • Reference(s)
  • Morrissy RT: Bone and joint sepsis, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, vol 1, pp 579-624.

 

  • 97.230 Item deleted after statistical review
  • (and no answer or references cited)

 

  • 97.231 What is the most likely reason that blood for a homologous transfusion that
  • tested negative for the HIV-antibody can carry a low but definite risk of HIV
  • transmission to recipients?
  • 1- There are many mutations of the HIV virus.
  • 2- The test for HIV-antibody is not very accurate.
  • 3- The virus may hide in the wall of red blood cells.
  • 4- The virus may hide in the wall of white blood cells.
  • 5- There is a delay between infection with HIV and the development of a detectable
  • antibody.

 

  • Question 97.231
  • Answer = 5
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 47-52.

 

  • 97.232 What is the most current recommendation for definitive treatment of a 15-
  • year-old boy who has a high-grade osteosarcoma of the distal femur?
  • 1- Surgical resection only
  • 2- Radiation therapy only
  • 3- Radiation therapy and surgical resection
  • 4- Chemotherapy only
  • 5- Chemotherapy and surgical resection

 

  • Question 97.232
  • Answer = 5
  • Reference(s)
  • Damron TA, Pritchard DJ: Current combined treatment of high-grade osteosarcomas. Oncology (Huntingt) 1995;9:327-343. Springfield DS, Schmidt R, Graham-Pole J, et al: Surgical treatment for osteosarcoma. J Bone Joint Sure, 1988;70A:1124-1130.

 

  • 97.233 What is the most common cause of injury to the vertebral artery during
  • anterior cervical decompression surgery?
  • 1- Excessive retraction of the vertebral artery
  • 2- Overdistraction of the cervical spine
  • 3- Lateral bone removal with an air drill
  • 4- Kyphotic kinking of the vertebral artery
  • 5- Malalignment of the anterior strut graft

 

  • Question 97.233
  • Answer = 3
  • Reference(s)
  • Smith MD, Emery SE, Dudley A, et al: Vertebral artery injury during anterior decompression of the cervical spine: A retrospective review of ten patients. J Bone Joint Sur- 1993;75B;410-415.

 

  • 97.234 Congenital scoliosis is detected in the chest radiograph of a 2-year-old child
  • undergoing a work-up for a heart murmur. The T7 hemivertebra is
  • semisegmented, and the patient has a 35-degree curve from T6 to T8. An MRI
  • scan is negative for intraspinal pathology, and a lateral radiograph shows that
  • the sagittal alignment is within the normal range. Management should consist
  • of
  • 1- observation.
  • 2- hemivertebra excision.
  • 3- in situ posterior fusion.
  • 4- in situ anterior and posterior fusion.
  • 5- application of a thoracolumbosacral brace.

 

  • Question 97.234
  • Answer = 1
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 551-572. McMaster MJ, David CV: Hemivertebra as a cause of scoliosis: A study of 104 patients. J Bone Joint Surg 1986;68B:588-595.

 

  • 97.235 What molecular defect correlates with the short stature condition shown in the
  • radiograph in Figure 65?
  • 1- BMP
  • 2- FGF3 receptor
  • 3- Type I collagen
  • 4- Type II collagen
  • 5- Proteoglycan metabolism
  • Figure 65

 

  • Question 97.235
  • Answer = 2
  • Reference(s)
  • Shiang R, Thompson LM, Zhu YZ, et al: Mutations in the transmembrane domain of FGFR3 cause the most common genetic form of dwarfism, achondroplasia. Cell 1994;78:335-342.

 

  • 97.236 Figures 66a and 66b show radiographs of a man who twisted his foot and ankle
  • while playing basketball. Examination shows no deformity of the fifth toe, nor
  • is there a prominence beneath the fifth metatarsal. Treatment for the metatarsal
  • fracture should include
  • 1- splinting with no weightbearing.
  • 2- open reduction with lag screws.
  • 3- open reduction with plate fixation.
  • 4- closed reduction and percutaneous fixation.
  • 5- a below-knee cast and partial weightbearing.
  • A
  • B
  • Figures 66

 

  • Question 97.236
  • Answer = 5
  • Reference(s)
  • Heckman JD: Fractures of the metatarsals, in Rockwood CA Jr, Green DP, Bucholz RW, et al (eds): Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, vol 2, pp 2373-2378. Johnson VS: Treatment of fractures of the forefoot in industry, in Bateman JE (ed): Foot Science. Philadelphia, PA, WB Saunders, 1976, pp 257-263.

 

  • 97.237 A 7-year-old boy who is in the 25th percentile for height has vague pain in
  • both lower extremities following exertion. Examination shows mild genu
  • valgum and mild short stature. Radiographs reveal symmetrical ovoid-shaped
  • femoral heads with irregular ossification, and mild flattening of the distal
  • femora and tibiae. The spine is straight, and the vertebrae are not flattened.
  • What is the most likely diagnosis?
  • 1- Achondroplasia
  • 2- Kniest syndrome
  • 3- Pseudoachondroplasia
  • 4- Multiple epiphyseal dysplasia
  • 5- Spondyloepiphyseal dysplasia congenita

 

  • Question 97.237
  • Answer = 4
  • Reference(s)
  • Crossan JF, Wynne-Davies R, Fulford GE: Bilateral failure of the capital femoral epiphysis: Bilateral Perthes disease, multiple epiphyseal dysplasia, pseudoachondroplasia, and spondyloepiphyseal dysplasia congenita and tarda. J Pediatr Orthop 1983;3:297-301.

 

  • 97.238 The lateral radiograph of a 3-year-old child with congenital kyphosis shows a
  • failure of segmentation associated with 35 degrees of kyphosis at the
  • thoracolumbar junction. Management should consist of
  • 1- observation for progression.
  • 2- brace treatment of the kyphosis.
  • 3- in situ posterior fusion.
  • 4- in situ anterior and posterior fusion.
  • 5- anterior release and osteotomy with posterior fusion and instrumentation.

 

  • Question 97.238
  • Answer = 3
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 551-572. Winter RB, Moe JH, Lonstein JE: The surgical treatment of congenital kyphosis: A review of 94 patients age 5 years or older with 2 years or more follow-up in 77 patients. Spine 1985;10:224-231.

 

  • 97.239 A 20-year-old man who sustains closed femoral and tibial shaft fractures has
  • mild distention of the abdomen, a systolic blood pressure of 75 mm Hg, and a
  • pulse rate of 135/min. His neurovascular examination is normal. Lateral
  • cervical spine, chest, and AP pelvis radiographs are normal. After
  • administration of 2 L of crystalloid, he has a systolic blood pressure of 95 mm
  • Hg and a pulse rate of 120/min. Management should now include
  • 1- diagnostic peritoneal lavage.
  • 2- immediate femoral nailing and splinting of the tibia.
  • 3- immediate stabilization of both the femur and the tibia.
  • 4- splinting the tibia and placing the femur in skeletal traction.
  • 5- simultaneous retrograde femoral nailing and an exploratory laparotomy.

 

  • Question 97.239
  • Answer = 1
  • Reference(s)
  • Ostrum RF, Verghese GB, Santner TJ: The lack of association between femoral shaft fractures and hypotensive shock. J Orthop Trauma 1993;7:338-342. Shock, in Alexander RH, Proctor HJ (eds): Advanced Trauma Life Support: Program for Physicians, ed 5. Chicago, IL, American College of Physicians, 1993, pp 75-110.

 

  • 97.240 Charcot-Marie-Tooth hereditary polyneuropathy is caused by a defect in
  • 1- myelin wrapping.
  • 2- fast axoplasmic transport.
  • 3- neurofilament phosphorylation.
  • 4- secondary synaptic cleft formation.
  • 5- postsynaptic hydrolysis of acetylcholine.
  • back

 

  • Question 97.240
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Hurst LC, Badalamente MA: Biochemical properties of peripheral nerve, in Gelberman RH (ed): Operative Nerve Repair and Reconstruction. Philadelphia, PA, JB Lippincott, 1991, pp 55-72.

 

  • 97.241 A 35-year-old man has had pain in the posteromedial ankle for the past 3
  • months when running, walking, or climbing stairs. Examination reveals
  • tenderness and swelling behind the medial malleolus. Passive extension of the
  • great toe is greater when the foot is plantarflexed. The most likely diagnosis is
  • 1- tarsal tunnel syndrome.
  • 2- sustentaculum talus impingement.
  • 3- posterior tibial tendinitis.
  • 4- flexor hallucis longus tendinitis.
  • 5- flexor digitorum longus tendinitis.
  • answer
  • back

 

  • Question 97.241
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Jones DC: Tendon disorders of the foot and ankle. J Am Acad Orthop Surg 1993;1:87-94. Hamilton WG: Foot and ankle injuries in dancers, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, CV Mosby, 1993, vol 2, pp 1241-1276.

 

  • 97.242 The end of spinal cord shock is signaled by the return of
  • 1- normal bowel sounds.
  • 2- spontaneous respirations.
  • 3- the Hoffman reflex.
  • 4- the bulbocavernosus reflex.
  • 5- a bilateral Babinski reflex.
  • answer
  • back

 

  • Question 97.242
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Bohlman HH, Ducker TB: Spine and spinal cord injuries, in Rothman RH, Simeone FA (eds): The Spine. Philadelphia, PA, WB Saunders, 1992, vol 2, pp 973-1104.

 

  • 97.243 The radiograph shown in Figure 67 most likely represents which of the
  • following disease processes?
  • 1- Sickle cell anemia
  • 2- Rheumatoid arthritis
  • 3- Ankylosing spondylitis
  • 4- Degenerative disk disease
  • 5- Diffuse idiopathic skeletal
  • hyperostosis
  • answer
  • back
  • Figure 67

 

  • Question 97.243
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Benoist, M: Inflammatory Disorders, in Weinstein JN, Wiesel SW (eds): The Lumbar Spine. Philadelphia, PA, WB Saunders, 1990, pp 637-642.

 

  • 97.244 A 29-year-old man who has an isolated knee
  • injury following a motor vehicle accident is
  • neurovascularly intact. Plain radiographs are
  • shown in Figures 68a and 68b, and two cuts of
  • an axial CT scan are shown in Figures 68c and
  • 68d. Reduction and fixation would best be
  • accomplished by
  • 1- percutaneous reduction and hybrid external fixation.
  • 2- arthroscopically assisted reduction and percutaneous
  • screw fixation from anterolateral to posteromedial.
  • 3- open reduction and plating through an anterolateral
  • approach with meniscal elevation.
  • 4- open reduction and screw fixation through a midline
  • anterior approach with tibial tubercle elevation.
  • 5- open reduction and plating through an approach
  • between the medial head of the gastrocnemius and the
  • semitendinosus.
  • back
  • Go to next slide for remaining
  • figures and answer link
  • A
  • B
  • Figures 68

 

  • answer
  • Figures 68
  • 97.244
  • D
  • C
  • back to question

 

  • Question 97.244
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • De Boeck H, Opdecam P: Posteromedial tibial plateau fractures: Operative treatment by posterior approach. Clin Orthop 1995;320:125-128. Georgiadis GM: Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg 1994;76B:285-289.

 

  • 97.245 Which of the following factors is the most important determinant of the
  • stability of an intertrochanteric fracture?
  • 1- Fracture displacement
  • 2- Status of the posteromedial cortex
  • 3- Angulation of the proximal fragment
  • 4- Displacement of the greater trochanter
  • 5- Bone density of the proximal femur
  • answer
  • back

 

  • Question 97.245
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 379-388. Desjardins AL, Roy A, Paiement G, et al: Unstable intertrochanteric fracture of the femur: A prospective randomized study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg 1993;95B:445-447.

 

  • 97.246 Item deleted after statistical review
  • (and no answer or references cited)
  • back
  • next question

 

  • 97.247 Figure 70 shows a CT scan of a 13-year-old girl who has had midcervical pain
  • of increasing intensity for the past 8 months. The pain does not radiate, and her
  • neurologic examination is normal. Results of CBC, erythrocyte sedimentation
  • rate, and chemistry profile are all within normal limits. Management should
  • include
  • 1- administration of a Philadelphia collar.
  • 2- administration of aspirin for a trial period.
  • 3- a lateral approach and excision of the lesion.
  • 4- an anterior approach and excision of the lesion.
  • 5- a posterior approach and excision of the lesion.
  • answer
  • back
  • Figure 70

 

  • Question 97.247
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Lewis MM: Musculoskeletal Oncology: A Multidisciplinary Approach. Philadelphia, PA, WB Saunders, 1992, pp 198-199.

 

  • 97.248 Figures 71a and 71b show the radiographs of a 5-year-old boy who has had
  • occasional pain in the hip and a minimal limp for the past 4 months. The
  • symptoms do not limit his activities, and he has no history of injury.
  • Examination shows normal range of motion, but he has some discomfort when
  • the right hip is rotated internally. Management should include
  • 1- observation.
  • 2- application of Petrie casts.
  • 3- a Scottish Rite abduction brace.
  • 4- bilateral interconnected long leg braces.
  • 5- varus rotation osteotomy of the involved hip.
  • answer
  • back
  • A
  • B
  • Figures 71

 

  • Question 97.248
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Thompson GH, Salter RB: Legg-Calve-Perthes disease. Clin Symp 1986;38:2-31. Herring JA: The treatment of Legg-Calve-Perthes disease: A critical review of the literature. J Bone Joint Sur- 1994;76A:448-458.

 

  • 97.249 What is the most appropriate indication for lateral retinacular release in the
  • knee?
  • 1- Diffuse knee pain following arthroscopy
  • 2- Anterior knee pain following physiotherapy
  • 3- Acute patellar dislocation associated with an increased Q angle
  • 4- Lateral patellar compression syndrome following physiotherapy and associated
  • lateral patellar subluxation
  • 5- Lateral patellar compression syndrome following physiotherapy and associated
  • lateral patellar tilt
  • answer
  • back

 

  • Question 97.249
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Fulkerson JP: Patellofemoral pain disorders: Evaluation and management. J Am Acad Orthop Surg 1994;2:124-132. Fulkerson JP, Shea KP: Disorders of patellofemoral alignment. J Bone Joint Surg 1990;72A:1424-1429.

 

  • 97.250 The radiographic findings of a child's wrist shown in Figures 72a and 72b are
  • most likely the result of which of the following processes?
  • 1- Traumatic
  • 2- Infectious
  • 3- Congenital
  • 4- Neoplastic
  • 5- Normal development
  • answer
  • back
  • A
  • B
  • Figures 72

 

  • Question 97.250
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Greulich WW, Pyle SI: Radiographic Atlas of Skeletal Development of the Hand and Wrist, ed 2. Stanford, CA, Stanford University Press, 1959. Treble NJ: Congenital absence of the scaphoid in the VATER association. J Hand Surg 1985; lOB:251-252.

 

  • 97.251 A 28-year-old laborer has an infection in his left shoulder following open
  • reduction and internal fixation of a proximal humerus fracture. The infection
  • is controlled after hardware removal, multiple debridements, and a long course
  • of IV antibiotics. The patient has loss of articular cartilage of the
  • glenohumeral joint and has severe pain with only 30 degrees of motion.
  • Surgical treatment should consist of
  • 1- shoulder arthrodesis.
  • 2- total shoulder arthroplasty.
  • 3- uncemented hemiarthroplasty.
  • 4- excision of the humeral head.
  • 5- debridement and release of contractures.
  • answer
  • back

 

  • Question 97.251
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Becker DA: Alternative reconstructive procedures: Arthrodesis, resection, synovectomy, osteotomy, in Morrey BF (ed): Reconstructive Surgery of Joints, ed 2. New York, NY, Churchill Livingstone, 1996, pp 801-814.

 

  • 97.252 A surgeon performs a fibular osteotomy during a corrective tibial osteotomy.
  • When measurement is made from the most proximal portion of the fibular
  • head, at what location is the peroneal nerve most at risk?
  • 1- 10 mm to 39 mm
  • 2- 40 mm to 69 mm
  • 3- 70 mm to 99 mm
  • 4- 100 mm to 129 mm
  • 5- Greater than 130 mm
  • answer
  • back

 

  • Question 97.252
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Kirgis A, Albrecht S: Palsy of the deep peroneal nerve after proximal tibial osteotomy: An anatomical study. J Bone Joint Surg 1992;74A:1180-1185. Mont MA, Dellon Al, Chen F, et al: The operative treatment of peroneal nerve palsy. J Bone Joint Surg 1996;78A:863-869.

 

  • 97.253 A 35-year-old man sustained a comminuted type II open fracture of the
  • humeral shaft associated with a complete radial nerve palsy as a result of a
  • motor vehicle accident. Along with administration of antibiotics and
  • debridement, treatment should include
  • 1- skeletal traction, an electromyogram, and nerve conduction studies.
  • 2- immediate nerve exploration and application of a hanging arm cast.
  • 3- surgical fracture fixation and immediate nerve exploration.
  • 4- surgical fracture fixation and nerve exploration if no recovery is apparent after 4
  • months.
  • 5- functional humeral bracing and nerve exploration in four months if no recovery is
  • apparent after 4 months.
  • answer
  • back

 

  • Question 97.253
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Foster RJ, Swiontkowski MF, Bach AW, et al: Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg 1993;18A:121-124. Ward EF, Savoie FH, Hughes JL: Fractures of the diaphyseal humerus, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 1177-1200.

 

  • 97.254 Which of the following factors is most responsible for the greater mechanical
  • demands on a plate, as compared to an intramedullary nail, when used in the
  • treatment of a subtrochanteric fracture?
  • 1- A greater bending moment on the plate
  • 2- Function of the plate as a tension band
  • 3- Less interfragmentary motion with the plate
  • 4- Less accurate restoration of the medial cortex
  • 5- Smaller screw diameters for the plate versus the intramedullary nail
  • answer
  • back

 

  • Question 97.254
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • DeLee JC: Fractures and dislocations of the hip, in Rockwood CA Jr, Bucholz RW, Green DP, Heckman JD (eds): Fractures in Adults, ed 4. Philadelphia, PA, Lippincott Raven, 1996, vol 2, pp 1659-1825.

 

  • 97.255 A 22-year-old student has pain in the ulnar side of the wrist following a recent
  • twisting injury. Examination reveals a possible peripheral detachment of the
  • triangular fibrocartilage. This diagnosis is best confirmed by
  • 1- an MRI scan.
  • 2- a CT arthrogram.
  • 3- diagnostic arthroscopy.
  • 4- three compartment wrist arthrography.
  • 5- standard wrist radiographs and a 30-degree supinated lateral view.
  • answer
  • back

 

  • Question 97.255
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Bowers WH: The distal radioulnar joint, in Green DP (ed): Operative Hand Surgery, ed 2. New York, NY, Churchill Livingstone, 1988, pp 939-989.

 

  • 97.256 What is the recommended treatment of a patient with ankylosing spondylitis
  • and an acute nondisplaced fracture of the cervical spine?
  • 1- Halo vest
  • 2- Halter traction
  • 3- Skeletal traction
  • 4- Two-poster brace
  • 5- Soft cervical collar
  • answer
  • back

 

  • Question 97.256
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Frymoyer JW (ed): Orthopaedic Knowledge Update 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993, pp 413-434. Detwiler KN, Loftus CM, Godersky JC, et al: Management of cervical spine injuries in patients with ankylosing spondylitis. J Neurosurg 1990;72:210-215. Graham B, Van Peteghem PK: Fractures of the spine in ankylosing spondylitis: Diagnosis, treatment, and complications. Spine 1989;14:803-807.

 

  • 97.257 A radiograph of a 30-year-old man with progressive weakness and loss of
  • range of motion of the wrist and fingers is shown in Figure 73. Which of the
  • following physical findings is likely to be noted?
  • 1- Malar rash
  • 2- Nail pitting
  • 3- Telangiectasias
  • 4- Cafe-au-lait spots
  • 5- Buccal ulcerations
  • answer
  • back
  • Figure 73

 

  • Question 97.257
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Kapasi OA, Ruby LK, Calney K: The psoriatic hand. J Hand Surg 1982;7A:472-497.

 

  • 97.258 Figures 74a and 74b show AP and lateral radiographs of a 48-year-old man
  • who has had persistent severe pain after undergoing a rotator cuff repair 2
  • years ago. He has forward flexion to 120 degrees but has a painful arc beyond
  • 90 degrees. Surgical treatment should consist of
  • 1- shoulder arthrodesis.
  • 2- humeral head resection.
  • 3- arthroscopic debridement.
  • 4- subacromial decompression.
  • 5- total shoulder arthroplasty.
  • answer
  • back
  • A
  • B
  • Figures 74

 

  • Question 97.258
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Cofield RH, Becker DA: Shoulder arthroplasty, in Morrey BF (ed): Reconstructive Surgery of Joints, ed 2. New York, NY, Churchill Livingstone, 1996, pp 773-788.

 

  • 97.259 A 36-year-old man who has a head injury and a closed tibial shaft fracture
  • that has been immobilized in a posterior splint is undergoing compartment
  • pressure monitoring to detect compartment syndrome. Compartment release
  • is indicated for
  • 1- anterior compartment pressure of 20 mm Hg.
  • 2- anterior compartment pressure 20 mm Hg greater than that of posterior compartment
  • pressure.
  • 3- an increase in pressure of 20 mm Hg in any compartment.
  • 4- a compartment pressure/diastolic pressure differential of 20 mm Hg.
  • 5- a combined anterior compartment/posterior compartment pressure of 40 mm Hg.
  • answer
  • back

 

  • Question 97.259
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Rorabeck CH: Compartment syndromes, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, vol 1, pp 285-309. McQueen MM, Court-Brown CM: Compartment monitoring in tibial fractures: The pressure threshold for decompression. J Bone Joint Surg 1996;78B:99-104. Whitesides TE Jr, Haney TC, Morimoto K, et al: Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop 1975;113:43-51.

 

  • 97.260 In a medical malpractice lawsuit, a part of the discovery process includes
  • 1- a pretrial conference.
  • 2- arbitration to settle the case.
  • 3- questions not answered under oath.
  • 4- motions to narrow the issue for trial.
  • 5- depositions concerning standard of care.
  • answer
  • back

 

  • Question 97.260
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Committee on Professional Liability (ed): Medical Malpractice: A primer for Orthopaedic Residents and Fellows. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1993.

 

  • 97.261 A 6-year-old child is unable to extend the proximal interphalangeal joint of the
  • small finger but reports no pain. This condition is most likely caused by
  • 1- clinodactyly.
  • 2- camptodactyly.
  • 3- pterygium syndrome.
  • 4- a locked trigger finger.
  • 5- a congenitally absent extensor tendon.
  • answer
  • back

 

  • Question 97.261
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Wood VE: Congenital Hand Deformities, in Green DP (ed): Operative Hand Surgery, ed 3. New York, NY, Churchill Livingstone, 1993, pp 411-417.

 

  • 97.262 The posture of the thumb shown in Figure 75 is secondary to dysfunction of
  • which of the following muscles?
  • 1- First dorsal interosseous and abductor pollicis brevis
  • 2- Opponens pollicis and abductor pollicis brevis
  • 3- Extensor pollicis longus and flexor pollicis brevis
  • 4- Adductor pollicis and first dorsal interosseous
  • 5- Adductor pollicis and deep head of the flexor pollicis brevis
  • answer
  • back
  • Figure 75

 

  • Question 97.262
  • Answer = 5
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  • next question
  • Reference(s)
  • Froment MJ: LaParalysie de 1'addecteur du pounce et le signe de la prehension. Rev Neurol 1915;28:1236-1240. Lister G: The Hand: Diagnosis and Indications, ed 3. New York, NY, Churchill Living stone, 1993, pp 155-281.

 

  • 97.263 Which of the following types of neural dysfunction is present with a cervical
  • fracture-dislocation resulting in a Brown-Sequard neurologic injury?
  • 1- Ipsilateral loss of pain and temperature recognition and contralateral loss of motor
  • function
  • 2- Ipsilateral loss of motor function and contralateral loss of pain and temperature
  • recognition
  • 3- Bilateral loss of pain and temperature recognition and unilateral loss of motor
  • function
  • 4- Bilateral loss of motor function and unilateral loss of pain and temperature
  • recognition
  • 5- Bilateral upper extremity loss of motor function and unilateral lower extremity loss
  • of pain and temperature recognition
  • answer
  • back

 

  • Question 97.263
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Stauffer ES: Diagnosis and prognosis of acute cervical spine cord injury. Clin Orthop 1975;112:9-15. Bosch A, Stauffer ES, Nickel V: Incomplete traumatic quadriplegia: A ten-year review. JAMA 1971;216:473-478.

 

  • 97.264 Figure 76 shows the radiographs of a 5-year-old girl who has pain in her left
  • shoulder as a result of a fall from a swing. Management should now include
  • 1- a biopsy.
  • 2- a CT scan.
  • 3- an MRI scan.
  • 4- a sling and swathe.
  • 5- curettage and bone grafting.
  • answer
  • back
  • Figure 76

 

  • Question 97.264
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Alin JI, Park JS: Pathological fractures secondary to unicameral bone cysts. Int Orthop 1994;18:20-22. Kricun ME: Imaging of bone tumors. Philadelphia, PA, WB Saunders, 1993, pp 65-67.

 

  • 97.265 Item deleted after statistical review
  • (and no answer or references cited)
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  • 97.266 Which of the following cells is responsible for the bone resorption seen in
  • multiple myeloma?
  • 1- Plasma
  • 2- Osteocyte
  • 3- Osteoclast
  • 4- Fibroblast
  • 5- Langerhans histiocyte
  • answer
  • back

 

  • Question 97.266
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Salmon SE, Cassidy JR: Plasma cell neoplasms, in DeVita VT, Hellman S, Rosenberg SA (eds): Cancer: Principles and Practice of Oncology, ed 4. Philadelphia, PA, JB Lippincott, 1993.

 

  • 97.267 The 11;22 chromosomal translocation is most commonly observed in which of
  • the following processes?
  • 1- Liposarcoma
  • 2- Osteosarcoma
  • 3- Chondrosarcoma
  • 4- Ewing's sarcoma
  • 5- Familial retinoblastoma
  • answer
  • back

 

  • Question 97.267
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 219-276.

 

  • 97.268 Which of the following congenital anomalies is most commonly seen in
  • association with pollex abductus?
  • 1- Cleft hand
  • 2- Windblown hand
  • 3- Arthrogryposis
  • 4- Symbrachydactyly
  • 5- Hypoplastic thumb
  • answer
  • back

 

  • Question 97.268
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Lister G: Pollex abductus in hypoplasia and duplication of the thumb. J Hand Surg 1991;16A:626-633.

 

  • 97.269 A 70-year-old woman underwent a cementless primary total knee arthroplasty
  • 6 months ago. For the past 3 months, she has had knee pain, and laboratory
  • studies show a WBC of 5,200/mm3 and an erythrocyte sedimentation rate of
  • 38 mm/hr. Aspiration of joint fluid grows Staphylococcus epidermidis that is
  • resistant to methicillin. Treatment should consist of
  • 1- arthrodesis.
  • 2- excision arthroplasty.
  • 3- one-stage exchange arthroplasty.
  • 4- two-stage exchange arthroplasty.
  • 5- operative debridement with exchange of polyethylene.
  • answer
  • back

 

  • Question 97.269
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • Windsor RE, Insall JN, Urs WK, et al: Two-stage reimplantation for the salvage of total knee arthroplasty complicated by infection: Further follow-up and refinement of indications. J Bone Joint Surg 1990;72A:272-278.

 

  • 97.270 Radiographs of a fracture after a rotational injury are shown in Figure 78. A mortise
  • view shows no widening of the ankle mortise. There is no swelling or tenderness over
  • the medial ankle. Which of the following treatment options will most rapidly and
  • effectively restore ankle function?
  • 1- Removable fracture brace and early mobilization
  • 2- Closed reduction and nonweightbearing cast immobilization
  • 3- Open reduction and plate fixation of the lateral malleolus
  • 4- Open reduction of the lateral malleolus and repair of the torn anterior tibiofibular ligament
  • 5- Open reduction of the lateral malleolus, repair of the torn anterior tibiofibular ligament, and
  • repair of the deltoid ligament
  • answer
  • back
  • Figure 78

 

  • Question 97.270
  • Answer = 1
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  • next question
  • Reference(s)
  • Port AM, Mc Vie JL, Naylor G, et al: Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus. J Bone Joint Surg 1996;78B:568-572.

 

  • 97.271 An 18-year-old high school football player injures his knee while decelerating
  • and pivoting to throw a ball. Hemarthrosis develops immediately after the
  • injury. Examination shows a large effusion, a 15- to 90-degree range of
  • motion, a 2+ Lachman test result, and no jointline tenderness. Treatment
  • should consist of
  • 1- acute anterior cruciate ligament repair.
  • 2- acute anterior cruciate ligament reconstruction using autogenous graft.
  • 3- acute anterior cruciate ligament reconstruction using autogenous graft and a synthetic
  • ligament augmentation device.
  • 4- anterior cruciate ligament repair when the knee range of motion has returned to
  • normal.
  • 5- anterior cruciate ligament reconstruction with autogenous graft when the knee range
  • of motion has returned to normal.
  • answer
  • back

 

  • Question 97.271
  • Answer = 5
  • back to this question
  • next question
  • Reference(s)
  • Kasser JR (ed): Orthopaedic Knowledge Update 5. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 463-480. Hamer CD, Irrgang JJ, Paul J, et al: Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992;20:499-506. Mohtadi NG, Webster-Bogaert S, Fowler PJ: Limitation of motion following anterior cruciate ligament reconstruction. Am J Sports Med 1991;19:620-624.

 

  • 97.272 Figures 79a and 79b show a
  • fracture of the tibia in a 53-year-
  • old woman who fell down stairs.
  • Management consists of closed
  • reduction, casting, and bracing.
  • Which of the following factors is
  • most likely to compromise the
  • outcome?
  • 1- Early weightbearing
  • 2- Age of the patient
  • 3- The intact fibula
  • 4- The initial angulation
  • 5- Location of the fracture
  • answer
  • back
  • A
  • B
  • Figures 79

 

  • Question 97.272
  • Answer = 3
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  • next question
  • Reference(s)
  • Sarmiento A, Sharpe FE, Ebramzadeh E, et al: Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop 1995;315:8-24. Teitz CC, Carter DR, Frankel VH: Problems associated with tibial fractures with intact fibulae. J Bone Joint Surg 1980;62A:770-776.

 

  • 97.273 Figures 80a and 80b show the radiographs of an otherwise healthy 79-year-old
  • woman who injured her left hip in a fall. Management should include
  • 1- hemiarthroplasty.
  • 2- total hip arthroplasty.
  • 3- in situ fracture fixation using multiple lag screws.
  • 4- in situ fracture fixation using a reconstruction nail.
  • 5- protected ambulation with toe-touch weightbearing
  • on the left side for 6 to 12 weeks.
  • answer
  • back
  • A
  • B
  • Figures 80

 

  • Question 97.273
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Garden RS: Selective surgery in medial fractures of the femoral neck: A review. Injury 1977;9:5-7. Koval KJ, Zuckerman JD: Hip fractures: 1. Overview and evaluation and treatment of femoral neck fractures. J Am Acad Orthop Surg 1994;2:141-149. Swiontkowski MR Intracapsular fractures of the hip. J Bone Joint Surg 1994;76A:129-138.

 

  • 97.274 Item deleted after statistical review
  • (and no answer or references cited)
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  • 97.275 A 10-year-old girl who sustains a fracture of the proximal radial metaphysis
  • after falling on her outstretched hand has a splint applied at the time of injury.
  • One week after the injury, examination shows that the physis is angulated 22
  • degrees to the long axis of the radius. Treatment at this time should consist of
  • 1- closed reduction.
  • 2- continued splinting.
  • 3- radial head excision.
  • 4- percutaneous reduction using a pin.
  • 5- open reduction and internal fixation.
  • answer
  • back

 

  • Question 97.275
  • Answer = 2
  • back to this question
  • End of 1997 Exam
  • Reference(s)
  • Kaufman B, Rinott MG, Tanzman M: Closed reduction of fractures of the proximal radius in children. J Bone Joint Surg 1989;71B:66-67.