Free Orthopedic MCQs 2022, Dec, 23 | 12:00 am

ORTHOPEDIC MCQS ONLINE BANK OITE 20

ORTHOPEDIC MCQS ONLINE BANK OITE 20

 

For OITE 20 FIGURE CLICK  OITE 20 FIGURES 

  • 00.1 A 25-year-old man sustains the injury shown in the radiographs in Figures 1A and 1B.
  • Examination reveals that he is neurovascularly intact, and there is a transverse 3-cm open
  • medial wound. In addition to urgent irrigation and debridement, definitive management
  • should include
  • 1- application of a spanning
  • external fixator.
  • 2- open reduction and internal
  • fixation of the fibula and the
  • syndesmosis.
  • 3- transarticular Steinmann pin
  • fixation.
  • 4- closed reduction and casting.
  • 5- closed reduction, rodding of
  • the fibula, and suture of the
  • deltoid ligament.
  • Figures 1
  • A
  • B

 

  • Question 00.1
  • Answer = 2
  • Reference(s)
  • Bray TJ, Endicott M, Capra SE: Treatment of open ankle fractures: Immediate internal fixation versus closed immobilization and delayed fixation. Clin Orthop 1989;240:47-52. Franklin JL, Johnson KD, Hansen ST Jr: Immediate internal fixation of open ankle fractures: Report of thirty-eight cases treated with a standard protocol. J Bone Joint Surg Am 1984;66:1349-1356. Wiss DA, Gilbert P, Merritt PO, Sarmiento A: Immediate internal fixation of open ankle fractures. J Orthop Trauma 1988;2:265-271.

 

  • 00.2 The mother of a 3-year-old boy reports that he suddenly refuses to bear weight on
  • the left lower extremity. He has a temperature of 102.2°F (39°C), and laboratory
  • studies reveal a WBC of 17,800/mm3 (normal 3,500 to 10,500/mm3).
  • Examination reveals that range of hip motion includes flexion from 10° to 110°,
  • and internal and external rotation of 40° each. He has irritability with palpation of
  • any portion of the left lower extremity. No joint effusion is noted. Plain
  • radiographs of the left lower extremity are normal. Management should now
  • include
  • 1- aspiration of the left hip.
  • 2- aspiration of the distal femoral metaphysic.
  • 3- a three-phase bone scan.
  • 4- an MRI scan of the pelvis.
  • 5- ELISA testing for antibodies to Borrelia burgdorferi.

 

  • Question 00.2
  • Answer = 3
  • Reference(s)
  • Morrissey RT: Bone and joint sepsis, in Morrissey RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 586-593. Aronson J, Garvin K, Seibert J, Glasier C, Tursky EA: Efficiency of the bone scan for occult limping toddlers. J Pediatr Orthop 1992;12:38-44.

 

  • 00.3 The blood supply for the lateral arm flap is supplied by which of the following
  • arteries?
  • 1- Anterior Numeral circumflex
  • 2- Posterior radial collateral
  • 3- Subscapular
  • 4- Profunda brachial
  • 5- Superior ulnar collateral

 

  • Question 00.3
  • Answer = 2
  • Reference(s)
  • American Society for Hand Surgery: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 309-316. Jone NF, Lister GD: Free skin and composite flaps, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 1159-1200.

 

  • 00.4 When compared with patients with osteoarthritis, patients with rheumatoid
  • arthritis who undergo total hip arthroplasty with cemented components can be
  • expected to show inferior results in which of the following categories?
  • 1- Functional scores
  • 2- Patient satisfaction
  • 3- Acetabular component loosening
  • 4- Femoral component loosening
  • 5- Polyethylene wear rate

 

  • Question 00.4
  • Answer = 1
  • Reference(s)
  • Creighton MG, Callaghan JJ, Olejniczak JP, Johnston RC: Total hip arthroplasty with cement in patients who have rheumatoid arthritis: A minimum ten-year follow-up study. J Bone Joint Surg Am 1998;80:1439-1446.

 

  • 00.5 Calcaneovalgus in a child with myelomeningocele is most likely the result of
  • 1- fetal positioning.
  • 2- an L5 neurologic level.
  • 3- spasticity of the extensor hallucis longus.
  • 4- the anterior tibialis functioning out of phase.
  • 5- nerve root sparing of L3.

 

  • Question 00.5
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 583-595.

 

  • 00.6 Which of the following factors is considered a disadvantage when using a
  • triceps- splitting approach for the management of an intra-articular distal humerus
  • fracture?
  • 1- Increased risk of radial nerve injury
  • 2- Increased risk of ulnar nerve injury
  • 3- Problems with wound healing
  • 4- Loss of triceps strength
  • 5- Inability to adequately see the fracture

 

  • Question 00.6
  • Answer = 5
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 323-335. Bryan RS, Morrey BF: Fracture of the distal humerus, in Morrey BF (ed): The Elbow And Hip Disorders. Philadelphia, PA, WB Saunders, 1995, pp 302-339.

 

  • 00.7 Virchow's triad of factors that leads to the development of venous thrombosis
  • consists of which of the following events?
  • 1- Platelet aggregation, thrombin release, and fibrin deposition
  • 2- Increased blood viscosity, immobility, and lower extremity paralysis
  • 3- Venous stasis, endothelial damage, and hypercoagulability
  • 4- Arterial stasis, fibrinolytic activation, and venous stasis
  • 5- Hyperactive platelets, fibrin formation, and clot propagation

 

  • Question 00.7
  • Answer = 3
  • Reference(s)
  • Della Valle CJ, Steiger DJ, DiCesare PE: thromboembolism after hip and knee arthroplasty: Diagnosis and treatment. J Am Acad Orthop Surg 1998;6:327-336.

 

  • 00.8 Which of the following fracture patterns is most characteristic of a nonaccidental
  • injury in a 6-month-old infant?
  • l- Salter type I fracture of the proximal tibia
  • 2- Metaphyseal or "comer" fracture of the distal tibia
  • 3- Spiral midshaft tibia fracture
  • 4- Transverse midshaft tibia fracture
  • 5- Oblique midshaft tibia fracture

 

  • Question 00.8
  • Answer = 2
  • Reference(s)
  • Kramer KE, Green NE: Child abuse, in Skeletal Trauma in Children. Philadelphia, PA, WB Saunders, 1998, pp 577-594.

 

  • 00.9 A 16-year-old basketball player sustained a stress fracture of the proximal right
  • fifth metatarsal shaft, and management consisted of a non-weight-bearing short
  • leg cast for 8 weeks. Three weeks after cast removal, the fracture site is tender.
  • Radiographs show no evidence of union. Management should now consist of
  • 1- discontinuation of competitive sports activities.
  • 2- a rocker-bottom shoe with a hard sole.
  • 3- a non-weight-bearing short leg cast for an additional 6 weeks.
  • 4- percutaneous injection of autogenous bone marrow into the fracture site.
  • 5- open reduction with screw fixation.

 

  • Question 00.9
  • Answer = 5
  • Reference(s)
  • Josefsson PO, Karlsson M, Redlund-Johnell I, Wendeberg B: Jones fracture: Surgical versus nonsurgical treatment. Clin Orthop 1994;299:252-255. Sammarco GJ: The Jones fracture. Instr Course Lect 1993;42:201-205.

 

  • 00.10 Figures 2a and 2b show the radiographs of a 27-year-old man who underwent
  • surgery for a fracture-dislocation of the ankle 3 months ago. He reports that he
  • has been walking for the past 4 weeks and has significant pain. Examination
  • reveals that the scars are well healed, and there are no signs of infection.
  • Management should consist of
  • 1- a double upright brace
  • and physical therapy.
  • 2- a sympathetic block.
  • 3- a fibular osteotomy and
  • syndesmotic
  • reconstruction.
  • 4- a vans distal tibial
  • osteotomy.
  • 5- open reduction of the
  • syndesmosis with fixation.
  • Figures 2
  • A
  • B

 

  • Question 00.10
  • Answer = 3
  • Reference(s)
  • Weber D, Friederich NF, Muller W: Lengthening osteotomy of the fibula for post- traumatic malunion: Indications, technique and result. Int Orthop 1998;22:149-152. Rupp RE, Ebraheim NA, Moronell M: Expanding the use of the ankle distractor in the treatment of complex ankle fractures. Orthopedics 1995;18:639-641.

 

  • 00.11 Patients with hereditary motor and sensory neuropathy type I are at increased
  • risk for which of the following hip abnormalities?
  • 1- Slipped capital femoral epiphysis
  • 2- Osteonecrosis
  • 3- Chondrolysis
  • 4- Developmental coxa vara
  • 5- Dysplasia

 

  • Question 00.11
  • Answer = 5
  • Reference(s)
  • Van Erve RH, Driessen AP: Developmental hip dysplasia in hereditary motor and sensory neuropathy type I. J Pediatr Orthop 1999;19:92-96.

 

  • 00.12 Instability of the lunotriquetral joint that results in volar tilt of the Innate is the
  • result of injury to the lunotriquetral ligament and a tear of what other ligament?
  • 1- Scapholunate
  • 2- Radioscapholunate
  • 3- Ulnar collateral
  • 4- Volar radioulnar
  • 5- Dorsal radiotriquetral

 

  • Question 00.12
  • Answer = 5
  • Reference(s)
  • Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA: A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995;20A:986-999. Patterson R, Viegas SF: Biomechanics of the wrist. J Hand Ther 1995;8:97-105.

 

  • 00.13 What finding on initial radiographs best predicts a greater incidence of varus
  • angulation after treatment of a tibial shaft fracture in a functional brace?
  • 1- Intact fibula
  • 2- Segmental fracture
  • 3- Tibia and fibula fractures at different levels
  • 4- Short oblique fracture
  • 5- Distal third fracture

 

  • Question 00.13
  • Answer = 1
  • Reference(s)
  • Sarmiento A, Sharpe FE, Ebramzadeh E, Normand P, Shankwiler J: Factors influencing the outcome of closed tibial fractures treated with functional bracing. Clin Orthop 1995;315:8-24.

 

  • 00.14 An otherwise healthy 10-year-old boy has an erythematous, painful epitrochlear
  • lymph node after visiting a relative with cats 3 days ago. Which of the following
  • organisms is the most likely cause of this problem?
  • 1- Bartonella henselae
  • 2- Mycobacterium marinum
  • 3- Eikenella corrodens
  • 4- Blastomycosis dermatitidis
  • 5- Pasteurella

 

  • Question 00.14
  • Answer = 1
  • Reference(s)
  • Laskin RS, Potenza AD: Cat scratch fever: A confusing diagnosis for the orthopaedic surgeon. Two case reports and a review of the literature. J Bone Joint Surg Am 1971;53:1211-1214. Bass JW, Vincent JM, Person DA: The expanding spectrum of Bartonella infections: 11. Cat-scratch disease. Pediatr Infect Dis J 1997;16:163-179. Adal KA, Cockerell CJ, Petri WA Jr: Cat scratch disease, bacillary angiomatosis, and other infections due to Rochalimaea. N Engl J Med 1994;330:1509-1515. Schurman DJ: Uncommon infections in orthopaedic surgery, in Evarts CM (ed): Surgery of the Musculoskeletal System, ed 2. New York, NY, Churchill Livingstone, 1990, pp 4573-4594.

 

  • 00.15 Accepted clinical evidence now supports the use of which of the following
  • medications in adult patients with acute spinal cord injury from nonpenetrating
  • trauma?
  • 1- Nonsteroidal anti-inflammatory drugs
  • 2- Potassium channel Mockers
  • 3- Methylprednisolone
  • 4- Naloxone
  • 5- Diuretics

 

  • Question 00.15
  • Answer = 3
  • Reference(s)
  • Bracken MB, Shepard MJ, Holford TR, et al: Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA 1997;277:1597-1604.

 

  • 00.16 A 63-year-old professional golfer reports night pain in his left nondominant
  • shoulder that now awakens him from sleep. Examination reveals weakness of
  • external rotation. What is the most likely diagnosis?
  • 1- Chronic shoulder subluxation
  • 2- Chronic calcific tendinitis
  • 3- Grade I impingement syndrome
  • 4- Rotator cuff tear
  • 5- Glenohumeral arthritis

 

  • Question 00.16
  • Answer = 4
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 123-133. Neer CS 11: Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg Am 1972;54:4150.

 

  • 00.17 The nuclear inclusions in the osteoclasts of patients with Paget's disease are
  • most likely related to
  • 1- human immunodeficiency virus (HIV).
  • 2- Epstein-Barr virus.
  • 3- paramyxovirus.
  • 4- adenovirus.
  • 5- chlamydia.

 

  • Question 00.17
  • Answer = 3
  • Reference(s)
  • Dorfman HD, Czermak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 1195- 1196. McCarthy EF, Frassica FJ: Pathology of Bone and Joint Disorders. Philadelphia, PA, WB Saunders, 1998, pp 166-167.

 

  • 00.18 An 11-year-old boy sustains a closed, completely displaced midshaft fracture of
  • the radius and ulna. Two attempts at closed reduction with the child completely
  • relaxed under a Bier (IV regional) block result in radiographic findings of 25° of
  • apex volar angulation of the ulna and bayonet apposition of the radius with 5° of
  • angulation. Management should now include
  • 1- a long arm cast.
  • 2- external fixation.
  • 3- intramedullary fixation of both bones with flexible nails.
  • 4- open reduction and crossed Kirschner wire fixation of the fracture.
  • 5- closed reduction under general anesthesia and application of a sugar tong splint.

 

  • Question 00.18
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 313-321. Huber RI, Keller HW, Huber PM, Rehm KE: Flexible intramedullary nailing as fracture treatment in children. J Pediatr Orthop 1996;16:602-605.

 

  • 00.19 Figures 3a and 3b show the radiographs of a 40-year-old man with rheumatoid arthritis
  • who underwent ankle arthrodesis 5 months ago. Although the patient reported favorable
  • results initially, he now states that he has had increased pain and a limp for the past 4
  • weeks. Examination reveals swelling and tenderness over the distal one third of the tibia.
  • Laboratory studies show a WBC of 6,000/mm3 (normal 3,500 to 10,500/mm3) and an
  • erythrocyte sedimentation rate of 18 mm/h (normal up to 20 mm/h). Management should
  • now include
  • 1- open biopsy.
  • 2- a short leg cast with no
  • weight bearing for 6
  • weeks.
  • 3- plate removal.
  • 4- replacement of the plate
  • with a longer plate.
  • 5- bone grafting.
  • Figures 3
  • A
  • B

 

  • Question 00.19
  • Answer = 2
  • Reference(s)
  • Lidor C, Ferris LR, Hall R, Alexander IJ, Nunley JA: Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot. J Bone Joint Surg Am 1997;79:558-564.

 

  • 00.20 A 32-year-old laborer reports a weak grip and is unable to actively or passively
  • fully flex the long finger following an amputation at the distal joint. When
  • isolated, each joint flexes fully. Treatment should now consist of
  • 1- attachment of the profundus tendon to the distal aspect of the middle phalanx.
  • 2- release of the conjoined lateral bands from the amputation site dorsally.
  • 3- central slip release or lengthening.
  • 4- resection of the radial lateral band.

 

  • Question 00.20
  • Answer = 4
  • Reference(s)
  • Harris C, Riordan DC: Intrinsic contracture in the hand and its surgical treatment. J Bone Joint Surg Am 1954;36:10-20.

 

  • 00.21 Which of the following variables is considered the best predictor of a successful
  • meniscus repair?
  • 1- Age of the patient
  • 2- Age of the tear
  • 3- Location of the tear
  • 4- Gender
  • 5- Medial versus lateral meniscus

 

  • Question 00.21
  • Answer = 3
  • Reference(s)
  • DeHaven KE: Meniscus repair. Am J Sports Med 1999:27:242-250. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 533-557.

 

  • 00.22 Evaluation of a 55-year-old man scheduled to undergo right total hip arthroplasty
  • reveals a history of left total hip arthroplasty complicated by heterotopic
  • ossification and a recent bleeding ulcer. Appropriate heterotopic ossification
  • prophylaxis should consist of
  • 1- divided dose radiation therapy.
  • 2- single fraction low-dose radiation therapy.
  • 3- alendronate.
  • 4- indomethacin.
  • 5- cyclooxygenase-2.

 

  • Question 00.22
  • Answer = 2
  • Reference(s)
  • Lewallen DG: Heterotopic ossification following total hip arthroplasty. Instr Course Lect 1995;44:287-292. Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 163-170.

 

  • 00.23 A 63-year-old woman reports pain and callus formation on the lateral aspect of
  • the foot after undergoing a triple arthrodesis 2 years ago. Examination reveals
  • hindfoot varus of 5° and forefoot supination of 15°. Radiographs show a well-
  • healed triple arthrodesis without adjacent joint arthritis or deformity. If
  • nonsurgical management fails to provide relief, surgical correction should consist
  • of a
  • 1- calcaneal osteotomy with derotation osteotomies of the transverse tarsal joints.
  • 2- medial displacement calcaneal slide with a first metatarsal-tarsal fusion.
  • 3- medial closing wedge osteotomy of the calcaneus.
  • 4- plantar flexion osteotomy of the first metatarsal.
  • 5- resection of the base of the fifth metatarsal.

 

  • Question 00.23
  • Answer = 1
  • Reference(s)
  • Haddad SL, Myerson MS, Pell RF IV, Schon LC: Clinical and radiographic outcome of revision surgery for failed triple arthrodesis. Foot Ankle Int 1997;18:489-499.

 

  • 00.24 A 13-year-old boy felt a painful pop in the left knee after stumbling while
  • running with a football. He states that there was immediate tenderness and
  • swelling, and he is unable to actively extend the knee. A lateral radiograph is
  • shown in Figure 4. Management should consist of
  • 1- toe-touch weight bearing while ambulating
  • with crutches.
  • 2- a knee immobilizer.
  • 3- fracture fragment excision and extensor
  • mechanism repair.
  • 4- closed reduction of the fracture and a long leg
  • cast with the knee in hyperextension.
  • 5- open reduction and screw fixation of the fracture.
  • Figure 4

 

  • Question 00.24
  • Answer = 5
  • Reference(s)
  • Ogden JA, Tross RB, Murphy MJ: Fractures of the tibial tuberosity in adolescents. J Bone Joint Surg Am 1980;62:205-215. Christie MJ, Dvonch VM: Tibial tuberosity avulsion fracture in adolescents. J Pediatr Orthop 1981;1:391-394.

 

  • 00.25 A primary deforming force on the fracture shown in Figure 5 is the
  • 1- anterior oblique ligament.
  • 2- adductor pollicis muscle.
  • 3- abductor pollicis brevis muscle.
  • 4- abductor pollicis longus muscle.
  • 5- opponens pollicis muscle.
  • Figure 5

 

  • Question 00.25
  • Answer = 4
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 95-109. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 361-386. Amadio PC, Beckenbaugh RD, Bishop AT, et al: Fractures of the Hand and Wrist, in Jupiter JB (ed): Flynn's Hand Surgery, ed 4. Baltimore, MD, Williams & Wilkins, 1991, pp 122-185.

 

  • 00.26 A 12-year-old boy is unable to bear weight on his right hip, and radiographs
  • reveal a slipped capital femoral epiphysis. The other hip appears normal. The
  • patient is at greatest risk for
  • 1- chondrolysis.
  • 2- endocrine abnormality.
  • 3- osteonecrosis.
  • 4- repeat slippage.
  • 5- adolescent Blount disease.

 

  • Question 00.26
  • Answer = 3
  • Reference(s)
  • Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD: Acute slipped capital femoral epiphysis: The importance of physeal stability. J Bone Joint Surg Am 1993;75:1134-1140.

 

  • 00.27 Figures 6a and 6b show the external rotation stress
  • mortise view and the lateral radiograph of a 45-year-
  • old man who sustained a twisting injury to the ankle.
  • Examination reveals swelling and tenderness over the
  • fibula but no medial swelling or tenderness.
  • Management should consist of
  • 1- a long leg cast in internal rotation.
  • 2- a short leg cast and no weight bearing for 6 weeks.
  • 3- an ankle walking brace and weight bearing as tolerated.
  • 4- open reduction and internal fixation of the fibula fracture.
  • 5- open reduction and
  • internal fixation of
  • the fibula fracture
  • and insertion of a
  • syndesmotic screw.
  • Figures 6
  • A
  • B

 

  • Question 00.27
  • Answer = 3
  • Reference(s)
  • Bauer M, Jonsson K, Nilsson B: Thirty-year follow-up of ankle fractures. Acta Orthop Scand 1985;56:103-106. Michelson JD: Fractures about the ankle. J Bone Joint Surg Am 1995;77:142-152. Zeegers AV, Van Raay JJ, van der Werken C: Ankle fractures treated with a stabilizing shoe. Acta Orthop Scand 1989;60:597-599.

 

  • 00.28 A patient has a left-sided far lateral disk herniation at the L4-LS level that is
  • confirmed by an MRI scan. Physical examination will most likely reveal
  • absence of the
  • 1- Achilles reflex and difficulty with toe walking.
  • 2- Achilles reflex and difficulty with heel walking.
  • 3- Achilles reflex and difficulty with squatting.
  • 4- patella reflex and difficulty with squatting.
  • 5- patella reflex and difficulty with toe walking.

 

  • Question 00.28
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 685-698.

 

  • 00.29 Nerve entrapment at the spinoglenoid notch may result in atrophy of which of
  • the following structures?
  • 1- Supraspinatus
  • 2- Supraspinatus and infraspinatus
  • 3- Infraspinatus
  • 4- Infraspinatus and teres minor
  • 5- Infraspinatus and teres major

 

  • Question 00.29
  • Answer = 3
  • Reference(s)
  • Williams PL, Warwick R (eds): Gray's Anatomy, ed 36. Philadelphia, PA, WB Saunders, 1980, pp 456-1096. Post M, Grinblat E: Suprascapular nerve entrapment: Diagnosis and results of treatment. J Shoulder Elbow Surg 1993;2:190-197.

 

  • 00.30 Following repair of a large rotator cuff tear using a suture-to-bone technique, the
  • postoperative rehabilitation program should include
  • 1- immobilization in 90° of abduction.
  • 2- sling immobilization for 12 weeks.
  • 3- early rotator cuff strengthening.
  • 4- early active motion.
  • 5- early passive motion.

 

  • Question 00.30
  • Answer = 5
  • Reference(s)
  • Iannotti JP: Full-thickness rotator cuff tears: Factors affecting surgical outcome. J Am Acad Orthop Surg 1994;2:87-95. Kibler WB, Livingston BK, Bruce RB: Current concepts in shoulder rehabilitation. Adv Oper Orthop 1995;3:249-300.

 

  • 00.31 What design parameter of reamers leads to increased formation of fat emboli
  • during femoral reaming?
  • 1- Wider driver shaft
  • 2- Deeper cutting flutes
  • 3- Shorter length reamer head
  • 4- Sharper cutting blades
  • 5- Narrower reamer tip

 

  • Question 00.31
  • Answer = 1
  • Reference(s)
  • Muller C, Frigg R, Pfister U: Effect of flexible drive diameter and reamer design on the increase of pressure in the medullary cavity during reaming. Injury 1993;24:540-547.

 

  • 00.32 A 17-year-old female high school varsity butterfly swimmer reports numbness
  • and tingling in the ulnar digits of her right dominant hand that is associated with
  • increasing pain throughout the right shoulder girdle. She also reports prominence
  • of her right shoulder blade. Examination will most likely reveal which of the
  • following physical findings?
  • 1- Limited elbow extension
  • 2- Loss of internal rotation
  • 3- Positive sulcus sign
  • 4- Weakness of external rotation
  • 5- Acromioclavicular joint tenderness

 

  • Question 00.32
  • Answer = 3
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 85-94. Itoi E, Motzkin NE, Morrey BF, et al: Scapular inclination and inferior stability of the shoulder. J Shoulder Elbow Surg 1992;1:131-139.

 

  • 00.33 Improvement in hip range of motion following cemented total hip arthroplasty in
  • patients with ankylosing spondylitis has been found to be limited by
  • 1- infection.
  • 2- neurologic involvement.
  • 3- heterotopic ossification.
  • 4- soft-tissue contractures.
  • 5- ankylosis of the lumbar spine.

 

  • Question 00.33
  • Answer = 3
  • Reference(s)
  • Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 79-86.

 

  • 00.34 A 30-year-old man who underwent closed treatment of an ankle fracture 6 years
  • ago now has chronic ankle pain. Radiographs show a healed fibula fracture, with
  • 5 mm of shortening and a lateral shift of the talus. The articular surfaces of the
  • ankle appear normal. Nonsurgical management has failed to provide relief.
  • Treatment should now consist of
  • 1- arthrodesis of the ankle.
  • 2- osteotomy and realignment of the distal fibula.
  • 3- arthroscopic debridement of the ankle.
  • 4- deltoid ligament reconstruction.
  • 5- lateral ligament reconstruction.

 

  • Question 00.34
  • Answer = 2
  • Reference(s)
  • Weber BG, Simpson LA: Corrective lengthening osteotomy of the fibula. Clin Orthop 1985;199:61-67. Marti RK, Raaymakers EL, Nolte PA: Malunited ankle fractures: The late results of reconstruction. J Bone Joint Surg Br 1990;72:709-713.

 

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

 

  • 00.36 The mother of an obese 13-year-old girl reports that she has been walking with a
  • painful externally rotated gait for the past 3 weeks. Examination reveals that
  • passive range of motion of the hip is not painful, but there is little internal
  • rotation of the right hip. Radiographs show a 50% slip of the right proximal
  • femoral epiphysis. Management should consist of
  • 1- in situ pinning.
  • 2- bed rest and gradually increased traction until the hip is reduced, followed by in
  • situ pinning.
  • 3- reduction under general anesthesia and percutaneous pinning.
  • 4- open epiphysiodesis.
  • 5- cuneiform osteotomy.

 

  • Question 00.36
  • Answer = 1
  • Reference(s)
  • Loder RT, Richards BS, Shapiro PS, Remick LR, Aronson DD: Acute slipped capital femoral epiphysis: The importance of physeal stability. J Bone Joint Surg Am 1993;75:1134-1140. Aronsson DD, Loder RT: Treatment of the unstable (acute) slipped capital femoral epiphysis. Clin Orthop 1996;322:99-110. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 409-425.

 

  • 00.37 Figures 7a and 7b show the radiographs of a 32-year-old man who underwent open
  • reduction and internal fixation of a displaced comminuted talar body fracture 2 years ago.
  • He now reports severe pain and swelling with ambulation that has failed to respond to
  • bracing and other nonsurgical management. Examination reveals ankle range of motion
  • that is painful and restricted. A CT scan shows no subtalar arthrosis. What is the preferred
  • surgical treatment?
  • 1- Talectomy
  • 2- Talectomy and
  • tibiocalcaneal
  • arthrodesis
  • 3- Bone grafting of the
  • talus
  • 4- Pantalar arthrodesis
  • 5- Tibiotalar
  • arthrodesis
  • Figures 7
  • A
  • B

 

  • Question 00.37
  • Answer = 5
  • Reference(s)
  • Kitaoka HB, Patzer GL: Arthrodesis for the treatment of arthrosis of the ankle and osteonecrosis of the talus. J Bone Joint Surg Am 1998;80:370-379.

 

  • 00.38 Examination of a patient who has weakness in the gastrocnemius muscle reveals
  • that he can perform 10 single leg/toe raises on the unaffected side but is unable
  • to perform any on the ipsilateral side. Manual muscle testing shows that the
  • patient can resist the examiner's maximal upper extremity strength throughout a
  • range of motion. What is the appropriate grading for this muscle?
  • 1- 1/5
  • 2- 2/5
  • 3- 3/5
  • 4- 4/5
  • 5- 5/5

 

  • Question 00.38
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 653-671.

 

  • 00.39 What type of tumor arises from notochordal rests?
  • 1- Giant cell
  • 2- Osteoblastoma
  • 3- Osteoid osteoma
  • 4- Chordoma
  • 5- Ewing's sarcoma

 

  • Question 00.39
  • Answer = 4
  • Reference(s)
  • Dorfman HD, Czerniak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 974- 977.

 

  • 00.40 A 20-year-old woman who underwent a posterior cervical lymph node biopsy 2
  • years ago now reports right periscapular pain. Examination of the shoulder
  • reveals ptosis, active total elevation of 130°, lateral scapular winging, and
  • scapulothoracic crepitus. Management consisting of physical therapy and
  • scapular bracing for 6 months has failed to provide relief. Treatment should now
  • consist of
  • 1- pectoralis major transfer.
  • 2- latissimus dorsi transfer.
  • 3- levator scapulae and rhomboid transfer.
  • 4- partial scapulectomy.
  • 5- scapulothoracic arthrodesis.

 

  • Question 00.40
  • Answer = 3
  • Reference(s)
  • Bigliani LU, Compito CA, Duralde XA, Wolfe IN: Transfer of the levator scapulae, rhomboid major, and rhomboid minor for paralysis of the trapezius. J Bone Joint Surg Am 1996;78:1534-1540. Kuhn JE, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surd 1995 ;3:319-325.

 

  • 00.41 Radiographic examination of a 2-year-old boy with scoliosis reveals normally
  • formed vertebrae with a measurement of 29° from T6 to T 12, convex to the left.
  • The difference between the angles formed by the rib with the vertebral end plate
  • at T9 is 10° (left minus right). An MRI scan of the brain stem and spinal cord is
  • normal, and there are no congenital abnormalities of the vertebrae or ribs.
  • Management should consist of
  • 1- a corrective thoracolumbosacral orthosis for 23 hours per day.
  • 2- a hypercorrective (Charleston-type) brace at night.
  • 3- serial cast treatment, followed by bracing.
  • 4- corrective instrumentation without fusion (growing rod).
  • 5- observation.

 

  • Question 00.41
  • Answer = 5
  • Reference(s)
  • Mehta MH: The rib-vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. J Bone Joint Surg Br 1972:54:230-243.

 

  • 00.42 A 67-year-old man who underwent a successful ankle fusion 5 months ago now
  • reports pain with localized swelling over the distal one third of his lower leg.
  • Radiographs are negative, but a bone scan reveals increased focal uptake in the
  • distal one third of the tibia. The next best course of action should include
  • 1- a biopsy of the tibia.
  • 2- a short leg cast.
  • 3- a bone stimulator.
  • 4- a shoe with a rocker sole.
  • 5- IV antibiotics.

 

  • Question 00.42
  • Answer = 2
  • Reference(s)
  • Lidor C, Ferris LR, Hall R, Alexander IJ, Nunley JA: Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot. J Bone Joint Surg Am 1997;79:558- 564. Hvid I, Rasmussen O, Jensen NC, Nielsen S: Trabecular bone strength profiles at the ankle joint. Clin Orthop 1985;199:306-312.

 

  • 00.43 A 69-year-old woman reports persistent right leg pain after surgery. Selective nerve root injection is performed, as shown in Figure 8. What nerve root is being blocked?
  • 1- L2
  • 2- L3
  • 3- L4
  • 4- LS
  • 5- S 1
  • Figure 8

 

  • Question 00.43
  • Answer = 3
  • Reference(s)
  • Rauschning W: Pathoanatomy of lumbar spinal stenosis: A pictorial outline, in Andersson GBT, McNeill TW (eds): Lumbar Spinal Stenosis. St Louis, MO, Mosby Year Book, 1992, pp 19-29.

 

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

 

  • 00.45 A 23-year-old house painter has mild pain and is unable to fully flex his finger
  • after accidentally discharging a high-pressure paint sprayer into the tip of his left
  • nondominant index finger 30 minutes ago. Examination reveals a 3-mm puncture
  • wound over the finger pulp, valor swelling of the digit, mildly restricted motion,
  • and intact neurovascular function. A lateral radiograph is shown in Figure 10. In
  • addition to broad-spectrum antibiotics, management should consist of
  • 1- surgical exploration and
  • chemical debridement.
  • 2- extended surgical exploration
  • and mechanical debridement.
  • 3- hospital admission, elevation,
  • and observation.
  • 4- debridement and irrigation of
  • the puncture wound and
  • observation.
  • 5- distal and proximal flexor
  • sheath decompression and
  • catheter irrigation of the flexor
  • sheath.
  • Figure 10

 

  • Question 00.45
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 361-386. Pinto MR, Turkula-Pinto LD, Cooney WP, Wood MB, Dobyns JH: High-pressure injection injuries of the hand: Review of 25 patients managed by open wound technique. J Hand Surg Am 1993;18:125-130.

 

  • 00.46 Which of the following processes is related to osteofibrous dysplasia
  • (Campanacci's disease)?
  • 1- Nonossifying fibroma
  • 2- Osteoid osteoma
  • 3- Adamantinoma
  • 4- Fibrosarcoma
  • 5- Ollier's disease (multiple enchondromatosis)

 

  • Question 00.46
  • Answer = 3
  • Reference(s)
  • Springfield DS, Rosenberg AE, Mankin HJ, Mindell ER: Relationship between osteofibrous dysplasia and adamantinoma. Clin Orthop 1994;309:234-244. Bridge JA, Dembinski A, DeBoer J, Travis J, Neff JR: Clonal chromosomal abnormalities in osteofibrous dysplasia: Implications for histopathogenesis and its relationship with adamantinoma. Cancer 1994;73:1746-1752.

 

  • 00.47 A 27-year-old woman sustained a radial head fracture after falling from a
  • ladder, and radiographs reveal that there are two large fragments. Treatment
  • should consist of
  • 1- open reduction and internal fixation.
  • 2- radial head excision.
  • 3- a Silastic implant.
  • 4- delayed excision of the fragments if pain persists.
  • 5- lidocaine injections and early motion.

 

  • Question 00.47
  • Answer = l
  • Reference(s)
  • Davidson PA, Moseley JB Jr, Tullos HS: Radial head fracture: A potentially complex injury. Clin Orthop 1993;297:224-230. Esser RD, Davis S, Taavao T: Fractures of the radial head treated by internal fixation: Late results in 26 cases. J Orthop Trauma 1995;9:318-323.

 

  • 00.48 A patient with degenerative hip arthritis caused by hip dysplasia undergoes
  • primary total hip arthroplasty. Immediately following the procedure, the patient
  • reports anteromedial leg numbness and is unable to extend the knee. What nerve
  • has most likely been injured?
  • 1- Sciatic
  • 2- Obturator
  • 3- Lateral femoral cutaneous
  • 4- Superior gluteal
  • 5- Femoral

 

  • Question 00.48
  • Answer = 5
  • Reference(s)
  • DeHart MM, Riley LH Jr: Nerve injuries in total hip arthroplasty. J Am Acad Orthop Surg 1999;7:101-111.

 

  • 00.49 What muscle lies between the superficial femoral and profunda femoris arteries
  • in the midthigh?
  • 1- Pectineus
  • 2- Rectus femoris
  • 3- Adductor magnus
  • 4- Adductor longus
  • 5- Sartorius

 

  • Question 00.49
  • Answer = 4
  • Reference(s)
  • Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 401-429.

 

  • 00.50 Which of the following structures is considered the primary restraint to anterior
  • translation in the cocking position of throwing?
  • 1- Subscapularis muscle
  • 2- Posterior labrum
  • 3- Anterior band of the inferior glenohumeral ligament
  • 4- Middle glenohumeral ligament
  • 5- Superior glenohumeral ligament

 

  • Question 00.50
  • Answer = 3
  • Reference(s)
  • O'Brien SJ, Neves MC, Amoczky SP, et al: The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am J Sports Med 1990;18:449-456. Matsen FA, Lippitt SB, Sidles JA, et al: Practical Evaluation and Management of the Shoulder. Philadelphia, PA, WB Saunders, 1994, pp 59-110.

 

  • 00.51 A 13-year-old girl with Down syndrome is a community ambulator and has had
  • a painless waddling gait for the past 4 years. Examination shows mild limitation
  • of hip abduction with no guarding. Radiographs reveal bilateral dislocated hips
  • with moderate acetabular dysplasia. The hips do not reduce in maximum
  • abduction. Management should consist of
  • 1- observation.
  • 2- bilateral split-Russell skin traction.
  • 3- closed reduction of both hips under general anesthesia.
  • 4- open reduction of both hips and capsular imbrication.
  • 5- open reduction of both hips and a Chiari innominate osteotomy.

 

  • Question 00.51
  • Answer = 1
  • Reference(s)
  • Bennet GC, Rang M, Roye DP, Aprin H: Dislocation of the hip in trisomy 21. J Bone Joint Surg Br 1982;64:289-294. Aprin H, Zink WP, Hall JE: Management of dislocation of the hip in Down syndrome. J Pediatr Orthop 1985;5:428-431.

 

  • 00.52 A 24-year-old man sustained a posterior hip dislocation 2 hours ago, and
  • treatment consists of immediate reduction. Postreduction radiographs and CT
  • scans confirm a concentric reduction with several small bony fragments in the
  • fovea that do not impinge on the head and no acetabular fracture. Management
  • should now include
  • 1- protected weight bearing as tolerated.
  • 2- a hip abduction orthosis, followed by weight bearing at 12 weeks.
  • 3- femoral traction for 6 weeks, followed by weight bearing as tolerated.
  • 4- irrigation and debridement of the hip and immediate full weight bearing.
  • 5- irrigation and debridement of the hip, followed by a hip abduction orthosis for 12
  • weeks.

 

  • Question 00.52
  • Answer = 1
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 281-286. Tometta P III, Mostafavi HR: Hip dislocation: Current treatment regimens. J Am Acad Orthop Surg 1997;5:27-36.

 

  • 00.53 An otherwise healthy 50-year-old woman has a painful planovalgus deformity of
  • the foot that is the result of chronic posterior tibial tendon deficiency. Both the
  • hindfoot and forefoot positions are passively correctable. Orthotic management
  • has failed to provide relief. Treatment should now consist of
  • 1- reconstruction of the posterior tibial tendon and spring (calcaneonavicular)
  • ligament.
  • 2- reconstruction of the posterior tibial tendon and a medial displacement calcaneal
  • osteotomy.
  • 3- varus osteotomy of the calcaneus and reconstruction of the spring
  • (calcaneonavicular) ligament.
  • 4- triple arthrodesis and lengthening of the Achilles tendon.
  • 5- arthrodesis of the talonavicular and calcaneocuboid joints.

 

  • Question 00.53
  • Answer = 2
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW: Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 253-277. Myerson MS: Adult acquired flatfoot deformity: Treatment of dysfunction of the posterior tibial tendon. Instr Course Lect 1997;46:393-405.

 

  • 00.54 Which of the following soft-tissue lesions is best described as a
  • Musculoskeletal Tumor Society stage 3 lesion (aggressive)?
  • 1- Nodular fasciitis
  • 2- Lipoma
  • 3- Malignant fibrous histiocytoma
  • 4- Fibromatosis (extra-abdominal desmoid)
  • 5- Giant cell tumor of the tendon sheath

 

  • Question 00.54
  • Answer = 4
  • Reference(s)
  • Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980;153:106-120. Enzinger FM, Weiss SW (eds): Soft-Tissue Tumors, ed 3. St Louis, MO, Mosby, 1995, pp 201-231.

 

  • 00.55 Examination of a 5-year-old girl with a limp reveals abduction of 40° in the left
  • hip compared with 60° in the right. A radiograph of the pelvis shows
  • fragmentation and irregularity of the entire left proximal femoral epiphysis, with
  • about a 40% loss of lateral epiphyseal height and no epiphyseal extrusion.
  • Management should consist of
  • 1- observation.
  • 2- adductor tenotomy.
  • 3- a proximal femoral osteotomy.
  • 4- a Salter iliac osteotomy.
  • 5- a hinged abduction brace.

 

  • Question 00.55
  • Answer = 1
  • Reference(s)
  • Catterall A: The natural history of Perthes' disease. J Bone Joint Surg Br 1971;53:37-53. Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH: The lateral pillar classification of Legb Calve-Perthes disease. J Pediatr Orthop 1992;12:143-150.

 

  • 00.56 Construct stability is enhanced with posterior spinous process wiring in the
  • presence of anterior cervical plating because of
  • 1- improved rotational stiffness.
  • 2- improved lateral bending stiffness.
  • 3- improved extension stiffness.
  • 4- reconstitution of the posterior tension band.
  • 5- augmentation of axial load resistance.

 

  • Question 00.56
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 747-756.

 

  • 00.57 What type of cells are responsible for the bone resorption in patients with
  • multiple myeloma?
  • 1- Plasma cells
  • 2- Langerhans' giant cells
  • 3- Polymorphonuclear leukocytes
  • 4- Osteoclasts
  • 5- Platelets

 

  • Question 00.57
  • Answer = 4
  • Reference(s)
  • Dorfman HD, Czerniak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 667-668. McCarthy EF, Frassica FJ: Pathology of Bone and Joint Disorders. Philadelphia, PA, WB Saunders, 1998, pp 185-194.

 

  • 00.58 What factor best differentiates radial tunnel syndrome from posterior
  • interosseous nerve syndrome?
  • 1- Electromyogram results that indicate denervation of the extensor muscles
  • 2- Significant pain in the forearm
  • 3- Weakness of the finger and thumb extensors
  • 4- A negative middle finger extension test
  • 5- The presence of a radially deviated wrist

 

  • Question 00.58
  • Answer = 2
  • Reference(s)
  • American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 221-231. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 387-405. Szabo RM: Entrapment and compression neuropathies, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 1404-1447.

 

  • 00.59 Figures 11a and 11b show the AP radiograph and CT scan of a 45-year-old woman who
  • reports shoulder pain after sustaining an injury to the left shoulder 3 weeks ago.
  • Examination reveals that passive elevation of the shoulder is limited to 80°, and passive
  • external rotation is limited to -10°. Pain is present on all movement of the shoulder. Initial
  • management should consist of
  • 1- open reduction.
  • 2- open reduction and lesser tuberosity transfer.
  • 3- closed reduction under general anesthesia.
  • 4- aggressive physical therapy.
  • 5- hemiarthroplasty.
  • Figures 11
  • A
  • B

 

  • Question 00.59
  • Answer = 3
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 15-24. Stableforth PG, Sarangi PP: Posterior fracture-dislocation of the shoulder: A superior subacromial approach for open reduction. J Bone Joint Surg Br 1992;74:579-584.

 

  • 00.60 Following arthroscopic repair of a 2- x 3-cm full-thickness tear of the
  • supraspinatus tendon, initial rehabilitation should consist of
  • 1- early active shoulder motion.
  • 2- early passive shoulder motion.
  • 3- early isometric rotator cuff strengthening.
  • 4- early isotonic rotator cuff strengthening.
  • 5- sling immobilization with no shoulder motion.

 

  • Question 00.60
  • Answer = 2
  • Reference(s)
  • Karas EH, lannotti JP: Failed repair of the rotator cuff: Evaluation and treatment of complications. Instr Course Lect 1998;47:87-95. Matsen FA III, Arntz CT, Lippitt SB: Rotator cuff, in Rockwood CA Jr, Matsen FA III, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 755-839.

 

  • 00.61 Figure 12 shows the radiograph of an 84-year-old woman who has been referred
  • by her rheumatologist for rotator cuff repair. History reveals that she has been
  • receiving intra-articular steroid injections at 6-month intervals for the past 8
  • years; however, they are no longer effective and she reports constant pain.
  • Treatment should now consist of
  • 1- latissimus dorsi tendon transfer.
  • 2- shoulder arthrodesis.
  • 3- rotator cuff repair with a fascia lata graft.
  • 4- total shoulder replacement.
  • 5- Numeral head replacement.
  • Figure 12

 

  • Question 00.61
  • Answer = 5
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 173-177. Collins DN, Harryman DT II: Arthroplasty for arthritis and rotator cuff deficiency. Orthop Clin North Am 1997;28:225-239.

 

  • 00.62 A 10-year-old girl sustained a left radial neck
  • fracture in a fall on the playground 24 hours
  • ago. Neurovascular examination is intact.
  • Under general anesthesia, examination reveals
  • forearm rotation of 25° supination and 35°
  • pronation. Following manual closed reduction
  • attempts under anesthesia, the intra-operative
  • radiograph shown in Figure 13 reveals no
  • change in angulation. Management should
  • now consist of
  • 1- a sling for 3 days, followed by early active range-
  • of-motion exercises.
  • 2- a long arm cast in maximum supination.
  • 3- a long arm cast in maximum pronation.
  • 4- percutaneous Kirschner wire reduction of the
  • fracture.
  • 5- open reduction of the fracture and transcapitellar
  • wire fixation.
  • Figure 13

 

  • Question 00.62
  • Answer = 4
  • Reference(s)
  • Bernstein SM, McKeever P, Bernstein L: Percutaneous reduction of displaced radial neck fractures in children. J Pediatr Orthop 1993;13:85-88. Rodriguez-Merchan EC: Percutaneous reduction of displaced radial neck fractures in children. J Trauma 1994;37:812-814. Steele JA, Graham HK: Angulated radial neck fractures in children: A prospective study of percutaneous reduction. J Bone Joint Surg Br 1992;74:760-764.

 

  • 00.63 Which of the following findings is considered the best indication for
  • exploration of the radial nerve in a patient who has a radial nerve palsy and an
  • acute Numeral shaft fracture from blunt trauma?
  • 1- Complete motor and sensory palsy
  • 2- Open Numeral fracture
  • 3- Oblique distal third Numeral fracture
  • 4- Transverse midshaft fracture
  • 5- 100% fragment displacement

 

  • Question 00.63
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 271-286. Foster RJ, Swiontkowski MF, Bach AW, Sack JT: Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg Am 1993;18:121-124.

 

  • 00.64 A 22-year-old man with Down syndrome who wants to participate in the
  • Special Olympics has been referred for evaluation. Screening radiographs show
  • 5 mm of motion at C1-C2 but are otherwise normal. Examination reveals no
  • signs or symptoms of neck pain or myelopathy, and the neurologic examination
  • is normal. Management should consist of
  • 1- posterior C 1-C2 fusion with transarticular screw fixation.
  • 2- posterior C1-C2 fusion with wiring and immobilization in a halo vest.
  • 3- posterior occiput-C2 fusion and immobilization in a halo vest.
  • 4- restriction from high-risk sports such as gymnastics or diving and observation.
  • 5- nonsurgical management that includes a program of cervical isometric
  • strengthening, followed by continued participation in sports without restriction.

 

  • Question 00.64
  • Answer = 4
  • Reference(s)
  • Ward WT: Atlantoaxial instability in children with Down syndrome, in Betz RR, Mulcahey MJ (eds): The Child With a Spinal Cord Injury. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 89-95. Doyle JS, Lauerman WC, Wood KB, Krause DR: Complications and long-term outcome of upper cervical spine arthrodesis in patients with Down Syndrome. Spine 1996;21:1223-1231. Segal LS, Drummond DS, Zanotti RM, Ecker ML, Mubarak SJ: Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome. J Bone Joint Surg Am 1991;73:1547-1554.

 

  • 00.65 A talar neck fracture heals in 20° of varus. This will most likely result in
  • 1- loss of dorsiflexion of the ankle.
  • 2- lateral foot overload.
  • 3- chronic posterior tibial tendinitis.
  • 4- osteonecrosis of the talus.
  • 5- a stress fracture of the cuboid.

 

  • Question 00.65
  • Answer = 2
  • Reference(s)
  • Daniels TR, Smith JW: Talar neck fractures. Foot Ankle 1993;14:225-234.

 

  • 00.66 During a routine preparticipation cardiovascular screening examination, an 18-
  • year-old soccer player admits to lightheadedness after exertion. Before clearing
  • the patient to play, the orthopaedic surgeon should order
  • 1- a cardiology consultation.
  • 2- a cardiac catheterization.
  • 3- an MRI scan of the brain.
  • 4- thallium stress testing.
  • 5- echocardiography.

 

  • Question 00.66
  • Answer = l
  • Reference(s)
  • Basilico FC: Cardiovascular disease in athletes. Am J Sports Med 1999;27:108-121. Mills JD, Moore GE, Thompson PD: The athlete's heart. Clin Sports Med 11)97;16:725-737.

 

  • 00.67 The key element of the fibrinolytic system is conversion of
  • 1- plasminogen to plasmin.
  • 2- fibrinogen to fibrin.
  • 3- prothrombin to thrombin.
  • 4- factor X to factor Xa.
  • 5- factor V to factor Va.

 

  • Question 00.67
  • Answer = 1
  • Reference(s)
  • Yamamoto K, Saito H: A pathological role of increased expression of plasminogen activator inhibitor-1 in human or animal disorders. Int J Hematol 1998:68:371-385. Shen GX: Vascular cell-derived fibrinolytic regulators and atherothrombotic vascular disorders (Review). Int J Mol Med 1998;1:399-408. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 63-72.

 

  • 00.68 Improvement in which of the following factors is considered the basis for
  • enhanced clinical results on the femoral side in cemented total hip arthroplasty?
  • 1- Patient selection
  • 2- Surgical approaches
  • 3- Surgical cement techniques
  • 4- Component instrumentation
  • 5- Component metallurgy

 

  • Question 00.68
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Mulroy WF, Estok DM, Harris WH: Total hip arthroplasty with use of so-called second-generation cementing techniques: A fifteen-year average follow-up study. J Bone Joint Surg Am 1995;77:1845-1852.

 

  • 00.69 A patient has midfoot arthritis, and management consists of an extended steel
  • shank as a shoe modification. The shoe prescription should also include
  • 1- a lateral heel wedge.
  • 2- a rocker sole.
  • 3- a heel lift.
  • 4- a cushioned heel (SACH).
  • 5- an offset medial stabilizer.

 

  • Question 00.69
  • Answer = 2
  • Reference(s)
  • Janisse D (ed): Introduction to Pedorthics. Columbia, MD, PFA, 1998, pp 267-272.

 

  • 00.70 Figure 14 shows the standing lateral
  • radiograph of a 16-year-old boy with
  • achondroplasia who reports bilateral
  • posterior thigh pain and numbness in the
  • legs after walking 2 blocks. Symptoms are
  • relieved with sitting and resting.
  • Examination shows increased
  • thoracolumbar kyphosis and lumbar
  • lordosis, both of which are partially
  • correctable. Motor strength and reflexes are
  • normal in the lower extremities. The
  • patient's symptoms are most likely the result
  • of
  • 1- cervical spinal stenosis.
  • 2- lumbar spinal stenosis.
  • 3- a thoracic herniated nucleus pulposus.
  • 4- a spinal cord cyst.
  • 5- a spinal tumor.
  • Figure 14

 

  • Question 00.70
  • Answer = 2
  • Reference(s)
  • Lutter LD, Langer LO: Neurological symptoms in achondroplastic dwarfs: Surgical treatment. J Bone Joint Surg Am 1977;59:87-91. Hecht JT, Butler IJ, Scott CI Jr: Long-term neurological sequelae in achondroplasia. Eur J Pediatr 1984;143:58-60. Tolo VT: Spinal deformity in short-stature syndromes. Instr Course Lect 1990;39:399-405.

 

  • 00.71 The radiographs shown in Figures 15a through 15c and the CT scans shown in
  • Figures 15d and 15e show what type of acetabular fracture pattern?
  • 1- Transverse
  • 2- T-shaped
  • 3- Posterior column
  • 4- Posterior column/posterior wall
  • 5- Posterior wall
  • Go to next slide
  • for remaining
  • figures and
  • answer link
  • Figures 15
  • A
  • B

 

  • answer
  • back to question
  • D
  • Figures 15
  • E
  • C

 

  • Question 00.71
  • Answer = 5
  • Reference(s)
  • Letournel E, Judet R: Posterior wall fractures, in Letournel E, Judet R (eds): Fractures of the Acetabulum, ed 2. Berlin, Germany, Springer-Verlag, 1993, pp 67-85.

 

  • 00.72 Formation of a boutonniere deformity requires injury to not only the central
  • tendon insertion at the level of the proximal interphalangeal joint, but also injury
  • of the
  • 1- sagittal bands.
  • 2- lateral bands.
  • 3- conjoined lateral bands.
  • 4- triangular ligament.
  • 5- oblique retinacular ligament.

 

  • Question 00.72
  • Answer = 4
  • Reference(s)
  • Harris C Jr, Rutledge GL Jr: The functional anatomy of the extensor mechanism of the finger. J Bone Joint Surg Am 1972;54:713-726. Micks JE, Hager D: Role of the controversial parts of the extensor of the finger. J Bone Joint Surg Am 1973;55:884.

 

  • 00.73 A 45-year-old man has had spontaneous neck and right arm pain for the past 2
  • days, and he states that the pain is relieved when he places his hand on the top of
  • his head. Examination reveals decreased sensation on the dorsum of the first
  • web space, weakness in the wrist extensors, and an absent brachioradialis reflex.
  • The remainder of the examination is unremarkable. What is the most likely
  • diagnosis?
  • 1- Double-crush phenomenon with carpal tunnel syndrome and cervical disk
  • herniation at CS-6
  • 2- Cervical disk herniation at C6-7
  • 3- Cervical disk herniation at CS-C6 with myelopathy
  • 4- Acute cervical disk herniation at CS-C6
  • 5- A shoulder impingement lesion and cervical disk herniation at C6-C7

 

  • Question 00.73
  • Answer = 4
  • Reference(s)
  • Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 75-86.

 

  • 00.74 A 48-year-old woman underwent a lateral sesamoidectomy 8 months ago
  • because of intractable pain under the first metatarsal. She now reports a
  • recurrence of similar symptoms, and nonsurgical management has failed to
  • provide relief. Examination reveals pain under the medial sesamoid with a local
  • callus under the same structure. Treatment should now consist of
  • 1- a medial sesamoidectomy.
  • 2- a dorsiflexion osteotomy of the first metatarsal.
  • 3- a Silastic implant.
  • 4- a plantar exostectomy of the medial sesamoid.
  • 5- arthrodesis of the first metatarsophalangeal joint.

 

  • Question 00.74
  • Answer = 4
  • Reference(s)
  • Coughlin MJ: Sesamoid pain: Causes and surgical treatment. Instr Course Lect 1990;39:23-35. Coughlin MJ, Mann RA: Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, pp 446-448.

 

  • 00.75 The sciatic nerve usually lies anterior to which of the following short external
  • rotator muscles of the hip joint?
  • 1- Quadratus femoris
  • 2- Obturator externus
  • 3- Obturator internus
  • 4- Superior gemellus
  • 5- Piriformis

 

  • Question 00.75
  • Answer = 5
  • Reference(s)
  • Hoppenfeld S, deBoer P: Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia, PA, JB Lippincott, 1984, p 341.

 

  • 00.76 A 42-year-old woman has had pain in the left shoulder for the past 3 months.
  • She denies any history of shoulder injury; however, she states that she has had
  • type I diabetes mellitus for the past 20 years. Examination reveals
  • anterosuperior shoulder tenderness, limited active and passive shoulder motion,
  • pain at the extremes of motion, and normal strength. Management should
  • consist of
  • 1- arthroscopic capsular release.
  • 2- stretching exercises.
  • 3- strengthening exercises.
  • 4- chiropractic manipulation.
  • 5- manipulation under anesthesia.

 

  • Question 00.76
  • Answer = 2
  • Reference(s)
  • Warner JJ: Frozen shoulder: Diagnosis and management. J Am Acad Orthop Surg 1997;5:130-140. Harryman DT II: Shoulders: Frozen and stiff. Instr Course Lect 1993;42:247-257.

 

  • 00.77 A 54-year-old woman with degenerative arthritis reports persistent, diffuse,
  • severe pain following primary total knee arthroplasty 6 months ago. Examination
  • shows a well-healed incision without erythema; however, the skin in the lower
  • extremity is shiny, mottled, hypersensitive to palpation, and cooler than the
  • opposite limb. The knee has smooth range of motion from full extension to 85°
  • of flexion and excellent stability. Radiographs show well-fixed, well-aligned
  • components. Laboratory studies show a WBC of 3,600/mm3 (normal 3,500 to
  • 10,500/mm3) and an erythrocyte sedimentation rate of 8 mm/h (normal up to 20
  • mm/h). Aspiration of the knee reveals 1,200 nucleated cells/mm3, predominately
  • lymphocytes, and cultures are negative. What is the most likely diagnosis?
  • 1- Infection
  • 2- Patellar maltracking
  • 3- Polyethylene synovitis
  • 4- Reflex sympathetic dystrophy
  • 5- Aseptic loosening

 

  • Question 00.77
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 559-582. Ritter MA: Postoperative pain after total knee arthroplasty. J Arthroplasty 1997;12:337-339.

 

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

 

  • 00.79 A 28-year-old woman has had intermittent aching pain in the left ankle for the
  • past year that is exacerbated by activity. Figures 17a through 17e show the plain
  • radiograph, the coronal T1-weighted MRI scan, the axial T2-weighted MRI scan,
  • and low- and high- power photomicrographs. What is the most likely diagnosis?
  • 1- Giant cell tumor
  • 2- Osteochondroma
  • 3- Enchondroma
  • 4- Chondromyxoid fibroma
  • 5- Chondroblastoma
  • Go to next slide
  • for remaining figures
  • and answer link
  • Figures 17
  • A
  • B

 

  • answer
  • back to question
  • C
  • D
  • Figures 17
  • E

 

  • Question 00.79
  • Answer = 4
  • Reference(s)
  • Scarborough MT, Moreau G: Benign cartilage tumors. Orthop Clin North Am 1996;27:583-589. Wu CT, Inwards CY, O'Laughlin S, Rock MG, Beabout JW, Un fi KK: Chondromyxoid fibroma of bone: A clinicopathologic review of 278 cases. Hum Pathol 1998;29:438-446.

 

  • 00.80 The radiographs of a 24-year-old female long-distance runner show a tibial
  • stress fracture. History reveals that she has had no menstrual periods for the
  • past 18 months. Further work-up should include
  • 1- dual-emission x-ray absorptiometry (DEXA).
  • 2- an MRI scan of the leg.
  • 3- a CT scan of the lumber spine.
  • 4- a three-phase bone scan.
  • 5- a skeletal survey.

 

  • Question 00.80
  • Answer = 1
  • Reference(s)
  • Snow-Harker CM: Bone health and prevention of osteoporosis in active athletic women. Clin Sports Med 1994;13:389-484. Voss LA, Fadale PD, Hulstyn MJ: Exercise-induced loss of bone density in athletes. J Am Acad Orthop Surg 1998;6:349-357.

 

  • 00.81 The anti-inflammatory action of nonsteroidal anti-inflammatory drugs and
  • aspirin is mediated by
  • 1- inhibiting cyclooxygenase.
  • 2- inhibiting phospholipase A2.
  • 3- suppressing leukocyte chemotactic mediators.
  • 4- decreasing cell membrane permeability.
  • 5- blocking lipoxygenase.

 

  • Question 00.81
  • Answer = 1
  • Reference(s)
  • Fadale PD, Wiggins ME: Corticosteroid injections: Their use and abuse. J Am Acad Orthop Surg 1994;2:133-140. Leadbetter WB: Corticosteroid injection therapy in sports injuries, in Leadbetter WB, Buckwalter JA, Gordon SL (eds): Sports-induced inflammation: Clinical and Basic Science Concepts. Park Ridge, IL, American Academy of Orthopaedic Surgeons, 1990, pp 527-545.

 

  • 00.82 A 10-year-old girl has had knee pain for the past 3 months.
  • History reveals that an incidental knee radiograph obtained 2
  • years ago showed no skeletal abnormalities. Current plain
  • radiographs and a biopsy specimen are shown in Figures 18a
  • through 18c. The patient's current condition is most likely
  • associated with
  • 1- familial infantile retinoblastoma.
  • 2- multiple hereditary
  • osteochondromatosis.
  • 3- multiple enchondromatosis.
  • 4- polyostotic fibrous dysplasia.
  • 5- Gaucher's disease.
  • C
  • Figures 18
  • A
  • B

 

  • Question 00.82
  • Answer = 1
  • Reference(s)
  • Hansen MF: Molecular genetic considerations in osteosarcoma. Clin Orthop 1991;270:237-246. Weis L: Common malignant bone tumors: Osteosarcoma, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 265-274.

 

  • 00.83 Camptodactyly is most commonly caused by
  • 1- volar skin deficiency.
  • 2- volar plate contractures.
  • 3- abnormalities of the palmar fascia and Landsmeer ligament.
  • 4- articular deformity of the proximal interphalangeal joint.
  • 5- anomalous lumbrical and superficialis insertions.

 

  • Question 00.83
  • Answer = 5
  • Reference(s)
  • McFarlane RM, Classen DA, Porte AM, Botz JS: The anatomy and treatment of camptodactyly of the small finger. J Hand Surg Am 1992;17:35-44.

 

  • 00.84 Which of the following actions best describes the process of osteoinduction?
  • 1- The creation of a scaffold for bone to form on
  • 2- The ability to signal local factors to stimulate bone formation
  • 3- Stimulation of revascularization
  • 4- Inactivation of osteoclast function
  • 5- Conversion of a soft callus to a hard callus

 

  • Question 00.84
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 25-35. Einhom TA: Enhancement of fracture healing. J Bone Joint Surg Am 1995;77:940-956. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 129-184.

 

  • 00.85 Surgeons can best prevent wrong-site surgery by performing which of the
  • following preoperative procedures?
  • 1- Check the surgical permit.
  • 2- Check with accompanying family members.
  • 3- Ask the patient and mark the surgical site.
  • 4- Review the medical record.
  • 5- Review the radiographs.

 

  • Question 00.85
  • Answer = 3
  • Reference(s)
  • Cowell HR (ed): Wrong-site surgery. J Bone Joint Surg Am 1998;80:463.

 

  • 00.86 A 20-year-old man injured his left nondominant shoulder in a fall while in-line
  • skating. Radiographs show an anteroinferior glenohumeral dislocation. After
  • successful closed reduction, initial management should consist of
  • 1- immediate range-of-motion exercises.
  • 2- sling immobilization.
  • 3- arthroscopic labral repair.
  • 4- arthroscopic capsular shrinkage.
  • 5- open instability repair.

 

  • Question 00.86
  • Answer = 2
  • Reference(s)
  • Green A, Norris TR: Proximal humerus fractures and glenohumeral dislocations: Part III. Glenohumeral dislocations, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 1639-1655.

 

  • 00.87 A 62-year-old man has had an
  • enlarging painless mass on his
  • thigh for the past 4 months. A
  • biopsy specimen and MRI scans
  • are shown in Figures 19a through
  • 19c. This type of tumor will most
  • often metastasize to which of the
  • following structures?
  • 1- Bone
  • 2- Lungs
  • 3- Liver
  • 4- Lymph nodes
  • 5- Kidney
  • C
  • Figures 6
  • A
  • B

 

  • Question 00.87
  • Answer = 2
  • Reference(s)
  • Choong PFM, Pritchard DJ: Common malignant soft-tissue tumors, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 541-553. Bertoni F, Capanna R, Biagini R, et al: Malignant fibrous histiocytoma of soft tissue: An analysis of 78 cases located and deeply seated in the extremities. Cancer 1985;56:356-367.

 

  • 00.88 What artery courses anterior to the superior edge of the quadratus femoris
  • muscle?
  • 1- Inferior gluteal
  • 2- Superior gluteal
  • 3- Profundus femoris
  • 4- Medial femoral circumflex
  • 5- Ascending branch of the lateral femoral circumflex

 

  • Question 00.88
  • Answer = 4
  • Reference(s)
  • Hoppenfeld S, deBoer P: Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia, PA, JB Lippincott, 1984, pp 345-346.

 

  • 00.89 A 10-year-old girl has a bulge on the lateral side of the elbow. History reveals
  • that she sustained a fracture of the ulna 1 year ago, had the cast removed after
  • healing, but did not return for any follow-up examinations. Radiographs reveal
  • an anterior dislocation of the radial head, with preservation of normal concavity
  • of the articular surface. The healed ulna has an anterior bow of 18°. Management
  • should consist of
  • 1- excision of the radial head.
  • 2- closed reduction of the radial head.
  • 3- open reduction of the radial head with repair of the annular ligament.
  • 4- open reduction of the radial head with reconstruction of the annular ligament.
  • 5- open reduction of the radial head with reconstruction of the annular ligament and
  • an ulnar osteotomy.

 

  • Question 00.89
  • Answer = 5
  • Reference(s)
  • Seel MJ, Peterson HA: Management of chronic posttraumatic radial head dislocation in children. J Pediatr Orthop 1999;19:306-312.

 

  • 00.90 A 25-year-old patient has chronic pain in the third interspace of the foot.
  • Nonsurgical management provides only temporary relief; orthotic treatment has
  • no effect on the patient's symptoms. The interspace is surgically explored and the
  • digital nerve appears normal. Treatment should now consist of
  • 1- excision of the interdigital nerve as far proximal in the interspace as possible.
  • 2- exploration of the adjacent second and fourth interspaces.
  • 3- release of the transverse intermetatarsal ligament.
  • 4- intrafascicular release of the interdigital nerve.
  • 5- resection of the third and fourth metatarsal heads.

 

  • Question 00.90
  • Answer = 3
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 101-111. Okafor B, Shergill G, Angel J: Treatment of Morton's neuroma by neurolysis. Foot Ankle Int 1997;18:284-287. Gauthier G: Thomas Morton's disease: A nerve entrapment syndrome. A new surgical technique. Clin Orthop 1979;142:90-92.

 

  • 00.91 A college football player sustains a head and neck injury while making a tackle.
  • Examination reveals no evidence of cardiorespiratory compromise. Initial
  • management should consist of
  • 1- immobilization with both the helmet and shoulder pads in place.
  • 2- immobilization, followed by removal of the helmet only.
  • 3- removal of both the helmet and shoulder pads, followed by immobilization.
  • 4- removal of the face mask and shoulder pads, followed by immobilization.
  • 5- removal of the helmet only, followed by immobilization.

 

  • Question 00.91
  • Answer = 1
  • Reference(s)
  • Torg JS: Athletic Injuries to the Head, Neck, and Face, ed 2. St Louis, MO, Mosby, 1991, pp 426-437. Warren WL, Balles JE: On the field evaluation of athletic neck injury, in Clinics in Sports Medicine. Philadelphia, PA, WB Saunders, 1998, vol 17, pp 99-110.

 

  • 00.92 A 52-year-old woman with no history of malignancy has had mild aching pain in the left
  • tibia for the past 2 years. Examination reveals a firm mass in the subcutaneous border of
  • the tibia; a bone scan shows this to be an isolated finding. Figures 20a through 20d show
  • the plain radiograph, the sagittal T1-weighted MRI scan, the axial T2-weighted MRI scan,
  • and the biopsy specimen. Management should now include
  • 1- serial radiographic
  • observation.
  • 2- curettage and bone
  • grafting.
  • 3- wide en bloc excision.
  • 4- chemotherapy and
  • wide en bloc excision.
  • 5- prophylactic
  • stabilization and
  • radiation therapy.
  • Go to next slide
  • for remaining
  • figures and
  • answer link
  • Figures 20
  • A
  • B

 

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

 

  • Question 00.92
  • Answer = 3
  • Reference(s)
  • Hazelbag HM, Taminiau AH, Fleuren GJ, Hogendoom PC: Adamantinoma of the long bones: A clinicopathological study of thirty-two patients with emphasis on histological subtype, precursor lesion, and biological behavior. J Bone Joint Surg Am 1994;76:1482-1499. Gebhardt MC, Springfield D, Eckardt JJ: Diaphyses, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott- Raven, 1998, pp 393-403.

 

  • 00.93 Normal cortical bone has which of the following MR signal characteristics?
  • 1- Low on T1-weighted images and low on T2-weighted images
  • 2- Low on T1-weighted images and high on T2-weighted images
  • 3- Moderate on T1-weighted images and low on T2-weighted images
  • 4- High on TI-weighted images and low on T2-weighted images
  • 5- High on TI-weighted images and high on T2-weighted images

 

  • Question 00.93
  • Answer = 1
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 81-87.

 

  • 00.94 Which of the following factors decreases the complication rate following
  • reamed, anterograde locked intramedullary nailing of Numeral shaft fractures?
  • 1- Use in patients older than age 60 years
  • 2- Use in patients with a Numeral canal diameter of greater than 10 mm
  • 3- Use in patients with preexisting shoulder pathology
  • 4- Use of large diameter nails
  • 5- Insertion of the nail through the tendinous portion of the rotator cuff

 

  • Question 00.94
  • Answer = 2
  • Reference(s)
  • Farragos AF, Schemitsch EH, McKee MD: Complications of intramedullary nailing for fractures of the humeral shaft: A review. J Orthop Trauma 1999;13:258-267. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 25-34.

 

  • 00.95 A 21-year-old male college lacrosse player reports pain in his right posterior
  • shoulder. Examination reveals marked atrophy of the infraspinatus muscle and
  • marked weakness of external rotation. The shoulder remains very strong in
  • elevation and abduction. An MRI scan would most likely show
  • 1- dislocation of the long head of the biceps.
  • 2- an isolated infraspinatus tear.
  • 3- a teres minor tear.
  • 4- an anterior labral tear.
  • 5- a spinoglenoid notch cyst.

 

  • Question 00.95
  • Answer = 5
  • Reference(s)
  • Fritz RC, Helms CA, Steinbach LS, Genant HK: Suprascapular nerve entrapment: Evaluation with MR imaging. Radiology 1992;182:437-444. Glennon TP: Isolated injury of the infraspinatus branch of the suprascapular nerve. Arch Phys Med Rehabil 1992;73:201-202.

 

  • 00.96 The use of a threaded uncemented acetabular component in total hip
  • arthroplasty has resulted in a high rate of
  • 1- aseptic loosening.
  • 2- acetabular fracture.
  • 3- infection.
  • 4- nerve injury.
  • 5- dislocation.

 

  • Question 00.96
  • Answer = 1
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492.

 

  • 00.97 A 3-year-old child with arthrogryposis multiplex congenita underwent an
  • extensive release procedure for clubfoot 1 year ago. Figure 21 shows the current
  • clinical photograph with the foot in maximum dorsiflexion. The mother of the
  • child states that the ankle-foot orthosis for the right foot has not fit properly for
  • the past 3 months. Management should now consist of
  • 1- serial casting.
  • 2- a new orthosis.
  • 3- posterior, medial, lateral, and plantar soft-tissue release.
  • 4- talectomy.
  • 5- triple arthrodesis.
  • Figure 21

 

  • Question 00.97
  • Answer = 4
  • Reference(s)
  • Tachdjian MO (ed): Pediatric Orthopaedics. Philadelphia, PA, WB Saunders, 1990, p 2099. Goldberg MJ: Syndromes of orthopaedic importance, in Morrissy RT, Weinstein SL (eds): Pediatric Orthopaedics. Philadelphia, PA, Lippincott-Raven, 1996, p 265.

 

  • 00.98 A 26-year-old plastics worker sustained concentrated hydrofluoric acid burns of
  • the dorsum of her right hand 1 hour ago. Initial treatment consisted of copious
  • irrigation with tap water and dressing of the wound. Management should now
  • include
  • 1- local calcium gluconate injections.
  • 2- local debridement and delayed skin coverage.
  • 3- repeated local debridements and silver sulfadiazine dressings.
  • 4- serial whirlpool debridements.
  • 5- wide local excision and immediate flap coverage.

 

  • Question 00.98
  • Answer = 1
  • Reference(s)
  • American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 405-411. Achauer BM: The burned hand, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 2045-2060.

 

  • 00.99 A 12-year-old child sustained the displaced supracondylar humerus fracture
  • shown in Figure 22. The elbow is swollen, and the neurovascular examination is
  • intact. Management should consist of
  • 1- a collar-and-cuff with the elbow in 130° of
  • flexion.
  • 2- a bridging external fixator.
  • 3- closed reduction with application of a long
  • arm cast.
  • 4- closed reduction with insertion of two smooth
  • pins.
  • 5- open reduction with lateral column plating.
  • Figure 22

 

  • Question 00.99
  • Answer = 4
  • Reference(s)
  • Topping RE, Blanco JS, Davis TJ: Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop 1995;15:435-439. France J, Strong M: Deformity and function in supracondylar fractures of the humerus in children variously treated by closed reduction and splinting, traction, and percutaneous pinning. J Pediatr Orthop 1992;12:494-498.

 

  • 00.100 Figures 23a and 23b show the left and right elbow radiographs of a 20-year-old student
  • with functional difficulties related to the inability to rotate her forearms. She denies any
  • pain. Examination reveals that both forearms are fixed in 30° of pronation. Management
  • should consist of
  • 1- reassurance only.
  • 2- resection of both synostoses.
  • 3- supination osteotomy of the nondominant forearm.
  • 4- rotational osteotomy of both forearms to neutral rotation.
  • 5- rotational osteotomy of the dominant forearm synostosis.
  • Figures 23
  • A
  • B

 

  • Question 00.100
  • Answer = 3
  • Reference(s)
  • American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 377-385. Ezaki M, Kay SPJ, Light TR, et al: Congenital hand deformities, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 325-551.

 

  • 00.101 Figure 24 shows the lateral radiograph of a 13-year-old football player who is
  • unable to bear weight on his left foot after sustaining an injury several hours
  • ago. The neurovascular examination is normal. Management should consist of
  • 1- a non-weight-bearing short leg cast.
  • 2- a short leg cast and full weight bearing.
  • 3- closed reduction of the fracture and a long leg cast.
  • 4- open reduction and screw fixation of the fracture.
  • 5- in situ percutaneous Kirschner wire fixation of the fracture.
  • Figure 24

 

  • Question 00.101
  • Answer = 4
  • Reference(s)
  • Letts RM, Gibeault D: Fractures of the- neck of the talus in children. Foot Ankle 1980;1:74-77. Canale ST, Kelly FB Jr: Fractures of the neck of the talus: Long-term evaluation of seventy-one cases. J Bone Joint Surg Am 1978;60:143-156.

 

  • 00.102 A 21-year-old patient with cerebral palsy and lower extremity spasticity has a
  • painful bunion deformity. Shoe wear modification has failed to provide relief.
  • A standing AP radiograph of the foot shows a large bunion deformity with an
  • intermetatarsal 1-2 angle of 14° and a hallux valgus angle of 30°. Surgical
  • treatment of the hallux should consist of a
  • 1- metatarsophalangeal arthrodesis.
  • 2- metatarsophalangeal resection arthroplasty.
  • 3- distal chevron bunionectomy.
  • 4- first metatarsal-tarsal fusion with distal soft-tissue realignment.
  • 5- simple bunionectomy with an Akin osteotomy of the proximal phalanx.

 

  • Question 00.102
  • Answer = 1
  • Reference(s)
  • Kelikian AS: Hallux valgus and metatarsus primus varus, in Kelikian AS (ed): Operative Treatment of the Foot and Ankle. Stamford, CT, Appleton and Lang, 1999, pp 61-93. Lutter LD, Mizel MS, Pfeffer GB (eds): Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 141-162.

 

  • 00.103 The preferred surgical approach to the injury shown in the radiographs in
  • Figures 25a and 25b and the CT scans in Figures 25c and 25d is between the
  • 1- pes anserinus and the medial patellar retinaculum.
  • 2- pes anserinus and the medial gastrocnemius.
  • 3- biceps femoris and the iliotibial band.
  • 4- lateral head of the gastrocnemius and the biceps femoris.
  • S- medial head of the gastrocnemius and the soleus.
  • Go to next slide for remaining figures and answer link
  • Figures 25
  • A
  • B

 

  • answer
  • back to question
  • C
  • D
  • Figures 25

 

  • Question 00.103
  • Answer = 2
  • Reference(s)
  • De Boeck H, Opdecam P: Posteromedial tibial plateau fractures: Operative treatment by posterior approach. Clin Orthop 1995;320:125-128. Geordiadis GM: Combined anterior and posterior approaches for complex tibial plateau fractures. J Bone Joint Surg Br 1994;76:285-289.

 

  • 00.104 Maximum rigidity of the fracture shown in Figure 26 is best achieved with
  • 1- dorsal plating.
  • 2- tension band wiring.
  • 3- intramedullary Kirschner wires.
  • 4- multiple crossed Kirschner wires.
  • 5- interfragmentary lag screws.
  • Figure 26

 

  • Question 00.104
  • Answer = 5
  • Reference(s)
  • Black DM, Mann RJ, Constine RM, Daniels AV: The stability of internal fixation in the proximal phalanx. J Hand Surg Am 1986;11:672-677.

 

  • 00.105 A 32-year-old man sustained an injury to the left ankle in a fall while playing
  • softball. Examination reveals moderate swelling about the ankle, tenderness at
  • the medial and lateral malleoli, and normal sensibility. A mortise view is shown
  • in Figure 27. The most reliable radiographic indicator of syndesmotic disruption
  • in this patient is the presence of
  • 1- a medial malleolar fracture.
  • 2- lateral translation of the talus beneath the tibia.
  • 3- a fibular fracture that is more than 4 cm above
  • the ankle joint.
  • 4- increased tibiofibular clear space.
  • 5- increased medial clear space.
  • Figure 27

 

  • Question 00.105
  • Answer = 4
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 191-209. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 597-612.

 

  • 00.106 Figure 28 shows the AP radiograph of a 65-year-old woman who has mild
  • shoulder pain and anemia. History reveals no significant illnesses or injuries.
  • What is the next step in evaluation?
  • 1- MRI scan
  • 2- Serum protein electrophoresis
  • 3- Serum alkaline phosphatase studies
  • 4- Open biopsy
  • 5- Needle biopsy
  • Figure 28

 

  • Question 00.106
  • Answer = 2
  • Reference(s)
  • Unni KK: Dahlin's Bone Tumors, ed 5. Philadelphia, PA, Lippincott-Raven, 1996, pp 225-236. George ED, Sadovsky R: Multiple myeloma: Recognition and management. Am Fam Physician 1999;59:1885-1894.

 

  • 00.107 Figure 29 shows the radiograph of a 40-year-old woman who has had severe
  • pain and limited motion in her nondominant shoulder for the past 3 months. She
  • is no longer able to perform her personal care without pain. History is
  • significant for type I diabetes mellitus, hypertension, and bronchial asthma.
  • What is the most likely diagnosis?
  • 1- Adhesive capsulitis
  • 2- Calcific tendinitis
  • 3- Acute impingement syndrome
  • 4- Rotator cuff tear
  • 5- Gouty arthritis
  • Figure 29

 

  • Question 00.107
  • Answer = 1
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 255-263. Zuckerman JD, Cuomo F, Rokito S: Definition and classification of frozen shoulder: A consensus approach. J Shoulder Elbow Surg 1994;3:572.

 

  • 00.108 Which of the following hamstring muscles has dual innervation?
  • 1- Semimembranosus
  • 2- Semitendinosus
  • 3- Sartorius
  • 4- Biceps femoris
  • 5- Gracilis

 

  • Question 00.108
  • Answer = 4
  • Reference(s)
  • Clanton TO, Coupe KJ: Hamstring strains in athletes: Diagnosis and treatment. J Am Acad Orthop Surg 1998;6:237-248. Hollinshead WH: Anatomy for Surgeons, ed 2. New York, NY, Harper & Row, 1969, pp 635-751.

 

  • 00.109 Which of the following is considered the most significant indication for
  • surgery when evaluating an adult with scoliosis?
  • 1- Double major curve pattern
  • 2- Evidence of crankshaft phenomenon
  • 3- Progression of the deformity
  • 4- Thoracolumbar curve pattern
  • 5- Association with spondylolisthesis

 

  • Question 00.109
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 707-712.

 

  • 00.110 A 25-year-old man sustained closed injuries to his arm in a motor vehicle accident.
  • Radiographs of the elbow and forearm are shown in Figures 30a through 30c. Exploration
  • of the radial head shows it to be too comminuted to repair. Management should consist of
  • 1- ulnohumeral pin fixation.
  • 2- radial head resection.
  • 3- silicone radial head replacement.
  • 4- Vitallium radial head replacement.
  • 5- application of a hinged elbow
  • distracter.
  • C
  • Figures 30
  • A
  • B

 

  • Question 00.110
  • Answer = 4
  • Reference(s)
  • Knight DJ, Rymaszewski LA, An-is AA, Miller JH: Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 1993;75:572- 576. Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS: Reconstructive strategies for radioulnar dissociation: A biomechanical study. J Orthop Trauma 1995;9:516- 522.

 

  • 00.111 Which of the following bone tumors is typically multifocal and involves bones
  • in the same extremity?
  • 1- Osteoblastoma
  • 2- Osteosarcoma
  • 3- Chondrosarcoma
  • 4- Chondroblastoma
  • 5- Hemangioendothelioma

 

  • Question 00.111
  • Answer = 5
  • Reference(s)
  • Dorfman HD, Czemiak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 369- 370. McCarthy EF, Frassica FJ: Pathology of Bone and Joint Disorders. Philadelphia, PA, WB Saunders, 1998, p 267.

 

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

 

  • 00.113 Which of the following structures is the principal vascular supply to the
  • articular segment of the Numeral head?
  • 1- Ascending branch of the anterior Numeral circumflex artery
  • 2- Posterior Numeral circumflex artery
  • 3- Subscapular artery
  • 4- Anastomotic vessels of the rotator cuff
  • 5- Medial Numeral capsular vessels

 

  • Question 00.113
  • Answer = 1
  • Reference(s)
  • Gerber C, Schneeberger AG, Vinh TS: The arterial vascularization of the humeral head: An anatomical study. J Bone Joint Surg Am 1990;72:1486-1494. Green A, Norris TR: Proximal humerus fractures and glenohumeral dislocations: Part I. Essential principles, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 1549-1570.

 

  • 00.114 What is the most common cause of death in patients with multiple injuries
  • who survive the first week after injury?
  • 1- Unstabilized long bone fractures
  • 2- Intracranial injury
  • 3- Disseminated intravascular coagulopathy
  • 4- Sepsis and multiple organ failure
  • 5- Cardiovascular collapse

 

  • Question 00.114
  • Answer = 4
  • Reference(s)
  • Pape HC, Remmers D, Kleemann W, Goris JA, Regel G, Tscheme H: Posttraumatic multiple organ failure: A report on clinical and autopsy findings. Shock 1994;2:228-234. Swiontkowski MF: The multiply injured patient with musculoskeletal injuries, in Rockwood CA, Green DP, Bucholz RW, et al (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, pp 121-157.

 

  • 00.115 The white oxidation bands observed in polyethylene components are
  • associated with which of the following sterilization techniques?
  • 1- Autoclaving
  • 2- Electron beam irradiation in nitrogen
  • 3- Gamma irradiation in air
  • 4- Ethylene oxide sterilization
  • 5- Gas plasma sterilization

 

  • Question 00.115
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 47-53. Bell CJ, Walker PS, Abeysundera MR, Simmons JM, King PM, Blunn GW: Effect of oxidation on delamination of ultrahigh-molecular-weight polyethylene tibial components. J Arthroplasty 1998;13:280-290. Sutula LC, Collier JP, Saum KA, et al: The Otto Aufranc Award: Impact of gamma sterilization on clinical performance of polyethylene in the hip. Clin Orthop 1995;319:28-40.

 

  • 00.116 Figures 31a and 31b show the plain AP and lateral radiographs of a 28-year-old
  • man who sustained a closed injury to his back in a fall from a roof. His
  • neurologic examination is normal. What is the most likely diagnosis for the
  • injury at L3?
  • 1- Burst fracture 4- Lumberjack (hyperextension) fracture
  • 2- Compression fracture 5- Traumatic spondylolisthesis
  • 3- Chance (flexion-distraction) fracture
  • Figures 31
  • A
  • B

 

  • Question 00.116
  • Answer = 1
  • Reference(s)
  • Ferguson RL, Allen BL Jr: A mechanistic classification of thoracolumbar spine fractures. Clin Orthop 1984;189:77-88. Scheffer MM, Currier BL: Thoracolumbar burst fractures, in Levine AM, Eisrnont FJ, Garfin SR, et al (eds): Spine Trauma. Philadelphia, PA, WB Saunders, 1998, pp 428-451. Denis F: The three-column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983;8:817-831.

 

  • 00.117 Adaptation of muscle fibers is directed through the influence of
  • 1- cardiovascular conditioning.
  • 2- endocrine pathways.
  • 3- neuromuscular facilitation.
  • 4- nutrition.
  • 5- heredity.

 

  • Question 00.117
  • Answer = 3
  • Reference(s)
  • Komi PV (ed): Strength and Power in Sports. Oxford, England, Blackwell Scientific, 1992, p 384. McArdle WD, Katch FI, Katch VL: Exercise Physiology, ed 2. Philadelphia, PA, Lea and Fabiger, 1986, pp 385-386.

 

  • 00.118 An MRI scan accurately diagnoses a grade III posterior cruciate injury in
  • what percent of patients?
  • 1- 10%
  • 2- 25%
  • 3- 50%
  • 4- 75%
  • 5- Greater than 90%

 

  • Question 00.118
  • Answer = 5
  • Reference(s)
  • Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD: Accuracy of diagnoses from magnetic resonance imaging of the knee: A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991;73:2-10. Hamer CD, Hoher J: Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998;26:471-482.

 

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

 

  • 00.120 Figure 33 shows the AP radiograph of the femur of an asymptomatic 14-year-
  • old patient. What is the
  • most likely diagnosis?
  • 1- Ollier's disease
  • 2- Paget's disease
  • 3- Fracture malunion
  • 4- Residual proximal femoral focal deficiency
  • 5- Fibrous dysplasia
  • Figure 33

 

  • Question 00.120
  • Answer = 5
  • Reference(s)
  • Unni KK: Dahlin's Bone Tumors, ed 5. Philadelphia, PA, Lippincott-Raven, 1996, pp 355-433.

 

  • 00.121 What structure is considered most at risk for injury during insertion of an
  • arthroscope into the ankle using the anterolateral portal?
  • 1- Peroneus tertius tendon
  • 2- Dorsalis pedis artery
  • 3- Saphenous nerve
  • 4- A branch of the superficial peroneal nerve
  • 5- A branch of the deep peroneal nerve

 

  • Question 00.121
  • Answer = 4
  • Reference(s)
  • Voto SJ, Ewing JW, Fleissner PR Jr, Alfonso M, Kufel M: Ankle arthroscopy: Neurovascular and arthroscopic anatomy of standard and trans-Achilles tendon portal placement. Arthroscopy 1989;5:41-46.

 

  • 00.122 Use of a retrograde femoral nail is best indicated for which of the following
  • injuries?
  • 1- An isolated femoral shaft fracture from a low-velocity gunshot
  • 2- A subtrochanteric femoral fracture
  • 3- A femoral shaft fracture with an associated unstable spinal injury
  • 4- A femoral shaft fracture with a contaminated open knee wound
  • 5- A femoral shaft fracture with a prior meniscectomy

 

  • Question 00.122
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 493-504. Moed BR, Watson, JAAOS: Review Article, July, 1999.

 

  • 00.123 The effectiveness of pamidronate in patients with metastatic bone cancer is
  • most likely the result of which of the following mechanisms?
  • 1- Stimulates osteoblasts
  • 2- Inhibits osteoclasts
  • 3- Inhibits neovascularization
  • 4- Binds to osteoid receptors
  • 5- Causes tumor cell necrosis

 

  • Question 00.123
  • Answer = 2
  • Reference(s)
  • Hortobagyi GN, Theriault RL, Porter L, et al: Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases: Protocol 19 Aredia Breast Cancer Study Group. N Eng J Med 1996;335:1785-1791.

 

  • 00.124 A 10-year-old boy sustains a Salter-Harris type II fracture of the proximal
  • humeral epiphysis. Examination reveals that the epiphysis is translated 50% and
  • angulated to 35° of varus. Management should consist of
  • 1- immobilization with a sling.
  • 2- a shoulder spica cast in flexion and abduction.
  • 3- closed reduction and percutaneous pin fixation.
  • 4- open reduction and internal fixation with flexible intramedullary nails.
  • 5- open reduction and plate fixation.

 

  • Question 00.124
  • Answer = 1
  • Reference(s)
  • Baxter MP, Wiley JJ: Fractures of the proximal humeral epiphysis: Their influence on humeral growth. J Bone Joint Surg Br 1986;68:570-573.

 

  • 00.125 Following surgical release of a complete posterior interosseous nerve palsy at
  • the arcade of Froshe, what muscle will most likely be first to be reinnervated or
  • show return of function?
  • 1- Supinator
  • 2- Extensor carpi ulnaris
  • 3- Extensor carpi radialis brevis
  • 4- Extensor digitorum communis
  • 5- Extensor pollicis longus

 

  • Question 00.125
  • Answer = 4
  • Reference(s)
  • Dawson DM, Hallet M, Millender LH: Entrapment Neuropathies, ed 2. Boston, MD, Little, Brown & Co, 1990, pp 199-231. Eaton CJ, Lister GD: Radial nerve compression. Hand Clin 1992;8:345-357.

 

  • 00.126 Which of the following factors is considered a major contributor to the
  • development of osteolysis about uncemented acetabular components?
  • 1- Titanium acetabular shell
  • 2- Cobalt-chromium acetabular shell
  • 3- Hydroxyapatite-coated acetabular shell
  • 4- Polyethylene thickness
  • 5- Geometric design of the porous surface

 

  • Question 00.126
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Jasty M, Goetz DD, Bragdon CR, et al: Wear of polyethylene acetabular components in total hip arthroplasty: An analysis of one hundred and twenty-eight components retrieved at autopsy or revision operations. J Bone Joint Surg Am 1997;79:349-358.

 

  • 00.127 Bending forces in the long bones most commonly result in what type of
  • fracture pattern?
  • 1- Short oblique
  • 2- Transverse with butterfly
  • 3- Linear shear of 45°
  • 4- Spiral
  • 5- Segmental

 

  • Question 00.127
  • Answer = 2
  • Reference(s)
  • Martin RB, Burr DB, Sharkey NA (eds): Skeletal Tissue Mechanics. New York, NY, Springer-Verlag, 1998, pp 127-180. Rockwood CA, Green DP, Bucholz RW, et al: Principles of fractures and dislocations, in Rockwood CA, Green DP, Bucholz RW, et al (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, pp 3-120.

 

  • 00.128 What percent of patients will report spontaneous resolution of acute low back
  • pain within 1 month?
  • 1- 15%
  • 2- 25%
  • 3- 50%
  • 4- 90%
  • 5- 99%

 

  • Question 00.128
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL,, American Academy of Orthopaedic Surgeons, 1999, pp 685-698.

 

  • 00.129 A 24-year-old woman who gave birth to her first child 1 month ago now reports
  • back pain. Standing radiographs reveal a 2-cm pubic diastasis. Management
  • should consist of
  • 1- symphyseal plating.
  • 2- symphyseal plating and sacroiliac joint screw fixation.
  • 3- bed rest for 3 months.
  • 4- pelvic external fixation.
  • 5- a pelvic binder.

 

  • Question 00.129
  • Answer = 5
  • Reference(s)
  • Rommens PM: Internal fixation in postpartum symphysis pubis rupture: Report of three cases. J Orthop Trauma 1997;11:273-276. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 427-439.

 

  • 00.130 A 20-year-old ballerina reports pain along the posterior medial ankle.
  • Examination reveals tenderness along the posterior medial ankle and increased
  • pain with plantar flexion of the toes against resistance. The remainder of the
  • foot examination and radiographs of the foot are normal. What is the most
  • likely cause of her pain?
  • 1- Medial ankle instability
  • 2- Tenosynovitis of the flexor hallucis longus tendon
  • 3- Tarsal tunnel syndrome
  • 4- Occult fracture of the posterior process of the talus
  • 5- Longitudinal tear of the posterior tibial tendon

 

  • Question 00.130
  • Answer = 2
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998. pp 39-54. Hamilton WG, Geppert MJ, Thompson FM: Pain in the posterior aspect of the ankle in dancers: Differential diagnosis and operative treatment. J Bone Joint Surg Am 1996;78:1491-1500.

 

  • 00.131 Which of the following conditions is most commonly associated with the foot
  • deformity shown in Figure 34?
  • 1- Streeter congenital constriction band syndrome
  • 2- Marfan syndrome
  • 3- Proteus syndrome
  • 4- Beckwith-Wiedemann syndrome
  • 5- Nail-patella syndrome (onycho-osteodysplasia)
  • Figure 34

 

  • Question 00.131
  • Answer = 3
  • Reference(s)
  • Stricker SJ: Musculoskeletal manifestations of Proteus syndrome. J Pediatr Orthop 1992;12:544-546. Demetriades D, Hager J, Nikolaides N, Malamitsi-Puchner A, Bartsocas CS: Proteus syndrome: Musculoskeletal manifestations and management. A report of two cases. J Pediatr Orthop 1992;12:106-113.

 

  • 00.132 A 50-year-old man sustained numerous injuries in a motor vehicle accident 1
  • week ago, including a four-part fracture-dislocation of the proximal humerus.
  • Radiographs obtained at the time of injury showed that the humeral head was
  • severely displaced. Because of the patient's overall medical status, surgery was
  • postponed for 1 week. The patient is now stable, and treatment should consist
  • of
  • 1- shoulder arthrodesis.
  • 2- total shoulder replacement.
  • 3- Numeral head replacement.
  • 4- open reduction and internal fixation.
  • 5- resection arthroplasty.

 

  • Question 00.132
  • Answer = 3
  • Reference(s)
  • Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD: Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. J Shoulder Elbow Surg 1995;4:81-86. Norris TR, Green A, McGuigan FX: Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures. J Shoulder Elbow Surg 1995;4:271-280.

 

  • 00.133 The mother of a 2-year-old boy reports that he has been walking with a limp on
  • the left lower extremity for the past 36 hours. She denies any history of trauma
  • or fever, but states that he had an upper respiratory infection 10 days before the
  • limp began. He currently has a temperature of 99.0°F (37.2°C). Examination
  • reveals no tenderness in the spine and pelvis, and the child allows passive hip
  • motion with mild guarding on the left side. Laboratory studies show an
  • erythrocyte sedimentation rate of 12 mm/h (normal up to 20 mm/h) and a
  • peripheral leukocyte count of 9,900/mm3 (normal 4,500 to 11,OOO/mm3).
  • Radiographs of the hips and pelvis are normal. An ultrasound of the left hip
  • shows a small effusion. Based on these findings, the patient should now undergo
  • 1- observation, followed by a repeat examination in 24 hours.
  • 2- a technetium Tc 99m triple-phase bone scan.
  • 3- a gallium scan.
  • 4- an MRI scan of the left hip with gadolinium enhancement. '
  • 5- arthrocentesis of the left hip.

 

  • Question 00.133
  • Answer = l
  • Reference(s)
  • Del Beccaro MA, Champoux AN, Bockers T, Mendelman PM: Septic arthritis versus transient synovitis of the hip: The value of screening laboratory tests. Ann Emerg Med 1992;21:1418-1422. Futami T, Kasahara Y, Suzuki S, Ushikubo S, Tsuchiya T: Ultrasonography in transient synovitis and early Perthes' disease. J Bone Joint Surg Br 1991;73:635-639.

 

  • 00.134 What component of cartilage is primarily responsible for retaining fluid in the
  • matrix?
  • 1- Chondrocytes
  • 2- Proteoglycans
  • 3- Collagen
  • 4- Noncollagenous proteins
  • 5- Calcium

 

  • Question 00.134
  • Answer = 2
  • Reference(s)
  • Heinegard D, Oldberg A: Structure and biology of cartilage and bone matrix noncollagenous macromolecules. FASEB J 1989;3:2042-2051. Oldberg A, Antonsson P, Hedborn E, Heinegard D: Structure and function of extracellular matrix proteoglycans. Biochem Soc Trans 1990;18:789-792.

 

  • 00.135 Which of the following is considered a risk factor for osteoporosis?
  • 1- Obesity
  • 2- Mediterranean heredity
  • 3- Fair skin and hair
  • 4- A history of manual labor
  • 5- Late-onset menopause

 

  • Question 00.135
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Riggs BL, Melton LJ III: The prevention and treatment of osteoporosis. N Engl J Med 1992;327:620-627.

 

  • 00.136 Which of the following is considered the earliest electrodiagnostic finding that
  • can help differentiate axonotmesis from neurapraxia following a peripheral
  • nerve injury?
  • 1- A conduction block across the site of injury
  • 2- The appearance of fibrillation potentials in muscles innervated distal to the level
  • of injury
  • 3- The appearance of positive sharp waves in muscles innervated distal to the level
  • of injury
  • 4- Slowing of the conduction velocity distal to the injury
  • 5- Abnormal distal motor recruitment

 

  • Question 00.136
  • Answer = 4
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 327-396. Dumitri D: Electrodiagnostic Medicine. Philadelphia, PA, Hanley & Belfus Inc/Mosby, 1995, pp 341-384.

 

  • 00.137 Figures 35a and 35b show the plain radiograph and CT scan of a 10-year-old girl who has
  • had pain and deformity in the left wrist for the past year. Management should consist of
  • 1- mid-diaphyseal ulnar shortening.
  • 2- distal ulnar physeal arrest.
  • 3- distal radial osteotomy and ulnar physeal arrest with
  • ulnar shortening.
  • 4- physiolysis (tether excision) of the distal radius.
  • 5- splinting and observation, followed by surgery 2 years
  • after the onset of
  • menarche.
  • Figures 35
  • A
  • B

 

  • Question 00.137
  • Answer = 4
  • Reference(s)
  • Vickers DW: Epiphysiolysis. Curr Orthopaedics 1989;3:41-47. Vickers DW, Nielson G: Madelung deformity: Surgical prophylaxis (physiolysis) during the late growth period by resection of the dyschondrosteosis lesion. J Hand Surg Br 1992;17:401-407.

 

  • 00.138 Which of the following is considered an absolute indication for emergency
  • spinal surgery in a patient with a thoracolumbar fracture?
  • 1- Concomitant fractures that involve multiple extremities
  • 2- Absence of bowel and bladder function
  • 3- Progression of neurologic deficit with documented spinal canal compression
  • 4- Posterior ligamentous instability as shown on an MRI scan and a palpable
  • interspinous gap on physical examination
  • 5- Neurogenic shock

 

  • Question 00.138
  • Answer = 3
  • Reference(s)
  • Kostuik JP, Huler RJ, Esses SI, et al: Thoracolumbar spine fracture, in Frymoyer JW (ed): The Adult Spine: Principles and Practice. New York, NY, Raven Press, 1991, pp 1269-1329.

 

  • 00.139 A 12-year-old girl has a right thoracic scoliosis of 29°. Like her mother, she is
  • tall and slender and has arachnodactyly. Examination reveals a prominent
  • pectus carinatum, generalized joint laxity, and right ectopia lends. The patient's
  • general condition is most likely the result of
  • 1- an autosomal-dominant defect of the FBN1 gene on chromosome 15 that encodes
  • for glycoprotein fibrillin.
  • 2- an autosomal-dominant defect in the COL1A1 gene.
  • 3- an autosomal-recessive deficiency in cystathionine.
  • 4- an autosomal-recessive defect in type II collagen.
  • 5- a sex-linked recessive defect on chromosome 23.

 

  • Question 00.139
  • Answer = 1
  • Reference(s)
  • Dietz HC, Pyeritz RE, Hall BD, et al: The Marfan syndrome locus: Confirmation of assignment to chromosome 15 and identification of tightly linked markers at 15qI5-q21.3. Genonucs 1991;9:355-361. Dietz HC, Cutting GR, Pyeritz RE, et al: Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 1991;352:337-339. Dietz FR, Mathews KD: Update on the genetic bases of disorders with orthopaedic manifestations. J Bone Joint Sur- Am 1996;78:1583-1598.

 

  • 00.140 Which of the following objective abnormalities in gait is greater in patients
  • with a significant difference (greater than 6 cm) in limb lengths?
  • 1- Mechanical work by the short limb
  • 2- Stance time on the short limb
  • 3- Step length on the short side
  • 4- Vertical ground-reaction force on the long limb
  • 5- Walking velocity

 

  • Question 00.140
  • Answer = 4
  • Reference(s)
  • Bhave A, Paley D, Herzenberg JE: Improvement in gait parameters after lengthening for the treatment of limb-length discrepancy. J Bone Joint Surg Am 1999;81:529-534.

 

  • 00.141 A patient who underwent a total knee replacement sustains a nondisplaced
  • transverse periprosthetic patella fracture in a fall. Radiographs reveal that the
  • patellar component appears stable. Management should consist of
  • 1- immediate range-of-motion exercises.
  • 2- immobilization of the knee in extension.
  • 3- open reduction and internal fixation of the fracture.
  • 4- excision of the inferior pole fragment.
  • 5- patellectomy.

 

  • Question 00.141
  • Answer = 2
  • Reference(s)
  • Engh GA, Ammeen DJ: Periprosthetic fractures adjacent to total knee implants: Treatment and clinical results. Instr Course Lect 1998;47:437-448. Rorabeck CH, Angliss RD, Lewis PL: Fractures of the femur, tibia, and patella after total knee arthroplasty: Decision making and principles of management. Instr Course Lect 1998:47:449-458.

 

  • 00.142 A 65-year-old patient reports shoulder discomfort after sustaining an injury in a
  • fall 6 weeks ago. Radiographs obtained at the time of the initial injury were
  • reported as normal. History reveals a record of ethanol abuse. Examination
  • reveals limited active and passive external rotation with the arm held at the
  • patient's side. The best course of action should be to
  • 1- apply a shoulder immobilizer and reexamination in 7 to 10 days.
  • 2- administer a subacromial lidocaine injection.
  • 3- obtain an arthrogram.
  • 4- obtain AP and axillary radiographs of the glenohumeral joint.
  • 5- begin physical therapy.

 

  • Question 00.142
  • Answer = 4
  • Reference(s)
  • Hawkins RJ, Neer CS II, Pianta RM, Mendoza FX: Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 1987;69:9-18. Neer CS, Rockwood CA: Fractures and dislocations of the shoulder, in Rockwood CA Jr, Green DP (eds): Rockwood and Green's Fractures in Adults, ed 2. Philadelphia, PA, JB Lippincott, 1984, vol 1, pp 675-985.

 

  • 00.143 A 76-year-old woman has had generalized muscle weakness and arthralgias for
  • the past 2 years. Radiographs show generalized osteopenia and a pseudofracture
  • (Looser's zone) in the inferomedial aspect of the femoral neck. Laboratory
  • studies show normal serum calcium and hemoglobin levels and a mildly
  • elevated alkaline phosphatase level. What is the most likely diagnosis?
  • 1- Osteomalacia
  • 2- Osteoporosis
  • 3- Multiple myeloma
  • 4- Leukemia
  • 5- Paget's disease of bone

 

  • Question 00.143
  • Answer = 1
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Mankin HJ: Metabolic bone disease. Instr Course Lect 1995;44:3-29.

 

  • 00.144 A 15-year-old gymnast with bilateral spondylolysis of the fourth lumbar
  • vertebra with no significant forward slip has had pain for the past year.
  • Management consisting of bracing for 3 months, followed by 10 weeks of cast
  • treatment, has failed to provide relief. The pain prevents her from participating
  • in all physical activities and she now seeks further treatment to relieve it.
  • Treatment should consist of
  • 1- posterior fusion of L3 to L4.
  • 2- laminectomy and posterior fusion of L4 to L5.
  • 3- laminectomy and posterior fusion of L4 to the sacrum.
  • 4- anterior fusion of L4 to L5.
  • 5- repair of the L4 pars defect.

 

  • Question 00.144
  • Answer = 5
  • Reference(s)
  • Pedersen AK, Hagen R: Spondylolysis and spondylolisthesis: Treatment by internal fixation and bone grafting of the defect. J Bone Joint Surg Am 1988;70:15-24.

 

  • 00.145 Which of the following is considered the most common perioperative
  • complication after fixation of a T-shaped acetabular fracture through an
  • extensile approach?
  • 1- Sciatic nerve injury
  • 2- Pulmonary embolus
  • 3- Infection
  • 4- Heterotopic ossification
  • 5- Flap necrosis

 

  • Question 00.145
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 427-439. Ghalambor N, Matta JM, Bernstein L: Heterotopic ossification following operative treatment of acetabular fracture: An analysis of risk factors. Clin Orthop 1994;305:96-105.

 

  • 00.146 What finding best indicates that a patient with type I diabetes mellitus has the
  • capacity to heal a plantar foot ulcer?
  • 1- Toe pressures of greater than 40 mm Hg
  • 2- A capillary refill time in the toes of greater than 3 seconds
  • 3- An ankle brachial index of greater than 1
  • 4- An ability to detect a 5.07 Semmes-Weinstein monofilament
  • 5- An absence of vascular calcifications on plain radiographs of the foot

 

  • Question 00.146
  • Answer = 1
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 113-121. Brodsky JW: The diabetic foot, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 877-958.

 

  • 00.147 Articular cartilage lesions that do not penetrate the subchondral bone are
  • unlikely to heal because the
  • 1- cartilage is avascular.
  • 2- cartilage is aneural.
  • 3- chondrocytes stop secreting matrix components in response to trauma.
  • 4- surrounding cartilage effectively unloads the defect.
  • 5- cytokines are unable to penetrate the cartilage.

 

  • Question 00.147
  • Answer = 1
  • Reference(s)
  • Chen FS, Frenkel SR, DiCesare PE: Repair of articular cartilage defects: Part I. Basic science of cartilage healing. Am J Orthop 1999;28:31-33.

 

  • 00.148 The risk of exposure to human immunodeficiency virus (HIV) from a ligament
  • allograft is
  • 1- 1:1,000.
  • 2- 1:10,000.
  • 3- 1:100,000.
  • 4- 1:1,000,000.
  • 5- 1:1,000,000,000.

 

  • Question 00.148
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 533-557. Getelman MH, Friedman MJ: Revision anterior cruciate ligament reconstruction surgery. J Am Acad Orthop Surg 1999;7:189-198.

 

  • 00.149 Which of the following structures is considered most at risk for injury when
  • posterolateral bone grafting is performed for midshaft tibial nonunion?
  • 1- Posterior tibial nerve
  • 2- Sural nerve
  • 3- Superficial peroneal nerve
  • 4- Lesser saphenous vein
  • 5- Branches of the peroneal artery

 

  • Question 00.149
  • Answer = 5
  • Reference(s)
  • Hoppenfeld S, deBoer P: Surgical Exposures in Orthopaedics. Philadelphia, PA, JB Lippincott, 1984, pp 448-450.

 

  • 00.150 What type of chondrosarcoma has the lowest 5-year disease-free survival rate?
  • 1- Chondrosarcoma developing in an osteochondroma
  • 2- Chondrosarcoma developing in Ollier's disease
  • 3- Intermediate grade (grade II)
  • 4- Mesenchymal
  • 5- Clear cell

 

  • Question 00.150
  • Answer = 4
  • Reference(s)
  • Dorfman HD, Czerniak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 421- 435. Nakashima Y, Unni KK, Shives TC, Swee RG, Dahlin DC: Mesenchymal chondrosarcoma of bone and soft tissue: A review of 111 cases. Cancer 1986;57:2444-2453.

 

  • 00.151 A 25-year-old man with multiple injuries has an injury severity score of 40.
  • His risk of mortality from his injuries is
  • 1- 0%.
  • 2- 20%.
  • 3- 50%.
  • 4- 80%.
  • 5- 100%.

 

  • Question 00.151
  • Answer = 3
  • Reference(s)
  • Baker SP, O'Neill B, Haddon W Jr, Long WB: The injury severity score: A method for describing patients with multiple injuries and evaluating emergency cases. J Trauma 1974;14:187-196. Swiontkowski M: The multiply injured patient with musculoskeletal injuries, in Rockwood CA, Green DP, Bucholz RW, et al (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, pp 121-158.

 

  • 00.152 Which of the following properties is most commonly associated with titanium
  • alloy implants when compared with cobalt-chromium alloys?
  • 1- Lower elastic modulus
  • 2- Lower corrosive resistance
  • 3- Better wear characteristics
  • 4- Lower notch sensitivity
  • 5- Greater hardness

 

  • Question 00.152
  • Answer = 1
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 447-486. Buckwalter JA, Einhom TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 182-215.

 

  • 00.153 Which of the following is considered the most common cause of persistent
  • symptoms following surgery for carpal tunnel syndrome?
  • 1- Error in preoperative diagnosis
  • 2- Double crush phenomenon
  • 3- Incomplete release of the median nerve at the wrist
  • 4- Permanent injury to the median nerve
  • 5- Secondary compression as the result of postoperative scarring

 

  • Question 00.153
  • Answer = 3
  • Reference(s)
  • Cobb TK, Amadio PC, Leatherwood DF, Schleck CD, Ilstrup DM: Outcome of reoperation for carpal tunnel syndrome. J Hand Surg Am 1996;21:347-356.

 

  • 00.154 Examination of a 50-year-old man with atraumatic shoulder pain and a 1-cm
  • tear of the supraspinatus tendon will most likely reveal
  • 1- decreased active forward elevation.
  • 2- weakness with external rotation.
  • 3- weakness with forward elevation.
  • 4- ain with external rotation stretching.
  • 5- pain with maximum passive elevation.

 

  • Question 00.154
  • Answer = 5
  • Reference(s)
  • Matsen FA III, Arntz CT, Lippitt SB: Rotator cuff, in Rockwood CA Jr, Matsen SA III, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 755-839.

 

  • 00.155 The use of injectable calcium phosphate cement for stabilizing metaphyseal
  • fractures may have which of the following potential biological disadvantages
  • compared with allograft bone?
  • 1- A necrotizing exothermic curing reaction
  • 2- Lack of osteoconductivity
  • 3- Slower replacement by normal trabecular bone
  • 4- Larger pore size
  • 5- Greater immunogenicity

 

  • Question 00.155
  • Answer = 3
  • Reference(s)
  • Frankenburg EP, Goldstein SA, Bauer TW, Harris SA, Poser RD: Biomechanical and histological evaluation of a calcium phosphate cement. J Bone Joint Surg Am 1998;80:1112-1124.

 

  • 00.156 A 20-year-old man sustains a closed posterior dislocation of the right elbow in a
  • fall from the roof. Management consists of reduction in the emergency
  • department within 20 minutes of the injury. Postreduction radiographs show no
  • fractures, and examination reveals that the elbow is stable. A posterior splint is
  • applied. Based on these findings, immobilization in the splint should be
  • continued for what period of time?
  • 1- 1 week
  • 2- 3 weeks
  • 3- 6 weeks
  • 4- 2 months
  • 5- 4 months

 

  • Question 00.156
  • Answer = 1
  • Reference(s)
  • Melhoff TL, Noble PC, Bennett JB, Tullos HS: Simple dislocation of the elbow in the adult: Results after closed treatment. J Bone Joint Surg Am 1988;70:244-249. Linscheid RL, O'Driscoll SW: Elbow dislocations, in Morrey BF (ed): The Elbow and Its Disorders. Philadelphia, PA, WB Saunders, 1993, pp 441-452.

 

  • 00.157 The risk of refracture is highest after which of the following methods of
  • treatment of femoral shaft fractures in children?
  • 1- Flexible intramedullary nailing
  • 2- External fixation
  • 3- Pontoon casting
  • 4- Immediate spica casting
  • 5- Traction and spica casting

 

  • Question 00.157
  • Answer = 2
  • Reference(s)
  • Green WB: Displaced fractures of the femoral shaft in children: Unique factors and therapeutic options. Clin Orthop 1998;353:86-96. Gregory P, Pevny T, Teague D: Early complications with external fixation of pediatric femoral shaft fractures. J Orthop Trauma 1996;10:191-198.

 

  • 00.158 Impairment is best defined as
  • 1- the effects of a disease on function.
  • 2- the psychosocial factors associated with an injury.
  • 3- the loss of a physiologic or anatomic structure or function.
  • 4- the extent of pain or suffering related to an injury.
  • 5- a pathologic condition of a body part.

 

  • Question 00.158
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 131-137.

 

  • 00.159 A 21-year-old marathon runner who is 5' 2" tall and weighs 95 lb reports the
  • onset of left leg pain when she increased her training program 2 months prior to
  • an event. History reveals that her last menstrual period was 18 months ago.
  • Bone density of the spine tested by DEXA is 1.8 standard deviations below the
  • mean for age. A bone scan is normal. Management should include
  • 1- cessation of running and 10 mg of alendronate per day.
  • 2- nutritional counseling and a stretching program.
  • 3- an ultrasound of the heel and 500 mg of calcium per day.
  • 4- calcitonin, a short leg cast, and multivitamins.
  • 5- evaluation of the amenorrhea, achievement of nutritional balance, and cross-
  • training.

 

  • Question 00.159
  • Answer = 5
  • Reference(s)
  • Arendt EA (ed): Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 43-47.

 

  • 00.160 An 18-year-old man reports a persistent foot drop after sustaining a knee injury
  • 2 years ago. He has been using an ankle-foot orthosis, but electrodiagnostic
  • studies fail to show any evidence of recovery. The patient now requests a more
  • definitive intervention. Treatment should consist of
  • 1- ankle arthrodesis.
  • 2- tenodesis of the anterior tibial tendon.
  • 3- anterior transfer of the Achilles tendon.
  • 4- anterior transfer of the posterior tibial tendon.
  • 5- anterior transfer of the peroneus longus tendon.

 

  • Question 00.160
  • Answer = 4
  • Reference(s)
  • Rodriguez RP: The Bridle procedure in the treatment of paralysis of the foot. Foot Ankle 1992;13:63-69. Santi MD, Botte MJ: Nerve injury and repair in the foot and ankle. Foot Ankle Int 1996;17:425-439.

 

  • 00.161 Which of the following most accurately diagnoses a complete rupture of the
  • anterior cruciate ligament at the time of the initial injury?
  • 1- Knee effusion
  • 2- Lachman test
  • 3- McMurray's test
  • 4- Anterior drawer test
  • 5- Pivot-shift test

 

  • Question 00.161
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, 1L, American Academy of Orthopaedic Surgeons, 1999, pp 533-557. Donaldson WF III, Warren RF, Wickiewicz T: A comparison of acute anterior cruciate ligament examinations: Initial versus examination under anesthesia. Am J Sports Med 1985;13:5-10.

 

  • 00.162 A sensory axon carries its impulse from the periphery to its cell body located in
  • the
  • 1- anterior horn of the spinal cord.
  • 2- dorsal column of the spinal cord.
  • 3- paravertebral ganglia.
  • 4- dorsal root ganglion.
  • 5- brain stem.

 

  • Question 00.162
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 3-23.

 

  • 00.163 Figures 36a through 36c show the radiographs of a 32-year-old woman who
  • sustained an isolated closed injury to the lower extremity in a fall.
  • Management should consist of
  • 1- a long leg cast until union is achieved.
  • 2- immediate application of a functional brace with weight bearing.
  • 3- internal fixation of the tibia and cast immobilization of the ankle.
  • 4- internal fixation of the ankle and functional brace management of the tibia.
  • 5- internal fixation of both the tibia and the ankle.
  • C
  • Figures 36
  • A
  • B

 

  • Question 00.163
  • Answer = 5
  • Reference(s)
  • Lonner JH, Jupiter JB, Healy WL: Ipsilateral tibia and ankle fractures. J Orthop Trauma 1993;7:130-137. Browner BD, Jupiter JB, Trafton P, et al (eds): Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1997, p 1658.

 

  • 00.164 Figure 37 shows the AP radiograph of a 25-year-old woman who has had
  • chronic pain and swelling in the second toe for the past several years. Orthotic
  • management has failed to provide relief.
  • Treatment should now consist of
  • 1- arthrodesis of the metatarsophalangeal joint.
  • 2- Silastic metatarsophalangeal joint replacement.
  • 3- debridement of the joint and metatarsal head.
  • 4- resection of the metatarsal head.
  • 5- dorsiflexion osteotomy of the distal metatarsal.
  • Figure 37

 

  • Question 00.164
  • Answer = 3
  • Reference(s)
  • Mann RA, Coughlin MJ: Keratotic disorders of the plantar skin, in Mann RA. Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 435-441. Mizel MS, Miller RA, Scioli MW: Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 65-78.

 

  • 00.165 Production of which of the following clotting factors is inhibited by warfarin?
  • 1- I
  • 2- VII
  • 3- XI
  • 4- XII
  • 5- XIII

 

  • Question 00.165
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 63-72. Lieberman JR, Wollaeger J, Dorey F, et al: The efficacy of prophylaxis with low-dose warfarin for prevention of pulmonary embolism following total hip arthroplasty. J Bone Joint Surg Am 1997;79:319-325.

 

  • 00.166 Which of the following congenital spinal anomalies will most likely cause a
  • progressive scoliotic deformity?
  • 1- Block vertebrae at L1 to L3
  • 2- Unilateral bar at T7 to T9
  • 3- Completely incarcerated hemivertebra at T12
  • 4- Nonincarcerated hemivertebra at T7
  • 5- Adjacent nonincarcerated hemivertebra (left T6, right T7)

 

  • Question 00.166
  • Answer = 2
  • Reference(s)
  • McMaster MJ, Ohtsuka K: The natural history of congenital scoliosis: A study of two hundred and fifty-one patients. J Bone Joint Surg Am 1982;64:1128-1147.

 

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

 

  • 00.168 During a routine total hip arthroplasty, active bleeding is encountered after a
  • retractor is placed under the transverse acetabular ligament. Which of the
  • following structures has most likely been injured?
  • 1- Inferior gluteal artery
  • 2- Obturator artery
  • 3- Hypogastric artery
  • 4- Femoral artery
  • 5- External iliac vein

 

  • Question 00.168
  • Answer = 2
  • Reference(s)
  • Wasielewski RC, Crossett LS, Rubash HE: Neural and vascular injury in total hip arthroplasty. Orthop Clin North Am 1992;23:219-235.

 

  • 00.169 A 42-year-old man has posttraumatic syringomyelia (cystic myelopathy) that
  • extends into his cervical spinal cord. He reports that he sustained a fracture-
  • dislocation at T7-T8 with paraplegia several years ago. Based on these findings,
  • what is the most important surgical indication?
  • 1- Homer's syndrome
  • 2- Radicular pain
  • 3- Autonomic dysreflexia
  • 4- Increased spasticity
  • 5- Motor loss in the hands

 

  • Question 00.169
  • Answer = 5
  • Reference(s)
  • Madsen PW, Green BA, Bowen BC: Syringomyelia, in Herkowitz HN, Eismont FJ, Garfin SR, et al (eds): Rothman-Simeone The Spine, ed 4. Philadelphia, PA, WB Saunders, 1999, pp 1421-1460. Madsen PW, Falcone S, Bowen BC, et al: Posttraumatic syringomyelia, in Levine AM, Eismont FJ, Garfin SR, et al (eds): Spine Trauma. Philadelphia, PA, WB Saunders, 1998, pp 608-623.

 

  • 00.170 During repair of an unstable fracture, the majority of osteoblasts originate from
  • 1- undifferentiated mesenchymal cells.
  • 2- dedifferentiated muscle cells.
  • 3- endothelial cells.
  • 4- transformed cartilage cells.
  • 5- circulating monocytes.

 

  • Question 00.170
  • Answer = 1
  • Reference(s)
  • Buckwalter JA, Einhom TA, Bolander ME, et al: Healing of the musculoskeletal tissues, in Rockwood CA, Green DP, Bucholz RW, et al (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, pp 261-304.

 

  • 00.171 Normal mineralization of bone is seen in which of the following conditions?
  • 1- Rickets
  • 2- Seizure disorder treated with phenytoin
  • 3- Renal osteodystrophy
  • 4- Fanconi syndrome type II
  • 5- Osteoporosis

 

  • Question 00.171
  • Answer = 5
  • Reference(s)
  • Mankin HJ: Metabolic bone disease. Instr Course Lect 1995;44:3-29. Lenchik L, Sartoris DJ: Orthopedic aspects of metabolic bone disease. Orthop Clin North Am 1998;29:103-134.

 

  • 00.172 A 58-year-old woman sustained a distal radius fracture 8 weeks ago and now
  • returns for removal of the cast. Examination reveals that flexion of the proximal
  • interphalangeal joints is less when the metacarpophalangeal joints are extended
  • rather than flexed. What is the most likely diagnosis?
  • 1- Joint contracture
  • 2- Extrinsic tightness
  • 3- Intrinsic tightness
  • 4- Volkmann contracture
  • 5- Tightness of the oblique retinacular ligament

 

  • Question 00.172
  • Answer = 3
  • Reference(s)
  • Smith RJ: Non-ischemic contractures of the intrinsic muscles of the hand. J Bone Joint Sur- Am 1971;53:1313-1331.

 

  • 00.173 Which of the following bone lesions arises exclusively in the epiphysis or
  • apophysis of the long bones?
  • 1- Giant cell tumor
  • 2- Aneurysmal bone cyst
  • 3- Unicameral bone cyst
  • 4- Fibrous dysplasia
  • 5- Chondroblastoma

 

  • Question 00.173
  • Answer = 5
  • Reference(s)
  • Dorfman HD, Czerniak B: Bone Tumors. St Louis, MO, Mosby, 1998, pp 296- 297. Turcotte RE, Kurt AM, Sim FH, Unni KK, McLeod RA: Chondroblastoma. Hum Pathol 1993;24:944-949.

 

  • 00.174 A 35-year-old woman sustains a comminuted fracture-dislocation of the
  • proximal tibia with a 10-cm posterior wound. After reduction of the dislocation
  • in the emergency department, examination reveals no pulse and an ischemic
  • limb. The patient is obtunded, and a CT scan of the head reveals diffuse edema.
  • Intubation results in aspiration of her stomach contents. Oxygenation is
  • maintained only with the use of 15 mm Hg of positive end-expiratory pressure;
  • a chest radiograph reveals bilateral infiltrates. Treatment of the leg injury at this
  • time should consist of
  • 1- amputation.
  • 2- a spanning external fixator and delayed vascular repair.
  • 3- a temporary vascular shunt and irrigation and debridement with definitive open
  • reduction and internal fixation of the plateau.
  • 4- definitive vascular repair and irrigation and debridement with spanning external
  • fixation of the plateau.
  • 5- definitive vascular repair and irrigation and debridement with open reduction and
  • internal fixation of the plateau.

 

  • Question 00.174
  • Answer = l
  • Reference(s)
  • Helfet DL, Howey T, Sanders R, Johansen K: Limb salvage versus amputation: Preliminary results of the Mangled Extremity Severity Score. Clin Orthop 1990;256:80-86. Tornetta P III, Olson SA: Amputation versus limb salvage. Instr Course Lect 1997;46:511-518.

 

  • 00.175 A 4-year-old child with a history of premature birth has bowing of the femur
  • and a limb length discrepancy, possibly secondary to distal physeal
  • embolization from an umbilical catheter in the newborn nursery. Examination
  • reveals 4 cm of shortening and 20° of varus angulation. A CT scan shows a
  • physeal bar that occupies 60% of the physeal area, with almost all of the medial
  • physis involved. To restore normal proportions to the extremity, treatment
  • should consist of
  • 1- physeal bar resection with fat graft interposition and physeal distraction.
  • 2- physeal bar resection with fat graft interposition and a valgus osteotomy.
  • 3- epiphysiodesis, gradual angular correction and limb lengthening with distraction
  • osteogenesis, and a planned second lengthening.
  • 4- epiphysiodesis, a closing wedge valgus osteotomy, and a planned limb
  • lengthening at puberty.
  • 5- lateral physeal stapling, with a planned limb lengthening at puberty.

 

  • Question 00.175
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 505-520. Aronson J: Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg Am 1997;79:1243-1258.

 

  • 00.176 What is the primary goal when using a total contact cast in the treatment of a
  • plantar foot ulcer in a patient with diabetes mellitus?
  • 1- Prevent weight bearing
  • 2- Prevent the onset of a neuropathic foot
  • 3- Prevent bacterial contamination of the ulcer
  • 4- Decrease pressure and shear stresses around the ulcer
  • 5- Protect the foot from further injury

 

  • Question 00.176
  • Answer = 4
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 113-121. Brodsky JW: The diabetic foot, in Mann RA, Coughlin MJ (eds): Surgery of the foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 877-958.

 

  • 00.177 A 24-year-old man is unable to extend his right knee following a twisting injury
  • while playing tennis. He had a similar injury to the same knee 4 years ago, and
  • the knee has also given way at least four times in the past 12 months. He uses a
  • knee brace while playing sports. Examination reveals a mild effusion and
  • medial joint line tenderness. The knee is locked in 20° of flexion. He has a
  • Lachman test result of grade II, and the pivot-shift test is difficult to elicit
  • because of pain. What is the most likely diagnosis?
  • 1- An acute-on-chronic anterior cruciate ligament injury with a medial collateral
  • ligament tear
  • 2- A chronic anterior cruciate ligament injury with a medial collateral ligament
  • injury
  • 3- A chronic anterior cruciate ligament injury with pseudolocking because of an
  • anterior cruciate ligament stump
  • 4- A chronic anterior cruciate ligament injury with a displaced bucket-handle tear of
  • the medial meniscus
  • 5- A chronic anterior cruciate ligament injury with a flexion contracture because of
  • pain and spasm

 

  • Question 00.177
  • Answer = 4
  • Reference(s)
  • Shelbourne KD, Johnson GE: Locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. Am J Sports Med 1993;21:779-782. Barrack RL, Bruckner JD, Kneisl J, Inman WS, Alexander AH: The outcome of nonoperatively treated complete tears of the anterior cruciate ligament in active young adults. Clin Orthop 1990;259:192-199.

 

  • 00.178 Which of the following is considered the most appropriate statistical test to
  • evaluate a prospective study with continuous variables and three treatment
  • groups?
  • 1- Student's t-test
  • 2- Analysis of variance
  • 3- Linear regression
  • 4- Chi-square
  • 5- Frequency analysis

 

  • Question 00.178
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 625-665.

 

  • 00.179 In automobiles with air bags, injuries to children younger than age 4 years may
  • be best minimized by having the child sit in the
  • 1- front seat in a forward-facing child seat.
  • 2- front seat in a rear-facing child seat.
  • 3- rear seat in a child seat.
  • 4- rear seat with a seat belt.
  • 5- rear seat with a soft cervical collar.

 

  • Question 00.179
  • Answer = 3
  • Reference(s)
  • MCaffrey M, German A, Lalonde F, Letts M: Air bags and children: A potentially lethal combination. J Pediatr Orthop 1999;19:60-64.

 

  • 00.180 A 32-year-old man has right hip pain and a limb-length inequality. History
  • reveals that he sustained a femoral neck fracture 2 years ago that was treated
  • with closed reduction and internal fixation. Radiographs show a femoral neck
  • nonunion with a neck shaft angle of 90°; however, an MRI scan shows no
  • osteonecrosis. Treatment should now consist of
  • 1- total hip arthroplasty.
  • 2- vascularized pedicle graft.
  • 3- valgus osteotomy with internal fixation.
  • 4- bipolar hemiarthroplasty.
  • 5- repeat internal fixation.

 

  • Question 00.180
  • Answer = 3
  • Reference(s)
  • Ballmer FT, Ballmer PM, Baumgaertel F, Ganz R, Mast JW: Pauwels osteotomy for nonunions of the femoral neck. Orthop Clin North Am 1990;21:759-767. Marti RK, Schuller HM, Raaymakers EL: Intertrochanteric osteotomy for non-union of the femoral neck. J Bone Joint Surg Br 1989;71:782-787.

 

  • 00.181 Osteomalacia in patients with renal osteodystrophy is most often the result of
  • 1- bisphosphonate compounds.
  • 2- aluminum-containing phosphate-binding antacids.
  • 3- insufficient sunlight.
  • 4- drug activation of P-450 system in the liver.
  • 5- dietary malabsorption.

 

  • Question 00.181
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Mankin HJ: Metabolic bone disease. Instr Course Lect 1995;44:3-29.

 

  • 00.182 Figure 38 shows the radiograph of a 58-year-old woman who has marked
  • weakness in her dominant arm and is unable to lift it overhead; however, she
  • reports only minimal pain. Examination reveals multiple blisters on the
  • ipsilateral hand. What is the most
  • likely diagnosis?
  • 1- Septic arthritis
  • 2- Gouty arthritis
  • 3- Rheumatoid arthritis
  • 4- Syringomyelia
  • S- Gorham's disease
  • Figure 38

 

  • Question 00.182
  • Answer = 4
  • Reference(s)
  • Rhoades CE, Neff JR, Rengachary SS, et al: Diagnosis of posttraumatic syringohydromyelia presenting as neuropathic joints: Report of two cases and review of the literature. Clin Orthop 1983;180:182-187. Tully JG Jr, Latteri A: Paraplegia, syringomyelia tarda and neuropathic arthrosis of the shoulder: A triad. Clin Orthop 1978;134:244-248.

 

  • 00.183 An 11-year-old boy has an enlarging, slightly tender mass over the proximal
  • phalanx of the third digit. The plain radiograph and a biopsy specimen are
  • shown in Figures 39a and 39b. What is the most likely diagnosis?
  • 1- Giant cell tumor
  • 2- Chondroblastoma
  • 3- Periosteal chondroma
  • 4- Aneurysmal bone cyst
  • 5- Nonossifying fibroma
  • Figures 39
  • A
  • B

 

  • Question 00.183
  • Answer = 3
  • Reference(s)
  • Scarborough MT, Moreau G: Benign cartilage tumors. Orthop Clin North Am 1996;27:583-589 Weiner SD, Iorio CD: Painless deformity of a long finger phalanx of a 4-year-old girl. Clin Orthop 1999;369:357-359, 364-365.

 

  • 00.184 A 30-year-old woman has chronic ankle pain and swelling without any history
  • of trauma. Examination reveals diffuse swelling and soft-tissue fullness along
  • the anterior aspect of the ankle joint. Plain radiographs are normal. An MRI
  • scan shows an effusion of the ankle and a soft-tissue mass arising from the
  • ankle joint that is dark on both T1- and T2weighted images. A needle biopsy
  • specimen is shown in Figure 40. Management should consist of
  • 1- below-knee amputation and chemotherapy.
  • 2- external beam radiation.
  • 3- extra-articular resection
  • and tibiotalar
  • arthrodesis.
  • 4- open synovectomy.
  • 5- triple antibiotic
  • therapy.
  • Figure 40

 

  • Question 00.184
  • Answer = 4
  • Reference(s)
  • Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 11-26. Enzinger FM, Weiss SW: Benign tumors and tumor-like lesions of synovial tissue, in Enzinger FM, Weiss SW eds): Soft Tissue Tumors. St Louis, MO, CV Mosby, 1983, pp 502-518.

 

  • 00.185 Which of the following radiographic findings suggests that a dislocation of the
  • metatarsophalangeal joint of the hallux may not be reduceable with closed
  • methods?
  • 1- Intra-articular displacement of the sesamoids
  • 2- Proximal displacement of the sesamoids
  • 3- Fracture of the medial sesamoid
  • 4- A medial-lateral separation of the sesamoids of greater than 5 mm
  • 5- An avulsion fracture of the adductor hallucis tendon insertion

 

  • Question 00.185
  • Answer = 1
  • Reference(s)
  • Jahss MH: Traumatic dislocations of the first metatarsophalangeal joint. Foot Ankle 1980;1:15-21. Schenck RC Jr, Heckman JD: Fractures and dislocations of the forefoot: Operative and nonoperative treatment. J Am Acad Orthop Surg 1995;3:70-78.

 

  • 00.186 A 1-year-old infant has a subtrochanteric femur fracture. Examination reveals
  • that the infant falls below the fifth percentile for height and weight, although the
  • head circumference is normal. Laboratory studies show low hematocrit and
  • platelet counts and an increased acid phosphatase level. Radiographs show no
  • discernible medullary canal of the femur. What is the most likely diagnosis?
  • 1- Achondroplasia
  • 2- Diastrophic dysplasia
  • 3- Osteogenesis imperfecta
  • 4- Osteopetrosis
  • 5- Mucopolysaccharidosis type I

 

  • Question 00.186
  • Answer = 4
  • Reference(s)
  • Armstrong DG, Newfield JT, Gillespie R: Orthopedic management of osteopetrosis: Results of a survey and review of the literature. J Pediatr Orthop 1999;19:122-132.

 

  • 00.187 Which of the following is considered a potential advantage of using ceramic
  • materials in total hip arthroplasty?
  • 1- High surface roughness
  • 2- High wear resistance
  • 3- Brittle nature
  • 4- Low tensile strength
  • 5- Low cost

 

  • Question 00.187
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 449-486.

 

  • 00.188 Following cervical or upper thoracic spinal cord injury, neurogenic shock is a
  • state of vasodilation that occurs anatomically because of disruption of the
  • 1- ascending sympathetic pathways.
  • 2- ascending parasympathetic pathways.
  • 3- ascending and descending parasympathetic pathways.
  • 4- descending sympathetic pathways.
  • 5- descending parasympathetic pathways.

 

  • Question 00.188
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 653-671.

 

  • 00.189 Which of the following findings is considered a contraindication to soft-tissue
  • release and proximal crescentic osteotomy of the first metatarsal in a patient
  • with a juvenile bunion?
  • 1- A hallux valgus angle of greater than 40°
  • 2- A distal metatarsal articular angle of greater than 15°
  • 3- An intermetatarsal angle of 14°
  • 4- An incongruent metatarsophalangeal joint
  • 5- Hypermobility of the first ray

 

  • Question 00.189
  • Answer = 2
  • Reference(s)
  • Mann RA: Distal soft-tissue procedure and proximal metatarsal osteotomy for correction of hallux valgus deformity. Orthopedics 1990;13:1013-1018. Thordarson DB, Leventen EO: Hallux valgus correction with proximal metatarsal osteotomy: Two-year follow-up. Foot Ankle 1992;13:321-326.

 

  • 00.190 Which of the following is considered the most common complication after open
  • reduction and internal fixation of a closed calcaneus fracture?
  • 1- Compartment syndrome
  • 2- Loss of fixation and fracture displacement
  • 3- Incision breakdown
  • 4- Injury to the tibial nerve
  • 5- Subtalar joint instability

 

  • Question 00.190
  • Answer = 3
  • Reference(s)
  • Abidi NA, Dhawan S, Gruen GS, Vogt MT, Conti SF: Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures. Foot Ankle Int 1998;19:856-861. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 215-227.

 

  • 00.191 What type of loading is most likely to cause a pure spiral fracture?
  • 1- Crush
  • 2- Bending
  • 3- Tensile
  • 4- Compression
  • 5- Torsion

 

  • Question 00.191
  • Answer = 5
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 279-323.

 

  • 00.192 Obstetrical brachial plexus injuries are most frequently associated with which
  • of the following risk factors?
  • 1- Prematurity, first born, and female gender
  • 2- Multiple birth pregnancy, oligohydramnios, and breech presentation
  • 3- Increased birth weight, delivery with instruments, and breech presentation
  • 4- Breech presentation, young maternal age, and preeclampsia
  • 5- Shoulder dystocia, fetal distress, and congenital anomalies of the upper extremity

 

  • Question 00.192
  • Answer = 3
  • Reference(s)
  • Geutjens G, Gilbert A, Helsen K: Obstetric brachial plexus palsy associated with breech delivery: A different pattern of injury. J Bone Joint Surg Br 1996;78:303-306. Waters PM: Obstetric brachial plexus injuries: Evaluation and management. J Am Acad Orthop Surg 1997;5:205-214.

 

  • 00.193 Following repair of zone III and IV extensor tendon lacerations, treatment by
  • immediate restricted active motion compared with postoperative
  • immobilization is most likely to result in a
  • 1- more severe extensor lag.
  • 2- longer treatment period.
  • 3- greater return of motion.
  • 4- higher rate of tendon rupture.
  • 5- lower infection rate.

 

  • Question 00.193
  • Answer = 3
  • Reference(s)
  • Evans RB: Immediate active short arc motion following extensor tendon repair. Hand Clin 1995;11:483-512. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 361-386.

 

  • 00.194 During a revision total hip arthroplasty, insertion of a screw in the anterior
  • superior quadrant results in active, uncontrolled bleeding. Which of the
  • following arteries has most likely been injured?
  • 1- Inferior gluteal
  • 2- Obturator
  • 3- Femoral
  • 4- Internal iliac
  • 5- External iliac

 

  • Question 00.194
  • Answer = 5
  • Reference(s)
  • Wasielewski RC, Crossett LS, Rubash HE: Neural and vascular injury in total hip arthroplasty. Orthop Clin North Am 1992;23:219-235.

 

  • 00.195 An otherwise healthy 37-year-old man has had bilateral posterior heel pain for
  • the past year. Examination reveals fullness, warmth, and tenderness over the
  • posterior aspect of the heels. Radiographs are normal. Laboratory studies show a
  • normal CBC and an erythrocyte sedimentation rate of 50 mm/h (normal up to 20
  • mm/h), and an HLA-B27 is positive. What is the most likely diagnosis?
  • 1- Rheumatoid arthritis
  • 2- Ankylosing spondylitis
  • 3- Lupus erythematosus
  • 4- Reiter syndrome
  • 5- Lyme disease

 

  • Question 00.195
  • Answer = 4
  • Reference(s)
  • Thomas FM, Mann RA: Arthritides, in Mann RA (ed): Surgery of the Foot and Ankle. St Louis, MO, Mosby, 1994, pp 618-619.

 

  • 00.196 The most common congenital carpal coalition is between which of the
  • following structures?
  • 1- Capitate and hamate
  • 2- Lunate and triquetrum
  • 3- Scaphoid and lunate
  • 4- Scaphoid, trapezium, and trapezoid
  • 5- Triquetrum and pisiform

 

  • Question 00.196
  • Answer = 2
  • Reference(s)
  • Delaney TJ, Eswar S: Carpal coalitions. J Hand Surg Am 1992;17:28-31.

 

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

 

  • 00.198 A 46-year-old man has severe loss of motion and nearly continuous pain in his
  • right dominant shoulder that has failed to respond to oral anti-inflammatory
  • drugs and analgesics. History reveals surgical repair of a shoulder dislocation 25
  • years ago. A radiograph is shown in Figure 42. Management should consist of
  • 1- shoulder arthrodesis.
  • 2- total shoulder replacement.
  • 3- arthroscopic debridement.
  • 4- release of the subscapular
  • tendon.
  • 5- resection arthroplasty.
  • Figure 42

 

  • Question 00.198
  • Answer = 2
  • Reference(s)
  • Bigliani LU, Weinstein DM, Glasgow MT, Pollack RG, Flatow EL: Glenohumeral arthroplasty for arthritis after instability surgery. J Shoulder Elbow Surg 1995 ;4:87-94. Brems JJ: Arthritis of dislocation. Orthop Clin North Am 1998;29:453-466.

 

  • 00.199 Tensile stiffness is greatest in which of the following zones of articular
  • cartilage?
  • 1- Tidemark
  • 2- Lamina splendins
  • 3- Deep zone
  • 4- Middle zone
  • 5- Superficial zone

 

  • Question 00.199
  • Answer = 5
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 3-23. Buckwalter JA, Mankin HJ: Articular cartilage: Tissue design and chondrocyte-matrix interactions. Instr Course Lect 1998;47:477-486.

 

  • 00.200 The metabolic response to severe injury is characterized by which of the
  • following actions?
  • 1- Decreased secretion of insulin
  • 2- Decreased secretion of aldosterone
  • 3- Catabolism that is reversed within 4 days of injury
  • 4- Increased serum levels of free fatty acids
  • 5- Increased affinity of hemoglobin for oxygen

 

  • Question 00.200
  • Answer = 4
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 123-130. Gann DS: Endocrine and metabolic responses to injury, in Schwartz SI, Shires GT, Spencer FC, et al (eds): Principles of Surgery, ed 4. New York, NY, McGraw-Hill, 1984, pp 6-29.

 

  • 00.201 What region of the femoral head is most frequently affected by nontraumatic
  • osteonecrosis of the femoral head?
  • 1- Posteromedial
  • 2- Anterolateral
  • 3- Anteromedial
  • 4- Inferomedial
  • 5- Central

 

  • Question 00.201
  • Answer = 2
  • Reference(s)
  • Mont MA, Hungerford DS: Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995;77:459-474.

 

  • 00.202 At which of the following levels does the greatest amount of flexion and
  • extension occur in the normal human spine?
  • 1- C1-C2
  • 2- C4-CS
  • 3- C7-TI
  • 4- T12-L1
  • 5- L4-LS

 

  • Question 00.202
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 521-622. White AA, Panjabi MM: Kinematics of the spine, in White AA, Panjabi MM f eds): Clinical Biomechanics of the Spine, ed 2. Philadelphia, PA, JB Lippincott, 1990. pp 97-102.

 

  • 00.203 Figures 43a and 43b show the radiographs of a 20-year-old man who sustained an injury
  • of the left leg after falling 15 feet. Which of the following techniques for treating this
  • type of fracture has the highest risk for severe complications?
  • 1- Fixation with a buttress plate within 6 hours of the injury
  • 2- Application of a spanning external fixator and delayed
  • internal fixation
  • 3- Application of a spanning
  • external fixator and delayed
  • hybrid fixation
  • 4- Application of an articulated
  • external fixator
  • 5- Application of a circular
  • external fixator on both sides
  • of the joint
  • Figures 43
  • A
  • B

 

  • Question 00.203
  • Answer = 1
  • Reference(s)
  • Bonar SK, Marsh JL: Tibial plafond fractures: Changing principles of treatment. J Am Acad Orthop Surg 1994;2:297-305. Wyrsch B, McFerran MA, McAndrew M, et al: Operative treatment of fractures of the tibial plafond: A randomized, prospective study. J Bone Joint Surg Am 1996;78:1646-1657.

 

  • 00.204 An 8-year-old girl sustains a mild traumatic brain injury and a displaced
  • transcervical femoral neck fracture after being struck by a car. Initial
  • management consists of alignment of the fracture in split-Russell skin traction.
  • Twenty hours later, she is cleared for surgery. Management should now consist
  • of
  • 1- continued split-Russell skin traction.
  • 2- distal femoral skeletal traction.
  • 3- closed reduction and a double hip spica cast.
  • 4- closed reduction and percutaneous fixation with two to three lag screws.
  • 5- open reduction and internal fixation with a blade plate.

 

  • Question 00.204
  • Answer = 4
  • Reference(s)
  • Hughes LO, Beaty JH: Fractures of the head and neck of the femur in children. J Bone Joint Surg Am 1994;76:283-292. Canale ST: Fractures of the hip in children and adolescents. Orthop Clin North Am 1990;21:341-352.

 

  • 00.205 What is the most common problem associated with a total knee arthroplasty in
  • a patient who has had a previous proximal tibia closing wedge osteotomy?
  • 1- Flexion deformity
  • 2- Extension deformity
  • 3- Varus deformity
  • 4- Valgus deformity
  • 5- Patella infera

 

  • Question 00.205
  • Answer = 5
  • Reference(s)
  • Mont MA, Antonaides S, Krackow KA, Hungerford DS: Total knee arthroplasty after failed high tibial osteotomy: A comparison with a matched group. Clin Orthop 1994;299:125-130. Windsor RE, Insall JN, Vince KG: Technical considerations of total knee arthroplasty after proximal tibial osteotomy. J Bone Joint Surg Am 1988;70:547-555.

 

  • 00.206 Which of the following diseases is characterized by a defect in type I collagen
  • metabolism?
  • 1- Diastrophic dwarfism
  • 2- Osteogenesis imperfecta
  • 3- Mucopolysaccharidosis
  • 4- Pseudoachondroplasia
  • 5- Multiple epiphyseal dysplasia

 

  • Question 00.206
  • Answer = 2
  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 187-217.

 

  • 00.207 A patient has proximal plantar fasciitis. To achieve the greatest amount of
  • improvement, initial management should consist of stretching in combination
  • with
  • 1- a silicone insert.
  • 2- a felt insert.
  • 3- a custom insert.
  • 4- a steroid injection.
  • 5- strapping of the heel.

 

  • Question 00.207
  • Answer = 1
  • Reference(s)
  • Davis PF, Severud E, Baxter DE: Painful heel syndrome: Results of nonoperative treatment. Foot Ankle Int 1994;15:531-535. Pfeffer G, Bacchetti P, Deland J, et al: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int 1999;20:214-221.

 

  • 00.208 What structure shown in Figure 44 passes beneath the retracted neurovascular
  • bundle and puts it at risk for injury during surgery for Dupuytren disease?
  • 1- Pretendinous band
  • 2- Spiral band
  • 3- Lateral cord
  • 4- Natatory cord
  • 5- Central cord
  • Figure 44

 

  • Question 00.208
  • Answer = 2
  • Reference(s)
  • American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 271-279. McFarlan RM: Patterns of the diseased fascia in the fingers in Dupuytren's contracture: Displacement of the neurovascular bundle. Plast Reconstr Surg 1974;54:31-44.

 

  • 00.209 A 22-year-old woman dislocated her right shoulder while lifting a suitcase 3
  • years ago. Because of persistent instability, the patient underwent an anterior
  • capsulorraphy. At surgery, the labrum was intact. The patient now reports a
  • sensation of shoulder slipping, pain, and intermittent hand numbness.
  • Examination reveals 3+ anterior and inferior glenohumeral translation and 2+
  • posterior translation. The left shoulder has 2+ glenohumeral translation in all
  • three directions. Despite a 6-month course of physical therapy, her symptoms
  • persist. Treatment should now consist of
  • 1- an inferior capsular shift.
  • 2- a posterior capsular shift.
  • 3- open labral repair.
  • 4- arthroscopic labral repair.
  • 5- arthroscopic capsular shrinkage.

 

  • Question 00.209
  • Answer = 1
  • Reference(s)
  • Neer CS 11, Foster CR: Inferior capsular shift for involuntary inferior and multidirectional instability of the shoulder: A preliminary report. J Bone Joint Surg Am 1980;62:897-908. Schenk TJ, Brems JJ: Multidirectional instability of the shoulder: Pathophysiology, diagnosis, and management. J Am Acad Orthop Surg 1998;6:65-72.

 

  • 00.210 Which of the following structures is considered the primary stabilizer to
  • anterior translation in the anterior cruciate ligament-deficient knee?
  • 1- Posterior horn of the lateral meniscus
  • 2- Posterior horn of the medial meniscus
  • 3- Lateral collateral ligament
  • 4- Medial collateral ligament
  • 5- Posterior cruciate ligament

 

  • Question 00.210
  • Answer = 2
  • Reference(s)
  • Shoemaker SC, Markolf KL: The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee: Effects of partial versus total excision. J Bone Joint Surg Am 1986;68:71-79. Levy IM, Torzilli PA, Warren RF: The effect of medial meniscectomy on the anterior-posterior motion of the knee. J Bone Joint Surg Am 1982;64:883-888.

 

  • 00.211 Metastatic disease of the spine most commonly originates in what location?
  • 1- Disk
  • 2- Epidural space
  • 3- Pedicle
  • 4- Spinous process
  • 5- Vertebral body

 

  • Question 00.211
  • Answer = 5
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 723-736. Harrington KD: Metastatic disease of the spine. J Bone Joint Surg Am 1986;68:1110-1115.

 

  • 00.212 Figure 45 shows the clinical photograph of a 35-year-old carpenter who
  • sustained a power saw injury to his dominant thumb. Radiographs show a 0.5
  • cm bone loss. Treatment should consist of
  • 1- a volar advancement flap.
  • 2- a full-thickness skin flap.
  • 3- an index finger vascularized flag flap.
  • 4- an index finger cross-finger flap.
  • 5- primary shortening and closure.
  • Figure 45

 

  • Question 00.212
  • Answer = 1
  • Reference(s)
  • American Society for Hand Surgery: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 289-293. Louis DS, Jebson PJL, Graham TC: Amputations, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 48-94.

 

  • 00.213 A 58-year-old woman underwent closed reduction and percutaneous pinning of a distal
  • radial fracture 2 weeks ago. AP and lateral radiographs obtained at the time of her first
  • postoperative visit are shown in Figures 46a and 46b. Examination reveals normal
  • neurovascular function in the hand. Management should now consist of removal of the
  • pins and
  • 1- repeat closed reduction and cast immobilization.
  • 2- closed reduction and external fixation.
  • 3- closed reduction and intrafocal pinning.
  • 4- open reduction and internal fixation through a dorsal approach.
  • 5- open reduction and internal fixation through a volar approach.
  • Figures 46
  • A
  • B

 

  • Question 00.213
  • Answer = 5
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 361-386. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 67-82.

 

  • 00.214 Figures 47a and 47b show the sagittal T1- and T2-weighted MRI scans of a 35-year-old
  • man who reports midback pain after lifting a heavy object at work. He has undergone a
  • thoracic laminectomy to treat the condition found in the anterior column of his spine.
  • What is the most likely underlying pathology?
  • 1- Giant cell tumor
  • 2- Multiple myeloma
  • 3- Osteomyelitis
  • 4- Metastatic colon cancer
  • 5- Compression fracture
  • Figures 47
  • A
  • B

 

  • Question 00.214
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 713-721.

 

  • 00.215 A 21-year-old female college cross-country runner reports aching, burning pain
  • in both lower legs that usually begins 5 minutes into the run and begins to
  • resolve 10 to 20 minutes after the end of the run. Over the past 3 months, she
  • has cut her running distance in half because of the increased symptoms. Most
  • recently she has noticed a feeling of tingling over the dorsum of her feet when
  • running. Examination reveals mild tenderness of the anterolateral leg
  • compartments bilaterally. Lower extremity pulses are normal, and her gait
  • reveals mild pronation of the midfoot. Plain radiographs and a three-phase bone
  • scan are normal. Management consisting of a home stretching and strengthening
  • program and fittings for orthotics twice in the past year has failed to provide
  • relief. Evaluation should now include
  • 1- measurement of compartment pressures before and after exercise.
  • 2- a CT scan.
  • 3- an MRI scan.
  • 4- an electromyogram and nerve conduction velocity studies.
  • 5- an arteriogram.

 

  • Question 00.215
  • Answer = 1
  • Reference(s)
  • Rencman RS: The anterior and the lateral compartmental syndrome of the leg due t o intensive use of muscles. Clin Orthop 1975;113:69-80. Schepsis AA, Martini D, Corbett M: Surgical management of exertional compartment syndrome of the lower leg: Long-term follow-up. Am J Sports Med 1993;21:811-817.

 

  • 00.216 Evaluation of a 13-year-old boy with back pain reveals a normal neurologic
  • examination and straight leg raising test. Radiographs reveal a thoracic scoliosis
  • that measures 13°, and there is narrowing of the disks with irregular end plates
  • from T12 to L2. What is the most likely cause of the pain?
  • 1- Posterior herniation of the nucleus pulposus
  • 2- Infectious diskitis
  • 3- Idiopathic scoliosis
  • 4- Scheuermann's apophysitis
  • 5- Epidural abscess

 

  • Question 00.216
  • Answer = 4
  • Reference(s)
  • Greene TL, Hensinger RN, Hunter LY: Back pain and vertebral changes simulating Scheuermann's disease. J Pediatr Orthop 1985;5:1-7.

 

  • 00.217 A 36-year-old man who bicycles 100 miles per week reports increasing groin pain and a
  • limp for the past 3 weeks that he feels may be related to falling off his bicycle 1 month
  • ago. Radiographs of the hip are shown in Figures 48a and 48b. Management should
  • consist of
  • 1- crutches and no weight bearing for 6 weeks.
  • 2- no bicycling for 1 month.
  • 3- valgus osteotomy.
  • 4- internal fixation.
  • 5- core decompression.
  • Figures 48
  • A
  • B

 

  • Question 00.217
  • Answer = 4
  • Reference(s)
  • DeLee JC: Fractures and dislocations of the hip, in Rockwood CA, Green DP, Bucholz RW, et al (eds): Rockwood and Green's Fractures in Adults. Philadelphia, PA, Lippincott-Raven, 1996, pp 1659-1826. Devas MB: Stress fractures of the femoral neck. J Bone Joint Surg Br 1965;47:728-738. Tountas AA, Waddell JP: Stress fractures of the femoral neck: A report of seven cases. Clin Orthop 1986;210:160-165.

 

  • 00.218 Figures 49a and 49b show the radiographs of a 25-year-old man who injured
  • his foot while playing basketball. Examination reveals an obvious foot
  • deformity. Which of the following structures may interfere with reduction?
  • 1- Flexor hallucis longus
  • 2- Extensor retinaculum
  • 3- Posterior tibial tendon
  • 4- Talonavicular capsule
  • 5- Spring ligament
  • Figures 49
  • A
  • B

 

  • Question 00.218
  • Answer = 3
  • Reference(s)
  • Heckman JD: Fractures and dislocations of the foot, in Rockwood CA Jr, Green DP (eds): Fractures in Adults. Philadelphia, PA, JB Lippincott, 1984, pp 1703-1832.

 

  • 00.219 A 38-year-old man is injured in a motor vehicle accident. Initial radiographs of
  • the chest reveal a comminuted scapular body fracture and two rib fractures.
  • There are no parenchymal changes. Follow-up radiographs obtained 6 hours
  • after injury show localized lung consolidation, and the patient is now
  • tachypneic. What is the most likely cause of his respiratory difficulties?
  • 1- Pulmonary embolus
  • 2- Pulmonary contusion
  • 3- Tension pneumothorax
  • 4- Phrenic nerve injury
  • 5- Cardiac tamponade

 

  • Question 00.219
  • Answer = 2
  • Reference(s)
  • Browner BD, Jupiter JB, Trafton P, et al (eds): Skeletal Trauma: Fractures, Dislocations, and Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1997, p 1659.

 

  • 00.220 The development of a hallux varus deformity after bunion surgery is related to
  • 1- inadequate plication and repair of the medial capsule of the metatarsophalangeal
  • joint.
  • 2- inadequate release of the adductor hallucis tendon and the intermetatarsal
  • ligament.
  • 3- undercorrection of the intermetatarsal 1-2 angle.
  • 4- excessive resection of the medial eminence of the metatarsal head.
  • 5- medial subluxation of the extensor hallucis longus and extensor hallucis brevis
  • tendons.

 

  • Question 00.220
  • Answer = 4
  • Reference(s)
  • Mann RA, Coughlin MJ: Adult hallux valgus, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 284-294. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 151-161.

 

  • 00.221 A patient undergoes revision total knee arthroplasty. Testing of the ligamentous
  • balance of the knee with the trial components in place reveals that the knee is
  • stable and is perfectly balanced in flexion; however, the knee hyperextends 15°.
  • The best course of action is to
  • 1- accept the hyperextension.
  • 2- place the femoral component in more external rotation.
  • 3- use distal femoral augmentation wedges to lengthen the femur.
  • 4- change to a larger femoral component.
  • 5- change to a larger polyethylene insert.

 

  • Question 00.221
  • Answer = 3
  • Reference(s)
  • Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 269-276.

 

  • 00.222 A 28-year-old man who sustained a displaced isolated ulna fracture in a motor
  • vehicle accident 6 months ago reports persistent pain. Current radiographs are
  • shown in Figures 50a through 50c. Management should consist of
  • 1- immobilization in a long
  • arm cast.
  • 2- immobilization in a
  • functional brace.
  • 3- open reduction and internal
  • fixation with a compression
  • plate.
  • 4- percutaneous nail fixation.
  • 5- percutaneous bone marrow
  • injection.
  • C
  • Figures 50
  • A
  • B

 

  • Question 00.222
  • Answer = 3
  • Reference(s)
  • Anderson LD, Meyer FN: Nonunion of the diaphysis of the radius and ulna. Instr Course Lect 1988;37:157-159. Browner BD, Jupiter JB, Trafton P, et al (eds): Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1997, p 1658.

 

  • 00.223 Figure 51 shows the cross section of the lower extremity at the level of the
  • ankle joint. The structure labeled A represents what tendon?
  • 1- Peroneus longus
  • 2- Peroneus brevis
  • 3- Posterior tibial
  • 4- Flexor digitorum longus
  • 5- Flexor hallucis longus
  • Figure 51

 

  • Question 00.223
  • Answer = 2
  • Reference(s)
  • Sobel M, Mizel MS: Peroneal tendon injury, in Pfeffer GB, Frey CC (eds): Current Practice in Foot and Ankle Surgery. New York, NY, McGraw-Hill, 1993, pp 30-56. Coughlin M: Disorders of tendons, in Coughlin M, Mann R (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, pp 786-861.

 

  • 00.224 A 24-year-old woman who plays competitive soccer has had snapping about the
  • right hip with running for the past 6 months. The phenomenon is reproduced by
  • extending the hip from a flexed, abducted, and externally rotated position. The
  • most likely etiology for this snapping is the
  • 1- iliotibial band over the greater trochanter.
  • 2- iliopsoas tendon over the femoral head.
  • 3- iliofemoral ligaments over the femoral head.
  • 4- biceps femoris over the ischial tuberosity.
  • 5- anterior border of the gluteus maximus over the greater trochanter.

 

  • Question 00.224
  • Answer = 2
  • Reference(s)
  • Jacobson T, Allen WC: Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990;18:470-474. Zoltan DJ, Clancy WG Jr, Keene JS: A new operative approach to snapping hip and refractory trochanteric bursitis in athletes. Am J Sports Med 1996;14:201-204.

 

  • 00.225 Figure 52 shows the lateral radiograph of the lumbar spine of a 35-year-old
  • woman who has had back and buttock pain for the past 10 years. What original
  • anatomic defect most likely led to the lumbosacral pathology seen in the
  • radiograph?
  • 1- Midline disk herniation at LS-S 1
  • 2- Facet subluxation at LS-S 1
  • 3- Congenital absence of the superior
  • articular facet of S 1
  • 4- Congenital lumbosacral kyphosis
  • 5- Fatigue fracture of the LS pars
  • interarticularis
  • Figure 52

 

  • Question 00.225
  • Answer = 5
  • Reference(s)
  • Bradford DS: Spondylolysis and spondylolisthesis, in Lonstein JE, Bradford DS, Winter RB, et al (eds): Moe's Textbook of Scoliosis and Other Spinal Deformities, ed 3. Philadelphia, PA, WB Saunders, 1995, pp 399-430. Lauerman WC, Cain JE: Isthmic spondylolisthesis in the adult. J Am Acad Orthop Surg 1996;4:201-208.

 

  • 00.226 Which of the following best describes the pharmacologic action of calcitonin?
  • 1- Decreases osteoclastic bone resorption
  • 2- Decreases osteoblastic formation
  • 3- Decreases the secretion of sodium and potassium chloride in the gastrointestinal
  • tract
  • 4- Increases tubular resorption of calcium
  • 5- Increases tubular resorption of phosphates

 

  • Question 00.226
  • Answer = 1
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Silver JJ, Majeska RJ, Einhorn TA: An update on bone cell biology. Curr Opin Orthop 1994;5:50-59.

 

  • 00.227 A patient with a unilateral transtibial prosthesis has knee extension that persists
  • from heel strike to the midstance phase of gait. This gait pattern is most likely
  • caused by a prosthetic
  • 1- foot that is too posterior.
  • 2- foot that is too dorsiflexed.
  • 3- foot that is too outset.
  • 4- limb that is too long.
  • 5- socket with insufficient flexion.

 

  • Question 00.227
  • Answer = 5
  • Reference(s)
  • Bowker JH, Michael JW (eds): American Academy of Orthopaedic Surgeons Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles, ed 2. St Louis, MO, Mosby-Year Book, 1992, pp 470-474.

 

  • 00.228 A 36-year-old man sustains the injury shown in Figures 53a and 53b. Following
  • closed reduction and percutaneous pin fixation, the most likely cause of
  • suboptimal results would be
  • 1- malreduction.
  • 2- soft-tissue problems.
  • 3- transfixion of the superficial peroneal nerve.
  • 4- deep infection.
  • 5- delayed weight bearing.
  • Figures 53
  • A
  • B

 

  • Question 00.228
  • Answer = 1
  • Reference(s)
  • Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 191-209. Amtz CT, Veith RG, Hansen ST Jr: Fractures and fracture-dislocations of the tarsometatarsal joint. J Bone Joint Surg Am 1988;70:173-181.

 

  • 00.229 What is the most likely cause of periprosthetic osteolysis in total hip
  • arthroplasty?
  • 1- Cement toxicity
  • 2- Metal toxicity
  • 3- Particle-induced bone resorption
  • 4- Infection
  • 5- Stress shielding

 

  • Question 00.229
  • Answer = 3
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. MeKellop HA, Campbell P, Park SH, et al: The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop 1995;311:3-20.

 

  • 00.230 Which of the following conditions is a known medical complication of
  • anabolic steroid abuse?
  • 1- Hyperthyroidism
  • 2- Testicular hypertrophy
  • 3- Menorrhagia
  • 4- Hypoinsulinemia
  • 5- Irreversible deepening of the female voice

 

  • Question 00.230
  • Answer = 5
  • Reference(s)
  • Alen M, Rahkila P: Anabolic-androgenic steroid effects on endocrinology and pid metabolism in athletes. Sports Med 1988;6:327-332. Sturmi JE, Diorio DJ: Anabolic agents. Clin Sports Med 1998;17:261-282.

 

  • 00.231 A 12-year-old boy underwent closed treatment of a displaced Salter-Harris type
  • II fracture of the right distal femur 2 years ago. Current radiographs show
  • evidence of central premature physeal arrest of the right distal femur. The plain
  • radiograph shows no angular deformity, but a scanogram shows 1.6 cm of
  • shortening, all in the right femur. The patient's height is at the 65th percentile for
  • age, and he has a bone age of 14 years, suggesting 2 cm of growth remaining in
  • the contralateral distal femur. Figure 54 shows a map of the bar derived from a
  • CT scan. Treatment should consist of
  • 1- excision of the physeal bar with fat interposition.
  • 2- left distal femoral epiphysiodesis.
  • 3- bilateral distal femoral epiphysiodesis.
  • 4- left femoral shortening of 3.5 cm
  • and locked intramedullary rod
  • fixation.
  • 5- right femoral lengthening at
  • skeletal maturity.
  • Figure 54

 

  • Question 00.231
  • Answer = 2
  • Reference(s)
  • Carlson WO, Wenger DR: A mapping method to prepare for surgical excision of partial physeal arrest. J Pediatr Orthop 1984;4:232-238. Loder RT, Swinford AE, Kuhns LR: The use of helical computed tomographic scan to assess bony physeal bridges. J Pediatr Orthop 1997;17:356-359.

 

  • 00.232 Figure 55 shows the radiograph of a 35-year-old man who sustained an injury
  • to his nondominant shoulder in a fall off his snowboard. Management should
  • consist of
  • 1- immediate active motion.
  • 2- open reduction and internal fixation.
  • 3- excision of the fragment.
  • 4- arthroscopic debridement of the loose body.
  • 5- immobilization for 6 weeks.
  • Figure 55

 

  • Question 00.232
  • Answer = 2
  • Reference(s)
  • Flatow EL, Cuomo F, Maday MG, Miller SR, McIlveen SJ, Bigliani LU: Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg Am 1991;73:1213-1218. Neer CS II: Displaced proximal humeral fractures: II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970;52:1090-1103.

 

  • 00.233 A 32-year-old man who is left-hand dominant reports pain, swelling, and limited
  • motion in his left elbow after falling onto his outstretched hand 2 days ago.
  • Examination reveals mild tenderness at the distal radioulnar joint; however, the
  • joint is stable. Plain radiographs are shown in Figures 56a and 56b. Management
  • should consist of
  • 1- elbow splinting for 4 weeks.
  • 2- immediate elbow motion.
  • 3- open reduction and internal fixation of the radial head.
  • 4- excision of the radial head.
  • 5- radial head replacement.
  • Figures 56
  • A
  • B

 

  • Question 00.233
  • Answer = 3
  • Reference(s)
  • Norris TR (ed): Orthopaedic Knowledge Update: Shoulder and Elbow. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 387-395.

 

  • 00.234 Figure 57 shows the lateral radiograph of a 52-year-old woman who has back
  • and leg pain. What condition is shown on the radiograph?
  • 1- Congenital kyphosis
  • 2- Isthmic spondylolisthesis at
  • L5-S1
  • 3- Degenerative spondylolisthesis
  • at L4-L5
  • 4- Sacral insufficiency fracture
  • 5- Sacral agenesis
  • Figure 57

 

  • Question 00.234
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 699-706. Lauerman WC, Cain JE: Isthmic spondylolisthesis in the adult. J Am Acad Orthop Surg 1996;4:201-208.

 

  • 00.235 An 18-year-old man who was involved in a high-speed motorcycle accident
  • sustained numerous injuries, including a lateral dislocation of the elbow and a
  • severe head injury that rendered him unconscious for several weeks. The elbow
  • was reduced within a few hours of the accident. Follow-up examination 1 month
  • after the accident reveals a very stiff elbow. Radiographs show extensive
  • ossification of the anterior soft tissues. Based on these findings, the heterotopic
  • bone should be excised
  • 1- while the bone scan is active.
  • 2- when the patient's medical condition allows.
  • 3- when the results of urinary alkaline phosphatase studies are normal.
  • 4- when the heterotopic bone is mature.
  • 5- no less than 1 year from the time of injury.

 

  • Question 00.235
  • Answer = 4
  • Reference(s)
  • Linscheid RL: Elbow dislocations, in Morrey BF (ed): The Elbow and Its Disorders. Philadelphia, PA, WB Saunders, 1985, pp 414-432. Roberts JB, Pankratz DG: The surgical treatment of heterotopic ossification at the elbow following long-term coma. J Bone Joint Surg Am 1979;61:760-763.

 

  • 00.236 A turf toe injury is most commonly the result of an injury to the
  • 1- intersesamoid ligament.
  • 2- plantar plate.
  • 3- abductor hallucis tendon.
  • 4- medial and accessory collateral ligaments.
  • 5- flexor hallucis longus tendon.

 

  • Question 00.236
  • Answer = 2
  • Reference(s)
  • Clanton TO, Schon LC: Athletic injuries to the soft tissues of the foot and ankle, in Mann RA, Coughlin MJ (eds): Surgery of the Foot and Ankle, ed 6. St Louis, MO, Mosby, 1993, pp 1191-1200. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 151-161.

 

  • 00.237 What is the most common complication of intramedullary nailing with a
  • piriformis entry portal and proximal locking in the femoral head (second
  • generation) for subtrochanteric femur fractures where the lesser trochanter is
  • displaced?
  • 1- Varus malreduction
  • 2- Screw cutout from the femoral head
  • 3- Osteonecrosis of the femoral head
  • 4- Nail breakage
  • 5- Heterotopic ossification

 

  • Question 00.237
  • Answer = 1
  • Reference(s)
  • French BG, Tometta P III: Use of an interlocked cephalomedullary nail for subtrochanteric fracture stabilization. Clin Orthop 1998:348:95-100.

 

  • 00.238 An axial MRI scan of the L3-L4 level is shown in Figure 58. The point of the
  • arrow lies on what structure?
  • 1- Inferior articular facet
  • 2- Lamina
  • 3- Ligamentum flavum
  • 4- L4 nerve root
  • 5- Dorsal root ganglion
  • Figure 58

 

  • Question 00.238
  • Answer = 3
  • Reference(s)
  • Bell GR, Modic MT: Radiology of the lumbar spine, in Herkowitz HN, Eisrnont FJ, Garfin SR, et al (eds): Rothman-Simeone The Spine, ed 4. Philadelphia, PA, WB Saunders, 1995, pp 109-134. Parke WW: Applied anatomy of the spine, in Herkowitz HN, Eismont FJ, Garfin SR, et al (eds): Rothman-Simeone The Spine, ed 4. Philadelphia, PA, WB Saunders, 1999, pp 29-74.

 

  • 00.239 A 30-year-old man who sustained an isolated comminuted closed tibial shaft
  • fracture after being struck by a car reports severe pain in his leg. Examination
  • reveals the smell of alcohol on his breath. The patient has a 1+ pulse, but he will
  • not cooperate with the neurologic examination. Management should include
  • 1- a long leg cast.
  • 2- an external fixator.
  • 3- an emergent angiogram.
  • 4- measurement of compartment pressures.
  • 5- administration of an analgesic and reexamination.

 

  • Question 00.239
  • Answer = 4
  • Reference(s)
  • McQueen MM, Court-Brown CM: Compartment monitoring in tibial fractures: The pressure threshold for decompression. J Bone Joint Surg Br 1996;78:99-104. Tometta P III, Templeman D: Compartment syndrome associated with tibial fracture. Instr Course Lect 1997;46:303-308.

 

  • 00.240 What is the treatment of choice for a 9-year-old child with a Salter-Harris type
  • IV fracture of the medial distal tibia with 2 mm of displacement?
  • 1- Tension band wiring
  • 2- Screw fixation parallel to the physis
  • 3- Transphyseal screw fixation
  • 4- Closed reduction and a long leg cast
  • 5- A long leg cast

 

  • Question 00.240
  • Answer = 2
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 583-595.

 

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

 

  • 00.242 Which of the following structures pass through the quadrangular space?
  • 1- Radial nerve and the posterior circumflex artery
  • 2- Radial nerve and the spinoglenoid artery
  • 3- Axillary nerve and the suprascapular artery
  • 4- Axillary nerve and the posterior circumflex artery
  • 5- Suprascapular nerve and the anterior circumflex artery

 

  • Question 00.242
  • Answer = 4
  • Reference(s)
  • Cahill BR, Palmer RE: Quadrilateral space syndrome. J Hand Surg Am 1983;8:65-69. Redler MR, Ruland LJ III, McCue FC Ell: Quadrilateral space syndrome in a throwing athlete. Am J Sports Med 1986;14:511-513.

 

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

 

  • 00.244 A patient with a long history of ankylosing spondylitis reports the sudden onset
  • of severe cervicothoracic pain that radiates into both arms with any change in
  • position. History reveals that prior to the onset of symptoms, the patient had
  • stiffness only and had been relatively pain-free for several years. The patient
  • denies any history of trauma. Current radiographs show no changes compared
  • with previous studies. What is the most likely cause for the increased pain?
  • 1- Increased inflammation as a result of the long-standing inflammatory arthritis
  • 2- Cervical disk herniation
  • 3- Hematogenous spinal osteomyelitis
  • 4- Spinal fracture
  • 5- Referred pain from occipital cervical degeneration

 

  • Question 00.244
  • Answer = 4
  • next question
  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 737-746.

 

  • 00.245 A reliable fracture classification system is best characterized by a high level of
  • 1- agreement between multiple observers.
  • 2- agreement of the same observer with repeated classification of the same fractures.
  • 3- correlation between classification and outcome.
  • 4- correlation between classification and treatment.
  • 5- correlation between mechanism of injury and fracture pattern.
  • answer
  • back

 

  • Question 00.245
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Dirschl DR, Adams GL: A critical assessment of factors influencing reliability in the classification of fractures, using fractures of the tibial plafond as a model. J Orthop Trauma 1997;11:471-476. Martin JS, Marsh JL, Bonar SK, DeCoster TA, Found EM, Brandser EA: Assessment of the AO/ASIF fracture classification for the distal tibia. J Orthop Trauma 1997;11:477-483. Swiontkowski MF, Sands AK, Agel J, Diab M, Schwappach JR, Kreder HJ: Interobserver variation in the AO/OTA fracture classification system for pilon fractures: Is there a problem? J Orthop Trauma 1997;11:467-470.

 

  • 00.246 What surgical consideration is most critical to successful patient function
  • following a transfemoral amputation?
  • 1- Use of a laterally based myocutaneous flap
  • 2- An amputation level 5 cm below the lesser trochanter
  • 3- Performing an adductor myodesis
  • 4- Performing an iliotibial band tenodesis
  • 5- Application of a rigid plaster dressing
  • answer
  • back

 

  • Question 00.246
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Gottschalk F: Transfemoral amputation: Surgical procedures, in Bowker JH, Michael JW (eds): American Academy of Orthopaedic Surgeons Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles, ed 2. St Louis, MO, Mosby-Year Book, 1992, pp 501-507. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 139-146.

 

  • 00.247 Figure 60 shows the bone mineral density (BMD) report for a 57-year-old Caucasian
  • woman. According to the National Osteoporosis Foundation guidelines, management
  • should consist of
  • 1- observation and serial BMD testing.
  • 2- vitamin D and calcium dietary supplements only.
  • 3- pharmacologic treatment if additional risk factors for fracture are positive.
  • 4- pharmacologic treatment in the absence of additional risk factors.
  • 5- pharmacologic treatment only if the patient has a history of a osteoporotic
  • fracture.
  • answer
  • back
  • Figure 60

 

  • Question 00.247
  • Answer = 4
  • back to this question
  • next question
  • Reference(s)
  • National Osteoporosis Foundation Development Committee: Osteoporosis: Physician's Guide to Prevention and Treatment of Osteoporosis. Belle Mead, NJ, Excerpta Medica, 1998, pp 18-22.

 

  • 00.248 An 11-year-old girl with idiopathic scoliosis has double major curves that
  • measure 36°. The apex of the right thoracic curve is T9, and the apex of the left
  • lumbar curve is L2. The iliac apophyses have ossified 20%. Management
  • should consist of
  • 1- observation.
  • 2- a Charleston bending brace at night.
  • 3- a Boston brace for 23 hours per day.
  • 4- electrical muscle stimulation at night.
  • 5- posterior spinal fusion.
  • answer
  • back

 

  • Question 00.248
  • Answer = 3
  • back to this question
  • next question
  • Reference(s)
  • Katz DE, Richards BS, Browne RH, Herring JA: A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis. Spine 1997;22:1302-1312. Howard A, Wright JG, Hedden D: A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis. Spine 1998;23:2404-2411. Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis: A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995;77:815-822.

 

  • 00.249 A 74-year-old woman sustained a traumatic anterior glenohumeral dislocation
  • and underwent closed reduction in the emergency department. Follow-up
  • examination 2 weeks later reveals infraspinatus atrophy and tenderness over the
  • greater tuberosity. There is active forward elevation of 60°, active external
  • rotation of 10°, and passive forward elevation of 145°. History reveals that she
  • underwent open repair of a massive rotator cuff tear 4 years ago. Plain
  • radiographs do not show a fracture. Treatment should now consist of
  • 1- a subacromial corticosteroid injection.
  • 2- exercise and physical therapy.
  • 3- arthroscopic debridement.
  • 4- rotator cuff repair.
  • 5- Numeral head replacement.
  • answer
  • back

 

  • Question 00.249
  • Answer = 2
  • back to this question
  • next question
  • Reference(s)
  • Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III: Repairs of the rotator cuff: Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991;73:982-989. Nakagaki K, Ozaki J, Tomita Y, et al: Alterations in the supraspinatus muscle belly with rotator cuff tearing: Evaluation with magnetic resonance imaging. J Shoulder Elbow Surg 1994;3:88-93.

 

  • 00.250 The cutaneous nerve that passes superficially over the dorsal medial aspect of
  • the hallux metatarsophalangeal joint is a branch of what nerve?
  • 1- Superficial peroneal
  • 2- Deep peroneal
  • 3- Saphenous
  • 4- Medial plantar
  • 5- Medial sural cutaneous
  • answer
  • back

 

  • Question 00.250
  • Answer = 1
  • back to this question
  • next question
  • Reference(s)
  • Blair JM, Botte MJ: Surgical anatomy of the superficial peroneal nerve in the ankle and foot. Clin Orthop 1994;305:229-238. Miller RA, Hartman G: Origin and course of the dorsomedial cutaneous nerve to the great toe. Foot Ankle Int 1996;17:620-622.

 

  • 00.251 The initial trauma radiograph shown in Figure 61 shows what type of posterior
  • pelvic ring injury?
  • 1- Fracture-dislocation of the sacroiliac joint
  • 2- Vertical sacral fracture
  • 3- H-shaped sacral fracture
  • 4- Acetabular fracture
  • 5- Sacroiliac dislocation
  • answer
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  • Figure 61

 

  • Question 00.251
  • Answer = 1
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  • Reference(s)
  • Browner BD, Jupiter JB, Trafton P, et al (eds): Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, PA, WB Saunders, 1997, p 1658. Matta JM, Tometta P III: Internal fixation of unstable pelvic ring injuries. Clin Orthop 1996;329:129-140.

 

  • 00.252 A 9-year-old girl with mild
  • left congenital femoral
  • hypoplasia has undergone
  • three scanograms and bone
  • age determinations in the past
  • 4 years. The results have been
  • plotted on the Moseley graph
  • shown in Figure 62. The .
  • predicted limb-length
  • discrepancy at skeletal
  • maturity will most likely be
  • how many centimeters?
  • 1- 9
  • 2- 12
  • 3- 15
  • 4- 18
  • 5- 21
  • answer
  • back
  • Figure 62

 

  • Question 00.252
  • Answer = 1
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  • Reference(s)
  • Moseley CF: A straight-line graph for leg-length discrepancies. J Bone Joint Surg Am 1977;59:174-179. Beumer A, Lampe HI, Swierstra BA, Diepstraten AF, Mulder PG: The straight line graph in limb length inequality: A new design based on 182 Dutch children. Acta Orthop Scand 1997;68:355-360.

 

  • 00.253 Which of the following factors is associated with progression of isthmic
  • spondylolisthesis?
  • 1- Spondylolytic defects at multiple levels
  • 2- Narrowing of the L5-S 1 disk space
  • 3- A buttressing osteophyte at S 1
  • 4- A dome-shaped vertebra at S 1
  • 5- A 25% slip
  • answer
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  • Question 00.253
  • Answer = 4
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 699-706.

 

  • 00.254 What is the rate of bone loss per year at menopause?
  • 1- 0.3% to 0.5% for 3 to 5 years
  • 2- 0.3% to 0.5% until age 65 years
  • 3- 2% to 3% for 2 to 3 years
  • 4- 2% to 3% for 6 to 10 years
  • 5- 4% to 5% for 2 to 3 years
  • answer
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  • Question 00.254
  • Answer = 4
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, 1L, American Academy of Orthopaedic Surgeons, 1999, pp 149-165.

 

  • 00.255 Assuming full weight bearing on the right side, the weight-bearing status that
  • places the least amount of stress through the left hip joint is
  • 1- no weight bearing.
  • 2- 20-1b weight bearing.
  • 3- 50% weight bearing.
  • 4- full weight bearing.
  • 5- a 4-point gait.
  • answer
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  • Question 00.255
  • Answer = 2
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 427-439. Letournel E, Judet R: Fractures of the Acetabulum, ed 2. New York, NY, Springer-Verlag, 1993, pp 410-414.

 

  • 00.256 Which of the following complications is most commonly associated with
  • noncircumferentially porous-coated femoral components?
  • 1- Heterotopic ossification
  • 2- Recurrent dislocation
  • 3- Diaphyseal osteolysis
  • 4- Intraoperative shaft fracture
  • 5- Postoperative infection
  • answer
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  • Question 00.256
  • Answer = 3
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Schmalzreid TP, Jasty M, Harris WH: Periprosthetic bone loss in total hip arthroplasty: Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am 1992;74:849-863.

 

  • 00.257 Which of the following substances momentarily released from the sarcoplasmic
  • reticulum into the muscle cytoplasm is considered the trigger that causes the
  • contractile proteins to interact and generate force?
  • 1- Glucose
  • 2- Adenosine triphosphate
  • 3- Amino acids
  • 4- Calcium
  • 5- Actin
  • answer
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  • Question 00.257
  • Answer = 4
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  • Reference(s)
  • Huxley HE: The mechanism of muscular contraction. Science 1969;164:1356-1365. Favero TG: Sarcoplasmic reticulum Ca(2+) release and muscle fatigue. J Appl Physiol 1999;87:471-483.

 

  • 00.258 What is the sequence of injury to the lateral ankle ligaments during an
  • inversion injury?
  • 1- Calcaneofibular ligament, followed by the posterior talofibular ligament
  • 2- Calcaneofibular ligament, followed by the anterior talofibular ligament
  • 3- Posterior talofibular ligament, followed by the calcaneofibular ligament
  • 4- Anterior talofibular ligament, followed by the posterior talofibular ligament
  • 5- Anterior talofibular ligament, followed by the calcaneofibular ligament
  • answer
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  • Question 00.258
  • Answer = 5
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 597-612. Colville MR: Surgical treatment of the unstable ankle. J Am Acad Orthop Surg 1998;6:368-377.

 

  • 00.259 What cervical spine dimensional parameter is considered most sensitive in
  • predicting paralysis in an adult with rheumatoid arthritis?
  • 1- Internal diameter of less than 25 mm in the C1 ring
  • 2- Anterior dens interval of 6 mm or greater
  • 3- Posterior dens interval of less than 14 mm
  • 4- Superior migration of the odontoid so that the tip is 2.5 mm above McGregor's
  • line
  • 5- Subaxial subluxation of 3.5 mm at C6-7
  • answer
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  • Question 00.259
  • Answer = 3
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 737-746. Boden SD, Dodge LD, Bohlman HH, Rechtine GR: Rheumatoid arthritis of the cervical spine: A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am l 993;75:1282-1297.

 

  • 00.260 What factor is most responsible for higher rates of malalignment after nailing
  • of proximal tibia fractures?
  • 1- A proximal locking screw position that is too distal
  • 2- A canal mismatch with the size of the nail
  • 3- Jig size that impinges on the fracture
  • 4- Nail rotation within the canal
  • 5- Errant portal location
  • answer
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  • Question 00.260
  • Answer = 5
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  • Reference(s)
  • Lang GJ, Cohen BE, Bosse MJ, Kellam JF: Proximal third tibial shaft fractures: Should they be nailed? Clin Orthop 1995;315:64-74. Freedman EL, Johnson EE: Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop 1995;315:25-33.

 

  • 00.261 Which of the following cell types produces alkaline phosphatase and is
  • responsive to parathyroid hormone?
  • 1- Osteoblasts
  • 2- Osteoclasts
  • 3- Chondrocytes
  • 4- Chondroclasts
  • 5- Fibroblasts
  • answer
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  • Question 00.261
  • Answer = 1
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  • Reference(s)
  • Mundy GR: Local control of bone formation by osteoblasts. Clin Orthop 1995;313:19-26. Marie PJ: Cellular and molecular alterations of osteoblasts in human disorders of bone formation. Histol Histopathol 1999;14:525-538. Simon SR (ed): Orthopaedic Basic Science: Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 129-184.

 

  • 00.262 A patient sustains a tear of the anterior cruciate ligament, and an MRI scan
  • reveals a bone contusion. Signal changes as the result of this injury would most
  • likely be located at the
  • 1- posterior one third of the lateral femoral condyle and the middle one third of the
  • lateral tibial plateau.
  • 2- posterior one third of the lateral femoral condyle and the anterior one third of the
  • lateral tibial plateau.
  • 3- middle one third of the lateral femoral condyle and the posterior one third of the
  • lateral tibial plateau.
  • 4- middle one third of the medial femoral condyle and the posterior one third of
  • the medial tibial plateau.
  • 5- anterior one third of the lateral femoral condyle and the posterior one third of the
  • medial tibial plateau.
  • answer
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  • Question 00.262
  • Answer = 3
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  • Reference(s)
  • Graf BK, Cook DA, DeSmet AA, Keene JS: Bone bruises on magnetic resonance imaging evaluation of anterior cruciate ligament injuries. Am J Sports Med 1993;21:220-223. Rosen MA, Jackson DW, Berger PE: Occult osseous lesions documented by magnetic resonance imaging associated with anterior cruciate ligament ruptures. Arthroscopy 1991;7:45-51.

 

  • 00.263 What type of prosthetic wear is caused by trapping of polymethylmethacrylate
  • particles in the femoral head-polyethylene interface?
  • 1- Adhesive
  • 2- Corrosive
  • 3- Third body
  • 4- Fatigue
  • 5- Abrasive
  • answer
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  • Question 00.263
  • Answer = 3
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  • Reference(s)
  • Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 449-486.

 

  • 00.264 When performing total knee arthroplasty (TKA) in a patient with a prior
  • patellectomy secondary to trauma, which of the following prosthetic designs
  • will most likely result in a successful outcome?
  • 1- Posterior cruciate ligament-substituting TKA
  • 2- Posterior cruciate ligament-retaining TKA
  • 3- Rotating hinge prosthesis
  • 4- Suture-anchored patellar prosthesis
  • 5- Mobile-bearing total knee prosthesis
  • answer
  • back

 

  • Question 00.264
  • Answer = 1
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 559-582. Paletta GA Jr, Laskins RS: Total knee arthroplasty after a previous patellectomy. J Bone Joint Surg Am 1995;77:1708-1712.

 

  • 00.265 After surgical treatment of unstable posterior pelvic ring injuries, functional
  • outcome correlates most closely with
  • 1- residual posterior pelvic displacement.
  • 2- sacroiliac joint arthrosis.
  • 3- associated injuries.
  • 4- limb-length discrepancy.
  • 5- the type of posterior fracture.
  • answer
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  • Question 00.265
  • Answer = 3
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  • Reference(s)
  • Cole JD, Blum DA, Ansel LJ: Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop 1996;329:160-179. Miranda MA, Riemer BL, Butterfield SL, Burke CJ III: Pelvic ring injuries: A long-term functional outcome study. Clin Orthop 1996;329:152-159. Tometta P III, Matta JM: Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop 1996;329:186-193.

 

  • 00.266 What bundle of the posterior cruciate ligament resists a posteriorly directed
  • force at 90° of flexion?
  • 1- Central
  • 2- Anterolateral
  • 3- Anteromedial
  • 4- Posterolateral
  • 5- Posteromedial
  • answer
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  • Question 00.266
  • Answer = 2
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  • Reference(s)
  • Hamer CD, Hoher J: Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 1998;26:471-482. Covey CD, Sapega AA: Injuries of the posterior cruciate ligament. J Bone Joint Sum Am 1993;75:1376-1386.

 

  • 00.267 Which of the following findings is more suggestive of vascular rather than
  • neurogenic claudication in the differential diagnosis of leg pain?
  • 1- Weakness of the extensor hallucis longus
  • 2- Normal hair pattern on both feet
  • 3- More difficulty standing upright and walking down an incline
  • 4- Pain that begins in the buttocks and radiates distally with further walking
  • 5- Pain that is relieved by stopping and standing still
  • answer
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  • Question 00.267
  • Answer = 5
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  • Reference(s)
  • Mirkovic S, Cybulski G, et al: Spinal stenosis: Clinical evaluation and differential diagnosis, in Herkowitz HN, Eismont FJ, Garfin SR, et al (eds): Rothman- Simeone The Spine, ed 4. Philadelphia, PA, WB Saunders, 1999, pp 796-806. Dodge LD, Bohlman HH, Rhodes RS: Concurrent lumbar spinal stenosis and peripheral vascular disease: A report of nine patients. Clin Orthop 1988;230:141-148.

 

  • 00.268 The mother of a 5-year-old boy with a tense effusion of the right knee reports
  • that he has had ongoing bouts of otitis media and sinusitis for the past 2 years.
  • History reveals that the mother had a brother who had similar symptoms during
  • childhood; he later died of respiratory system failure. Aspiration of the knee is
  • performed, and laboratory studies reveal a WBC count of 500/mm; (normal
  • 3,500 to 10,500/mm3). A Gram stain is negative. Which of the following
  • studies will best help confirm the systemic diagnosis?
  • 1- Culture and sensitivity studies of the joint aspirate
  • 2- Serum immunoelectrophoresis
  • 3- HIV titer
  • 4- Sweat test
  • 5- Erythrocyte sedimentation rate
  • answer
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  • Question 00.268
  • Answer = 2
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  • Reference(s)
  • Ochs HD, Wedgwood RJ: Disorder of the B-Cell system, in Stiehm ER (ed): Immunologic Disorder in Infants and Children. Philadelphia, PA, WB Saunders, 1989, pp 230-235. Bruton OC: Agammaglobulinemia. Pediatrics 1952;9:722-728. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 221-276.

 

  • 00.269 When the body vector line is placed posterior to the knee, the moment is
  • balanced by which of the following muscles?
  • 1- Quadriceps
  • 2- Iliopsoas
  • 3- Adductor longus
  • 4- Biceps femoris
  • 5- Sartorius
  • answer
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  • Question 00.269
  • Answer = 1
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 37-45. Morrison JB: The mechanics of the knee joint in relation to normal walking. J Biomech 1970;3:51-61.1 Buckwalter JA, Einhom TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 732-827.

 

  • 00.270 Open reduction and internal fixation of the humerus is considered the treatment
  • of choice in a 25-year-old man with a spiral fracture that is associated with
  • 1- a radial nerve palsy.
  • 2- a concomitant bicondylar tibial plateau fracture.
  • 3- a rib fracture.
  • 4- a splenic injury.
  • 5- no other injury.
  • answer
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  • Question 00.270
  • Answer = 2
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  • Reference(s)
  • Modabber MR, Jupiter JB: Operative management of diaphyseal fractures of the humerus: Plate versus nail. Clin Orthop 1998;347:93-104. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 271-286.

 

  • 00.271 Gait studies conducted following a successful, well-positioned ankle fusion
  • have shown that the loss of ankle motion is compensated for by which of the
  • following mechanisms?
  • 1- Increased motion in the contralateral ankle
  • 2- Increased motion in the joints of the ipsilateral midfoot
  • 3- An increase in stride length
  • 4- External rotation of the contralateral hip
  • 5- Hyperextension of the ipsilateral knee
  • answer
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  • Question 00.271
  • Answer = 2
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  • Reference(s)
  • Mazur JM, Schwartz E, Simon SR: Ankle arthrodesis: Long-term follow-up with gait analysis. J Bone Joint Surg Am 1979;61:964-975 Morrey BF, Wiedeman GP Jr: Complications and long-term results of ankle arthrodeses following trauma. J Bone Joint Surg Am 1980;62:777-784.

 

  • 00.272 A 71-year-old man reports shoulder and arm pain after injuring his left shoulder
  • pulling open a heavy door 1 week ago. He states that he has had a history of
  • intermittent shoulder pain for the past 10 years that has been treated with home
  • exercises and corticosteroid injections. Examination reveals anterosuperior
  • shoulder swelling, and midarm ecchymosis and swelling. Active shoulder
  • elevation is 120°. External and internal rotation strength are normal.
  • Management should now include
  • 1- a corticosteroid injection.
  • 2- sling immobilization.
  • 3- physical therapy.
  • 4- arthroscopic debridement.
  • 5- biceps tenodesis.
  • answer
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  • Question 00.272
  • Answer = 3
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  • Reference(s)
  • Matsen FA III, Amtz CT, Lippitt SB: Rotator cuff, in Rockwood CA Jr, Matsen FA III, Wirth MA, et al (eds): The Shoulder, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 755-839.

 

  • 00.273 Item deleted after statistical review
  • (and no answer or references cited)
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  • 00.274 An 18-year-old man is shot with a low-velocity handgun and sustains an
  • isolated midshaft humerus fracture. The neurologic and vascular examinations
  • are normal in the injured extremity. In addition to administration of antibiotics,
  • management of the fracture should include
  • 1- a functional brace.
  • 2- a hanging arm cast.
  • 3- a plate and screw fixation.
  • 4- an intramedullary nail.
  • 5- an external fixator.
  • answer
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  • Question 00.274
  • Answer = 1
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  • Reference(s)
  • Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 271-286. Wiss DA, Gellman H: Gunshot wounds to the musculoskeletal system, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 367-378.

 

  • 00.275 The organic portion of bone consists primarily of
  • 1- osteopontin.
  • 2- osteocalcin.
  • 3- type I collagen.
  • 4- type II collagen.
  • 5- hydroxyapatite.
  • answer
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  • Question 00.275
  • Answer = 3
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  • End of 2000 Exam