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11. In adolescents, the most likely mechanism of injury to the lumbosacral spine, that could lead to a spondylolysis, would be:

A. Acute flexion
B. Repetitive extension-rotation injuries
C. Repetitive flexion rotation injuries
D. Distraction injuries
E. Axial compression injuries

Answer: B. Repetitive extension-rotation injuries

Repetitive extension-rotation injuries are the most likely mechanism of injury to the lumbosacral spine that could lead to a spondylolysis in adolescents.

12. In acquired flatfoot in an adult, the tendon that is usually involved would be:

A. Peroneus brevis
B. Peroneus longus
C. Posterior tibial tendon
D. Anterior tibial tendon
E. Flexor digitorum longus tendon

Answer: C. Posterior tibial tendon

In acquired flatfoot in an adult, the posterior tibial tendon is usually involved.

13. The parents of a 13-year-old boy known to have tuberculosis, notice swelling in the upper right buttock. He was presumed to have migration of the abscess posteriorly. This would be through which path:

A. Triangle of the inguinal canal
B. The adductor triangle
C. The triangle of petit
D. The iliopsoas triangle
E. The sacroiliac joint

Answer: C. The triangle of petit

The migration of the abscess in a 13-year-old boy with tuberculosis would most likely be through the triangle of petit, resulting in swelling in the upper right buttock.

14. A ten-year-old boy presented with low back pain. Plain X-rays revealed flattening of the vertebral bodies at level L2 and L4. Your first diagnosis would be:

A. Osteoblastoma
B. Eosinophilic granuloma
C. Tuberculosis
D. Aneurysmal bone cyst
E. Neuroblastoma

Answer: B. Eosinophilic granuloma

In a ten-year-old boy with low back pain and flattening of the vertebral bodies at L2 and L4, the first diagnosis would be eosinophilic granuloma.

15. When a Margeryl transarticular screw is inserted between C1-2 and is slightly long and passes anterior through the C1 facet, it may lead to a unilateral deviation of the tongue. Which of the following nerves is injured:

A. Spinal accessory
B. Long thoracic
C. Hypoglossal
D. Glossopharyngeal
E. Vagus

Answer: C. Hypoglossal

When a Margeryl transarticular screw inserted between C1-2 passes anterior through the C1 facet, it may lead to a unilateral deviation of the tongue due to injury of the hypoglossal nerve.

16. During anterior spinal surgery, the left vertebral artery was injured. Should the artery be ligated, what would the incidence of brain stem infarction be:

A. 1%
B. 1.8%
C. 3.1%
D. 6%
E. 100%

Answer: C. 3.1%

If the left vertebral artery is injured during anterior spinal surgery and ligated, the incidence of brain stem infarction would be 3.1%.

17. During anterior spinal surgery when the esophagus is injured and detected late 48 hours postoperatively, the mortality risk is estimated to be:

A. 50%
B. 25%
C. 75%
D. 100%
E. 10%

Answer: A. 50%

If the esophagus is injured during anterior spinal surgery and detected late 48 hours postoperatively, the mortality risk is estimated to be 50%.

18. In which of the following cervical vertebrae is the pedicle of sufficient diameter to allow the insertion of a pedicle screw:

A. C1
B. C2
C. C3
D. C4
E. C5

Answer: B. C2

In the cervical spine, the pedicle of sufficient diameter to allow the insertion of a pedicle screw is found in C2.

19. The differential diagnosis of most bone tumors is derived from which of the following radioimaging techniques:

A. MRI
B. CT scan
C. Plain radiography
D. Scintigraphy
E. Ultrasonography

Answer: C. Plain radiography

The differential diagnosis of most bone tumors is derived from plain radiography.

20. Patients with osteoid osteomas are known to have pain, more severe at night. This is most probably due to:

A. Sensory nerve fibers within the nidus
B. The accumulation of cyclooxygenases and prostaglandins within the lesion
C. Expanding nature of the lesion
D. Over accumulation of a parathyroid-like substance within the lesion
E. Necrotizing effect of the lesion

Answer: B. The accumulation of cyclooxygenases and prostaglandins within the lesion

Patients with osteoid osteomas are known to have pain, more severe at night, which is most probably due to the accumulation of cyclooxygenases and prostaglandins within the lesion.

21. With which of the following lesions listed below, osteoid osteoma, is very similar on pathologic analysis:

A. Osteomas
B. Enostosis
C. Osteoblastoma
D. Subperiosteal chondromas
E. Parosteal osteosarcoma

Answer: C. Osteoblastoma

On pathologic analysis, osteoid osteoma is very similar to osteoblastoma.

22. Telangiectatic osteosarcoma is most commonly confused with:

A. Unicameral bone cyst
B. Metaphyseal osseous defects
C. Fibrous dysplasia
D. Aneurysmal bone cyst
E. Periosteal chondromas

Answer: D. Aneurysmal bone cyst

Telangiectatic osteosarcoma is most commonly confused with aneurysmal bone cyst.

23. A focus of mature compact (cortical) bone within the cancellous bone is known to occur in:

A. Enostosis
B. Osteoid osteoma
C. Cavernous hemangioma
D. Heterotopic ossification
E. Enchondroma

Answer: A. Enostosis

A focus of mature compact (cortical) bone within the cancellous bone is known to occur in enostosis.

24. A condition associated with intestinal polyposis and multiple osteomas would be:

A. Crohn's disease
B. Gardner's syndrome
C. Gaucher's disease
D. Albright's syndrome
E. Whipple's disease

Answer: B. Gardner's syndrome

A condition associated with intestinal polyposis and multiple osteomas would be Gardner's syndrome.

25. Which of the following nerves is most likely to be injured on correction of cervical kyphosis:

A. C2
B. C3
C. C4
D. C5
E. C6

Answer: D. C5

During correction of cervical kyphosis, the C5 nerve is most likely to be injured.

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