Promoting Transparency and Trust: Sharing MCQ Questions and Typical Answers

Sana'a University

Faculty of Medicine and Health Sciences

Doctorate of Orthopedics(MD) Exam Part 1

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جامعة صنعاء

كلية الطب والعلوم الصحية

امتحان الدكتوراه جراحة العظام (MD)

الجزء الأول

Question 1
Following an open reduction and internal fixation of a fracture, what is the insertion of the ligament that should next be addressed surgically if the elbow remains unstable?
Click to see answer
Correct answer: b. Crista supinatoris of proximal ulna
Question 2
Which of the following statements is true regarding venous thromboembolism (VTE) following major orthopaedic hip or knee surgery?
Correct answer: a. Almost all patients receive VTE prophylaxis, though often not in compliance with the American College of Chest Physicians (ACCP) guidelines
Question 3
What complaint or examination finding is NOT consistent with a prosthetic foot that is placed too far inset in a 27-year-old patient with a below knee amputation prosthesis?
Correct answer: c. Increased knee extension during stance
Question 4
Compared with a premenopausal female who sustained similar polytrauma, a male who sustains multiple traumatic injuries is most likely to have which of the following at long-term follow-up?
Correct answer: a. Higher quality-of-life scores than females
Question 5
In a patient with a below knee amputation who is interested in hiking as a hobby, what does a SACH foot or non-dynamic response (non-energy storing) foot demonstrate when compared to the dynamic response foot (energy storing)?
Correct answer: c. Longer duration midstance of gait
Question 6
What complication is more likely following excessive medial retraction of the anterior covering structures during the anterolateral (Watson-Jones) approach to the hip?
Correct answer: c. Quadriceps weakness
Question 7
During the medial parapatellar approach to the knee, most of the arterial supply to the patella is divided. What artery is at risk if a lateral retinacular release is performed?
Correct answer: b. Lateral superior genicular
Question 8
During a left-sided transforaminal lumbar interbody fusion at the L4-5 level, the surgeon notes a significant amount of bleeding that cannot be controlled while using a pituitary rongeur. What anatomic structure has been injured?
Correct answer: b. Common iliac artery
Question 9
After arthroscopic shoulder surgery a 45-year-old male develops pain, weakness and decreased sensation over the lateral arm and shoulder. If this injury was due to portal placement, which of the following portals would be the most likely site of injury?
Correct answer: d. Posterior inferior portal
Question 10
What intermuscular plane is most commonly used in the anterior approach to the ankle?
Correct answer: b. Between extensor hallucis longus and extensor digitorum longus
Question 11
Figure 8 shows an axial T1-weighted MRI scan of the foot of a 13-year-old boy. The three-pronged structure indicated by the arrow shows which of the following?
Click to see answer
Correct answer: d. Inferior calcaneonavicular (spring) ligament
Question 12
What is the interval used during an anterior approach (Henry) for a distal radius shaft fracture?
Correct answer: c. Brachioradialis-flexor carpi radialis
Question 13
A 41-year-old man has a severe posttraumatic elbow contracture. The surgeon chooses to approach laterally. This exposure to the anterior elbow capsule exploits what anatomic interval?
Correct answer: e. Brachioradialis/extensor carpi radialis longus and anterior surface of the humerus
Question 14
During a posterolateral exposure of the knee, the fascial intervals between the iliotibial band and the biceps femoris tendon are incised. What vascular structure is at most risk during this exposure?
Correct answer: d. Inferior lateral genicular artery
Question 15
Which of the following best describes the relationship of the median nerve to the flexor carpi radialis tendon just proximal to the carpal canal?
Correct answer: c. Median nerve is dorsal and ulnar
Question 16
When harvesting an iliac crest bone graft from the posterior approach, what anatomic structure is at greatest risk for injury if a Cobb elevator is directed too caudal?
Correct answer: d. Superior gluteal artery
Question 17
What approach should be chosen for the injury seen in Figure 9?
Click to see answer
Correct answer: e. Kocher-Langenbeck
Question 18
A 28-year-old football player sustained a displaced posterior glenoid fossa fracture. He elects to undergo open reduction and internal fixation using a posterior approach to the shoulder. What intermuscular interval should be used to expose the posterior glenoid?
Correct answer: b. Teres minor and Infraspinatus
Question 19
When performing a gastrocnemius recession, what structure should be protected?
Correct answer: e. Sural nerve
Question 20
A 28-year-old man has decreased finger proximal interphalangeal (PIP) joint range of motion after open reduction and internal fixation of a proximal phalanx fracture with the use of a side plate. Examination shows greater passive PIP joint flexion with metacarpophalangeal (MP) joint extension, than when the MP joint is flexed. This finding demonstrates contracture/scarring of which of the following structures?
Correct answer: b. Extensor tendon
Question 21
What is the name for the closed osteocutaneous resection of the distal fibula and adjacent lateral malleolus, along with the overlying skin and subcutaneous tissue, as part of limb salvage surgery?
Correct answer: b. Boyd amputation
Question 22
Damaged bone tissue can be removed without compromising structural integrity by what phenomenon?
Correct answer: a. Creep
Question 23
Which ligamentous structure provides stability to the proximal radioulnar joint when the elbow is extended?
Correct answer: b. Quadrate ligament
Question 24
What nerve is most commonly injured with anterior shoulder dislocation?
Correct answer: a. Axillary nerve
Question 25
What structure is most commonly damaged in a lateral ankle sprain?
Correct answer: b. Calcaneofibular ligament
Question 26
What test can be used to assess the integrity of the anterior cruciate ligament (ACL)?
Correct answer: a. Lachman test
Question 27
What term describes the anatomical position in which the hand is twisted laterally (thumb pointing away from the body)?
Correct answer: a. Supination
Question 28
What is the common name for tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons?
Correct answer: a. De Quervain's tenosynovitis
Question 29
What is the term for a fracture that occurs through a bone weakened by pre-existing disease?
Correct answer: a. Pathologic fracture
Question 30
What type of bone healing occurs with rigid fixation in the absence of tissue interposition?
Correct answer: a. Primary bone healing
Question 31
What osseous ridge separates the femoral attachments of the anteromedial and posterolateral bundles of the anterior cruciate ligament?
Correct answer: b. Lateral bifurcate ridge
Question 32
During an anterior approach to the shoulder, what is the most likely arterial structure to be encountered in the superior extent of the deltopectoral interval (just distal to the anterior edge of the clavicle)?
Correct answer: a. Acromial branch of the thoracoacromial artery
Question 33
Which of the following neurovascular structures is closest to the posterior capsule of the knee?
Correct answer: b. Popliteal artery
Question 34
The main blood supply to the capital femoral epiphysis in a 10-year-old child is supplied from the:
Correct answer: d. Posterosuperior and posteroinferior retinacular branches of the medial femoral circumflex artery
Question 35
The teardrop shape marked with an asterisk in Figure 35 represents what anatomic structure?
Click to see answer
Correct answer: c. A column of bone running from the anterior inferior iliac spine (AIIS) to the posterior superior iliac spine (PSIS)
Question 36
Which of the following is an FDA approved adjunctive treatment for an acute open tibia fracture being treated with an intramedullary nail?
Correct answer: b. rhBMP-2
Question 37
A 24-year-old male sustains the fracture dislocation shown in Figure 37. How is this fracture pattern best classified?
Correct answer: c. Schatzker III
Question 38
A middle-aged man sustains traumatic loss of the second, third, and fourth toes in a lawnmower accident. The wound is grossly contaminated with soil. Penicillin is added to his antibiotic regimen for coverage of what bacteria?
Correct answer: a. Clostridium
Question 39
What mechanism of injury is most likely to cause a fracture of the anteromedial facet of the coronoid?
Correct answer: b. Varus and posteromedial rotation
Question 40
Figure 40 shows a coronal T2-weighted MRI scan. What is the name of the labeled torn structure?
Click to see answer
Correct answer: e. Lateral collateral ligament (LCL)
Question 41
Which of the following deformities is most common after the amputation shown in Figure A?
Correct answer: d. Equinovarus
Question 42
A 25-year-old motorcyclist has a knee dislocation that is reduced by the trauma surgeon in the emergency department. Radiographs show no fracture and a reduced knee joint. What is the most appropriate initial step for evaluation of a potential arterial injury?
Correct answer: c. Measurement of the ankle-brachial index (ABI)
Question 43
A 29-year-old female has sustained the acute injury shown in Figure A. Which of the following is an indication for open reduction internal fixation in this patient?
Correct answer: d. Medial clear space widening with gravity stress radiographs
Question 44
Which of the following methods of treating a vertically oriented (eg, Pauwels III) femoral neck fracture is mechanically optimal?
Correct answer: e. Sliding hip screw and side plate
Question 45
Which of the following is most commonly associated with an open clavicular fracture?
Correct answer: b. Closed head injury
Question 46
Which of the following injuries is most likely associated with the fracture seen in Figure A?
Correct answer: b. Lateral meniscal tear
Question 47
A 41-year-old woman with diabetes mellitus fell onto her outstretched arm and sustained an injury to the right elbow. Radiographs are shown in Figures 47a. What is the most appropriate management?
Correct answer: a. Open reduction and internal fixation
Question 48
A 76-year old patient underwent partial foot amputation through the talonavicular and calcaneocuboid joints. Besides Achilles tendon lengthening, what additional procedure(s) may be required to prevent the most common post-operative deformity?
Correct answer: b. Anterior tibialis transfer to the talar neck
Question 49
A 25-year-old male polytrauma patient undergoes initial temporary external fixation for a femoral shaft fracture. He is converted to a femoral nail at 7 days. This management can be expected to result in
Correct answer: c. equal union and infection rates.
Question 50
A patient falls off a roof and sustains the fracture shown in Figure A. What is the most likely complication that results from injury to the structure that is located at the arrow?
Correct answer: b. Pain or popping with great toe flexion
Question 51
Glenohumeral disarticulation often leads to which of the following changes?
Correct answer: a. Hiking of the shoulder girdle
Question 52
When planning pin placement for external fixation of the tibia, what is the maximum extent of the knee capsular reflection from the subchondral joint line?
Correct answer: d. 14 mm
Question 53
In a polytraumatized patient with a high lactate level, large base deficit, and pulmonary injury, what is the best initial treatment for a femoral shaft fracture?
Correct answer: e. External fixation
Question 54
A patient sustains an injury to the pelvis as a result of high-energy trauma. A radiographic and clinical assessment is performed. A lateral view of the pelvis will best identify
Correct answer: d. spinopelvic dissociation.
Question 55
A 26-year-old woman sustained a nondisplaced femoral neck fracture and treatment consisted of use of percutaneous cannulated screws. At her 3-month follow-up visit, she reports hip pain and is unable to ambulate. A radiograph is shown in Figure A. What is the next most appropriate treatment?
Correct answer: b. Hemiarthroplasty
Question 56
Figures A are the radiographs of an isolated injury. What is the next most appropriate step in management?
Correct answer: d. Application of a spanning external fixator
Question 57
A 60-year-old woman sustains the injury shown in Figure A. Prior to her injury, she lived independently and was a community ambulator without need for any assistive devices. What treatment will give her the greatest long-term painless hip function with the lowest reoperation rate?
Correct answer: a. Total hip arthroplasty
Question 58
Which of the following factors is a significant predictor of reoperation following open reduction and internal fixation of intertrochanteric fractures with a sliding-compression hip-screw device?
Correct answer: c. Fracture through the lateral femoral cortex
Question 59
What is the most common complication associated with open reduction and internal fixation using a 90/90 plate configuration and olecranon osteotomy for an OTA type C2 distal humerus fracture?
Correct answer: e. Pain related to the olecranon fixation
Question 60
A subtrochanteric femur fracture in which the lesser trochanter is intact is associated with what deformity?
Correct answer: d. Abduction and flexion of the proximal fragment
Question 61
A 23-year-old woman sustains the injury seen in Figures 96a. Treatment should consist of which of the following?
Correct answer: c. Open reduction and internal fixation of both the radial head and distal humerus
Question 62
Figures A are the radiographs of a 45-year-old man with diabetes who fell 12 feet from a ladder and sustained an isolated closed injury to his left leg. Examination revealed that he was neurovascularly intact and compartments were soft. A damage control knee spanning external fixator was applied and after 2 weeks in the frame, his blisters have resolved and his skin now wrinkles. What is the most appropriate treatment?
Correct answer: e. Open reduction and internal fixation with posteromedial and lateral plates
Question 63
Which of the following occurs frequently after nonsurgical management of displaced intra-articular fractures of the calcaneus?
Correct answer: e. Peroneal tendinitis
Question 64
Figures 23a show the radiographs of a 75-year-old woman who sustained an injury to her nondominant hand. Initial treatment should consist of
Correct answer: a. closed reduction and splinting.
Question 65
Which of the following findings best describes the acetabular fracture shown in Figure 38?
Correct answer: d. Posterior wall with articular impaction and a free intra-articular fragment
Question 66
The dominant arterial blood supply to the patella enters at which anatomical location?
Correct answer: e. Distal pole
Question 67
Figure 53 is the radiograph obtained at the time of transfer to the trauma center of a 41-year-old man who was involved in a motor vehicle accident. What is the most appropriate initial management?
Correct answer: d. Closed reduction of the right hip
Question 68
Sacral fractures are most likely to be associated with neurologic deficits when they involve what portion of the sacrum?
Correct answer: c. Zone 3 (the central canal)
Question 69
A 43-year-old man sustained a closed, intra-articular pilon fracture. It has now been 1 year since he underwent open reduction and internal fixation. Which of the following statements most accurately describes his perceived outcome?
Correct answer: e. He will perceive improvements for a period of over 2 years.
Question 70
A 71-year-old woman who reports long-term use of oral steroids for asthma is referred for treatment of a distal humerus fracture. Radiographs reveal diffuse osteopenia and a severely comminuted intra-articular fracture. What is the most appropriate treatment?
Correct answer: b. Total elbow arthroplasty
Question 71
Which muscles are responsible for the displacement of the proximal fragment of the fracture shown in Figure 75 https://hutaif-orthopedic.com/upload/1695041314.png?
Correct answer: d. Hamstrings, hip abductors, hip internal rotators
Question 72
A 31-year-old man sustained an unstable closed left posterior hip dislocation in a motorcycle accident. A postreduction radiograph is shown in Figure and CT scans are shown in Figures https://hutaif-orthopedic.com/upload/1695041474.png. What is the optimal surgical approach that will allow for the most appropriate treatment?
Correct answer: a. Surgical hip dislocation (“Berne” approach)
Question 73
What is the most common complication following surgery for a "terrible triad" elbow fracture-dislocation?
Correct answer: d. Restricted range of elbow motion
Question 74
Pelvic packing for a hemodynamically unstable patient with a pelvic ring fracture is best described by which of the following techniques?
Correct answer: a. Placing a pelvic external fixator followed by packing the pelvis with lap pads via a subumbilical incision
Question 75
Plate fixation of olecranon fractures is recommended over tension band wire fixation when
Correct answer: c. the fracture is comminuted.
Question 76
A 25 year-old-male presents with the injury seen in Figure A https://hutaif-orthopedic.com/upload/1695041537.png. Which of the following would be a contraindication to closed management with a functional brace?
Correct answer: d. Brachial plexus injury
Question 77
The implant shown in Figures https://hutaif-orthopedic.com/upload/1695042327.png is introduced submuscularly employing a minimally invasive technique. A percutaneous method of screw insertion is used distally. What nerve is most at risk?
Correct answer: c. Superficial peroneal
Question 78
Following a fall from a height of 5 feet, a patient reports pain along the lateral border of the foot. The CT scan shown in Figure https://hutaif-orthopedic.com/upload/1695042377.png indicates what pathology?
Correct answer: d. Avulsion injury of the bifurcate (Y) ligament
Question 79
A 38-year-old woman is polytraumatized in a motor vehicle crash. She has multiple injuries including a unilateral femur fracture. The patient is felt to be borderline and, although she is currently stable, she could potentially deteriorate quickly. Which of the following parameters has been suggested as an indicator of which patients would benefit from damage control?
Correct answer: d. Injury severity score of greater than 40 without thoracic injury
Question 80
A 73-year-old man sustains the fracture shown in Figure 62 https://hutaif-orthopedic.com/upload/1695042436.png. Which of the following factors or combination of factors puts this patient at highest risk for nonunion if nonsurgical management is used?
Correct answer: e. Fracture comminution, fracture displacement, and advanced age
Question 81
The essential lesion in recurrent or posterior instability following simple dislocation of the elbow typically involves which of the following structures?
Correct answer: b. Lateral ulnar collateral ligament
Question 82
A fracture in the following location is most commonly associated with procurvatum and valgus malalignment?
Correct answer: c. Proximal tibia
Question 83
An otherwise healthy 25-year-old man with an isolated closed mid-diaphyseal femoral fracture undergoes intramedullary nailing. Compared with nonreamed nailing, reamed femoral nailing is associated with a higher rate of
Correct answer: a. union.
Question 84
In each of the following scenarios, atrophic fracture nonunion occurred after initial treatment with intramedullary nail fixation. Which scenario has shown to have the highest rate of osseous union if treated with exchange intramedullary nailing?
Correct answer: e. Oligotrophic nonunion of an oblique tibial shaft fracture
Question 85
Compared with myodesis, osteomyoplasty offers which of the following advantages in transtibial amputation?
Correct answer: a. Enhanced end-bearing
Question 86
Figure A https://hutaif-orthopedic.com/upload/1695042487.png is a radiograph of a healthy, independent 51-year-old male. He is treated with immediate open reduction internal fixation to prevent which of the following complications?
Correct answer: b. Avascular necrosis
Question 87
A 40-year-old man sustains a scapular body fracture after an all- terrain vehicle accident. Which of the following is the most commonly associated injury?
Correct answer: a. Chest injury
Question 88
Compared with surgically treated patients, patients with extra-articular distal third humeral shaft fractures that are treated nonsurgically with functional bracing can be expected to show which of the following findings?
Correct answer: a. Similar loss of elbow motion
Question 89
A healthy 27 year-old-male is brought into the emergency department after a fall from height. He has a suspected left C8-T1 nerve injury. Which of the following findings would most suggest a root avulsion injury rather than a brachial plexus injury at this level?
Correct answer: e. Drooping of the left eyelid
Question 90
A patient reports hyperesthesia over the base of the thenar eminence following volar locked plating of a distal radius fracture. A standard volar approach of Henry was used. What is the most likely cause of the hyperesthesia?
Correct answer: d. Palmar cutaneous nerve injury
Question 91
What is the greatest benefit of external fixation for treatment of displaced and unstable pelvic ring injuries with hemodynamic instability?
Correct answer: b. It helps maintain a stable clot over injured vessels.
Question 92
A 35-year-old woman is involved in a head-on collision while driving. Initial radiographs are shown in Figures 8a https://hutaif-orthopedic.com/upload/1695042935.png. Injury to what vessel increases the risk for osteonecrosis of the injured bone?
Correct answer: d. Artery of the tarsal canal
Question 93
Which of the following findings is a contraindication to isolated percutaneous pinning of a distal radius fracture?
Correct answer: b. Volar comminution
Question 94
Which of the following long bone fracture patterns occurs after a pure bending force is exerted to the bone?
Correct answer: c. Transverse
Question 95
An elderly woman with osteoporosis falls from a standing height, sustaining a low-energy fracture of the acetabulum. What structures are most likely fractured?
Correct answer: b. Anterior column and medial wall
Question 96
Mirror therapy is indicated for which of the following clinical conditions?
Correct answer: e. Phantom pain
Question 97
A 29-year-old patient sustains a closed, displaced joint depression intra-articular calcaneus fracture. In discussing potential complications of surgical intervention through an extensile lateral approach, which of the following is considered the most common complication following surgery?
Correct answer: e. Posttraumatic arthritis
Question 98
Following surgery for an ankle fracture, which of the following is considered the most important factor in achieving a satisfactory outcome?
Correct answer: c. Anatomic alignment
Question 99
A 22-year-old woman underwent closed reduction and percutaneous pinning with casting of a displaced extra-articular distal radius fracture. The surgery was completed with a supraclavicular regional anesthesia. After the block wears off, she reports new onset dense numbness in the palmar aspect of the thumb, index, and middle fingers as well as severe pain in the hand. What is the next step in management?
Correct answer: b. Return to the operating room for open carpal tunnel release
Question 100
Figure is the radiograph of a 24-year-old man who was involved in a motor vehicle accident. A closed reduction is performed and a post-reduction CT scan is shown in Figure 89b https://hutaif-orthopedic.com/upload/1695042991.png. What is the next most appropriate step in management?
Correct answer: d. Assessment of hip stability
Question 101
A 26-year-old man is involved in a high-speed motorcycle accident. He sustains a grade IIIB open tibia fracture. Examination reveals a large soft-tissue defect and an insensate foot. What is the expected outcome in this scenario?
Correct answer: a. Equal functional outcome when limb salvage is compared with amputation
Question 102
A 32-year-old man has an open comminuted humeral shaft fracture. Examination reveals absence of sensation in the first web space and he is unable to fully extend the thumb, fingers, and wrist. What is the recommended treatment following irrigation and debridement of the fracture?
Correct answer: d. Open reduction and internal fixation, radial nerve exploration
Question 103
What complication is most likely to occur following proximal humeral fixation with a locked plate-and-screw construct?
Correct answer: a. Screw penetration
Question 104
Patient outcome after open reduction and internal fixation of tibial plateau fractures shows that patients older than 50 years of age when compared to younger patients have
Correct answer: e. worse outcomes in low-energy fractures.
Question 105
What role does quorum sensing play in the development of a bacterial biofilm?
Correct answer: a. Activates genes that produce virulence factors
Question 106
Which of the following patients is more likely to have an overall poorer outcome following a lower extremity amputation?
Correct answer: b. A male patient with a through-the-knee amputation performed in a zone of injury
Question 107
A 22-year-old woman injured her ankle when she fell off a ladder. Radiographs reveal a displaced large posterior malleolus fracture of about 45% of the joint. What is the best definitive treatment?
Correct answer: a. Open reduction and internal fixation with absolute stability
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