FREE Orthopedics MCQS 2022 1451-1500
FREE Orthopedics MCQS 2022 1451-1500
1451. (2163) Q4-2589:
Which of the following terms is not used in reference to macrodactyly:
1) Megalodactyly
3) Gigantism
2) Overgrowth
5) Macrodactylia fibrolipomatosis
4) Symbrachydactyly
Symbrachydactyly is a term that encompasses all variations of shortened digits. Symbrachydactyly may be associated with syndactylies, but it is not a term used in reference to macrodactyly.
■Correct Answer:Symbrachydactyly
1452. (2164) Q4-2590:
Most cases of macrodactyly are:
1) Bilateral and affect men more often than women
3) Unilateral and affect men more often than women
2) Bilateral and affect women more often than men
5) Bilateral with equal frequency in both men and women
4) Unilateral and affect women more often than men
The majority of patients (90%) present with unilateral macrodactyly, and men are more often affected than women. Macrodactyly is most frequently found in the index finger, followed by the long finger, thumb, ring, and little fingers. Typically, two digits are affected â most commonly the thumb and index or the index and long.
■Correct Answer:Unilateral and affect men more often than women
1453. (2165) Q4-2591:
Which digit is most commonly affected by macrodactyly:
1) Thumb
3) MIddle
2) Index
5) Small
4) Ring
The index finger is most frequently affected, although multiple digital enlargement is actually more commonly seen.C orrect
Answer: Index
1454. (2166) Q4-2592:
Syndactyly is present in what percentage of patients with macrodactyly:
1) 10%
3) 30%
2) 20%
5) 50%
4) 40%
The majority of patients (90%) present with unilateral macrodactyly, and men are more often affected than women. Macrodactyly is most frequently found in the index finger, followed by the long finger, thumb, ring, and little fingers. Typically, two digits are affected â most commonly the thumb and index or the index and long. Syndactyly may be present in 10% of patients with macrodactyly.
■Correct Answer:10%
1455. (2167) Q4-2593:
Macrodactyly that is present at birth is termed:
1) Birth advancing macrodactyly (BAM)
3) Progressive macrodactyly
2) Static macrodactyly
5) C omplex macrodactyly
4) Simple macrodactyly
Barsky described macrodactyly as either static or progressive. Static macrodactyly is present at birth, and the affected digit grows larger as the child develops. In the progressive type of macrodactyly, growth begins soon after birth. This form of the disorder is more common than static macrodactyly.
■Correct Answer:Static macrodactyly
1456. (2168) Q4-2594:
The most accepted theory for the cause of macrodactyly is:
1) Idiopathic
3) Vascular
2) Neural
5) C ongenital
4) Humoral
Some surgeons believe that macrodactyly is a variant of neurofibromatosis. Although macrodactyly is not an inherited anomaly, there are syndromes that may be associated with enlarged digits such as Proteus syndrome. Although numerous causes have been suggested, the most accepted theory was described by Inglis in 1950. He theorized that the abnormal nerves exert influence on the local tissues to stimulate growth.
■Correct Answer:Neural
1457. (2169) Q4-2595:
Syndromes that may be associated with macrodactyly include:
1) Proteus syndrome
3) Madelungâs deformity
2) Freeman-Sheldon syndrome
5) Poland syndrome
4) Holt-Oram syndrome
Some surgeons believe that macrodactyly is a variant of neurofibromatosis. Although macrodactyly is not an inherited anomaly, there are syndromes that may be associated with enlarged digits such as Proteus syndrome. Theoretical causes for macrodactyly include a neural cause, a vascular cause, as well as a humoral mechanism. The most accepted theory is that abnormal nerves exert some influence on the local tissues to stimulate growth.
■Correct Answer:Proteus syndrome
1458. (2170) Q4-2596: Macrodactyly affects:
1) Only bones
3) Bones, fat, and nerves
2) Bones and fat
5) Bones, fat, nerves, blood vessels, and tendons
4) Bones, fat, nerves, and blood vessels
Although this is controversial, the majority of surgeons believe that macrodactyly affects bones, fat, and nerves.
■Correct Answer:Bones, fat, and nerves
1459. (2171) Q4-2597:
A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. After examination of the patient, you recommend:
1) Scheduling the patient for immediate surgery
3) Performing surgery within 1 week of diagnosis
2) Telling the parents to return when the child develops functional abnormalities
5) Performing additional testing
4) Scheduling surgery to coincide with the patient beginning school
The child is not ready for surgery. Although surgery may coincide with the patient beginning school, this does not always occur. At this time, additional examination and testing are recommended.
■Correct Answer:Performing additional testing
1460. (2172) Q4-2598:
A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. The childâs parents inform you that they would like you to amputate the affected digits as soon as possible. You should:
1) Begin radiation therapy to arrest the growth of the affected digits
3) Send the patient to another hand surgeon
2) Proceed with amputation because you have the parentsâ consent
5) Schedule the patient for a debulking procedure
4) Explain the typical course of macrodactyly and order additional testing
Although amputation may be necessary in some patients with macrodactyly, it is too early in the course of this case to begin entertaining such a drastic measure. A debulking procedure is not recommended for a 2-year-old child. Radiation therapy is not an option in uncomplicated cases of macrodactyly. The surgeon must educate the parents about the disease process and order additional testing.
■Correct Answer:Explain the typical course of macrodactyly and order additional testing
1461. (2173) Q4-2599:
You discover that a patient who you have been treating for macrodactyly has been followed by the Proteus Syndrome
Foundation. Exhaustive work-up has been completed and radiographs of the hand reveal:
1) Multiple enchondromas in the affected fingers
3) Enlarged bones in length and width
2) Enlarged bones in length only
5) Normal appearing bones
4) Enlarged bones in width only
In patients with macrodactyly, surgeons do not typically find enchondromas, especially not multiple enchondromas in the affected fingers. Enlargement of the bones is found in all dimensions â not only in the length and width. If the bones appear normal on radiograph, then they are not affected by macrodactyly.
■Correct Answer:Enlarged bones in length and width
1462. (2174) Q4-2600:
A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. After examination of the patient, you discuss the diagnosis of macrodactyly with the parents. The parents feel assured after your discussion of the disease process and your review of the radiographs. You should next see the patient:
1) Never
3) When functional abnormalities develop
2) In 1 year
5) When the patient is old enough to consent for surgery
4) When the enlargement of the digits has ceased
Patients with macrodactyly should be followed up yearly. Although the parents may be difficult, this is not a reason to stop seeing a patient. The other answers choices are incorrect because treatment would be too late.
■Correct Answer:In 1 year
1463. (2175) Q4-2601:
Which of the following is not a complication of macrodactyly surgery:
1) Nerve injury
3) Decreased sensation
2) Bony malunion
5) Infection
4) Joint laxity
C omplications of macrodactyly surgery include poor healing of flaps secondary to devascularization or undue tension, nerve injury or decreased sensation, infection, stiffness, bony nonunion or malunion, and failure of the epiphysiodesis.
■Correct Answer:Joint laxity
1464. (2176) Q4-2602:
Epiphysiodesis for macrodactyly should be performed at the following location:
1) Proximal phalanx only
3) Proximal phalanx, middle phalanx, and distal phalanx
2) Proximal phalanx and middle phalanx
5) Proximal phalanx and distal phalanx
4) Middle phalanx only
Treatment by epiphysiodesis for macrodactyly is ineffective if only single phalanges are treated. Therefore, treatment of the proximal phalanx, distal phalanx, or the middle phalanx alone is incorrect. The author prefers to perform epiphysiodesis only on the proximal and distal phalanges. The middle phalanx is not treated to preserve motion at the proximal interphalangeal joint.
■Correct Answer:Proximal phalanx and distal phalanx
1465. (2187) Q4-2614:
When ruptured, which portion of the scapholunate ligament leads to scaphoid-lunate diastasis:
1) Distal
3) Intermediate
2) Proximal
5) Volar
4) Dorsal
The dorsal section of the scapholunate ligament is the strongest portion, requiring 300 N of load for failure. The volar (150 N) and intermediate portions (25 N to 50 N) contribute less to overall stability.
■Correct Answer:Dorsal
1466. (2188) Q4-2615:
Which of the following radiographic views is not routinely used to diagnose scapholunate injury:
1) Semisupination oblique view
3) Lateral view
2) C lenched fist view
5) Oblique view
4) Anteroposterior (AP) view
The semisupination oblique view is used to visualize the pisiform and pisotriquetral joint. The PA oblique and lateral views are the primary films used to diagnose scapholunate instability. The clenched fist view is used as a provocative view to bring out dynamic instability.
■Correct Answer:Semisupination oblique view
1467. (2189) Q4-2616:
Which of the following treatments is not used for acute scapholunate ligament ruptures:
1) Open repair with bone sutures
3) C losed reduction and long arm cast
2) Proximal row carpectomy
5) Open repair with suture anchors
4) Arthroscopically assisted reduction and pinning
Proximal row carpectomy is a salvage procedure for chronic instability with focal radioscaphoid arthritis. Open repair with sutures through bone tunnels, open repair with suture anchors, and arthroscopically assisted reduction and pinning have been used successfully in acute cases.
■Correct Answer:Proximal row carpectomy
1468. (2190) Q4-2617:
Which of the following is considered indicative of a scaphoid-lunate ligament tear on posteroanterior radiograph:
1) Terry Thomas sign
3) Spilled tea cup sign
2) Volar intercalated segmental instability (VISI) pattern
5) Dorsal intercalated segment instability (DISI) pattern
4) Watson-Jones scaphoid shift
The VISI, DISI, and spilled tea cup signs are seen on lateral radiographs, whereas the Watson-Jones scaphoid shift test is a clinical sign. The classic pattern after scaphoid-lunate ligament injury is a DISI pattern as the lunate extends and the scaphoid flexes. The spilled tea cup sign is present in perilunate dislocations.
■Correct Answer:Terry Thomas sign
1469. (2191) Q4-2618:
The Terry Thomas sign, which is considered indicative of scaphoid-lunate ligament rupture, is best described as:
1) Scapholunate diastases larger than 3 mm
3) Reduction and exaggeration of scapholunate diastases on radial and ulnar deviation motion studies
2) Scapholunate angle more than 30º to 60º on lateral radiographs
5) Scaphoid flexion with lunate extension
4) Exaggeration and reduction of scaphoid-lunate diastases on radial and ulnar deviation radiographs, respectively
The Terry Thomas sign refers to scapholunate diastases that may be apparent on posteroanterior radiographs of the wrist and is indicative of rupture if the diastases are larger than 3 mm. It is named after the famous comedian who had a gap between his front teeth.
■Correct Answer:Scapholunate diastases larger than 3 mm
1470. (2192) Q4-2619:
The most important requirement for a diagnostic magnetic resonance image (MRI) study in cases of scaphoid-lunate ligament injury is:
1) 2 mm thin slices
3) Gallium-enhanced scan
2) Tangential cuts
5) MRI in neutral, radial, and ulnar deviation
4) Dedicated wrist coil
MRI is not considered the technique of choice for the evaluation of the scaphoid-lunate ligament. Standard MRI coils are not adequate for the evaluation of the ligaments of the wrist. To maximize the yield from a wrist MRI, high-field strength and high- resolution images must be obtained using dedicated wrist coils. Only with such dedicated coils can detailed information be derived regarding the continuity of the scapoid-lunate ligament. Physical examination and wrist arthroscopy remain the gold standards for the evaluation of a torn scaphoid-lunate ligament.
■Correct Answer:Dedicated wrist coil
1471. (2193) Q4-2620:
In cases of subacute scaphoid-lunate ligament injury with no arthrosis, all of the following are acceptable options except:
1) Herbert screw (reduction association of the scapholunate)
3) Scaphoid-lunate ligament reconstruction using bone-ligament-bone autograft
2) Scaphotrapeziotrapezoid (STT) fusion
5) Repair with capsulodesis
4) Allograft ligament
In cases of subacute scaphoid-lunate ligament injury without arthrosis, it is acceptable to attempt reconstruction with bone anchors, allograft ligament repair, capsulodesis, bone-ligament-bone autograft, and the RASL procedure with a Herbert screw. In the presence of localized arthritis, one might consider one of the limited wrist fusions such as scaphotrapeziotrapezoid fusion.
■Correct Answer:Scaphotrapeziotrapezoid (STT) fusion
1472. (2317) Q4-2770:
Mallet finger injuries refer to:
1) Fractures of the bony tuft
3) Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint
2) Flexor tendon injuries
5) Intrinsic tightness
4) Fractures of the middle phalanx
Mallet finger injuries may be associated with fractures of the bony tuft, fractures of the middle phalanx, flexor tendon injuries, and intrinsic tightness. However, mallet injuries refer to lack of continuity at the DIP joint.
■Correct Answer:Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint
1473. (2318) Q4-2772:
In mallet finger injuries, the distal phalanx posture is:
1) Hyperextended
3) Neutral
2) Flexed
5) Ulnarly deviated
4) Radially deviated
The characteristic deformity is âdroopingâ at the distal interphalangeal (DIP) joint. The DIP is flexed. It is not hyperextended, neutral, or deviated.
■Correct Answer:Flexed
1474. (2319) Q4-2773:
Mallet finger injuries are typically:
1) Secondary to hyperextension injuries
3) Secondary to torsion injuries
2) Secondary to forced flexion injuries
5) Asymptomatic
4) Secondary to fingertip amputations
Mallet finger usually results from a blow to the tip of the extended finger. This forces distal phalanx flexion and disruption of the extensor mechanism at the distal interphalangeal joint. Open injuries to the extensor mechanism can also cause mallet finger.
■Correct Answer:Secondary to forced flexion injuries
1475. (2320) Q4-2774:
Treatment of a type I mallet finger is typically closed. This involves:
1) C ast immobilization of the affected digit in extension
3) Early active motion of the affected joint
2) Dorsal block splint of the affected digit
5) Splinting of the affected DIP joint in extension
4) Splinting of the affected distal interphalangeal joint (DIP) joint in flexion
C ast immobilization is excessive and will cause undue stiffness in the affected finger. Dorsal blocking splints, splinting in flexion, and early active motion are contraindicated in these injuries. Only the affected joint should be splinted in extension.
■Correct Answer:Splinting of the affected DIP joint in extension
1476. (2321) Q4-2775:
Type I mallet finger injuries must be immobilized constantly for a minimum of:
1) 4 weeks
3) 6 weeks
2) 5 weeks
5) 8 weeks
4) 7 weeks
Eight weeks of immobilization is preferred. If the finger is immobilized for a shorter period of time, the clock is reset and immobilization is started again.
■Correct Answer:8 weeks
1477. (2323) Q4-2777:
The most common mallet finger injuries are:
1) Type I
3) Type III
2) Type II
5) Type V
4) Type IV
Type I mallet injuries are by far the most common mallet injuries. There is no such classification as a type V injury.C orrect
Answer: Type I
1478. (2324) Q4-2778:
On physical examination, a mallet finger assumes a:
1) Resting flexed posture with active and passive extension
3) Resting flexed posture without active extension
2) Resting flexed posture without passive extension
5) Resting flexed posture with active extension
4) Resting flexed posture without active or passive extension
The distal phalanx assumes a resting flexed posture. The patient is not able to actively extend the fingertip, but it can be passively extended.
■Correct Answer:Resting flexed posture without active extension
1479. (2325) Q4-2779:
The following mallet finger injuries always require tendon repair:
1) Type I and type II
3) Type III and type IV
2) Type II and type III
5) Type I and type IV
4) Type IV and type V
Type II and III injuries have absolute requirements for tendon repair as there is a laceration or loss of tendon substance.C orrect
Answer: Type II and type III
1480. (2326) Q4-2780:
After placing a type I mallet finger in a splint at the initial visit, next follow-up should be:
1) The following day
3) In 2 weeks
2) In 1 week
5) At the end of the 8-week regimen
4) In 1 month
After placement of the splint, the patient should follow-up in the next week to make sure the finger is still maintained in full extension. Loosening of the splint will occur as swelling decreases.
■Correct Answer:In 1 week
1481. (2335) Q4-2792:
The most common bone tumor of the upper extremity is:
1) Enchondroma
3) Osteochondroma
2) Osteoblastoma
5) C hondromyxoid tumor
4) Giant cell tumor
Osteochondromas are the most common primary benign bony tumors.
■Correct Answer:Osteochondroma
1482. (2336) Q4-2793:
The most common benign bone tumor of the hand is:
1) Enchondroma
3) Osteochondroma
2) Osteoblastoma
5) C hondromyxoid tumor
4) Giant cell tumor
Unlike the entire upper extremity, enchondromas are the most common tumors of the hand.
■Correct Answer:Enchondroma
1483. (2337) Q4-2794:
Osteochondromas are benign but can have a malignant transformation in which of the following cases:
1) Diaphyseal achalasia
3) Osteochondromatosis malignant transformans
2) Ollierâs disease
5) Mafucci's syndrome
4) Osteochondroma larger than 5 cm
Diaphyseal achalasia, also known as multiple hereditary exostoses, has a risk of malignant degeneration in up to 25% patients. Ollierâs disease and Mafucciâs syndrome are associated with enchondromas. There is no lesion called an osteochondromatosis malignant transformans.
■Correct Answer:Diaphyseal achalasia
1484. (2338) Q4-2795:
The risk of malignant transformation in patients with multiple hereditary exostoses is:
1) 0%
3) 1% to 2%
2) Less than 1%
5) 0.5% to 25%
4) Greater than 5%
The rate of malignant transformation in patients with multiple hereditary exostoses is variable and is generally reported between
0.5% to 25%.
■Correct Answer:0.5% to 25%
1485. (2339) Q4-2796:
Recurrence of osteochondroma is likely if:
1) The cartilage cap is incompletely excised
3) The bony stalk is incompletely excised
2) The overlying bursa is incompletely excised
5) Its connection with the medullary canal is not obliterated
4) The tumor is incompletely excised
The cartilaginous portion of an osteochondroma is the neoplastic part; its complete excision is essential to avoid recurrences.
■Correct Answer:The cartilage cap is incompletely excised
1486. (2340) Q4-2797:
Malignant transformation of osteochondroma commonly occurs to:
1) High-grade osteosarcoma
3) Low-grade chondrosarcoma
2) High-grade chondrosarcoma
5) Parosteal osteosarcoma
4) Low-grade osteosarcoma
Osteochondroma is a cartilaginous tumor and malignant transformation is to a low-grade chondrosarcoma.
■Correct Answer:Low- grade chondrosarcoma
1487. (2341) Q4-2798:
All of the following suggest a possibility of malignant transformation in multiple hereditary exostoses except:
1) Recent onset of pain
3) C artilaginous cap thickness greater than 3 cm
2) Growth after skeletal maturity
5) C alcific stippling in the cap on radiograph
4) Soft tissue extension
Stippling on radiographs in the cap is due to calcification and is a common characteristic of cartilaginous tumors.
■Correct Answer:C alcific stippling in the cap on radiograph
1488. (2342) Q4-2799:
Enchondromas are commonly involved in which of the following sites:
1) Metacarpals
3) Radius
2) C arpus
5) C lavicle
4) Ulna
Metacarpals and phalanges are the most common areas of hand involvement, and the hand is involved in 40% to 65% of cases. Enchondromas are also the most common primary benign bone tumor of the hand (90% cases).
■Correct Answer:Metacarpals
1489. (2343) Q4-2800:
The most common forearm deformity in patients with hereditary multiple osteochondromatosis is:
1) Ulnar shortening
3) Radial head dislocation
2) Radial shortening
5) Translocation of carpus
4) Madelungâs deformity
Ulnar involvement and shortening frequently occurs in patients with hereditary multiples osteochondromatosis because the distal ulnar growth plate is smaller than that of the radius, consequently its length is affected more. The ulnar shortening causes radial bowing or radial head dislocation.
■Correct Answer:Ulnar shortening
1490. (2344) Q4-2801:
Slide 1
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the patientâs forearm. The anteroposterior radiograph is shown (Slide). The next step is to order a:
1) Skeletal radiograph survey
3) Magnetic resonance imaging (MRI) with wrist arthrogram
2) Magnetic resonance imaging (MRI)
5) C omputed tomography (C T) scan
4) Genetic evaluation
The next step is to order a skeletal survey to rule out involvement of other areas.
■Correct Answer:Skeletal radiograph survey
1491. (2345) Q4-2802:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
An immediate appointment for magnetic resonance imagine (MRI) and computed tomography (C T) scan are not available, and a genetic evaluation has been carried out previously. As you await the report from the geneticist office, you decide to get a skeletal radiograph series on the patient. The radiograph of the opposite forearm (Slide 1) and right leg are shown (Slide 2).
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 3). Your suspected diagnosis is:
1) Diaphyseal achalasia
3) Multiple enchondromatosis
2) Madelungâs deformity
5) Infection
4) Multiple epiphyseal dysplasia
Diaphyseal achalasia, also called multiple hereditary exostoses, classically presents in a young individual with multiple sites of involvement. The more involved the disease, the more likely hand involvement becomes. Forearm involvement is also common. The radius is bowed due to the shortened ulna. The risk of radial head dislocation is higher if the radius does not bow. While infection or traumatic injury could have produced early physeal arrest as seen in the first radiograph, presence of lesions elsewhere indicates multiple hereditary exostoses and should be investigated with skeletal surveys. Multiple epiphyseal dysplasia is not a possible diagnosis as only the ulna is involved in the first radiograph and radius alone in the left forearm. No enchondromas are present.
■Correct Answer:Diaphyseal achalasia
1492. (2346) Q4-2803:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The genetic pattern seen in patients with this type of presentation is:
1) Autosomal recessive
3) Sex-linked recessive
2) Autosomal dominant
5) Sporadic
4) Sex-linked dominant
Multiple hereditary exostoses is inherited in an autosomal-dominant manner with 90% penetrance.
■Correct Answer:Autosomal dominant
1493. (2347) Q4-2804:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
Which of the following areas is unlikely to be involved:
1) Phalanges
3) C lavicle
2) Pelvis
5) Talus
4) Femur
The clavicle is a membranous bone, and osteochondromas do not arise in membranous bones.
■Correct Answer:C lavicle
1494. (4053) Q4-2805:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The chance of hand involvement in this child is:
1) 0%
3) 25%
2) 10%
5) Undetermined
4) Greater than 25%
The hand is involved in 30% to 80% of cases.
■Correct Answer:Greater than 25%
1495. (2348) Q4-2806:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The most likely complication in this child is:
1) Malignant degeneration
3) Posterior interosseous neuropathy (PIN) palsy
2) C arpal translocation
5) Elbow dislocation
4) Peroneal nerve palsy
Ulnar carpal translocation occurs due to the steep radial articular angulation that occurs due to the tethering effect of a shortened ulna and is already apparent in early stages in the first radiograph. While peroneal palsy is possible due to a proximal fibula lesion, it is less common. Malignant transformation occurs, risk varies with families.
■Correct Answer:C arpal translocation
1496. (2349) Q4-2807:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The difference between Madelungâs deformity and this boyâs condition is:
1) The ulna is shorter
3) There is radial head dislocation
2) The radius is shorter
5) It is not congenital
4) There is bilateral involvement
The ulna is elongated or dorsally subluxed in Madelung's deformity.
■Correct Answer:The ulna is shorter
1497. (2350) Q4-2808:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
All of the following are acceptable options, either alone or in combination, for management of this childâs condition, except:
1) Excision of osteochondromas
3) Hemiphyseal stapling
2) Ulnar lengthening
5) Observation
4) Radial osteotomy
Although hemiphyseal stapling is an acceptable option to correct radial articular angulation, in this boy the distal radial physis is already fused as is seen in the first radiograph.
■Correct Answer:Hemiphyseal stapling
1498. (2351) Q4-2809:
Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
Which of the following is not true regarding the possibility of malignant degeneration in this child:
1) There is a risk of up to 25%
3) Most common secondary malignancy is chondrosarcoma
2) Bone scan can differentiate
5) Malignant change occurs in adulthood
4) Risk of malignancy varies between families
Bone scan cannot differentiate between an active lesion and a malignant transformation.
■Correct Answer:Bone scan can differentiate
1499. (2352) Q4-2810:
Hornerâs syndrome includes all of the following except:
1) Miosis
3) Enophthalmosis
2) Anhidrosis
5) Diplopia
4) Exophthalmosis
Hornerâs syndrome is caused by disruption of sympathetic innervation and is characterized by enophthalmosis, not exophthalmosis. Other symptoms include anhidrosis, miosis, and ptosis.
■Correct Answer:Exophthalmosis
1500. (2353) Q4-2811:
Axonotmesis involves injury to the:
1) Epineurium
3) Perineurium
2) Endoneurium
5) Vasonervorum
4) Axon
Axontmesis, as described in Seddonâs classification, implies injury to the axon and myelin sheath. Neurontmesis involves injury to all three layers.
■Correct Answer:Axon