Orthopedic Board Review: Mock Exam Set #949 | 100 High-Yield MCQs for ABOS, OITE & FRCS

With a full-thickness articular cartilage injury, the body's healing response produces cartilage mainly composed of what type of collagen?

In the treatment of acetabular dysplasia, what type of pelvic osteotomy leaves the "teardrop" in its original position and redirects the acetabulum?

A 67-year-old woman has had pain in the area of the metatarsal heads and toes bilaterally for the past 18 months. She describes a diffuse discomfort and a constant burning sensation. She notes that the area feels swollen. Examination reveals that her pulses are normal, and there is no frank swelling or focal tenderness. What is the most likely diagnosis?

Type II collagen in nondiseased adult human articular cartilage has a half-life that is generally

Figures 22a and 22b show the radiographs of a patient who reports stiffness of the hip and associated pain. Management should consist of

A 62-year-old man has cervical myelopathy with no evidence of cervical radiculopathy. MRI reveals stenosis at C4-5 and C5-6 with severe cord compression. Examination will most likely reveal which of the following findings?

The illustration shown in Figure 19 shows a Chamberlain line. What is the most likely diagnosis?

Figure 19 shows the radiograph of a 6-month-old infant who has limited hip motion. History reveals no complications during pregnancy or delivery. Examination reveals that hip abduction is 45 degrees in flexion bilaterally. The neurologic examination is normal. What is the best course of action?

A 6-year-old boy with acute hematogenous osteomyelitis of the distal femur is being treated with intravenous antibiotics. The most expeditious method to determine the early success or failure of treatment is by serial evaluations of which of the following studies?

A 13-year-old girl is diagnosed with a stage IIB osteosarcoma of the proximal tibia. Following neoadjuvant chemotherapy, local control should consist of

Which of the following increases radiation exposure to patients and personnel during surgery?

A 45-year-old man is seeking evaluation of an injury sustained in a motor vehicle accident 10 weeks ago. Current radiographs are shown in Figures 2a and 2b. Based on the radiographic findings, what is the most likely diagnosis?

A 20-year-old professional female jockey who is wearing a helmet is thrown from her horse. What is the most likely location of her injury?

A 65-year-old man has a painful and often audible crepitus after undergoing a total knee arthroplasty 8 months ago. His symptoms are reproduced with active extension of about 30 degrees. Examination reveals no effusion or localized tenderness, a stable knee, and a range of motion of 5 degrees to 120 degrees. Radiographs are shown in Figures 37a and 37b. Management should consist of

A 14-year-old boy undergoes application of a circular frame with tibial and fibular osteotomy for gradual limb lengthening. He initiates lengthening 7 days after surgery. During the first week of lengthening, he reports that turning of the distraction devices is becoming increasingly difficult. On the 9th day of lengthening, he is seen in the emergency department after feeling a pop in his leg and noting the acute onset of severe pain. What complication has most likely occurred?

What is the best approach to reduce and stabilize a displaced volar lunate facet fracture of the wrist?

A 23-year-old man who is a competitive overhead athlete has shoulder pain. Based on the pathology shown in Figure 47, what treatment option would yield the highest satisfaction and return to overhead sports?

An 18-year-old gymnast has had a 1-year history of foot pain. Examination reveals medial midfoot tenderness without swelling. Non-weight-bearing in a cast for 6 weeks has failed to provide relief. An axial CT scan of the midfoot is shown in Figure 20. What is the optimal treatment for this condition?

Figure 19 shows the radiograph of a 45-year-old woman who has a painful nonunion. Treatment should consist of

A patient who underwent a high tibial osteotomy (HTO) is now scheduled to undergo total knee arthroplasty (TKA). When compared with a patient undergoing primary TKA without a prior HTO, the patient should be advised to expect a higher incidence of

A 29-year-old woman was injured in a high-speed motor vehicle accident 3 hours ago. Radiographs are shown in Figures 7a through 7e. Her right foot injury is open and contaminated. Her associated injuries include a closed head injury and a ruptured spleen requiring resection. She has had 6 units of packed red blood cells and the trauma surgeon has turned her care over to you. Her current base deficit is 10 and her urinary output has averaged 0.4 mL/kg for the last 2 hours. What is the best treatment at this time?

Where is the watershed zone for tarsal navicular vascularity?

A 13-year-old girl who competes in gymnastics reports the insidious onset of lateral left elbow pain over the past 6 months. She also notes occasional catching episodes in the elbow; however, she denies any history of trauma. Examination reveals tenderness over the lateral epicondyle and extensor muscle origin. The elbow is stable and has full flexion, but lacks 10 degrees of full extension. An AP plain radiograph and an MRI scan are shown in Figures 17a and 17b. Management of the elbow should consist of

In hip arthroplasty, the location of the medial femoral circumflex artery is best described as

A 67-year-old man who underwent humeral head arthroplasty for a four-part fracture 6 months ago reports that he is still unable to actively elevate his arm. Rehabilitation after surgery consisted of a sling with passive range-of-motion exercises for 2 weeks and then progressed to active-assisted and strengthening exercises at 3 weeks. Radiographs are shown in Figures 28a and 28b. What is the primary cause of his inability to elevate the arm?

Figures 38a and 38b show the CT scans of a 64-year-old woman. What is the most likely diagnosis?

A 24-year-old woman has a spleen laceration and hypotension. Radiographs reveal a pulmonary contusion and a displaced mid-diaphyseal fracture of the femur. The trauma surgeon clears her for stabilization of the femoral fracture. What technique will offer the least potential for initial complications?

Which of the following patients with cerebral palsy is considered the ideal candidate for a selective dorsal rhizotomy?

Figure 40 shows the radiographs of a 2-year-old boy who has a deformed leg. The patient is ambulatory and has no pain. What is the most appropriate management?

A 51-year-old male truck driver has had progressive left hip pain for more than 2 years, and he reports that the pain has become severe in the past 9 months. He is now unable to work because of the pain. Examination reveals that range of motion of the hip is limited to 95 degrees of flexion, 0 degrees of internal rotation, and 20 degrees of external rotation. The plain radiograph, MRI scan, and intraoperative gross photographs are shown in Figures 9a through 9d. Management should consist of

A 52-year-old woman who is right hand-dominant sustains an injury to her elbow in a fall. A radiograph is shown in Figure 60. The preferred treatment of this injury pattern should include

Posterior sternoclavicular dislocations are most commonly associated with which of the following complications?

What is the most likely long-term sequela of the injury shown in Figures 47a and 47b?

Which of the following factors is associated with decreases in active periprosthetic osteolysis in total hip arthroplasty?

A 25-year-old woman has significant pain and swelling in her left ankle after falling off her bicycle. Examination reveals that she is neurovascularly intact. Radiographs are shown in Figures 33a through 33c. What is the next most appropriate step in management?

A 62-year-old man with diabetes mellitus has had a persistent 2-cm ulcer under the third metatarsal head for the past 4 months. He reports that he has had similar ulcers twice before, and both healed with nonsurgical management. He has used multiple types of commercial walking braces, shoes, and commercial dressings without resolution. He is insensate to the Semmes-Weinstein 5.07 monofilament. When the wound is probed with culture swab, there is no communication with the metatarsal head. Radiographs, bone scans, and laboratory studies reveal no evidence of osteomyelitis. What is the most predictable method of accomplishing wound healing without recurrence?

A 61-year-old woman with a long-standing history of rheumatoid arthritis reports progressive elbow pain for the past 12 months. She denies any recent trauma to the elbow; however, she notes increasing pain and decreased joint motion that are now compromising her function. Radiographs are shown in Figures 57a and 57b. What is the most appropriate treatment at this time?

A 24-year-old man who was involved in a high speed motor vehicle accident is transferred for definitive care after having been diagnosed with an acute spinal cord injury from a fracture-dislocation at C6-7. He has a complete C6 neurologic level and it is now approximately 10 hours from his injury. What is the most appropriate pharmacologic treatment at this time?

Figure 24 shows an axial MRI scan of the ankle. The arrowhead is pointing to what structure?

What is the most common donor site complication following a free vascularized fibular graft for osteonecrosis of the femoral head?

A 15-year-old athlete collapses suddenly during practice and dies. What is the most likely cause of death?

Figure 17 shows the radiograph of an 11-year-old boy with Duchenne muscular dystrophy who has been nonambulatory for the past 2 years. Management of the spinal deformity should consist of

The arrow in Figure 11 points toward a finding consistent with which of the following?

A 15-year-old diver has had persistent, activity-related low back pain for the past 2 months. He denies any history of trauma. Examination reveals that the pain is localized to the lumbosacral junction, and there are no radicular symptoms. The pain is worse with back extension. Neurologic examination is normal, as are AP, lateral, and oblique radiographs of the lumbosacral spine. Further evaluation should include

Figures 20a and 20b show the radiographs of a 14-year-old boy who sustained a twisting injury to his ankle. If attempted closed reduction is unsuccessful, what is the primary reason to proceed with surgical treatment?

A 30-year-old patient has had severe left hip pain and difficulty ambulating, necessitating the use of a cane, for the past 6 months. A photomicrograph of the femoral head sectioned at the time of surgery is shown in Figure 31. What is the most likely diagnosis?

A 12-year-old girl who is Risser stage 3 has had intermittent mild midback pain for the past 4 weeks. The pain is worse after prolonged sitting and after carrying a heavy backpack at school. She occasionally takes acetaminophen, but the pain does not limit sport activities. Examination reveals a mild right rib prominence during forward bending. Neurologic examination is normal. Radiographs show a 20-degree right thoracic scoliosis with no congenital anomalies or lytic lesions. Management should consist of

Which of the following muscles has dual innervation?

A 12-year-old child with spina bifida paraplegia requires brace management for ankle stability. Which of the following principles applies to brace management in this individual?

What is the primary concern for arthrodesis of a failed infected total knee arthroplasty using internal fixation?

What is the best surgical approach for the scapular fracture shown in Figure 46?

A 68-year-old woman stepped on a needle while walking barefoot 10 days ago. She is not certain but thinks it is imbedded in her foot, and she notes local tenderness at the puncture site and drainage. Her primary care physician has been treating her with oral antibiotics. A plain radiograph is shown in Figure 38. What is the best course of action?

An 18-year-old rugby player has had pain in his ring finger after missing a tackle 1 week ago. Examination reveals tenderness in the distal palm, and he is unable to actively flex the distal interphalangeal (DIP) joint. Radiographs are normal. What is the most appropriate management?

What is the most common indication for revision following unconstrained elbow arthroplasty?

A 43-year-old woman has an enlarging mass in the left groin. A radiograph, CT scan, and a biopsy specimen are shown in Figures 42a through 42c. Treatment should consist of

What is the reported failure rate for surgical treatment of a Morton's neuroma?

The mother of a 2-year-old boy reports that he had pain in the right hip all night and refuses to walk on the leg this morning. He is afebrile. Examination reveals pain on hip extension and adduction, but he is able to internally and externally rotate the hip approximately 20 degrees in each direction without pain. Laboratory studies reveal a WBC count of 7,400/mm3, with 62% polymorphonuclear neutrophil leukocytes. The AP radiograph shown in Figure 15 reveals a left teardrop distance of 8 mm, while the right side measures 10 mm. Which of the following diagnostic studies will best help confirm the diagnosis?

Figure 63 shows the radiographs of a 23-year-old man who sustained a twisting injury at work. Swelling, tenderness, and ecchymosis are noted about the entire midfoot. What associated injury is most likely to be problematic?

Which of the following is associated with the use of bisphosphonates in the setting of metastatic breast cancer to the spine?

In recurrent posterior shoulder instability, what is the recommended approach to the posterior capsule?

Failure of high tibial osteotomy (HTO) is most closely associated with which of the following factors?

A 17-year-old boy has had elbow pain for the past 6 weeks. A radiograph, MRI scans, and biopsy specimens are shown in Figures 65a through 65e. What is the most likely diagnosis?

A 53-year-old man with a history of severe left hip pain has a significant limp that is the result of a 5-cm limb-length discrepancy. An AP radiograph is shown in Figure 48. The underlying etiology is most likely related to a history of

A 27-year-old woman sustained a bilateral C5-6 facet subluxation in a motor vehicle accident. Neurologic evaluation reveals normal motor, sensory, and reflex functions. She is awake, alert, and cooperative. Initial management should consist of

A 54-year-old man with metastatic renal cell carcinoma has had increasing pain in the left hip for the past 6 weeks. A radiograph is shown in Figure 36. Prophylactic stabilization will most likely result in

Figure 50 shows the cross table lateral radiograph of a 31-year-old paratrooper who has recalcitrant groin pain. The pain is worse after activities such as standing or sitting (driving). Examination reveals that pain can be reproduced by internal rotation of the leg with the hip and knee in 90 degrees of flexion. Extensive nonsurgical managment has failed to provide relief. What is the treatment of choice?

A 42-year-old man has a symptomatic flatfoot deformity and walks with a slight limp after falling off a scaffold 9 months ago. He also reports that he has had difficulty returning to work. Orthotics have failed to provide relief. Current radiographs are shown in Figures 19a and 19b. To relieve his pain and return the patient to work, treatment should consist of

A 27-year-old man sustained a gunshot wound to the lumbar spine and undergoes an exploratory laparotomy. An injury to the cecum is identified and treated. Management should now include

A 7-year-old boy sustained an acute puncture wound of the foot after stepping barefoot on a piece of glass 1 day ago. His mother states that she is not sure if she got the piece of glass out; however, she reports that his immunizations are up-to-date. Examination reveals that the wound is slightly erythematous, less than 1 mm in length on the heel, and is not currently draining. What is the next most appropriate step im management?

A 47-year-old woman underwent a bunionectomy and hallux valgus correction a few years ago. She now has the complication shown in Figures 38a and 38b. She has no pain with motion of the metatarsophalangeal or interphalangeal joints. What is the best reconstructive option in this setting?

A 45-year-old woman with a long-standing history of diabetes mellitus has a large draining plantar ulcer of the right foot. Examination reveals some local cellulitis and erythema surrounding the ulcer. A clinical photograph is shown in Figure 7. Based on these findings, what is the most appropriate antibiotic?

A 58-year-old woman sustained a ruptured Achilles tendon 1 year ago, and management consisted of an ankle-foot orthosis. She now reports increasing difficulty with ambulation and increasing pain. An MRI scan shows a 6-cm defect in the right Achilles tendon. Management should now consist of

Figure 41 shows the MRI scan of a 38-year-old weightlifter. What does the arrow on the MRI scan indicate?

A 16-year-old girl sustained the injury shown in Figure 7a. CT scans are shown in Figures 7b through 7d. The results of treatment of this injury have been shown to most correlate with which of the following factors?

Treatment of a cruciate-retaining total knee that is unstable in flexion is best accomplished by

A 14-year-old girl reports a 3-week history of anterior thigh pain and a palpable mass after sustaining a soccer-related injury. Examination reveals a tender, firm mass in the midportion of the rectus femoris. MRI scans are shown in Figures 39a through 39c. What is the most appropriate management?

A 51-year-old man sustained an open fracture of his tibia in Korea 42 years ago. An infection developed and it was resolved with surgical treatment. For the past 6 months, an ulcer with mild drainage has developed over the medial tibia. The ulcer is small and there is minimal erythema at the ulcer site. A radiograph and MRI scan are shown in Figures 43a and Figure 43b. Initial cultures show Staphylococcus aureus susceptible to the most appropriate antibiotics. Laboratory studies show an erythrocyte sedimentation rate of 70 mm/h. What is the most appropriate surgical treatment at this time?

A 26-year-old man has recurrent right knee pain. Figures 9a and 9b show consecutive sagittal T2-weighted MRI scans, and Figure 9c shows a coronal T1-weighted MRI scan. What is the most likely diagnosis?

In Figure 49, line AB connects the anterior arch of C1 to the posterior margin of the foramen magnum. Line CD connects the anterior margin of the foramen magnum to the posterior arch of C1. What is the normal ratio of displacement from CD to AB (Power's ratio)?

Which of the following is most commonly associated with an open clavicular fracture?

Which of following side effects is most commonly seen in a pediatric patient undergoing ketamine anesthesia?

Split posterior tibial tendon transfer is used in the treatment of children with cerebral palsy. Which of the following patients is considered the most appropriate candidate for this procedure?

What is the most common location of osteosarcoma?

A 32-year-old man sustained a fracture of his upper arm in a motor vehicle accident. Radiographs are shown in Figure 32. Because of other associated injuries, surgical stabilization is chosen. What technique will result in the least complications and the best outcome?

A 28-year-old man sustained a shoulder dislocation 2 years ago. It remained dislocated for 3 weeks and required an open reduction. He now reports constant pain and has only 60 degrees of forward elevation and 10 degrees of external rotation. He desires to return to some sporting activities. An AP radiograph and intraoperative photograph (a view of the humeral head through a deltopectoral approach) are shown in Figures 31a and 31b. What is the best treatment option to decrease pain and improve function?

Which of the following factors is most commonly associated with mechanical failure of a cemented total hip arthroplasty?

A 20-year-old man reports painless snapping about the lateral aspect of the right hip. He denies any history of trauma. Examination reveals no limp or tenderness. Hip range of motion is full, and there is good strength. Radiographs are normal. What anatomic structure is most likely causing these symptoms?

A 23-year-old man who was the restrained driver in a car involved in a high-speed motor vehicle accident sustained the closed injury shown in Figures 32a through 32c. Which of the following factors has the greatest impact on the risk of osteonecrosis?

When treating thoracolumbar spine fractures, which of the following is considered the major advantage of using a thoracolumbosacral orthosis (TLSO) when compared to a three-point fixation brace (Jewett)?

Which of the following statements most accurately describes the layers of articular cartilage?

A 7-year-old boy sustained a 2-cm laceration to the anterior aspect of his left knee after falling on a rock. Examination reveals that the joint surface is not visible through the wound. Radiographs show no evidence of a foreign body or free air in the joint. Management should consist of

What gene is expressed the earliest during the differentiation of a chondrocyte during endochondral ossification?

A 16-year-old high school student undergoes a routine preparticipation physical examination at the beginning of the school year. Examination reveals marked laxity of both shoulders but only mild generalized laxity in other joints. The load and shift test allows for anterior humeral translation to the glenoid rim and posterior humeral translation beyond the glenoid rim. The sulcus sign is present. What is the next most appropriate step in management?

What is the function of the rotator cuff during throwing?

An obese patient undergoing total knee arthroplasty is at increased risk for which of the following complications?

Figures 10a through 10c show the radiographs of an 85-year-old man who underwent a revision total knee arthroplasty for loosening of the tibial component 6 months ago. He now reports a mildly uncomfortable mass on the anterior part of the knee joint. Examination reveals 95 degrees of motion and good quadriceps strength, and he can ambulate with minimal pain with a walker. History reveals chronic lymphocytic leukemia for which he is taking antineoplastic medication. Culture of the mass aspirate grew Candida albicans on two separate occasions. The patient and the family strongly prefer nonsurgical management. If long-term suppression is chosen as treatment, what advice should be given to the patient and family?

A 65-year-old man with ankylosing spondylitis has neck pain after falling back over his lawnmower, striking his thoracic spine, and forcing his neck into extension. Examination reveals subtle weakness of the intrinsics and finger flexors at approximately 4+/5. Initial management consists of immobilization in a rigid collar, and placing his head in the anatomic position. Radiographs reveal a subtle extension fracture of the lower cervical spine. Approximately 6 hours after the injury, he reports increasing paresthesias in his upper and lower extremities, and examination now shows his intrinsics are 2/5, finger flexors are 3/5, and his triceps are now weak at 4/5 on manual motor testing. In addition, his lower extremities now show weakness in both dorsal and plantar flexion of the ankle in the range of 4/5. Repeat radiographs appear unchanged. An MRI scan is shown in Figure 2. Management should now consist of

A 13-year-old girl has had increasing left hip pain for the past 4 months. A radiograph, bone scan, MRI scan, and photomicrograph are shown in Figures 1a through 1d. Which of the following immunohistochemistry results would confirm the most likely diagnosis?

Osteopenia is defined by the World Health Organization (WHO) as a bone mineral density (BMD) that is

What is the most common complication of halo vest immobilization in adults?