100 High-Yield Orthopedic MCQs: ABOS & OITE Practice Set #323 (Trauma, Spine, Arthroplasty, Sports)

The mother of a healthy 8-month-old boy reports that her son refuses to use his left arm. Examination reveals that the arm hangs limp at his side in an adducted and internally rotated position, and the affected shoulder subluxates posteriorly. Passive external rotation measures 15 degrees. Management should consist of

Which of the following findings is a prerequisite for a high tibial valgus osteotomy for medial compartment gonarthrosis?

Which of the following is considered a reasonable goal for arthroplasty surgery in rotator cuff arthropathy?

What is the most important factor in determining recovery after surgical repair of a complete laceration of a nerve at the wrist?

The radiographic feature seen in Figure 37 that best indicates a slow-growing process is the

The load versus deformation curve of the functional spinal unit (FSU) is made up of the neutral zone, the elastic zone, and the plastic zone. What is the plastic zone of the curve believed to represent?

Fully dense alumina and zirconia materials have been used as bearing materials in hip arthroplasty to provide greater wear resistance than polished metallic surfaces. Although both have shown reduced wear clinically, what concerns continue to exist about the use of zirconia?

The mother of a 26-month-old boy reports that he has been unwilling to bear weight on his left lower extremity since he awoke this morning. She denies any history of trauma. He has a temperature of 99.4 degrees F (37.4 degrees C), and examination reveals that abduction of the left hip is limited to 30 degrees. Laboratory studies show a WBC of 11,000/mm3 and an erythrocyte sedimentation rate of 22 mm/h. A radiograph of the pelvis is shown in Figure 13. Management should consist of

A 46-year-old woman reports pain and a shortened appearance of her toe after undergoing a Keller resection arthroplasty 2 years ago for hallux rigidus. Examination reveals mild swelling and motion limited to 25 degrees at the metatarsophalangeal joint. Radiographs show large dorsal osteophytes on the first metatarsal head, 50% resection of the proximal phalanx, and complete loss of the metatarsophalangeal joint space. Which of the following is considered the most reliable procedure to improve her pain and the appearance of her toe?

Figure 49 shows an acute axial MRI scan of a left knee. What is the most likely diagnosis?

Figures 42a through 42c show the clinical photographs and radiograph of a patient with diabetes mellitus who lives independently. The patient was admitted to the hospital late yesterday afternoon with clinical signs of sepsis. Parenteral antibiotic therapy resolved the sepsis, and blood glucose levels are now well controlled. The patient has no palpable pulses. The ankle-brachial index is 0.70. Laboratory studies show a WBC count of 8,500/mm3, a serum albumin of 1.9 g/dL, and a total lymphocyte count of 1,500/mm3. What treatment has the best potential to optimize his survival and independence?

A 32-year-old man has a closed oblique displaced fracture at the junction of the lower and middle third of the humeral shaft and a complete radial nerve palsy. Closed reduction is performed and is felt to be acceptable. Management of the radial nerve palsy should consist of

Figures 44a through 44c show the radiographs of an 18-year-old female soccer player who fell on her outstretched hand 1 day ago. She denies any history of wrist pain. Examination reveals tenderness at the anatomic snuffbox. Management should consist of

Ulnohumeral distraction interposition arthroplasty is considered the most appropriate treatment for which of the following patients?

Which of the following lesions most closely resembles Ewing's sarcoma histologically?

A 19-year-old college football player reports persistent weakness, tingling, and numbness of both upper extremities at half time. He states that these symptoms initially occurred after tackling an opposing player with his head early in the game. History reveals that he has had "burners" in the past that typically resolved within 15 to 30 minutes. Examination reveals pain-free cervical motion, weakness to shoulder abduction testing bilaterally, normal upper extremity reflexes, and decreased sensation over both shoulders and the upper arms. Appropriate initial management should consist of

Which of the following substances does not have androgenic effects?

A patient reports persistent anterior shoulder pain following a forceful external rotation injury to the shoulder. An MRI scan is shown in Figure 4. The patient remains symptomatic despite 3 months of nonsurgical management. Treatment should now consist of

A 26-year-old man has had a 2-year history of pain and stiffness after sustaining a comminuted olecranon fracture. Treatment at the time of injury consisted of open reduction and internal fixation with tension band wiring. Examination reveals motion of 45 degrees to 110 degrees and pain throughout the arc of motion. Resisted flexion and extension are painful. Forearm rotation is normal. Radiographs are shown in Figure 51. Treatment should consist of

Which of the following agents have been shown to reduce the incidence of skeletal events in patients with multiple myeloma?

A 29-year-old woman who underwent an anterior cruciate ligament (ACL) reconstruction 6 months ago now reports difficulty achieving full knee extension, and physical therapy fails to provide relief. The knee is stable on ligament testing. Figure 3 shows the findings at a repeat arthroscopy. Treatment should now include

A 29-year-old man undergoes surgery for a grade I isthmic spondylolisthesis at L5. Following surgery, what type of brace will best immobilize the L5-S1 motion segment?

An 83-year-old woman with diabetes mellitus has a history of recurrent infection over the medial aspect of her great toe and has had a painless bunion for the past 45 years. Shoe wear modifications have failed to provide relief. Pedal pulses are palpable. Figures 30a and 30b show the clinical photograph and radiograph. Management should now consist of

A 36-year-old woman is placed in a short arm cast for a nondisplaced extra-articular distal radius fracture. Seven weeks later she notes the sudden inability to extend her thumb. What is the most likely cause of her condition?

When considering a flexor digitorum longus tendon transfer as part of the surgical treatment in patients with symptomatic flatfoot deformity caused by posterior tibial tendon insufficiency, which of the following patients is the most appropriate candidate?

Which of the following statements about injury of the anterior vascular structures during lumbar disk surgery is true?

To preserve blood supply to the fractured bone seen in Figures 12a and 12b, care should be taken when exposing which of the following areas?

Which of the following is considered an important factor in improved cemented femoral stem survivorship?

A 65-year-old man with ankylosing spondylitis sustains an extension injury to his cervical spine. Two days later, a progressive neurologic deficit develops at the C6 level. An MRI scan is shown in Figure 1. What is the most likely diagnosis?

The first branch of the lateral plantar nerve innervates the

Figures 20a and 20b show lateral and AP radiographs of a 49-year-old man who sustained a gunshot wound through the left shoulder. He reports neck pain and examination reveals weakness in all four extremities. What is the priority of evaluation?

A 13-year-old boy has a mild deformity of the left sternoclavicular joint after being involved in a rollover accident while riding an all-terrain vehicle. Examination in the emergency department reveals that he is hemodynamically stable, and his neurovascular examination is normal. The CT scan shown in Figure 22 was obtained because radiographs were inconclusive. Management should consist of

When the elbow is extended and an axial load is applied, what percent of stress distribution occurs across the ulnohumeral and radiohumeral articular surface, respectively?

At the L4-5 level, what is the location of the S2-5 nerve roots in relationship to the L5 and S1 nerve roots?

A 10-year-old boy reports a gradual onset of weakness; however, he is fully ambulatory. History reveals that he has a 17-year-old brother who has just stopped walking because of a similar condition. Laboratory studies show a creatine kinase level of 5,480 IU/L (normal 25 to 232 IU/L), and examination shows a slightly positive Gower sign. What is the most likely diagnosis?

A 45-year-old woman awakens with the acute onset of burning left shoulder pain that radiates toward the axilla. She denies any history of trauma. On examination, she is unable to abduct her arm but has full passive shoulder motion. Her sensation is intact. Cervical spine examination reveals full range of motion and a negative Spurling's test. Radiographs and MRI studies are normal for the cervical spine and shoulder. What is the most likely diagnosis?

A 7-year-old girl has had a painful forearm for the past 2 months. Examination reveals fullness on the volar aspect of the forearm. Radiographs and an MRI scan are shown in Figures 42a through 42c. Biopsy specimens are shown in Figures 42d and 42e. What is the most likely diagnosis?

A 55-year-old man has had progressive right shoulder pain for the past 2 years. Examination reveals active elevation to 120 degrees, external rotation to 20 degrees, and internal rotation to the sacrum. AP and axillary radiographs are shown in Figures 23a and 23b. Which of the following procedures would result in the most predictable long-term pain relief?

What is the most common nonanesthetic-related reversible cause of changes in intraoperative neurophysiologic monitoring data?

A 68-year-old man embarks on a 24-week strength training program. He trains at 80% of his single repetition maximum for both the upper and lower extremities. Which of the following changes can be anticipated?

Which of the following actions best enhances performance when an athlete is participating in a 10K race?

A 13-year-old boy injured his knee playing basketball and is now unable to bear weight. Examination reveals tenderness and swelling at the proximal anterior tibia, with a normal neurologic examination. AP and lateral radiographs are shown in Figures 1a and 1b. Management should consist of

A 4-year-old child was born with bilateral congenital radial clubhands. Which of the following associated conditions is a contraindication to centralization of the hands on the ulna?

A 55-year-old woman with type I diabetes mellitus has a chronic ulcer over the dorsum of her right foot and reports forefoot pain. Examination reveals 1- x 2-cm nondraining ulcer over the dorsum of the foot. The patient has 1-2+ pain with compression of the foot and ankle. She has a weakly palpable posterior tibial pulse and an absent dorsalis pedis pulse. There is no erythema, cellulitis, or drainage. Radiographs are normal. Which of the following diagnostic studies should be obtained?

Figure 47 shows the radiograph of a 2-day-old girl who has been referred for swelling and limited use of the right upper extremity. The second of twins, the infant was breech and delivered with forceps at age 38 weeks, weighing 5.37 lb. Difficulty in moving the arm was noted shortly after birth. Examination shows no active motion of the shoulder, elbow, or wrist. Active finger flexion and extension are present. The elbow is mildly swollen, and passive motion shows lack of full extension of 20 degrees, lack of full flexion of 15 degrees, and no restriction of pronation or supination. What is the most likely diagnosis?

Which of the following primary prognostic factors best predicts the outcome of the knee lesion shown in Figure 22?

A 21-year-old patient has had pain and a marked decrease in active and passive shoulder motion after having had a seizure 2 months ago as the result of alcohol abuse. Current AP and axillary radiographs and a CT scan are shown in Figures 26a through 26c. Management should consist of

Kyphosis from a vertebral osteoporotic compression fracture often results in progressive kyphosis due to

Which of the following best describes the function of the notochord?

Figures 45a and 45b show the radiographs of a 46-year-old man who reports the acute onset of right knee pain and is unable to bear weight on the extremity. His medical history is unremarkable. The next most appropriate step in management should consist of

Linazolid exerts its antimicrobial action by inhibiting bacterial

In providing culturally competent care to a Muslim woman with a cervical spine injury, which of the following most accurately describes the steps a male orthopaedist should take to respect her religious beliefs during his examination?

Antibiotic-loaded bone cement prostheses, such as that shown in Figure 8, are best created by using which of the following methods?

A football player sustains a traumatic anterior inferior dislocation of the shoulder in the last game of the season. It is reduced 20 minutes later in the locker room. The patient is neurologically intact and has regained motion. If the patient undergoes arthroscopic evaluation, what finding is seen most consistently?

A 21-year-old man has mild but persistent aching pain in his left proximal thigh during impact loading activities. He denies pain at rest and has no other symptoms. Figures 34a through 34e show the radiographs and T1-weighted, T2-weighted, and gadolinium MRI scans of the left hip. What is the most likely diagnosis?

A 15-year-old boy reports a 2-day history of progressive left buttock pain and severe limping. He denies any history of trauma or radiation of the pain. He has an oral temperature of 100.4 degrees F (38 degrees C). Examination reveals that the lumbar spine and left hip have unguarded motion. The abdomen is nontender. There is moderate tenderness of the left sacroiliac region with no palpable swelling. Pain is elicited when the left lower extremity is placed in the figure-4 position (FABER test). Laboratory studies show a peripheral WBC count of 11,500/mm3 (normal to 10,500/mm3) and an erythrocyte sedimentation rate of 38 mm/h (normal up to 20 mm/h). Radiographs of the pelvis, hips, and lumbar spine are normal. A nucleotide bone scan (posterior view) is shown in Figure 44. Initial management should consist of

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

A 14-year-old boy has an asymptomatic mass on the right arm. MRI scans and biopsy specimens are shown in Figures 51a through 51d. Immunostaining is positive for desmin. Additional staging studies should include

The cervical disk herniation shown in the MRI scans in Figures 30a and 30b will most likely create which of the following constellations of symptoms?

Which of the following tendons is the primary antagonist of the posterior tibialis tendon?

An 8-year-old girl sustained a displaced fracture at the base of the femoral neck in a motor vehicle accident. Management should consist of

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 40-year-old man has a painless mass around his left ankle. He notes minimal growth over the past year. An MRI scan is shown in Figure 73a, and biopsy specimens are shown in Figures 73b and 73c. What is the most likely diagnosis?

Figures 3a and 3b show the inversion stress radiographs of a patient's ankle. What is the most likely ligament injury pattern?

A 52-year-old woman who underwent cheilectomy 1 year ago for hallux rigidus now reports continued pain in the first metatarsophalangeal joint. She did not have any incision healing problems, and has not had any fevers, erythema, or drainage. Which of the following procedures will provide the best combination of pain relief and function?

Figures 23a and 23b show the AP and lateral radiographs of the elbow of a 30-year-old professional pitcher. The pathology shown in these studies is most consistent with which of the following conditions?

Which of the following knee ligament injury patterns is most associated with an increase in external tibial rotation with the knee at 90 degrees of flexion?

Figures 26a through 26c show the MRI scans of a 47-year-old man who underwent arthroscopic shoulder surgery 6 months ago and continues to have pain despite a prolonged course of rehabilitation. Management should now consist of

An otherwise healthy 33-year-old man who works in construction reports a 3-month history of knee pain. Radiographs are shown in Figures 9a and 9b. An axial T1-weighted MRI scan with contrast, an angiogram, and histologies are shown in Figures 9c through 9f. What is the most likely diagnosis?

Following ankle arthroscopy performed through a posterolateral portal, a patient notes numbness on the lateral half of the heel pad of the foot. What is the most likely injured structure?

A 25-year-old farm worker sustained a grade III open fracture of the midshaft of the left tibia after falling from a ladder. Which of the following antibiotic regimens is best for this patient?

A 75-year-old patient returns for follow-up after undergoing bilateral total hip arthroplasty (THA). The right hip is a hybrid THA performed 12 years ago, whereas the left hip is a cementless THA performed 10 years ago. Both acetabular components are the same type, same size, and from the same manufacturer. Both femoral heads are 28-mm cobalt-chromium components. What is the most likely explanation for the advanced polyethylene wear in one hip?

A 25-year-old man has ankle instability and a lateral foot callosity. Radiographs are shown in Figures 49a through 49c. Management options are best determined by the

Figures 35a and 35b show the radiographs of a patient who underwent debridement of a chronically infected, fully constrained knee prosthesis and now reports pain and instability despite bracing. History reveals that the patient has had no drainage since undergoing the last debridement 6 months ago. A C-reactive protein level and aspiration are negative for infection. Treatment should now consist of

What is the most common surgical cause of the foot deformity shown in Figure 9?

An otherwise healthy 32-year-old man who underwent an uneventful L5-S1 lumbar microdiskectomy 6 weeks ago now reports increasing and severe back pain that awakens him from sleep. Examination reveals a benign-appearing wound, and the neurologic examination is normal. Laboratory studies show an erythrocyte sedimentation rate (ESR) of 90 mm/h and a WBC of 9,000/mm3. Plain radiographs are normal. What is the next most appropriate step in management?

A 68-year-old man reports a 4-week history of progressive left-sided lower back and hip pain. The pain is in the posterior buttock region with radiation to the groin and to the left anterior knee region. The pain is aggravated with walking and improves with rest. There is no history of previous trauma. Radiographs are seen in Figures 14a and 14b, and MRI scans are seen in Figures 14c through 14e. What is the most appropriate treatment option at this time?

Which of the following surgical devices employed for stabilization of the sternoclavicular joint is associated with the highest incidence of life-threatening complications?

An 11-year-old boy has had a fever and pain and swelling over the lateral aspect of his right ankle for the past 3 days. Examination reveals warmth, swelling, and tenderness over the lateral malleolus, and he has a temperature of 103.2 degrees F (39.5 degrees C). Laboratory studies show a WBC count of 13,200/mm3 with 61% neutrophils, an erythocyte sedimentation rate of 112 mm/h, and a C-reactive protein of 15.7. Radiographs and a T2-weighted MRI scan are shown in Figures 13a through 13c. Aspiration yields 1 mL of purulent fluid. Management should now consist of

An active 60-year-old man is evaluated 4 years following surgical correction of a hallux valgus deformity. The patient reports that a hallux varus deformity developed rapidly following his initial surgery. Conservative management consisting of wider shoes, toe strapping, and anti-inflammatory drugs has failed to provide relief. Examination reveals a hallux varus deformity with restricted painful motion of the metatarsophalangeal joint and callus formation under the second metatarsal head. What is the next most appropriate step in management?

What is the most appropriate orthotic management for the lesion shown in Figure 6?

A 63-year-old woman reports giving way of the knee and pain after undergoing primary total knee arthroplasty (TKA) 1 year ago. Examination reveals that the knee is stable in full extension but has gross anteroposterior instability at 90 degrees of flexion. The patient can fully extend her knee with normal quadriceps strength. Studies for infection are negative. AP and lateral radiographs are shown in Figures 12a and 12b, respectively. What is the appropriate management?

Which of the following best describes the mechanical response of the inferior glenohumeral ligament to repetitive subfailure strains?

Examination of an obese 3-year-old girl reveals 30 degrees of unilateral genu varum. A radiograph of the involved leg with the patella forward is shown in Figure 10. Management should consist of

What cell type causes the bone destruction in metastatic lesions?

A 67-year-old woman is seen in the emergency department after falling at home. Radiographs before and after treatment are shown in Figures 49a and 49b, respectively. Which of the following best explains the 8-week postinjury clinical findings seen in Figure 49c?

Figure 24 shows the radiograph of a 10-year-old boy who sustained a valgus injury to the knee. Examination reveals grade III medial laxity. Initial management should consist of

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?

Figure 16 shows the clinical photograph of a 3-month-old infant with a foot deformity that has been nonprogressive since birth. Examination reveals that the deformity corrects actively and with passive manipulation. There is no associated equinus. Management should consist of

Osteophyte formation at the posteromedial olecranon and olecranon articulation in high-caliber throwing athletes is most often the result of underlying

Figures 34a and 34b show the radiographs of a 28-year-old man who fell on his outstretched arm with significant force while mountain biking. The nerve deficit most likely to occur would result in weakness of

A 55-year-old woman with polyarticular rheumatoid arthritis has had progressively increasing left shoulder pain for the past 2 years despite nonsurgical management. No focal weakness is noted during examination of the shoulder. AP and axillary radiographs are shown in Figures 47a and 47b. Treatment should consist of

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 45-year-old man has persistent hindfoot pain that is aggravated by weight-bearing activities. History reveals that he sustained a calcaneus fracture 2 years ago, and he underwent a subtalar fusion 1 year ago. Examination reveals tenderness in the sinus tarsi and across the transverse tarsal joint. A plain radiograph and a CT scan are shown in Figures 24a and 24b. A technetium Tc 99m bone scan reveals uptake at the subtalar joint and at the transverse tarsal joints. Management should now consist of

When 6 weeks of noninvasive nonsurgical management fails to provide relief for a lumbar disk herniation, a trial of epidural steroid injections is likely to yield which of the following results?

A 43-year-old man reports a 3-year history of progressively worsening pain in the first metatarsophalangeal joint that is aggravated by activity. Larger shoes, intra-articular corticosteroid injections, and a Morton's extension pedorthic have failed to provide relief. Motion is limited to 10 degrees of dorsiflexion, and the "grind test" is positive. An AP radiograph is shown in Figure 39. What is the most appropriate surgical treatment?

Figures 45a and 45b show the radiographs of a 14-year-old boy who sustained a distal radius fracture while playing hockey. After 1 year the patient is asymptomatic. Follow-up and comparison radiographs and an MRI scan are shown in Figures 45c and 45d. What is the next most appropriate step in management?

During primary total knee arthroplasty with trial implants in place, the surgeon notes technically satisfactory patellar resurfacing and restoration of a physiologic mechanical axis but excessively lateral patellar tracking. Treatment should now include

A 22-year-old skier reports painful range of motion in the left thumb after falling forward on his outstretched hand while holding his ski pole. Examination of the left thumb reveals increased AP laxity and 45 degrees of valgus laxity at the metacarpophalangeal (MCP) joint. Examination of the right thumb shows 25 degrees of valgus laxity at the MCP joint. Radiographs are normal. Management should consist of

In the preoperative planning of revision acetabular reconstruction, the surgeon should identify significant posterior column deficiency by noting which of the following radiographic features?