Orthopedic Board Review: 100 MCQs (Set 310) for ABOS, OITE & FRCS Exams

Which of the following statements best describes the outcome of the routine use of continuous passive motion (CPM) machines after total knee arthroplasty (TKA)?

A 62-year-old woman has back pain and right L2 radicular pain. MRI scans suggest a neoplastic lesion at L2, and a bone scan is negative except at L2. History reveals that she was treated for breast cancer without known metastatic disease 12 years ago and is thought to be free of disease. What is the next most appropriate step in management?

Examination of a carpenter who hit his thumb with a hammer reveals that the nail plate is broken but in place, and there is a 100% subungual hematoma that covers 100% of the area under the nail plate. Radiographs reveal a comminuted distal phalangeal tuft fracture. Management should consist of

What neurovascular structure is at greatest risk when creating a proximal anterolateral elbow arthroscopy portal?

Figure 47 shows a transverse MRI scan of a patient's left shoulder. The findings reveal which of the following abnormalities?

Duchenne's muscular dystrophy is a genetic disorder that is transmitted by which of the following modes of inheritance?

Osteoclasts originate from which of the following cell types?

When examining a patient with marked hyperreflexia, which of the following findings best suggests that the condition is not caused by a cerivcal spine pathology?

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 neurologic injury at T11-L2 with loss of bowel and bladder control is best described as what syndrome?

Which of the following lesions is best suited for autologous chondrocyte implantation?

A 24-year-old man sustained a grade IIIb open tibial fracture and an ipsilateral grade IIIa femoral fracture in a motorcycle accident. He is unresponsive, intubated, and has a Glasgow Coma Scale score of 8. He is resuscitated and taken to the operating room for definitive orthopaedic care. Which of the following intraoperative problems will most likely adversely affect his long-term outcome?

Figure 17 shows the clinical photograph of a 45-year-old female tennis player who has right arm pain and weakness with elevation after undergoing a cervical biopsy several months ago. The cause of her shoulder weakness is damage to the

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 67-year-old patient seen in the emergency department reports the acute onset of pain and is unable to ambulate. History reveals that the patient underwent surgical treatment for a periprosthetic femoral fracture 6 months ago. A radiograph is shown in Figure 41. What is the best treatment option at this time?

A 40-year-old man reports an enlarging soft-tissue mass in his right shoulder. Based on the MRI scan and biopsy specimens shown in Figures 40a through 40c, what is the most likely diagnosis?

Figure 11a shows the AP pelvis radiograph of a 25-year-old man who sustained a spinal cord injury 10 years ago. A bone scan and a CT scan are shown in Figures 11b and 11c. To prevent recurrence after resection, management should consist of

The so-called high ankle sprain from an external rotation mechanism of injury typically involves injury to which of the following structures?

Radiographs of an 80-year-old woman with back pain reveal a compression fracture. Which of the following imaging studies best evaluates the acuity of the fracture?

The risk of local recurrence after surgical resection of a soft-tissue sarcoma is most closely related to

An 8-year-old boy sustains injuries to his head, abdomen, and left lower extremity after being struck by a truck. In the emergency department, his mental status deteriorates and he is intubated after assessment reveals a Glasgow Coma Scale score of 3; the score subsequently improves to 10. A CT scan reveals a right parietal intracranial hemorrhage, and an abdominal ultrasound reveals free fluid. Prior to an emergency laparotomy, the swollen left thigh is evaluated. Radiographs reveal a transverse fracture of the mid-diaphysis. Management of the fracture should consist of

A 23-year-old man has pain and a callus beneath the second metatarsal head. Initial management should consist of

In patients with neurofibromatosis, what is the most important sign of impending rapid progression of a spinal deformity?

Figures 45a and 45b show the AP and lateral radiographs of a 15-year old patient who is undergoing surgery to add 3 cm of length to the femur. Based on the radiographic findings, what is the next most appropriate step in management?

A 22-year-old professional baseball catcher has posterior shoulder pain and severe external rotation weakness with the arm in adduction. Radiographs are normal. MRI scans are shown in Figures 15a through 15c. Management should consist of

A 28-year-old woman has left shoulder pain and a tender soft-tissue mass. Based on the MRI scan and biopsy specimens shown in Figures 74a through 74c, what is the most likely diagnosis?

A coronal MRI scan through the shoulder joint is shown in Figure 26. The cyst indicated by the arrow will most likely cause compression of what nerve?

A 10-year-old boy has a painful thigh mass. A radiograph, MRI scan, and biopsy specimen are shown in Figures 42a through 42c. What is the most likely diagnosis?

What process is often found associated with other neoplasms?

A 40-year-old man has a palpable mass over the dorsum of the ankle. He reports no history of direct trauma but notes that he sustained a laceration to the middle of his leg 6 weeks ago. Examination reveals a 4-cm x 1-cm mass. T1- and T2-weighted MRI scans are shown in Figures 12a and 12b. An intraoperative photograph and biopsy specimen are shown in Figures 12c and 12d. What is the most likely diagnosis?

A 47-year-old man ruptured his left patellar tendon and twisted his right ankle in a fall. Initial radiographs of the ankle are unremarkable. One week following repair of the left patellar tendon, he reports increased pain with weight bearing in his right ankle. A follow-up radiograph is shown in Figure 38. Management of the ankle injury should consist of

A 15-year-old boy has a mass at the knee. Radiographs show an aggressive tumor involving the proximal tibia, and biopsy findings reveal a high-grade osteosarcoma. Staging studies show that the tumor impinges on the neurovascular bundle. The tumor enlarges during preoperative chemotherapy. Management should now consist of

An 18-month-old boy with obstetric brachial plexus palsy is being evaluated for limited right shoulder motion. Physical therapy for the past 6 months has failed to result in improvement of the contracture. Which of the following studies is necessary prior to any shoulder reconstruction?

A 10-year-old girl has a midshaft both bone forearm fracture. After attempted closed reduction, alignment consists of bayonet apposition, 10 degrees of malrotation, and 8 degrees of volar angulation. Management should now consist of

A 19-year-old football player who sustained three traumatic anterior shoulder dislocations underwent surgery to repair a Bankart lesion. Nine months after surgery, examination reveals stability, elevation to 150 degrees, external rotation to 0 degrees with the elbow at his side and to 50 degrees at 90 degrees of abduction, and internal rotation to T12. If his range of motion does not improve, he is at most risk for

An adult patient has an 8- x 4- x 10-cm soft-tissue mass located within the adductor compartment of the thigh. Staging studies should consist of

An axial T1-weighted MRI scan of the pelvis is shown in Figure 35. Which of the following structures is enclosed by the circle?

What neurovascular structure is most at risk when performing an inside-out repair of the posterior horn of the medial meniscus?

The view from an anterosuperior portal of the right shoulder shown in Figure 12 reveals which of the following findings?

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?

Radiographs of a 12-year-old boy who has knee pain show a 2-cm osteochondral lesion of the lateral aspect of the medial femoral condyle. The fragments are not detached from the femur. Initial management should consist of

A 64-year-old man who underwent an L4-5 decompression approximately 1 year ago reported relief of his claudicatory leg pain initially, but he now has increasing low back pain and recurrent neurogenic claudication despite nonsurgical management. Radiographs show new asymmetric collapse and spondylolisthesis at the decompressed segment, and MRI scans show lateral recess stenosis. The next most appropriate step in management should consist of

A 37-year-old man who works in a factory has isolated, lateral unicompartmental pain about his knee with activities. Nonsurgical management has failed to provide relief. The radiograph shown in Figure 45 reveals a tibiofemoral angle of approximately 15 degrees which is clinically correctable to neutral. What is the best surgical option in this patient?

In a patient who has had low back pain for less than 2 weeks, which of the following findings is an indication for continued observation and symptomatic treatment rather than more aggressive evaluation and/or treatment?

A 21-year-old professional baseball player has had painful catching and stiffness in his dominant right elbow for the past year. Examination reveals a flexion contracture of 2 degrees and mild pain with full elbow flexion. Radiographs are shown in Figures 33a and 33b. The most effective management should consist of

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

What radiographic view will best reveal degeneration of the pisotriquetral joint in a patient who is being evaluated for pisotriquetral arthrosis?

An active 55-year-old man who felt a sudden pop in the left heel while playing tennis 6 months ago was diagnosed with an ankle sprain around the time of injury. He now reports calf atrophy and severe weakness with running. Examination reveals a palpable defect in the Achilles tendon and only trace passive ankle flexion when the calf is squeezed. At the time of surgery, an Achilles tendon defect of 6 cm cannot be approximated. Surgical management of the Achilles tendon should include

Within the menisci, the majority of the large collagen fiber bundles are oriented in what configuration?

A 58-year-old woman with rheumatoid arthritis has progressive neck pain, upper extremity and lower extremity weakness, and difficulty with fine motor movements. Examination reveals hyperreflexia with mild to moderate objective weakness but the patient has no difficulty with ambulation for short distances. What is the most important preoperative imaging finding that predicts full neurologic recovery with surgical stabilization?

What is the most common bacteria cultured from dog and cat bites to the upper extremity?

Radiographs of a pediatric patient reveal a suspected osteosarcoma of the distal femur. Additional staging studies should consist of

A 52-year-old man has shoulder pain and stiffness after undergoing a "mini-lateral" rotator cuff repair 6 months ago. Examination reveals that he is afebrile with normal vital signs. There is slight erythema but no drainage from the incision. Range of motion is limited in all planes, and there is weakness with resisted external rotation and abduction. Radiographs show a well-positioned metal implant within the greater tuberosity. Laboratory studies reveal a WBC count of 8,400/mm3 (normal 3,500 to 10,500/mm3) and an erythrocyte sedimentation rate of 63 mm/h (normal up to 20 mm/h). What is the next most appropriate step in management?

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

The mother of a 3-month-old infant states that she has difficulty positioning the infant's legs during diaper changes. Examination reveals limited abduction of both hips and a negative Ortolani sign. A radiograph reveals bilaterally dislocated hips. Initial management consists of guided reduction in a Pavlik harness, with weekly follow-up. Figures 57a and 57b show the radiograph and CT scan obtained after 6 weeks in the harness. Management should now consist of

A study is conducted to measure the difference in bone mineral density between postmenopausal women taking a drug treatment versus those taking a placebo. What is the most important result to be reported from this study?

A 60-year-old woman has activity-related hip pain after undergoing arthroplasty 5 years ago. She has severe Parkinsonism and denies fevers or chills. Radiographs are shown in Figures 45a and 45b. What is the most likely cause of her pain?

During the evaluation of a patient suspected of having a lumbar disk herniation, T1- and T2-weighted MRI scans reveal a hyperintence lobular, well-defined lesion in the L2 vertebral body. What is the most likely diagnosis?

A 35-year-old woman who is a recreational runner reports posterior knee pain and tightness in the knee with flexion during running. She denies any history of trauma. Examination reveals normal patellar glide and tilt and no patellar apprehension. Range of motion is 5 degrees to 120 degrees, and quadriceps function and knee ligamentous examination are normal. Radiographs are normal. An MRI scan is shown in Figure 18. What is the most likely diagnosis?

A 78-year-old woman falls onto her nondominant left elbow and sustains the injury shown in Figure 5. What treatment option allows her the shortest recovery time and highest likelihood of good function and range of motion?

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?

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

A 13-year-old boy has a painless "knot" over his left hip. History reveals that he injured his left hip playing soccer 4 months ago. A radiograph and MRI scan obtained at the time of injury are shown in Figures 7a and 7b. He is very active and is currently asymptomatic. A current radiograph is shown in Figure 7c. What is the next most appropriate step in management?

Factors contributing to an increased risk of hip fracture include reduced bone mineral density of the femoral neck, cognitive status of the individual, and

What is the most common associated pathology in patients who have suprascapular nerve entrapment secondary to ganglion cysts?

What is the relative amount of type II collagen synthesis in disease-free adult articular cartilage compared to developing teenagers?

A 21-year-old football player who sustained a direct blow to the posterior hindfoot while making a cut is unable to bear weight on the injured foot. Examination reveals tenderness and swelling of the great toe metatarsophalangeal (MTP) joint. Radiographs are shown in Figures 9a and 9b. What is the most likely diagnosis?

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 40-year-old unrestrained passenger reports chest wall pain after a motor vehicle accident. Which of the following structures is most important in preventing the injury shown in Figure 33?

When using surgery extending to the pelvis to treat long spinal deformity in adults, the addition of anterior interbody structural support at the lumbosacral junction serves what biomechanical function?

Sacral fractures are most likely to be associated with neurologic deficits when they involve what portion of the sacrum?

Figure 22 shows the MRI scan of a 20-year-old female basketball player who has pain over the anterior knee that interferes with her performance. Examination reveals phase III Blazina patellar tendinosis. Management should consist of

Figures 23a and 23b show the AP and lateral radiographs of a 67-year-old woman who has severe left knee pain when ambulating. History reveals that she underwent primary total knee arthroplasty 7 years ago. The patient reports increasing deformity over the past several years and uses a knee brace and a cane. Examination reveals that she walks with a varus thrust and has an uncorrectable varus deformity with valgus force. What is the primary reason for implant failure?

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 22-year-old college quarterback is tackled and sustains a reducible first carpometacarpal dislocation. What is the recommended treatment?

A 26-year-old man has had hand pain and progressive swelling in the knuckle for the past several months. He denies any trauma to the hand. The ring finger metacarpophalangeal joint is tender, and there is loss of motion in the digit. Figure 32a shows the radiograph and Figures 32b through 32d show the T1-weighted, T2-weighted, and gadolinium MRI scans, respectively. What is the most likely diagnosis?

For the athlete performing heavy exercise, the magnitude of core temperature and heart rate increase is most proportional to

Figure 26a shows the radiograph of a 55-year-old woman who has pain in her right leg after falling. Laboratory studies reveal an elevated alkaline phosphatase level. A biopsy specimen from the proximal tibia is shown in Figure 26b. What is the most likely diagnosis?

Which of the following drawbacks is associated with the Ganz periacetabular osteotomy?

Figure 33 shows the CT scan of a 40-year-old man who injured his left shoulder while skiing. What structure is attached to the bony fragment?

Figures 35a through 35c show the clinical photograph and radiographs of a 15-year-old boy who stubbed his toe 1 day ago while walking barefoot in the yard. Management should consist of

Figure 48 shows the initial AP chest radiograph of a 21-year-old motorcycle rider who sustained multiple injuries after striking a telephone pole at high speed. What is the most significant radiographic finding leading to a diagnosis?

Following resection of malignant tumors, complications related to endoprosthetic reconstruction are most common in what anatomic location?

During the implantation of a cementless acetabular component in total hip arthroplasty, placement of a screw in the anterior superior quadrant puts which of the following structures at risk for damage?

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

What is one of the principle concerns when a fracture such as the one seen in Figure 18 is encountered?

Figure 23 shows the radiograph of a 55-year-old man who underwent a total hip arthroplasty 5 years ago. Management should now consist of

A 45-year-old woman who recently underwent biopsy of a lymph node in the right posterior cervical triangle now finds it difficult to hold objects overhead and has diffuse aching in the right shoulder region. What is the most likely diagnosis?

Femoral osteotomy for dysplasia of the hip will most likely result in

What pharmacologic agents are preferred for the treatment of symptomatic active Paget's disease?

A 77-year-old woman who underwent total knee arthroplasty 16 years ago now reports pain, swelling, and notable crepitation with range of motion. AP, lateral, and Merchant radiographs are shown in Figures 54a through 54c. What is the most likely diagnosis?

When compared with cobalt-chromium and stainless steel implants, a titanium implant has what biomechanical properties?

A 42-year-old man sustained a fracture of the distal radius with subsequent stiffness in the ipsilateral shoulder. Despite a 6-month program of range-of-motion exercises, external rotation at the side is limited to 10 degrees. Attempts at closed manipulation are unsuccessful. Treatment should now consist of

Which of the following findings is considered a contraindication for posterior decompression (with or without fusion) for myelopathy?

A 26-year-old man sustained an isolated injury to his left hip joint in a motor vehicle accident. Closed reduction was performed, and the postreduction radiograph is shown in Figure 29. Management should now consist of

Initial management of a pathologic fracture of the humerus secondary to a unicameral bone cyst should include

Figures 29a and 29b show the AP radiograph and CT scan of a 70-year-old man who has left thigh pain. Serum protein electrophoresis shows a monoclonal gammopathy. Additional radiographs of the femur show other lesions. Management should consist of

A 45-year-old woman sustains an injury to her lower leg. Examination reveals that there is a deformity with no neurologic or vascular problems. The skin is intact. Radiographs are shown in Figures 46a and 46b. Which of the following factors would make closed management the least appropriate choice for this injury?

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

A 16-year-old girl has had pain in the left groin for the past 4 months. She notes that the pain is worse at night; however, she denies any history of trauma and has no constitutional symptoms. There is no history of steroid or alcohol use. Examination reveals pain in the left groin with rotation of the hip. There is no associated soft-tissue mass. A radiograph and MRI scan are shown in Figures 32a and 32b, and biopsy specimens are shown in Figures 32c and 32d. What is the most likely diagnosis?