Orthopedic Board Review Mock Exam Set 293: 100 High-Yield MCQs for ABOS & OITE

What patient factor is predictive of better outcomes for surgical management of a displaced calcaneal fracture compared to nonsurgical management?

A 38-year-old man has winging of the ipsilateral scapula after undergoing a transaxillary resection of the first rib 3 weeks ago. What is the most likely cause of this finding?

A 48-year-old man reports localized plantar forefoot pain. Examination reveals a discrete callus (intractable plantar keratosis) with well-localized tenderness beneath the second metatarsal head. The callus most likely lies beneath what structure?

Which of the following factors can contribute to patellar subluxation following routine total knee arthroplasty?

A 28-year-old man has had a 2-year history of progressive lateral ankle pain. History reveals that he underwent a triple arthrodesis at age 13 for a tarsal coalition. The pain has been refractory to braces, custom inserts, and nonsteroidal anti-inflammatory drugs. Weight-bearing radiographs of the ankle and foot are shown in Figures 3a through 3d. Surgical management should include which of the following?

Figures 16a and 16b show the radiographs of an otherwise healthy 3 1/2-year-old boy who has an isolated deformity of the left leg. Definitive primary treatment of this condition should consist of

A 20-year-old collegiate football player sustains an injury to his left foot 3 weeks before the start of the fall season. Examination reveals localized tenderness over the lateral midfoot and normal foot alignment. Radiographs are shown in Figures 28a through 28c. What is the treatment of choice?

A 35-year-old woman dislocated her right shoulder in a fall from a step stool several months ago. She now reports several painful recurrences. Examination reveals anterior and inferior apprehension that reproduces her symptoms. An MRI scan is shown in Figure 17. Management should consist of

A 30-year-old woman who runs approximately 30 miles a week has had right hip and groin pain for the past 3 weeks. Examination reveals an antalgic gait, limited motion of the right hip, and pain, especially with internal and external rotation. Plain radiographs are normal, and an MRI scan is shown in Figure 21. Management should consist of

Which of the following is considered the best measure of the adequacy of resuscitation in the first 6 hours after injury?

An active 72-year-old woman sustained a mid-diaphyseal right humerus fracture 16 months ago. History reveals that she was first treated with a brace for 7 months. Additional treatment consisted of intramedullary nailing 9 months ago. Recently the rod was removed, and the patient now reports pain and gross motion at the fracture site. Current radiographs are shown in Figures 37a and 37b. What is the next most appropriate step in management?

Figure 10 shows the MRI scan of a 56-year-old woman with metastatic breast cancer who now reports progressive paraparesis. Her general health remains good. Treatment should consist of

A 6-year-old African-American boy with sickle cell disease has had pain and limited use of his right arm for the past 3 days. History reveals that he sustained a humeral fracture approximately 3 years ago. A lateral radiograph is shown in Figure 25. Based on these findings, a presumptive diagnosis of chronic osteomyelitis is made. What are the two most likely organisms?

A 38-year-old man who is an avid tennis player has had persistent pain over the medial aspect of his knee for the past 6 years. He notes that the pain occurs on a daily basis with any significant activity. Nonsteroidal anti-inflammatory drugs have failed to provide relief. Radiographs are shown in Figures 22a and 22b. What is the best course of action?

In the treatment of all magnitudes of bunionette deformities, what is the most common complication associated with lateral condylectomy of the fifth metatarsal head?

Linazolid exerts its antimicrobial action by inhibiting bacterial

When performing ankle arthroscopy through the anterolateral portal, what anatomic structure is at greatest risk?

Manipulation under anesthesia for resistant frozen shoulder should be avoided in patients with

A 52-year-old woman slipped on ice in her driveway. Radiographs are shown in Figures 19a and 19b. The patient was treated in a short leg cast with weight bearing as tolerated for 6 weeks. Due to persistent tenderness at the fracture site, a CAM walker was used for an additional 8 weeks. Nine months after the injury, the patient still walks with a limp and reports pain with deep palpation at the fracture site. What is the next most appropriate step in management?

Figures 46a through 46e show the radiographs of a 22-year-old man who injured his wrist in a motorcycle accident. He has no other injuries. What is the best course of action?

Which of the following procedures is included in third-generation cement technique?

A 35-year-old male laborer with isolated posttraumatic degenerative arthritis of the right hip undergoes the procedure shown in Figure 8. What is the most appropriate position of the right lower extremity?

An otherwise healthy 35-year-old woman reports dorsal wrist pain and has trouble extending her thumb after sustaining a minimally displaced fracture of the distal radius 3 months ago. What is the next most appropriate step in management?

A 6-year-old girl has the bilateral foot deformity shown in Figure 1. There is no family history of disease. Examination reveals fixed hindfoot equinus, and muscle function testing shows strong posterior tibial function, fair plus anterior tibial function, poor peroneal function, and strong gastrocnemius function. A Coleman block test shows a correctable hindfoot. Nerve conduction velocity studies show diminished function in the peroneal and ulnar nerves on both sides. Pathologic changes found in a sural nerve biopsy include "onion bulb" formation, and DNA testing confirms the presence of a mutation in the MPZ gene, consistent with hereditary motor sensory neuropathy type III (HMSN-III). What is the best course of action?

What percent of patients initially diagnosed with classic, high-grade osteosarcoma of the extremity have visible evidence of pulmonary metastasis on CT of the chest?

A 32-year-old woman with systemic lupus erythematosus treated with methotrexate and oral corticosteroids reports right groin pain with ambulation and night pain. Examination reveals pain with internal and external rotation and flexion that is limited to 105 degrees because of discomfort. Laboratory studies show a serum WBC of 9.0/mm3 and an erythrocyte sedimentation rate of 35 mm/h. Figures 5a and 5b show AP and lateral radiographs of the right hip. Further evaluation should include

Figure 14 shows a lateral radiograph of a knee joint. The bony structure indicated by the arrow is a sesamoid bone that resides in what tendon?

A 4-month-old infant is unable to flex her elbow as a result of an obstetrical brachial plexus palsy. This most likely illustrates a predominate injury to what structure?

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

The MRI scan shown in Figure 24 reveals a right-sided herniated nucleus pulposus at L4-5 in a patient with pain in the right leg. Administration of a caudal epidural steroid injection provides immediate relief. Over the next week he notes generalized weakness of the lower extremities and has one episode of urinary incontinence. What is the next most appropriate step in management?

The parents of a 15-month-old child report that he is not yet walking. Further evaluation, rather than reassurance and observation, should be conducted if the child is not performing what other activity?

Torsional moments about the longitudinal axis of a total hip arthroplasty show what change during stair climbing compared with walking?

A 51-year-old woman with no preoperative neurologic deficit is undergoing elective anterior cervical diskectomy and fusion (ACDF) with plating and fusion for a C5-6 disk herniation with right-sided neck pain. Thirty minutes into the surgery the neurophysiologic monitoring shows a rapid drop and then loss of amplitude in the right cortical somatosensory-evoked potential waveform. All other waveforms remained normal and unchanged, including right-sided cervical (subcortical) and peripheral (Erb's point), and those from the left-sided upper extremity and both lower extremities. What is the most likely cause of the change?

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

An adult with a distal humeral fracture underwent open reduction and internal fixation. What is the most common postoperative complication?

Posterior spinal fusion for scoliosis should be performed on a patient with Duchenne muscular dystrophy when

Which of the following substances does not have androgenic effects?

A 44-year-old man reports persistent left leg pain following a L5-S1 hemilaminotomy and partial diskectomy. Examination shows a grade 4 weakness of the left extensor hallucis longus and a positive left straight leg raise. A radiograph is shown in Figure 1a, and sagittal and axial MRI scans are shown in Figures 1b and 1c. Nonsurgical management consisting of medication, physical therapy, and injections has failed to provide relief. Surgical management should consist of

Based on the findings seen at C5-6 in Figure 30, the most likely deficit for this patient will be weakness of the

A previously asymptomatic 14-year-old girl sustained a twisting injury to her ankle. Radiographs are shown in Figures 2a and 2b. Management should consist of

Figures 5a and 5b show the radiographs of an active 52-year-old man who has increasing knee pain and progressive varus deformity after undergoing total knee arthroplasty 7 years ago. Examination reveals a small effusion, but he has good motion and stability. What is the most likely diagnosis?

Based on the findings shown in Figures 22a and 22b, corrective surgery to obtain maximal safe correction and optimal instrumentation fixation should be performed at which of the following locations?

What normal tissue has a low signal intensity (appears black) on both T1- and T2-weighted images?

The acceleration of an object under the influence of a force depends directly on the mass of the object. The angular acceleration of an object under the influence of a moment depends directly on the

What percent of the adult human meniscus is vascularized?

A 48-year-old woman reports bilateral thigh pain that is limiting her function as a librarian. A radiograph and a bone scan are shown in Figures 23a and 23b. What is the most likely diagnosis?

When compared to traditional open repair through a posterior incision, percutaneous Achilles tendon repair clearly results in a reduction of what complication?

Medial dislocation of the long head of the biceps tendon in the shoulder is most commonly caused by a

A 55-year-old man reports increasing weakness in his arms that has progressed to his lower limbs, resulting in frequent tripping and falling. Examination reveals weakness in shoulder abduction and external and internal rotation bilaterally. Fasciculation is noted. He also has weakness in elbow flexion and extension bilaterally, and his grip strength is diminished. An electromyogram and nerve conduction velocity studies show decreased amplitude of compound motor action potential, slightly slowed motor conduction velocity, and denervation signs with decreased recruitment in all extremities. The sensory study is normal. Based on these findings, what is the most likely diagnosis?

Figures 42a and 42b show the radiographs of a 52-year-old man who sustained a fall from a motorcycle 6 months ago and now reports pain and stiffness in his left shoulder. What is the most reliable treatment to improve function and comfort of the shoulder?

What significant structure is most at risk during a posterior approach of the Achilles tendon near its musculotendinous junction?

Figure 50 shows the AP radiograph of an asymptomatic 82-year-old woman who underwent total hip arthroplasty 16 years ago. What is the most likely diagnosis?

A knock-out mouse for the Vitamin D receptor has which of the following phenotypes?

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?

In revision total hip arthroplasty, an acetabular reconstruction cage is best indicated for which of the following patterns of bone loss?

What is the most common primary malignant tumor of bone in childhood?

An otherwise healthy 70-year-old man has back and bilateral leg pain in an L5 distribution that is aggravated by standing more than 10 minutes or walking more than 100 feet. He has to sit to get relief. Neurologic and pulse examinations are normal. A radiograph and MRI scan are shown in Figures 4a and 4b. Treatment should consist of

Figures 32a and 32b show the radiographs of an active 13-year-old boy who has persistent left thigh pain and a limp despite a trial of protected weight bearing. Management should consist of

What type of multiple lesions is associated with Maffucci's syndrome?

Compared with cobalt-chromium, the biomechanical properties of titanium on polyethylene articulation in total hip replacement result in

Osteolysis after total knee arthroplasty can be minimized through prosthetic design features such as

An 11-year-old girl has had pain in the medial arch of her foot for the past 3 months. She reports that pain is present even with daily activities such as walking to class at school, and ibuprofen provides some relief. She denies any history of trauma. Examination reveals a flexible pes planus with focal tenderness over a prominent tarsal navicular tuberosity. Radiographs show a prominent accessory navicular. Management should consist of

Figure 31 shows the radiograph of an 8-year-old boy who has a swollen forearm after falling out of a tree. Examination reveals that all three nerves are functionally intact, and there is no evidence of circulatory embarrassment. Management should consist of

Figure 6 shows an object being held in an outstretched hand. To offset the moment created by the object (ignoring the weight of the forearm), the biceps must generate a force of

A 14-year-old girl has a painful hallux valgus deformity that has not responded to shoe modifications. Figure 21 shows a standing AP radiograph. What is the most appropriate surgical procedure?

When compared to smokers who do not quit, an improvement in the rate of lumbar fusion is seen in patients who cease smoking for at least how many months postoperatively?

A 58-year-old woman has had a painless periscapular mass for the past year. An MRI scan and biopsy specimen are shown in Figures 4a and 4b. What is the most likely diagnosis?

Figure 45 shows the lateral radiograph of a 19-year-old swimmer who has had back pain for the past 2 months. What is the most likely diagnosis?

A 9-year-old girl reports progressive right knee pain. Radiographs are shown in Figures 59a and 59b. Work-up reveals no other sites of disease. Low- and high-power photomicrographs are shown in Figures 59c and 59d. What is the most appropriate treatment?

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

Figures 30a and 30b show the MRI scans of a 51-year-old woman who has had an enlarging soft-tissue mass in her right thigh for the past 18 months. Examination reveals no inguinal adenopathy. Results of a biopsy show a high-grade sarcoma. A bone scan is unremarkable, and a CT scan of the chest shows no evidence of pulmonary metastasis. According to the Musculoskeletal Tumor Society (MSTS) staging system, the tumor should be classified as what stage?

A 25-year-old left hand-dominant man has severe left shoulder pain after being involved in a high-speed motor vehicle accident. Examination reveals that he is unable to move the left shoulder. His neurovascular status is intact in the entire left upper extremity. A radiograph is shown in Figure 19. What is the most appropriate surgical management of this injury?

A 15-year-old boy who participates in track reports acute pain along the left iliac crest during a sprint. Examination reveals that the anterior superior iliac spine is nontender. The most likely diagnosis is an injury to the

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?

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

Which of the following complications occurs more commonly after antegrade femoral nail insertion when compared with retrograde insertion?

Use of prophylactic knee bracing in contact sports participants results in which of the following?

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

A 17-year-old woman seen in the emergency department reports right knee pain and swelling that has progressively worsened over the past several weeks. Radiographs are shown in Figures 31a and 31b. What is the most likely diagnosis?

Figure 4 shows the AP radiograph of a 28-year-old woman who has had moderate pain in the left hip for the past year. Nonsurgical management has failed to provide relief. She denies any history of hip pain, pathology, or trauma. Management should consist of

Figures 5a and 5b show the radiographs of an 11-year-old boy who felt a pop and immediate pain in his right knee as he was driving off his right leg to jam a basketball. Examination reveals that the knee is flexed, and the patient is unable to actively extend it or bear weight on that side. There is also a large effusion. Management should include

A 65-year-old woman sustained an axial load on the arm followed by an abduction injury after falling on ice. Treatment in the emergency department consisted of reduction of an anterior dislocation. She now has a positive drop arm sign and a positive lift-off test. An MRI scan is shown in Figure 9. Based on these findings, management should consist of

What is the most common cause of mechanical failure of an orthopaedic biomaterial during clinical use?

A 15-year-old boy reports leg pain after being tackled during football practice. Radiographs and a CT scan are shown in Figures 46a through 46c. The patient has a pathologic fracture through what underlying lesion?

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

A 43-year-old bus driver sustains a hyperextension injury to her arm and shoulder 4 months after undergoing an open Bankart repair. Examination reveals increased external rotation, anterior shoulder pain, and internal rotation weakness. Her examination also reveals the findings shown in Figure 44. What is the most likely diagnosis?

The wear resistance of ultra-high molecular weight polyethylene can be improved by exposing the polymer to high-energy radiation (eg, gamma or electron beam), followed by a thermal treatment. What is one detrimental side effect of this process?

A 19-year-old college student reports a 1-week history of wrist pain following an intramural rugby match. A PA radiograph is shown in Figure 6. He denies any prior wrist injury. What is the best course of action?

Calcitonin acts as an antiresorptive agent by

Figures 1a through 1c show the radiograph and MRI scans of a 16-year-old patient who has a painful hip. Examination reveals a significant limp, limited abduction and internal rotation, and severe pain with internal rotation and adduction. A biopsy specimen is shown in Figure 1d. What is the deposited pigment observed in this condition?

What type of thoracolumbar spinal injury is associated with an increased risk of neurologic deterioration following admission to the hospital?

A 47-year-old man has an acute swollen, red, painful first metatarsophalangeal joint. He denies any history of similar symptoms. What is the first step in evaluation?

Which of the following muscles has dual innervation?

An otherwise healthy 54-year-old man who underwent a successful multilevel lumbar decompression and fusion 4 years ago now reports increasingly severe bilateral thigh claudication with paresthesia and severe back pain for the past 12 months. Physical therapy, bracing, and epidural steroids have failed to provide relief. A radiograph and MRI scans are shown in Figures 15a through 15c. He is afebrile, and laboratory studies show an erythrocyte sedimentation rate of 5 mm/h and a normal WBC count. What is the best course of action?

A 50-year-old man reports the onset of back pain and incapacitating pain radiating down his left leg posterolaterally and into the first dorsal web space of his foot 1 day after doing some yard work. He denies any history of trauma. Examination reveals ipsilateral extensor hallucis longus weakness. MRI scans are shown in Figures 19a through 19c. What nerve root is affected?

What is the peak period of onset in children with pauciarticular juvenile rheumatoid arthritis?

An orthopaedic surgeon frequently uses hip and knee prostheses from a specific manufacturer. The surgeon becomes acquainted with the manufacturer's representative who provides the support for these prostheses in the hospital. They develop a personal relationship outside of work through a common interest in sailing. Together they become interested in buying a sailboat. The manufacture's representative suggests a partnership in a boat costing $200,000. The manufacture's representative would purchase a 90% interest and the surgeon a 10% interest in the boat. There would be no restrictions on use of the boat by the surgeon. What should the orthopaedic surgeon do?

A patient is treated with volar plating for a distal radius fracture. The CT scan shown in Figure 15 is obtained after union of the fracture because the patient reports ongoing symptoms. The prominent hardware is most likely injuring what tendon?

A 65-year-old man has a painful right hip mass that has been growing for several years. A radiograph, CT scan, and photomicrograph are shown in Figures 56a through 56c. What is the most appropriate treatment?

A 6-year-old Little League pitcher has had pain in the right elbow for the past 2 weeks. Examination reveals mild lateral elbow joint tenderness with full range of motion and no effusion or collateral laxity. A radiograph is shown in Figure 38. Initial management should consist of