Orthopedic Surgery MCQs: Trauma, Spine, Sports & Recon – Mock Exam #514

The best patient-related outcomes, following the surgical treatment of cauda equina syndrome secondary to a large L5-S1 disk herniation, are most closely related to which of the following?

A right-handed 24-year-old woman underwent an arthroscopic Bankart repair for recurrent anterior dislocations 9 months ago. Despite extensive physical therapy for 8 months, the patient has very limited range of motion (elevation to 130 degrees and external rotation to 10 degrees with the arm at the side). Shoulder radiographs are normal. The next step in management should consist of

A 47-year-old woman has a painful bunion of the right foot, and shoe wear modifications have failed to provide relief. Examination reveals a severe hallux valgus with dorsal subluxation of the second toe. Radiographs are shown in Figures 14a and 14b. The most appropriate management should include

A 70-year-old former baseball catcher reports long-standing pain in the ring and little fingers. A gradient-echo MRI scan is shown in Figure 26. What is the most likely diagnosis?

A 58-year-old woman with rheumatoid arthritis and a severe hindfoot valgus deformity now reports recurrent lateral ankle pain. Examination reveals pain over the fibula and sinus tarsi, with a valgus hindfoot that is passively correctable. Despite the use of an ankle-foot orthosis, this is the second time this problem has occurred. Radiographs and a clinical photograph are shown in Figures 28a through 28c. What is the next most appropriate step in treatment?

A 17-year-old high school football player reports wrist pain after being tackled. Radiographs are shown in Figures 22a through 22c. What is the recommended intervention?

Patients with rheumatoid arthritis may exhibit an increase in viral load for which of the following viruses?

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 67-year-old woman undergoes a revision total shoulder arthroplasty for replacement of a loose glenoid component. Examination in the recovery room reveals absent voluntary deltoid and triceps contraction, weakness of wrist and thumb extension, and absent sensation in the palmar aspect of all fingertips and the radial forearm. The next most appropriate step in management should consist of

Where is the most common site for tuberculosis (TB) spondylitis in children?

Figure 2 shows the radiograph of a 26-year-old auto mechanic who injured his right dominant elbow in a fall during a motocross race. Examination reveals pain and catching that limits his range of motion to 45 degrees of supination and 20 degrees of pronation. The interosseous space and distal radioulnar joint are stable. Management should consist of

A 25-year-old woman has had continuous pain after falling on her outstretched wrist 12 weeks ago. A current radiograph is shown in Figure 11. Management should consist of

Which of the following treatment regimens for thromboembolic prophylaxis meets the American College of Chest Physicians Guidelines for 10-day treatment after total hip arthroplasty and total knee arthroplasty?

The lesion seen in Figure 4 is most likely the result of metastases from what solid organ?

Ganglion cysts about the wrist most commonly arise from what structure?

A 7-year-old patient has had a painless limp for several months. Examination reveals pain and spasm with internal rotation, and abduction is limited to 10 degrees on the involved side. Management consists of 1 week of bed rest and traction, followed by an arthrogram. A maximum abduction/internal rotation view is shown in Figure 40a, and abduction and adduction views are shown in Figures 40b and 40c. The studies are most consistent with

A 24-year-old professional football player underwent surgery for a symptomatic cervical disk herniation with radiculopathy 9 months ago. A current radiograph is shown in Figure 17. He has normal neurologic findings, no pain, and full range of motion. A CT scan shows a solid fusion. When can he expect to return to play?

Figures 34a through 34c show an axial proton density (spin echo long TR, short TE) image, a sagittal inversion recovery (STIR) image, and a sagittal T1-weighted (short TR, short TE) image of the left thigh. What is the most likely diagnosis?

Figure 8 shows the radiograph of a 72-year-old man who has had severe pain in the left hip for the past 3 weeks. History reveals alcohol abuse. The next most appropriate step should consist of

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?

A 5-year-old boy sustained an elbow injury. Examination in the emergency department reveals that he is unable to flex the interphalangeal joint of his thumb and the distal interphalangeal joint of his index finger. The radial pulse is palpable at the wrist, and sensation is normal throughout the hand. Radiographs are shown in Figures 6a and 6b. In addition to reduction and pinning of the fracture, initial treatment should include

Figure 53a shows the AP radiograph of a 70-year-old patient who is scheduled to undergo unicompartmental knee arthroplasty. Figure 53b shows the immediate postoperative radiograph, and the radiograph shown in Figure 53c, obtained 6 months after surgery, shows a medial tibial plateau fracture. The etiology of the fracture is best related to

Which of the following is considered the cause of Milwaukee shoulder, a joint disease similar to rotator cuff arthropathy?

An 82-year-old woman reports activity-related knee pain. History reveals that she underwent total knee arthroplasty 16 years ago. AP and lateral radiographs and a bone scan are shown in Figures 38a through 38c. What is the most likely diagnosis?

A 19-year-old man sustains a low-velocity gunshot wound to the forearm. What factor most strongly correlates with the development of compartment syndrome after this injury?

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?

Figure 18a shows the clinical photograph of a 2-year old boy who has a deformity of the right leg. Examination reveals eight cutaneous markings similar to those shown in Figure 18b. Radiographs are shown in Figure 18c. Management should consist of

A 6-year-old child has a fixed flexion deformity of the interphalangeal (IP) joint of the right thumb. The thumb is morphologically normal, with a nontender palpable nodule at the base of the metacarpophalangeal joint. Clinical photographs are shown in Figures 42a and 42b. Based on these findings, what is the treatment of choice?

Which of the following statements best characterizes polymethylmethacrylate (PMMA) when it is used to secure joint components in bone and to distribute the forces evenly across the bone-implant interface?

Which of the following radiographic views best depicts a Hill-Sachs defect?

A 40-year-old man with an acetabular chondrosarcoma has a small soft-tissue mass. Treatment should consist of

In addition to pain, which of the following factors are considered most predictive of the risk of pathologic fracture?

A 40-year-old carpenter has a 3-month history of right arm pain and neck pain that now leaves him unable to work. Examination reveals a positive Spurling test, weakness of the biceps, and a mildly positive Hoffman's sign on the right side. Electromyography and nerve conduction velocity studies show a right C6 deficit. Figures 27a through 27c show MRI scans that reveal two-level spondylotic disease at C5-6 and C6-7, a large herniated nucleus pulposus at C5-6, and a prominent ridge and hard disk at C6-7. Nonsurgical management fails to provide relief, so the patient elects surgical intervention. Which of the following surgical options would give the best long-term results?

Bacitracin is a topical antibiotic agent that may be added to solutions and used for intraoperative lavage. What is this agent effective against?

A 73-year-old man is scheduled to have mature heterotopic bone resected from around his left total hip arthroplasty. The optimal management for prophylaxis against the return of heterotopic bone postoperatively is radiation therapy that consists of

In patients with displaced radial neck fractures treated with open reduction and internal fixation with a plate and screws, the plate must be limited to what surface of the radius to avoid impingement on the proximal ulna?

A 42-year-old man sustained the periprosthetic fracture shown in Figures 19a and 19b. The femoral component is well fixed. What is the next most appropriate step in management?

A 25-year-old student sustains the injury shown in Figures 13a through 13c after falling off a curb. Initial management should consist of

Which of the following factors increases the risk of sciatic nerve injury in primary total hip arthroplasty (THA)?

A 30-year-old woman has pain in her right hand. The radiograph, CT scan, and biopsy specimen are seen in Figures 38a through 38c. What is the most likely diagnosis?

Figures 15a through 15c show the radiographs of a 23-year-old football player who was injured when another player fell on his flexed and planted foot. He reports severe pain in the midfoot with a feeling of numbness on the dorsum of the foot, and he is unable to bear weight on the limb. Examination reveals mild swelling. Management should consist of

A newborn girl is referred for evaluation of suspected hip instability. What information from her history would place her in the highest risk category?

An 80-year-old man has had increasing shoulder pain for the past 4 months. He reports that it began with soreness and stiffness after chopping some wood. A coronal MRI scan is shown in Figure 16. Initial management should consist of

A purulent flexor tenosynovitis of the thumb may communicate with the small finger flexor through which of the following structures?

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 increases radiation exposure to patients and personnel during surgery?

Figures 12a and 12b show the radiographs of a 50-year-old patient who reports acute knee pain after sustaining a twisting injury while playing tennis. Examination is unremarkable. The next most appropriate step in management should consist of

Figure 12 shows a lateral radiograph of the elbow. What is the most likely diagnosis?

What is the correct order of the elastic modulus of the following materials from greatest to least?

A 21-year-old man has had posterior neck discomfort for the past 6 months. A whole-body bone scan and a cervical single-photon emission CT reveal increased activity at the C7 spinous process. MRI reveals multifocal involvement of the spinous process lamina and facet of C7. A CT-directed needle biopsy reveals osteoblastoma. What is the best course of action?

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

Which of the following nerves is susceptible to entrapment near the calcaneal attachment site of the plantar fascia and can mimic or co-exist with plantar fasciitis?

Figures 21a and 21b show the radiographs of a 12-year-old patient with an L4-level myelomeningocele who has scoliosis that has been slowly progressing for the past several years. There has been no loss of motor function. An MRI scan shows no syringomyelia or increased hydrocephalus. Management should consist of

A 77-year-old woman with osteoporosis who underwent cemented total hip arthroplasty 12 years ago fell down a flight of stairs. A radiograph is shown in Figure 15. What is the best option for treating this fracture?

Which of the following findings is a contraindication to isolated percutaneous pinning of a distal radius fracture?

Which of the following describes the correct proximal to distal progression of the annular and cruciform pulleys of the digits?

An 8-year-old girl has had a painless enlarging mass of insidious onset in the left thigh for the past 3 weeks. Her mother denies any history of trauma, fever, or disease. Examination reveals a nontender, mobile mass in the left medial thigh. Her gait is normal. Figures 25a through 25d show the frog-lateral radiograph, the axial and coronal T1-weighted MRI scans, and the axial T2-weighted MRI scan. Biopsy results reveal a nonrhabdomyosarcoma soft-tissue sarcoma. The most appropriate treatment should consist of

A 40-year-old woman has had sciatic pain on the left side for the past 8 weeks. She reports that the pain radiates to her posterior thigh, lateral calf, and into the dorsum of her left foot. Neurologic examination shows weakness of the left extensor hallucis longus. Axial T2-weighted MRI scans through L4-L5 are shown in Figure 14. Management should consist of

A 23-year-old man has had right posterolateral knee pain and occasional lateral calf dysesthesias for the past 8 months. A radiograph, CT scan, MRI scans, and a biopsy specimen are shown in Figures 62a through 62e. What is the most likely diagnosis?

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

A 63-year-old woman with a history of poliomyelitis has a fixed 30-degree equinus contracture of the ankle, rigid hindfoot valgus, and normal knee strength and stability. She reports persistent pain and has had several medial forefoot ulcerations despite a program of stretching, bracing, and custom footwear. What is the next most appropriate step in management?

Which of the following statements best describes the anatomic considerations of the popliteal artery posterior to the knee joint?

When converting the knee shown in Figure 20 to a total knee arthroplasty, satisfactory outcome can be expected in what percent of patients?

A 21-year-old soccer player reports pain and is unable to straighten his knee following an acute injury during a game. He is unable to continue to play. An MRI scan is shown in Figure 3. What is the next most appropriate step in management?

Which of the following is considered a potential advantage in prophylaxis for the prevention of deep venous thrombosis associated with the use of low-molecular weight heparin (LMWH) as compared with fixed-dose unfractionated heparin?

Which of the following is considered the lowest level that a standard thoracolumbosacral orthosis (TLSO) can immobilize?

A 13-year-old girl with hallux valgus reports pain after playing basketball. Radiographs show a hallux valgus angle of 20 degrees, an intermetatarsal angle of 11 degrees, a distal metatarsal articular angle of 10 degrees, and a congruent joint. Management should consist of

What does Dual Energy X-ray Absorptiometry (DEXA) testing, as a technique, measure?

What nerve is at the highest risk for injury with a percutaneous repair of an Achilles tendon injury?

During stabilization of a slipped capital femoral epiphysis, the screw penetrates into the joint. The screw is repositioned so that it is within the femoral head. This transient penetration of the hip joint will most likely lead to

Figures 37a and 37b show radiographs of a 24-year-old man who has a humeral bone lesion that was found during a screening chest radiograph. He denies any symptoms despite leading a very active lifestyle. What is the most likely diagnosis?

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

Risk of fat embolism is greatest during what step of total hip arthroplasty?

Evaluation of the percent of necrosis in the resected specimen after preoperative chemotherapy is of prognostic value for what type of sarcoma?

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

A 5-year-old boy has a deformity of his right arm after falling from a jungle gym. A radiograph is shown in Figure 37. Management should consist of

A 57-year-old man reports right hip pain that has been progressive for the past several months. The pain is exacerbated by weight-bearing activities and improves somewhat with rest. A radiograph is shown in Figure 10a and a coronal T1-weighted MRI scan is shown in Figure 10b. What is the most likely diagnosis?

What is the most common long-term complication of the fracture shown in Figure 32?

Compared to eumenorrheic athletes, amenorrheic athletes have more frequent occurrences of

A 42-year-old man reports a 12-month history of a painful fusiform swelling of the Achilles tendon. Physical therapy, heel lifts, and anti-inflammatory drugs have failed to provide relief. MRI scans are shown in Figures 44a and 44b. What is the treatment of choice?

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

An infant is born with a mass that involves both the volar and dorsal compartments of the left arm. A clinical photograph and biopsy specimen are shown in Figures 41a and 41b. What is the best initial course of action?

Figure 6 shows a sagittal oblique MRI scan. The arrow is pointing to what structure?

Figure 33 shows the venogram of a patient who has a long history of alcohol abuse. Warfarin should be used cautiously because of the interaction with which of the following factors?

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)?

It has been shown that bisphosphonate-based supportive therapy (pamidronate or zoledronate) reduces skeletal events (onset or progression of osteolytic lesions) both in patients with multiple myeloma and in cancer patients with bone metastasis. The use of biphosphonate therapy has been associated with

A 66-year-old woman who previously underwent hemiarthroplasty 2 years ago for a fracture continues to have severe pain and loss of motion despite undergoing physical therapy. A radiograph is shown in Figure 2. What is the most likely reason that this patient has failed to improve her motion?

In the anterior forearm approach to the distal radius (Henry approach), the radial artery is located between what two structures?

Which of the following best describes the course of the median nerve at the elbow?

The use of a screw between the clavicle and the coracoid process to maintain the clavicle and acromioclavicular (AC) joint in a reduced position is a treatment option for AC joint separations. Screw removal is generally recommended after soft-tissue healing. What effect does this rigid coracoclavicular fixation have on shoulder kinematics?

What type of muscle contraction occurs while the muscle is lengthening?

A 15-year-old boy has had pain in the right shoulder for the past 3 months. He denies any history of trauma and has no constitutional symptoms. Examination reveals a large firm mass in the proximal arm. A radiograph and MRI scan are shown in Figures 27a and 27b. Biopsy specimens are shown in Figures 27c and 27d. Management should consist of

Figure 35 shows the AP radiograph of a patient who underwent a previous upper tibial osteotomy (UTO). The patient may be at risk for which of the following during total knee arthroplasty (TKA)?

What is the primary mechanism of injury for the fracture shown in Figures 33a and 33b?

A 25-year-old man underwent a Putti-Platt repair for recurrent anterior dislocation of his right shoulder 9 months ago. He reports no further episodes of instability but continues to have severely restricted motion, with external rotation limited to less than 0 degrees with the arm at the side. He has pain at the ends of range of motion and restricted activities of daily living despite undergoing nearly 9 months of physical therapy. Radiographs of the shoulder show no arthritic changes. Management should now consist of

A 48-year-old woman has knee pain that is worse with weight bearing. She reports no night pain or pain at rest. History reveals that she underwent total knee arthroplasty with cementless components 2 years ago. Examination reveals tenderness along the medial joint line. Figures 12a through 12c show radiographs and a bone scan. What is the most likely cause of the patient's pain?

What is the recommended treatment of a skeletally immature 12-year-old boy who has an anterior cruciate ligament-deficient knee?

A 13-year-old boy has had a painless mass in the arm for the past 2 months. An MRI scan and biopsy specimens are shown in Figures 46a through 46c. What is the most likely diagnosis?

Anabolic steroid use has which of the following effects on serum lipoprotein levels?

The vascularity of the digital flexor tendons is significantly richer in what cross-sectional region?