Orthopedic Board Review Set 171: 100 MCQs (Spine, Trauma, Peds)

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

Figure 11 shows the radiograph of a 26-year-old man with type I diabetes mellitus who was struck by a motor vehicle. What is the most common complication associated with this pelvic fracture?

A 20-year-old athlete sustains a 2- x 3-cm grade IV chondral injury to the right knee. After failure of nonsurgical management, which of the following procedures would ensure the highest percentage of hyaline-like cartilage?

A 16-year-old boy sustains a twisting injury to the left knee while wrestling. MRI scans are shown in Figures 22a through 22c. What is the most likely diagnosis?

Figure 43 shows the lateral radiograph of a 12-year-old boy with mild osteogenesis imperfecta who injured his left elbow after pushing his brother. Treatment should consist of

A 42-year-old woman underwent an instrumented posterior spinal fusion at L3-S1 with transforaminal lumbar interbody fusion. She had an excellent clinical result with complete resolution of leg pain. Three months later she now reports increasing back pain and weakness in her legs. Examination reveals weakness in the quadriceps and tibialis anterior. Radiographs show no interval changes in the position of the hardware. MRI scans are shown in Figures 2a through 2c. What is the next most appropriate step in management?

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

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

A 12-year-old girl sustains an acute injury to the right elbow in a fall. An AP radiograph is shown in Figure 5. Nonsurgical management will most likely result in

A 22-year-old man has mild hip pain bilaterally and multiple skeletal lesions. Based on the pelvic radiograph shown in Figure 30, what is the inheritance pattern for his disorder?

Figure 22 shows the radiograph of a 7-year-old boy who underwent retrograde elastic nailing of a femoral shaft fracture. What is the most common problem following this procedure?

A 7-month-old girl has had a severe flatfoot deformity since birth. The talar head is prominent in the medial plantar arch of the foot. No other deformities of the spine or extremities are present. Motor and sensory examinations of the extremities are normal. Figures 37a through 37c show simulated weight-bearing AP and lateral radiographs and a planter flexion lateral view. What is the most likely diagnosis?

Flexion and extension of the elbow occur about an axis of rotation that

Figures 18a and 18b show the radiographs of a patient who has pain with walking. On careful questioning, it is determined that the discomfort occurs at push-off, or when the patient attempts to climb stairs. What nonsurgical option is most likely to ameliorate the symptoms?

A 16-year-old female swimmer reports several episodes of atraumatic glenohumeral instability that occur with different arm positions. Examination reveals generalized ligamentous laxity and a positive sulcus sign, and her shoulder can be subluxated both anteriorly and posteriorly. Initial management should consist of

Which of the following factors is the strongest predictor of vertebral fracture in postmenopausal women?

The additional risk of complications in organ transplant patients receiving a total joint arthroplasty is attributed to

A 47-year-old man with Charcot-Marie-Tooth (CMT) disease was treated with a fifth metatarsal head resection for a symptomatic bunionette 2 years ago. What is the most likely complication seen at this time?

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

A 24-year-old man reports the development of a foot drop following a knee dislocation 1 year ago. The common peroneal nerve was found to be in continuity at the time of surgical reconstruction of the posterolateral corner of the knee joint. He would like to eliminate the need for an ankle-foot orthosis. What is the best option to achieve elimination of the orthosis?

Figure 37 shows the radiograph of a 21-year-old collegiate basketball player who has had mild midfoot aching for the past 4 months. What is the best course of action?

A 35-year-old female runner reports progressive vague aching pain involving her midfoot. Her pain is most notable when running. She denies specific injury. Examination reveals minimal swelling and localized tenderness over the dorsal medial midfoot and navicular. Radiographs and an MRI scan are shown in Figures 37a through 37c. What is the most appropriate management?

An 8-year-old boy has had pain and swelling around the right knee for the past 4 weeks. He recalls bumping it about 4 weeks ago. He has no pain in other joints, and denies any fevers, chills, or other symptoms. A radiograph is shown in Figure 13. Laboratory studies show a WBC count of 9,700/mm3, an erythrocyte sedimentation rate of 18 mm/h, and a C-reactive protein level of 3.7 mg/L. What is the next most appropriate step in management?

An 18-year-old collegiate basketball player has had a 3-month history of activity-related back pain. She describes isolated low back pain without radiation that increases with training and playing basketball. Her pain resolves with rest. Physical therapy for 6 weeks has failed to provide relief. An axial CT scan is shown in Figure 17a, and Figures 17b and 17c show sagittal CT reconstructions through the right and left lumbar facets, respectively. Further management should consist of which of the following?

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

Figures 11a and 11b show the AP and lateral radiographs of a 32-year-old patient on hemodialysis who has increasing elbow pain and a visibly growing mass over the extensor surface. Figure 11c shows the photomicrograph of the biopsy specimen. What is the most likely diagnosis?

Which of the following factors is responsible for causing the distal femur to pivot about a medial axis as the knee moves from full extension into early flexion?

A 42-year-old man sustained a burst fracture at L2 in a motor vehicle accident. Examination reveals that he is neurologically intact. Figure 18 shows a cross-sectional CT scan through the fracture. If the fracture is managed nonsurgically for the next 2 years, the retained fragments can be expected to

A 17-year-old girl with Charcot-Marie-Tooth disease reports the development of progressive instability when walking on uneven surfaces. Her involved heel is positioned in varus when viewed from behind. Examination reveals that she walks on the outer border of the involved foot. She has full passive motion of the ankle and hindfoot joints. She is able to dorsiflex the ankle against resistance. The heel varus fully corrects with the Coleman block test. Standing radiographs reveal a cavus deformity with valgus of the forefoot. She would like to avoid using an ankle-foot orthosis. What is the best surgical option?

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?

An 82-year-old man is seen in consultation after being admitted for a fall from ground level. There was no loss of consciousness and the patient recalls striking his head and sustaining a hyperextension-type injury to the cervical spine. Examination reveals an 8-cm head laceration with only mild axial neck tenderness. He has generalized weakness throughout the upper extremities and maintained motor function of the lower extremities. There are no obvious sensory deficits, and the bulbocavernous reflex and deep tendon reflexes are maintained. What is the most appropriate diagnosis at this time?

What muscle is most often encountered during surgical approaches to C5-6?

Figure 15a shows the radiograph of a patient who has a chondrosarcoma of the acetabulum. Bone scans are shown in Figures 15b and 15c. Numerous soft subcutaneous masses are present. A clinical photograph of the hand is shown in Figure 15d. What is the most likely diagnosis?

A 10-month-old boy has multiple skeletal lesions and a skin rash that he has had since he was a newborn. Based on the radiographs and biopsy specimens shown in Figures 79a through 79d, what is the most likely diagnosis?

A 62-year-old patient with rheumatoid arthritis has had pain and instability of the elbow following total elbow replacement 2 years ago. A complete work-up, including aspiration and cultures, is negative. Figures 9a and 9b show the AP and lateral radiographs. Treatment should consist of

Figure 10 shows the radiograph of a 7-year-old patient who has a bilateral Trendelenburg limp and limited range of hip motion but no pain. His work-up should include

The artery located within the substance of the coracoacromial ligament is a branch of what artery?

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

Figures 5a and 5b show the clinical photograph and radiograph of a patient who has difficulty wearing shoes and has persistent symptoms medially and laterally at the first and fifth metatarsophalangeal joints. Because shoe modifications have failed to provide relief, management should now consist of

When performing a flexor tendon repair of a digit other than the thumb, what structures of the flexor tendon sheath should be preserved?

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

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 22-year-old man reports anterior knee pain, swelling, and is unable to perform a straight leg raise after undergoing endoscopic anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone autograft 1 week ago. He is afebrile. Examination reveals a clean incision, moderate effusion, a weak isometric quadriceps contraction, active knee range of motion of 5 degrees to 45 degrees, and the patella is ballottable. Knee radiographs show postoperative changes with good femoral and tibial tunnel placements, and normal patellar height. What is the next most appropriate step in management?

Which of the following best describes the course of the ulnar nerve in the midforearm?

Which of the following illustrations shown in Figures 21a through 21e correctly shows the projection of the sacroiliac joint on the outer table of the ilium?

During C1-C2 transarticular screw fixation, screw misplacement is most likely to result in injury to the

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

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?

A 55-year-old woman with a history of untreated idiopathic scoliosis has had neurogenic claudication for the past several months. MRI reveals spinal stenosis at L2-L3, L3-L4, and L4-L5. Radiographs show a 45-degree lumbar curve from T10 to L4, with a degenerative spondylolisthesis at L4-L5. Laminectomy at the stenotic levels and stabilization of the deformity are planned. Which of the following is NOT considered an absolute indication for extending the fusion to the sacrum, rather than stopping at L5?

Patients in compensated shock (normal vital signs) are thought to be at risk for which of the following?

Figure 5 shows the radiograph of a 10-year-old girl who reports chronic shoulder pain after her gymnastics classes. Examination reveals pain on internal and external rotation but no instability. What is the most likely diagnosis?

A 72-year-old woman who sustained a cerebrovascular accident 9 months ago now has a fixed elbow flexion contracture of 80 degrees. Management should consist of

The primary function of structure "A" in Figure 29 is to limit

When treating osteoporosis with alendronate, what is the most common side effect?

A 30-year-old woman injured her ankle playing soccer 3 months ago. She now reports popping and pain over the lateral side of her ankle. An MRI scan is shown in Figure 33. What structure needs to be repaired to alleviate the popping?

The parents of a 10-year-old boy with Down syndrome are seeking sports clearance for participation in the high jump at the Special Olympics. He is asymptomatic, and the neurologic examination is normal. The hips and patellae are clinically stable. Radiographs of the cervical spine in flexion and extension show a maximum atlanto-dens interval (ADI) of 6 mm. Based on these findings, what recommendation should be made?

A 45-year-old woman has had radiating pain in the medial ankle for the past 3 months. Examination reveals a small mass in the retromedial ankle region and a positive Tinel's sign. An intraoperative photograph and a hematoxylin/eosin biopsy specimen are shown in Figures 24a and 24b. Treatment should consist of

Figures 11a and 11b show the radiographs of a 50-year-old man who was struck by a car. Treatment should consist of

During total knee arthroplasty, the patella is noted to subluxate laterally despite a lateral retinacular release. Which of the following methods is most likely to improve patellar stability?

Figure 3 shows the radiograph of an asymptomatic 10-year-old boy. Management should consist of

The peroneus tertius is a commonly used landmark for arthroscopic portal placement. What is the function of this tendon?

The most common mechanism of injury to the triangular fibrocartilage complex (TFCC) involves

A 58-year-old man has had a 3-year history of recurrent ulcerations of the left ankle and instability despite multiple attempts at custom bracing, contact casting, and surgical debridement. He has an ankle-brachial index of 0.76. A clinical photograph and radiographs are shown in Figures 16a through 16c. Treatment should now consist of

A 30-year-old man caught his dominant little finger on the straps of his windsurfing board 10 days ago. He reports swelling about the distal phalanx and has difficulty completely extending the distal interphalangeal joint. A radiograph is shown in Figure 47. What is the most appropriate treatment for this injury?

A 22-year-old right hand-dominant man who fell off his motorcycle onto the tip of his right shoulder 2 weeks ago now reports pain and difficulty raising his right arm. Examination reveals tenderness and gross movement over the lateral scapular spine and severe weakness during resisted abduction. A radiograph and 3D-CT scan are shown in Figures 24a and 24b. What is the next most appropriate step in management?

A 14-year-old football player has had right knee pain for the past 2 months; however, he denies any history of trauma. Examination shows an abductor lurch and increased external rotation of the right lower extremity. The best course of action should be to

When compared to patients with osteoarthritis, patients with ankylosing spondylitis undergoing total hip arthroplasty can expect a

What is the most common adverse postoperative complication of laminoplasty for multilevel cervical spondylotic myelopathy?

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

A 7-year-old boy has had low back pain for the past 3 weeks. Radiographs reveal apparent disk space narrowing at L4-5. The patient is afebrile. Laboratory studies show a WBC count of 9,000/mm3 and a C-reactive protein level of 10 mg/L. A lumbar MRI scan confirms the loss of disk height at L4-5 and reveals a small perivertebral abscess at that level. To achieve the most rapid improvement and to lessen the chances of recurrence, management should consist of

A 58-year-old woman has a fracture through a metacarpal lesion after a motor vehicle accident. She denies any preinjury symptoms and the fracture heals uneventfully. Based on the radiograph and MRI scans shown in Figures 22a through 22c obtained following fracture healing, follow-up management should consist of

Which of the following infectious organisms may be associated with underlying malignancy?

An ulnar nerve palsy at the level of the wrist is typically associated with deficits in the palmaris brevis, the hypothenar muscles, and what other groups of muscles?

Which of the following best describes the mechanism of action of gentamycin?

A 27-year-old woman has a bilateral C5-C6 facet dislocation and quadriparesis after being involved in a motor vehicle accident. Initial management consisted of reduction with traction, but she remains a Frankel A quadriplegic. To facilitate rehabilitation, surgical stabilization and fusion is planned. From a biomechanical point of view, which of the following techniques is the LEAST stable method of fixation?

The mother of a 24-month-old girl reports that the child cannot rotate her right forearm. She also notes delayed development, with the child first walking at 18 months. The child has a five-word vocabulary and has not begun using simple phrases. Examination reveals that the right forearm is fixed in 80 degrees of pronation. The remainder of the examination of both upper extremities is otherwise normal. A radiograph is shown in Figure 41. Which of the following studies will best aid in diagnosis?

A 7-year-old girl sustains the fracture shown in Figure 29a. Casting results in uneventful healing. Ten months later, the patient has a progressive valgus deformity of the right lower extremity. A radiograph is shown in Figure 29b. Management should now consist of

Late surgical treatment of posttraumatic cubitus varus (gunstock deformity) is usually necessitated by the patient reporting problems related to

A 26-year-old man is brought to the emergency department unresponsive and intubated after being found lying on the side of the road. He has a Glasgow Coma Scale score of 6. A chest tube has been inserted on the right side of the chest for a pneumothorax. An abdominal CT scan reveals a small liver laceration and minimal intraperitoneal hematoma. A pneumatic antishock garment (PASG) is on but not inflated. He has bilateral tibia fractures. A pelvic CT scan shows an anterior minimally displaced left sacral ala fracture and left superior and inferior rami fractures. He has received 2 L of saline solution and 4 units of blood but remains hemodynamically unstable. What is the next most appropriate step in management?

A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. A current radiograph is shown in Figure 40. What is the best treatment option?

A 2-year-old girl was born with the toe deformity shown in Figure 2. She has difficulty wearing shoes despite having adequate room in the toe box. Management at this time should consist of

An acetabular reinforcement cage is most often indicated for which of the following conditions?

A 24-year-old woman fell from a horse and landed on her outstretched right arm. Radiographs reveal an elbow dislocation with a type II coronoid fracture and a nonreconstructable comminuted radial head fracture. What is the most appropriate management?

A 16-year-old boy has had a painful ingrown nail on his great toe for the past 3 months. When initial management consisting of soaking the foot in Epsom salts and trimming the nail failed to provide relief, his family physician recommended 2 weeks of oral antibiotics. His symptoms persist, and he is now seeking a second opinion. A clinical photograph is shown in Figure 18. Management should now consist of

A 35-year-old recreational basketball player reports shoulder pain following a sprawl for a rebound. While examination reveals that he can actively elevate the arm with pain, a subacromial injection fails to provide relief. An MRI scan reveals medial subluxation of the long head of the biceps. Which of the following structures most likely has also been injured?

Which of the following is considered a specific advantage of using COX-2 inhibitors over COX-1 inhibitors?

A baseball pitcher has intractable posterior and superior shoulder pain. The arthroscopic view seen in Figure 25 shows no Bankart or Hill-Sachs lesion and a negative drive-through sign. There are no signs of ligamentous laxity, but active compression and anterior slide tests are positive. Treatment should consist of

A 22-year-old patient underwent successful reduction of a posterolateral elbow dislocation. Management should now consist of

Which of the following best characterizes the antigenicity of allograft bone?

A 78-year-old patient undergoing revision total knee arthroplasty has bone loss throughout the knee at the time of revision. A distal femoral augment is used to restore the joint line. One month after surgery, the patient reports pain and is unable to ambulate. A lateral radiograph is shown in Figure 34. What is the most likely etiology of this problem?

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 clinical parameter will most likely decrease the need for blood transfusion after total joint arthroplasty?

Figure 12 shows the radiograph of a 55-year-old man who has severe, painful osteoarthritis of the left hip and is scheduled to undergo a left total hip arthroplasty. History reveals that he underwent a right total hip arthroplasty 5 years ago that remains pain-free. Based on the preoperative radiograph, the patient is at greatest risk for what complication?

The flap shown in the clinical photograph seen in Figure 51 is based on what arterial supply?

Mutations of what gene are associated with subsequent development of osteosarcoma?

An 18-year-old man was in a motor vehicle accident and sustained a closed head injury, right displaced scapular body and glenoid fractures, a right proximal humeral fracture, fractures of ribs one through three, facial fractures, and bilateral pubic rami fractures with minimal displacement. He has a systolic blood pressure of 80/40 mm Hg despite fluid resuscitation. A radiograph is shown in Figure 17. Spiral CT does not identify any thoracic or abdominal injuries. What is the next most appropriate step in management?

Figures 13a and 13b show the preoperative radiographs of a 60-year-old woman who is scheduled to undergo total knee arthroplasty under epidural anesthesia. Postoperatively she reports a burning sensation on the dorsum of her foot despite the administration of IV analgesics through a patient-controlled analgesia (PCA) pump. Management should now include

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?

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