Orthopedic Board Review Practice Exam: Set 556 | 100 High-Yield MCQs

What region of the thoracic curve is most dangerous for pedicle screw insertion while performing a posterior fusion for adolescent idiopathic scoliosis?

A right-handed 14-year-old pitcher has had a 3-month history of shoulder pain while pitching. Examination reveals full range of motion, a mildly positive impingement sign, pain with rotational movement, and no instability. Plain AP radiographs of both shoulders are shown in Figures 25a and 25b. Management should consist of

When polyethylene is exposed to radiation and subsequently heated, certain chemical changes occur in the material. Which of the following statements best describes these changes?

Figures 57a through 57c show the radiographs of a patient who has pain, discomfort, and a popping sensation localized to the posterior aspect of the knee after undergoing primary left total knee arthroplasty 6 months ago. Examination reveals that the patient is able to ambulate without a limp. There is no significant swelling, erythema, or effusion. Range of motion is 0 degrees to 115 degrees, and a palpable crepitation or snapping is detected at the posterior lateral joint line. What is the most likely diagnosis?

What is the mechanism of action of bisphosphonates?

Dislocation following primary total hip arthroplasty is more likely to occur in which of the following situations?

Which of the following findings is the best radiographic indicator of segmental instability at L4-L5?

Examination of an 18-year-old professional soccer player who was forcefully kicked across the shin while attempting a slide tackle reveals a marked effusion and limited motion of the knee. The tibia translates 12 mm posterior to the femoral condyles when the knee is held in 90 degrees of flexion. There is no posteromedial or posterolateral instability. Management should consist of

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

Posterior lumbar spine arthrodesis may be associated with adjacent segment degeneration cephalad or caudad to the fusion segment. Which of the following is the predicted rate of symptomatic degeneration at an adjacent segment warranting either decompression and/or arthrodesis at mid-range follow-up (5-10 years) after lumbar fusion?

What is the effect on knee kinematics following placement of an anterior cruciate ligament (ACL) graft at the 12 o'clock position?

A player on a professional football team sustains a knee injury and is diagnosed with an anterior cruciate ligament rupture. When employed as the team physician, your ethical obligation is to inform

Figures 24a through 24c show the coronal T1-weighted, T2-weighted fat-saturated, and T1-weighted fat-saturated gadolinium MRI scans of the proximal thigh of a 52-year-old woman who reports a mass in the medial thigh and groin area. She notes that the fullness has grown in size over the course of many months. Based on these findings, what is the most likely diagnosis?

Figures 34a and 34b show the clinical photographs of a 46-year-old woman who has a painful deformity of the second toe. Surgical treatment consisting of metatarsophalangeal capsulotomy and proximal interphalangeal joint resection arthroplasty resulted in satisfactory correction, but the toe remains unstable at the metatarsophalangeal joint. What is the next most appropriate step?

A 20-year-old college athlete is seen for follow-up after sustaining an injury at football practice 2 days ago. He reports that he tackled a player and felt neck pain and numbness in both arms. The numbness resolved within seconds, but his neck remains painful and stiff. He denies any history of neck pain or injury. Examination reveals limited neck motion. The neurologic examination and radiographs are normal. MRI scans of the cervical spine are shown in Figure 34. During counseling, the patient, his family, and his coach should be informed that he has an acute cervical disk herniation and cannot play

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

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

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

Split posterior tibial tendon transfer is used in the treatment of children with cerebral palsy. Which of the following patients is considered the most appropriate candidate for this procedure?

A patient who was involved in a motor vehicle accident 2 days ago now reports neck pain. He denies any other symptoms. Radiographs reveal a type II odontoid fracture that is 2 mm anteriorly displaced. Management consists of halo vest immobilization in extension, and repeat radiographs reveal that the fracture is completely reduced. The patient is discharged to home, but later that evening he notes difficulty swallowing while trying to eat dinner. What is the most likely cause of this difficulty?

Which of the following statements most accurately describes the layers of articular cartilage?

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?

In hybrid arthroplasty, the use of a polymethylmethacrylate (PMMA) precoated femoral component has been shown to result in

When using the direct lateral (or Hardinge) approach for hip arthroplasty, three muscles are detached from the femur. In addition to the vastus lateralis, they include the

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

A 32-year-old man sustained a closed injury after falling 25 feet from a roof. His ankle and foot are severely swollen. Radiographs and CT scans are shown in Figures 29a through 29d. Initial management should consist of

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

An excessively large radial styloidectomy poses a risk for wrist instability. What ligament is at greatest risk for injury?

Figures 31a and 31b show the T1- and T2-weighted MRI scans of a patient's knee joint. What is the most likely diagnosis?

A 71-year-old woman undergoes a posterior lumbar decompression and fusion from L4-S1. Thirty-six hours after the procedure, she reports severe right-sided chest pain and shortness of breath. Doppler ultrasound reveals a clot proximal to the knee within the femoral vein. A large pulmonary embolus is confirmed by CT angiography. The next most appropriate step in management should consist of

When conducted at near physiologic strain rates, tensile studies of the inferior glenohumeral ligament (IGHL) have shown that the

A 50-year-old woman has a painful hallux valgus and a painful callus beneath the second metatarsal head. A radiograph is shown in Figure 46. To correct these problems, treatment of the great toe deformity should consist of

Which of the following is considered the treatment of choice for a chondroblastoma of the proximal tibial epiphysis without intra-articular extension?

A 70-year-old man underwent primary total knee arthroplasty 3 months ago. Figures 7a and 7b show the radiograph and clinical photograph following incision and drainage of the wound 1 week ago. Aspiration of the joint reveals methicillin-sensitive Staphylococcus aureus. What is the next most appropriate step in management?

An 11-year-old boy has right shoulder pain and has been unwilling to use the arm after throwing a baseball in a Little League game 3 weeks ago. Examination reveals upper arm and shoulder tenderness with swelling. A radiograph and MRI scan are shown in Figures 27a and 27b. Management should consist of

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

A 22-year-old college football player reports shortness of breath and dyspnea after a tackle. Examination reveals tachypnea, tachycardia, the trachea is shifted to the right, and there are decreased breath sounds on the left lung fields. The first line of treatment on the field should be

A 16-year-old girl has had hip pain for 1 year. Approximately 2 months ago she noted the development of a hard mass in the right buttock that has steadily increased in size. She now reports severe pain in the right buttock, with radiation down the leg and numbness involving the right foot and toes. A radiograph is shown in Figure 70a and an axial postcontrast T1-weighted MRI scan is shown in Figure 70b. A biopsy specimen is shown in Figure 70c. The chest CT shows multiple lung metastases. Treatment of this lesion should consist of

Based on the MRI scan shown in Figure 6, the abnormal signal is seen in what carpal bone?

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?

Which of the following clinical scenarios represents an appropriate indication for convex hemiepiphysiodesis/hemiarthrodesis in the treatment of a child with a congenital spinal deformity?

A 7-year-old boy has had chronic left leg pain that is worse at night but is not activity related. Use of nonsteroidal anti-inflammatory drugs for the past 6 months has failed to provide relief. A CBC count with differential, erythrocyte sedimentation rate, and C-reactive protein are within normal limits. Radiographs and a CT scan are shown in Figures 31a through 31c. Management should consist of

Spontaneous entrapment of the posterior interosseous nerve most commonly occurs in which of the following locations?

A 22-year-old wrestler who underwent an open anterior shoulder reconstruction to repair a dislocated shoulder 6 months ago now reports shoulder pain after attempting a takedown. Examination reveals external rotation that is 15 degrees greater than the contralateral side. He has pain associated with abduction and external rotation but no apprehension. Which of the following tests would most likely reveal positive findings?

A 48-year-old man has recurrent right knee pain. Figure 52a shows the sagittal proton density T2-weighted MRI scan, and Figure 52b shows the sagittal T2-weighted MRI scan at the same level. The arrow is pointing to a

A 65-year-old man with ankylosing spondylitis has neck pain after falling back over his lawnmower, striking his thoracic spine, and forcing his neck into extension. Examination reveals subtle weakness of the intrinsics and finger flexors at approximately 4+/5. Initial management consists of immobilization in a rigid collar, and placing his head in the anatomic position. Radiographs reveal a subtle extension fracture of the lower cervical spine. Approximately 6 hours after the injury, he reports increasing paresthesias in his upper and lower extremities, and examination now shows his intrinsics are 2/5, finger flexors are 3/5, and his triceps are now weak at 4/5 on manual motor testing. In addition, his lower extremities now show weakness in both dorsal and plantar flexion of the ankle in the range of 4/5. Repeat radiographs appear unchanged. An MRI scan is shown in Figure 2. Management should now consist of

A 20-year-old football player has repeated episodes of heat cramps during summer training sessions. A deficiency of what electrolyte is most responsible for heat cramps?

A 15-year-old girl who plays high school basketball has had worsening forefoot pain and swelling that is aggravated by activity for the past 5 weeks. She denies any history of an injury. Examination reveals no deformities. A radiograph is shown in Figure 38. Initial management should consist of

Which of the following findings is considered a poor prognostic factor for postoperative neurologic recovery in patients with rheumatoid arthritis?

Which of the following is associated with the use of bisphosphonates in the setting of metastatic breast cancer to the spine?

In addition to the radiographic features seen in Figures 49a and 49b, this patient will most likely have which of the following findings?

Which of the following prognostic indicators is associated with the least favorable outcome for patients newly diagnosed with osteosarcoma?

A 52-year-old woman with a 2-year history of a flexible (stage II) adult-acquired flatfoot deformity has failed to respond to nonsurgical management consisting of immobilization, custom orthotics, nonsteroidal anti-inflammatory drugs, and physical therapy. The patient is unable to perform a single limb heel rise. Weight-bearing radiographs are shown in Figures 30a through 30c. What is the most appropriate surgical correction?

A 19-year-old man has had back pain with activity, especially running in soccer and baseball, for the past 4 months. He denies any history of trauma. Examination reveals no motor weakness or sensory changes in the lower extremities. Range of motion shows increased pain with extension and mild limitation with flexion. A sitting straight leg raising test is limited at approximately 60 degrees bilaterally by back and buttocks pain. Plain radiographs are normal. MRI scans are shown in Figures 13a through 13e. What is the most likely diagnosis?

Figure 22 shows the radiograph of a 67-year-old woman who has an infected left total hip arthroplasty. The most efficient means to remove the distal cement mantle includes the use of

Figure 29 shows the AP radiograph of a 14-year-old boy. The radiographic findings are most consistent with what pathologic process?

Etanercept is a recombinant genetically engineered fusion protein used to treat rheumatoid arthritis. What is its mode of action?

An 18-year-old man recently underwent an uncomplicated arthroscopic partial medial meniscectomy that was complicated by reflex sympathetic dystrophy (RSD), also termed "sympathetically maintained pain" (SMP). What is the most common finding of this condition?

Which of the following best characterizes bone mineralization?

A 16-year-old boy has had thigh pain for the past several months. He denies any history of trauma. Examination reveals a large, deeply fixed, soft-tissue mass in the thigh. Laboratory results show an elevated erythrocyte sedimentation rate (ESR) and leukocytosis. A plain radiograph and MRI scan are shown in Figures 1a and 1b. Biopsy specimens are shown in Figures 1c and 1d. What is the most likely diagnosis?

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

A 14-year-old boy reports a 4-month history of increasing backache with difficulty walking long distances. His parents state that he walks with his knees slightly flexed and is unable to bend forward and get his hands to his knees. He denies numbness, tingling, and weakness in his legs and denies loss of bladder and bowel control. A lateral radiograph of the lumbosacral spine is shown in Figure 18. What is the best surgical management for this condition?

What are the two terminal branches of the lateral cord of the brachial plexus?

Figure 63 shows the radiographs of a 23-year-old man who sustained a twisting injury at work. Swelling, tenderness, and ecchymosis are noted about the entire midfoot. What associated injury is most likely to be problematic?

A collegiate football player who sustained a blow to the head during the first quarter of a game is confused for several minutes after the hit but does not lose consciousness. He had two similar episodes in games earlier in the season. When should he be allowed to return to play?

A 6-year-old boy with spastic diplegic cerebral palsy has a crouched gait. Examination reveals hip flexion contractures of 15 degrees and popliteal angles of 70 degrees. Equinus contractures measure 10 degrees with the knees extended. Which of the following surgical procedures, if performed alone, will worsen the crouching?

A 48-year-old man has had pain and swelling of the hallux metatarsophalangeal joint for the past 9 months. A rocker bottom stiff-soled shoe has failed to provide relief; however, two cortisone injections have temporarily alleviated his symptoms. The radiographs shown in Figures 20a and 20b reveal diffuse arthritis of the entire hallux metatarsophalangeal joint. What is the most definitive surgical treatment?

What is the most common primary malignant bone or cartilage tumor in children?

A 65-year-old woman landed on her nondominant left shoulder in a fall. An AP radiograph is shown in Figure 39. Management should consist of

A 9-year-old boy falls from a scooter and sustains the injury shown in the radiographs in Figure 26. After closed reduction and cast immobilization, what is the most likely complication that can result?

What is the maximum acceptable amount of divergence of the interference screw in the femoral tunnel from the bone plug of a bone-patellar tendon-bone graft in anterior cruciate ligament (ACL) reconstruction before pull-out strength is statistically decreased?

Which of the following findings is most prognostic for the ability of a young child with cerebral palsy to walk?

A 54-year-old man undergoes uneventful anterior cervical diskectomy and interbody fusion at C4-5 for focal disk herniation and C5 radiculopathy. At the 3-week follow-up examination, the patient reports a persistent cough. Pulmonary evaluation reveals a mild but persistent aspiration. Laryngoscopy reveals partial paralysis of the left vocal cord, most likely caused by

A 10-year-old boy has had wrist pain for the past 3 months. He denies any history of trauma. He reports mild tenderness associated with a palpable mass. A radiograph and biopsy specimens are shown in Figures 52a through 52c. What is the most likely diagnosis?

When compared with a patient who has a subluxated hip, a patient with a dislocated hip who is undergoing acetabular reconstruction for developmental dysplasia of the hip will most likely have

A 36-year-old woman sustained a tarsometatarsal joint fracture-dislocation in a motor vehicle accident. The patient is treated with open reduction and internal fixation. What is the most common complication?

To adequately expose the volar plate of the proximal interphalangeal joint of the finger, which of following pulleys is typically incised?

A 15-year-old boy with a type I hereditary sensory motor neuropathy (Charcot-Marie-Tooth disease) reports recurrent ankle sprains and significant pain in the hindfoot and midfoot despite orthotic management. Examination reveals that he walks with a drop foot and has dynamic clawing of the toes. Clinical photographs of the left foot are shown in Figure 7. Management 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?

A 10-year-old child reports acute leg pain after wrestling with his brother. AP and lateral radiographs are shown in Figures 21a and 21b. What is the best course of action?

A skeletally mature 15-year-old girl who was thrown from the car in a rollover accident sustained the injuries shown in Figures 23a through 23d. Examination reveals no neurologic deficit, but the patient has moderate posterior spinal tenderness at the level of the injury. What is the most appropriate treatment?

A 22-month-old child has scrapes and bruises on his head and a severe deformity of the forearm after being thrown from a car as an unrestrained passenger in a motor vehicle accident. Examination reveals a Glasgow Coma Scale score of 12. Prior to treatment of the forearm, management should include

When performing a total knee arthroplasty using modular components, what is the minimum recommended thickness of an ultra-high molecular weight polyethylene insert for a tibial component?

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?

Figures 20a and 20b show the AP and lateral radiographs of a 62-year-old man who has had hip pain for the past 3 weeks. Figure 20c shows a CT scan of the abdomen and pelvis. A needle biopsy specimen is shown in Figure 20d. Preoperative management should include which of the following?

The main advantage of surgical repair of an acute Achilles tendon rupture, when compared with nonsurgical management, is reduced

A 25-year-old man has had an insidious onset of left hip pain over the past 11 months. A radiograph, coronal MRI scan, and histopathologic specimens are seen in Figures 2a through 2d. What is the most likely diagnosis?

A 42-year-old woman has a history of nontraumatic ankle swelling with tenderness over the Achilles tendon and plantar fascia. She reports that while vacationing in Connecticut 2 months ago she noted the presence of a "red bull's eye" rash. Management should consist of

Figure 11a shows the clinical photograph of a 46-year old woman who reports a 3-week history of pain and a "lump" at the base of her neck. She is otherwise in good health and denies any trauma. A 3-D reconstruction CT is shown in Figure 11b. What is the most likely diagnosis?

What is the most appropriate indication for replantation in an otherwise healthy 35-year-old man?

During the first 2 years of life, which of the following actions is most responsible for increasing structural stability of the physis?

Which of the following properties apply to the human meniscus when compared with articular cartilage?

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

A 28-year-old professional football player reports painless loss of ankle motion after sustaining a "severe" ankle sprain 12 months ago. A mortise radiograph is shown in Figure 1. Surgical treatment should be reserved for which of the following conditions?

A 28-year-old cowgirl was injured while herding cattle 1 week ago. A radiograph and CT scans are shown in Figures 13a through 13c. What is the most appropriate management for this injury?

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 42-year-old man who is right-hand dominant injured his right shoulder when he fell from a ladder onto his outstretched arm 1 hour ago. Radiographs reveal a two-part greater tuberosity anterior fracture-dislocation. Initial management should consist of

A 35-year-old woman who underwent open reduction and internal fixation of a calcaneal fracture 14 months ago reports pain that has failed to respond to nonsurgical management. Examination reveals limited painful subtalar motion but no hindfoot deformity. A lateral radiograph is shown in Figure 6. Surgical reconstruction is best accomplished with

A patient with myelopathy underwent a one-level corpectomy 1 day ago and is now home. In the middle of the night he calls to report markedly increased difficulty in swallowing, diaphoresis, a change in his voice, and difficulty lying flat. What is the best course of action?

Which of the following statements describing chordomas is false?