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Question 1201

Topic: 1. General Principles & Basic Science

C ardinal signs of evenomation include all of the following except:

. Fang marks
. C yanosis
. Pain
. Swelling
. Ascending lymphangitis

Correct Answer & Explanation

. C yanosis


Explanation

The cardinal signs of evenomation appear between 10 minutes and 4 hours after a person is bitten. The signs include fang marks, pain, swelling, and local necrosis. Cyanosis is not considered a cardinal sign of evenomation.

Question 1202

Topic: Infection, Pharmacology & VTE

A 24-year-old man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. An important step in assessment of human bites is:

. Evaluation for tendon injury in clenched-fist position
. Bone scan to rule out osteomyelitis
. Ultrasound to rule out septic arthritis
. Monitoring finger girth to document progress
. None of the above

Correct Answer & Explanation

. Evaluation for tendon injury in clenched-fist position


Explanation

Evaluation for tendon injury in a clenched-fist position is essential because tendons slide proximally in the open-hand position. Involvement of tendon or joint usually necessitates surgical debridement.C orrect Answer: Evaluation for tendon injury in clenched-fist position

Question 1203

Topic: Infection, Pharmacology & VTE

A 24-year-old white man presents to the emergency department. He was bitten on his fist while fighting with another man. You notice teeth marks on the dorsum of the metacarpophalangeal (MC P) joint of the right middle finger. The bite does not appear to be deep because the joint is not exposed, and you can see the extensor tendon, which seems intact. The patient has active extension at the MC P joint. The wound is red and swollen, but there is no tenderness or redness on the volar aspect of the MCP joint. The patient has some limitation in range of motion. He is afebrile. Radiographs reveal soft tissue involvement but no joint dislocation or fracture, and there is no neurovascular deficit. The most appropriate antibiotic treatment includes:

. Imipenam and ciprofloxacin
. C efotaxime and ciprofloxacin
. Amoxicillin and ciprofloxacin
. Amoxicillin and flocloxacillin
. Bactrim and rifampin

Correct Answer & Explanation

. Imipenam and ciprofloxacin


Explanation

Imipenam and ciprofloxacin provide treatment for gram-negative and gram- positive organisms.C orrect Answer: Imipenam and ciprofloxacin

Question 1204

Topic: 1. General Principles & Basic Science

Which of the following organisms is most likely found in a cat bite:

. Eikenella corrodens
. Pasteurella multocida
. Micrococcus
. Borrelia recurrentis
. None of the above

Correct Answer & Explanation

. Pasteurella multocida


Explanation

Pasteurella multocida is the most common organism found in animal bites.

Question 1205

Topic: 1. General Principles & Basic Science

Which of the following fascial structures does not contribute to the formation of the spiral cord:

. Pretendinous band
. Lateral digital sheet
. Graysons ligament
. Clelands ligament
. Spiral band

Correct Answer & Explanation

. Clelands ligament


Explanation

The pretendinous band, spiral band, lateral digital sheet, and Grayson's ligament are all parts of the normal fascia that contribute to the formation of the spiral cord. C leland's ligament is not involved at all in the disease process.

Question 1206

Topic: 1. General Principles & Basic Science
Skin pits in Dupuytren's disease are caused by:
. Vertical septae of Legueu and Juvara
. Vertical fibers of palmar aponeurosis anchoring to the skin
. Longitudinal fibers of palmar aponeurosis inserting into the skin
. Longitudinal pretendinous bands
. Contractures of the natatory ligaments

Correct Answer & Explanation

. Longitudinal fibers of palmar aponeurosis inserting into the skin


Explanation

The longitudinal fibers forming layer 1 of the palmar aponeurosis insert into the dermis and, when contracted, give rise to skin pits. The pretendinous bands give rise to the central cord. Contractures of the natatory ligament give rise to the natatory cord. Vertical fibers and septae do not give rise to pits.

Question 1207

Topic: 1. General Principles & Basic Science

Which of the following is not a characteristic of an acrolentiginous melanoma:

. Involves palm and nail bed
. Delays in diagnosis are common
. Presents in older patients
. Does not commonly metastasize
. Develops rapidly

Correct Answer & Explanation

. Delays in diagnosis are common


Explanation

Acrolentiginous melanomas are usually flat, pigmented lesions. These melanomas often occur in older patients, affecting the palm and nail bed. At the time of presentation, acrolentiginous melanomas are frequently metastasized.

Question 1208

Topic: 1. General Principles & Basic Science

Which of the following terms is not used in reference to macrodactyly:

. Megalodactyly
. Overgrowth
. Gigantism
. Symbrachydactyly
. Macrodactylia fibrolipomatosis

Correct Answer & Explanation

. Symbrachydactyly


Explanation

Symbrachydactyly is a term that encompasses all variations of shortened digits. Symbrachydactyly may be associated with syndactylies, but it is not a term used in reference to macrodactyly.

Question 1209

Topic: 1. General Principles & Basic Science
Most cases of macrodactyly are:
. Bilateral and affect men more often than women
. Bilateral and affect women more often than men
. Unilateral and affect men more often than women
. Unilateral and affect women more often than men
. Bilateral with equal frequency in both men and women

Correct Answer & Explanation

. Unilateral and affect men more often than women


Explanation

The majority of patients (90%) present with unilateral macrodactyly, and men are more often affected than women. Macrodactyly is most frequently found in the index finger, followed by the long finger, thumb, ring, and little fingers. Typically, two digits are affected—most commonly the thumb and index or the index and long.

Question 1210

Topic: Biology, Genetics & Bone Healing

A 30-year-old female presents with knee pain. Radiographs show an eccentric, lytic lesion in the distal femoral epiphysis extending to the subchondral bone without a sclerotic margin. Biopsy reveals multinucleated giant cells. Which medication acts by binding to RANKL to treat this condition?

. Zoledronic acid
. Denosumab
. Methotrexate
. Doxorubicin
. Imatinib

Correct Answer & Explanation

. Denosumab


Explanation

The clinical and histologic findings describe a giant cell tumor (GCT) of bone. Denosumab is a monoclonal antibody that binds to RANKL, inhibiting osteoclast-like giant cells, and is used for advanced or recurrent GCTs.

Question 1211

Topic: Biomechanics & Biomaterials

During viscoelastic testing of a tendon, a constant load is applied over time, resulting in progressive deformation (elongation) of the tissue. What is this biomechanical phenomenon called?

. Stress relaxation
. Creep
. Hysteresis
. Strain rate dependency
. Fatigue failure

Correct Answer & Explanation

. Creep


Explanation

Creep is the time-dependent elongation of a viscoelastic material under a constant load. Stress relaxation is the decrease in internal stress over time when the material is held at a constant length.

Question 1212

Topic: Biomechanics & Biomaterials

A surgeon is considering using a stainless steel screw in combination with a titanium plate for fracture fixation. Which of the following best describes the primary risk associated with mixing these two metals?

. Fretting corrosion
. Galvanic corrosion
. Crevice corrosion
. Stress corrosion cracking
. Pitting corrosion

Correct Answer & Explanation

. Galvanic corrosion


Explanation

Mixing two dissimilar metals with different electrochemical potentials in an electrolytic environment (like the body) leads to galvanic corrosion. The less noble metal will corrode at an accelerated rate, potentially leading to implant failure.

Question 1213

Topic: Biology, Genetics & Bone Healing

Which of the following is the true neoplastic cell population in a Giant Cell Tumor (GCT) of bone?

. Multinucleated giant cells
. Osteoclasts
. Spindle-shaped mononuclear cells
. Chondroblasts
. Histiocytes

Correct Answer & Explanation

. Spindle-shaped mononuclear cells


Explanation

The neoplastic cells in GCT are the spindle-shaped mononuclear cells of osteoblastic lineage. The hallmark multinucleated giant cells are actually reactive osteoclast-like cells recruited by RANKL expression from the mononuclear cells.

Question 1214

Topic: Biology, Genetics & Bone Healing

A 65-year-old woman on long-term bisphosphonate therapy presents with prodromal thigh pain. Radiographs show cortical thickening and a transverse radiolucent line on the lateral aspect of the femoral diaphysis. What is the recommended management?

. Discontinue bisphosphonate and prescribe crutches for non-weight bearing
. Switch to teriparatide and repeat radiographs in 6 weeks
. Prophylactic intramedullary nailing of the femur
. Application of a hip spica cast
. Observation with serial dual-energy X-ray absorptiometry (DEXA) scans

Correct Answer & Explanation

. Prophylactic intramedullary nailing of the femur


Explanation

The presence of prodromal thigh pain combined with a radiographic "beaking" or a radiolucent line on the lateral femoral cortex indicates an impending atypical femoral fracture. The standard of care is prophylactic intramedullary nailing to prevent complete displacement.

Question 1215

Topic: Surgical Anatomy & Approaches

A 6-year-old boy sustains a completely displaced, extension-type supracondylar humerus fracture. The distal fragment is displaced posteromedially. Which nerve is most commonly at risk in this specific displacement pattern?

. Radial nerve
. Ulnar nerve
. Anterior interosseous nerve
. Posterior interosseous nerve
. Musculocutaneous nerve

Correct Answer & Explanation

. Radial nerve


Explanation

In posteromedial displacement of an extension-type supracondylar fracture, the proximal fragment is displaced anterolaterally. This sharp metaphyseal spike places the radial nerve at the greatest risk of injury.

Question 1216

Topic: 1. General Principles & Basic Science

Which anatomical feature does not predispose patients to peroneal tendon dislocation:

. Shallow peroneal groove
. Insufficient superior peroneal retinaculum
. Peroneus quartus
. Low-lying peroneus brevis muscle belly
. Varus heel alignment

Correct Answer & Explanation

. Varus heel alignment


Explanation

A varus heel alignment would stabilize the peroneal tendons medially into the peroneal groove. Valgus heel alignment is associated with increased risk for peroneal tendon dislocation because this predisposes the tendons to move laterally out of the groove. The other anatomical features have all been implicated as risk factors for peroneal tendon dislocation.

Question 1217

Topic: Biology, Genetics & Bone Healing

In normal development, the differentiation of the interdigital web space is influenced by which of the following factors:

. Bone morphogenetic protein (BMP)
. Fibroblast growth factor-3 (FGF-3)
. Interleukin-1 (IL-1)
. Apical ectodermal ridge maintenance factor (AERMF)
. Thalidomide

Correct Answer & Explanation

. Apical ectodermal ridge maintenance factor (AERMF)


Explanation

The distal phalanges are composed of two germ cell layers. Ectodermal cells produce the tuft of the distal phalanx and the nail elements, while mesodermal cells form the epiphysis, physis, and metaphysis. Apical ectodermal ridge maintenance factor (AERMF) is a substance elaborated by the mesenchymal condensations between digits. When AERMF ceases to be produced, the apical ectodermal ridge begins to break apart. This in turn triggers the release of lysosomes which dissolve the mesenchymal connections between the developing digits, completing web space formation.

Question 1218

Topic: 1. General Principles & Basic Science

The ______ of the brachial plexus emerge between the anterior middle scalane muscles:

. Roots
. Trunks
. Divisions
. Cords
. Branches

Correct Answer & Explanation

. Trunks


Explanation

After the roots emerge between the anterior scalene muscles, they merge to form trunks. The trunks branch into divisions and then merge into cords in the axilla. The cords branch into nerves.

Question 1219

Topic: 1. General Principles & Basic Science

Horner syndrome includes all of the following except:

. Miosis
. Anhidrosis
. Enophthalmos
. Exophthalmos

Correct Answer & Explanation

. Exophthalmos


Explanation

Horner syndrome is due to disruption of sympathetic innervation and is characterized by enophthalmos not exophthalmos.

Question 1220

Topic: 1. General Principles & Basic Science

Axonotmesis involves injury to which of the following structure:

. Epineurium
. Endoneurium
. Perineurium
. Axon

Correct Answer & Explanation

. Axon


Explanation

Axonotmesis as described in Seddon classification implies injury to the axon and myelin sheath. It is neurotmesis that involves injury to all the three layers.