A 14-year-old patient who has homocystinuria and is Risser 3 is referred for surgical treatment of scoliosis. In addition to the usual risks associated with posterior spinal fusion, the family should

Correct Answer: Spinal pseudoarthrosis. Explanation:

Radiographs of a 20-year-old college athlete who sustained an injury to the ankle reveal no fractures or widening of the ankle mortise. Examination shows swelling at the ankle region and pain with me

Correct Answer: Inversion stress radiograph. Explanation:

A forward bend examination of an asymptomatic premenarchal 12-year-old girl who has waist asymmetry reveals a right thoracolumbar angle of trunk rotation of 12 degrees. The radiograph shown in Figure

Correct Answer: Observation and repeat radiographs in 4 months. Explanation:

Which of the following advantages does the use of a vascularized fibula graft have over a nonvascularized fibula graft?

Correct Answer: Begins to remodel and hypertrophy more quickly. Explanation:

A 14-year-old girl has idiopathic scoliosis with a 52-degree right thoracic curve and a 36-degree left lumbar curve. The rotation of the apical vertebra appears greater in the thoracic curve. A sagit

Correct Answer: Anterior fusion of the lumbar curve. Explanation:

A 20-year-old college football player sustains a forceful hyperextension injury to his shoulder 4 months after undergoing an anterior capsular shift. Examination 2 weeks later reveals anterior tender

Correct Answer: Subscapularis rupture. Explanation:

The familial occurrence of Legg-Calve-Perthes disease may, in some cases, be attributed to

Correct Answer: hypophosphatemia. Explanation:

Which of the following methods of treatment of a displaced Lisfranc fracture-dislocation will most reliably lead to good functional results?

Correct Answer: Weightbearing short leg cast. Explanation:

Which of the following metastatic tumors to bone carries the greatest risk of complications from intraoperative bleeding?

Correct Answer: Breast. Explanation:

A high school distance runner reports a 3-week history of heel pain while running. Examination elicits no pain with dorsiflexion or with palpitation of the plantar fascia; however, pain is evident wi

Correct Answer: Heel spur. Explanation:

A 40-year-old woman has progressive pain and limited range of motion in her long finger. Figure 28a shows the radiograph, and Figure 28b shows a biopsy specimen of the same lesion. What is the most l

Correct Answer: Enchondroma. Explanation:

A patient reports persistent pain in the wrist 6 months after undergoing open reduction and internal fixation of a Galleazi fracture. Radiographs of the wrist in a neutral position are normal. Which

Correct Answer: Arthrogram of the wrist. Explanation:

A form of renal osteodystrophy that is characterized by pure osteomalacia is caused by

Correct Answer: Secondary hyperparathyroidism. Explanation:

Clinic OS

Q: Which of the following types of osteosarcoma is associated with the best prognosis & long survival?

Correct Answer: Parosteal. Explanation:

Q: A patient undergoes anterior spinal decompression through a left retroperitoneal approach as treatment of an L2 burst fracture. Following surgery, examination reveals the temperature of the right foot

Correct Answer: Cauda equina. Explanation:

Q: A healed fracture of the tibia that demonstrates 25 degrees apex posterior angulation and 28 degrees varus angulation on AP and lateral radiographs is most accurately described as a

Correct Answer: Complex deformity with an angulation in two planes. Explanation:

Q: A normal functioning posterior tibialis tendon is best confirmed by which of the following physical findings?

Correct Answer: Pronation of the foot during the stance phase of gait. Explanation:

Question 4141

Topic: 10. Pathology and Oncology

Which of the following types of osteosarcoma is associated with the best prognosis & long survival?

. Parosteal

. Periosteal

. High-grade intramedullary

. Osteosarcoma occurring in Paget’s disease

. Osteosarcoma occurring in irradiated bone

. Cauda equina

. Conus medullaris

. Genitofemoral nerve

. Lumbar sympathetic plexus

. Lumbar parasympathetic plexus

. Spinal pseudoarthrosis

. Spinal cord traction injury with paralysis

. Arterial and venous thromboses

. Superior mesenteric artery syndrome

. Crankshaft phenomenon

. Inversion stress radiograph

. MRI scan

. CT scan

. Nuclear bone scan

. External rotation stress radiograph

. Complex deformity with an angulation in two planes

. Single deformity less than 20 degrees, apex posterolateral

. Single deformity greater than 30 degrees, apex posterolateral

. Single deformity less than 20 degrees, apex posteromedial

. Single deformity greater than 30 degrees, apex posteromedial

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

!. Electrical stimulation at night

". Physical therapy

#. Begins to remodel and hypertrophy more quickly

$. Provides a better scaffold for osteoconduction

%. Reduces the risk of early fracture

&. Reduces technical difficulty

'. Lowers donor site morbidity

(. Anterior fusion of the lumbar curve

). Anterior and posterior fusion of the thoracic curve

*. Posterior fusion of the thoracic curve

+. Posterior fusion of the thoracic and lumbar curves

,. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

-. Subscapularis rupture

.. Type III SLAP lesion

/. Disruption of capsular shift

0. Isolated traumatic subluxation

1. Injury to the axillary nerve after dislocation

2. hypophosphatemia

3. high dietary cholesterol intake

4. deficiency of lipoprotein A

5. deficiency of protein S and protein C

6. elevated levels of antithrombin III

7. Weightbearing short leg cast

8. Nonweightbearing short leg cast

9. Removable splint and early motion

:. Open reduction and internal fixation

;. Elastic compression bandage with full weightbearing

<. Breast

=. Prostate

>. Gastrointestinal

?. Kidney

@. Multiple myeloma

A. Varus stress

B. Valgus stress

C. Torsional loading

D. Hyperextension of the knee

E. Contraction of the quadriceps while axially loaded

F. Primary internal fixation at both fracture levels

G. External fixation as definitive ttt for both #

H. Skeletal traction and delayed internal fixation of both fractures

I. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

J. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

K. Heel spur

L. Plantar fascitis

M. Dysfunction of the tibialis posterior tendon

N. Compression of the first branch of the lateral plantar nerve

O. Compression of the calcaneal nerve

P. Displaced labral tear

Q. Tear of the rotator cuff

R. Fracture of the glenoid rim

S. Palsy of the axillary nerve

T. Palsy of the musculocutaneus nerve

U. Enchondroma

V. Osteoblastoma

W. Giant cell tumor

X. Aneurysmal bone cyst

Y. Fibrous dysplasia

Z. Arthrogram of the wrist

[. MRI scan of both wrists

\. CT scan of both wrists in the same position

]. Radiographs of the wrist in supination and pronation

^. Radiographs of the opposite wrist in the same position

_. Secondary hyperparathyroidism

`. Phosphate retention secondary to uremia

A. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

B. Aluminum deposition in bone from oral phosphate binders

C. Persistent acidosis aggravating the negative calcium balance

D. Posterior fusion at T10-L3 with segmental instrumentation

E. Laminectomy and fusion of T12-L2 with segmental instrumentation

F. Bed rest in a hyperextension brace

G. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

H. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

I. Positive-pressure ventilation

J. An immediate radiograph of the chest

K. Adjustment of the position of the endotrachael tube

L. Insertion of a large-bore needle into the pericardial space

M. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

N. Allowing the ends of the fracture to touch

O. Adding a second connecting bar

P. Adding one pin to each fracture fragment

Q. Increasing the pin diameter from 4 mm to 6 mm

R. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

S. Osteomyelitis

T. Malignant degeneration

U. Stress fracture

V. Local recurrence of the giant cell tumor

W. Bone resorption due to methylmethacrylate

X. Advancement of the plantar plate

Y. Resection of the second metatarsal head

Z. Dorsiflexion osteotomy of the second metatarsal neck

{. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

|. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

}. Sacral fracture

~. Burst fracture of L5

. Cauda equina syndrome

. Distraction-flexion injury at L3

. Distraction-extension injury at L3

. An MRI scan of the shoulder

. An MRI scan of the cervical spine

. Electromyographic and nerve conduction velocity studies

. Immobilization in a sling and early passive range of motion exercises

. Immediate return to the operating room for exploration of the brachial plexus

. cerclage wiring

. tension band wiring

. removal of the patellar component

. revision of the patellar component

. immobilization of the knee and protected weightbearing

. Liposarcoma

. Nodular fasciitis

. Rabdomyosarcoma

. Malignant fibrous histiocytoma

. Extra-abdominal desmoid tumor

. Clubfeet

. Thrombocytopenia

. Congenital scoliosis

. Ventricular septal defect

. Arnold-Chiari malformation

. delayed primary closure

. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

¡. Tear of the rotator cuff

¢. Loosening of the humeral component

£. Arthritis of the glenoid

¤. Arthritis of the A-C joint

¥. Reduced morbidity

¦. Improved osteoinduction

§. Improved osteoconduction

¨. More rapid revascularization

©. Lower risk of disease transmission

ª. Manipulation Under Anesthesia

«. Arthroscopic acromioplasty

¬. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

®. Lengthening of the subscapularis and release of the anterior capsule

¯. Bacteroides

°. E. coli

±. Staph. aureus

². group A streptococcus

³. Clostridium perforingens

´. observation and exercises

Μ. bracing with a thoracolumbar orthosis

¶. fusion of the posterior spine

·. fusion of the anterior spine

¸. fusion of the anterior and posterior spine

¹. Total wrist replacement and bridge grafts

º. palmar shelf arthroplasty and tendon transfers

». Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

¼. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

½. Total wrist fusion and tendon transfers

¾. constrained acetabular component

¿. protrusion ring with morselized graft

À. cemented metal backed acetabular component

Á. cemented all-polyethylene acetabular component

Â. cementless hemispherical component with screw fixation

Ã. application of a hip abduction brace for 22 hours per day

Ä. application of a hip spica under anesthesia

Å. discontinuance of all bracing and repeat radiographs in 3 months

Æ. open reduction of the hip and application of a spica cast

Ç. open reduction, varus osteotomy, and application of a spica cast

È. Loss of skin hair on the feet

É. Absent pulses on vascular examination

Ê. Pain that originates proximally and spreads distally

Ë. Pain that is relieved by stopping and standing

Ì. Pain that is worse when the patient walks uphill rather downhill

Í. wrist flexors and finger flexors

Î. elbow flexors and wrist flexors

Ï. elbow flexors and finger flexors

Ð. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

Ñ. elbow extensors and wrist extensors

Ò. Syndactyly

Ó. Macrodactyly

Ô. Camptodactyly

Õ. Preaxial polydactyly

Ö. Postaxial polydactyly

×. Arthrodesis

Ø. Rotationplasty

Ù. Above-knee amputation

Ú. Osteoarticular allograft

Û. Endoprosthesis (custom arthroplasty)

Ü. Plantar fascia

Ý. Spring ligament

Þ. Deltoid ligament

SS. Intrinsic tendons

À. Gastorcnemius-solelus complex

Á. Prevention of presynaptic release of acetylcholine

Â. Prevention of synthesis of presynaptic acetylcholine

Ã. Activation of acetylcholinesterase at the motor end-plate

Ä. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Å. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Æ. stiffness of the femoral component.

Ç. head offset of the femoral component.

È. femoral component material modulus of elasticity.

É. extent of the femoral component porous coating.

Ê. Presence of a femoral component collar.

Ë. plantar fascia and quadratus plantae tendon.

Ì. ligamentous structures connecting the tarsal bones.

Í. shape of the tarsal bones and the intervening joints.

Î. activity of the intrinsic muscles of the foot.

Ï. activity of the posterior tibialis and the peroneus longus muscles.

Ð. scapulothoracic fusion

Ñ. strengthening of the periscapular muscles

Ò. pectoralis minor-fascia lata graft transfer to the scapula

Ó. pectoralis major-fascia lata graft transfer to the scapula

Ô. exploration of the long thoracic nerve, with sural nerve graft

Õ. tricompartmental knee replacement

Ö. unicompartmental knee replacement

÷. medial compartment meniscal allograft

Ø. valgus-producing distal femoral osteotomy

Ù. valgus-producing proximal tibial osteotomy

Ú. Internal rotation of the femoral component

Û. External rotation of the tibial component

Ü. Lateral placement of the femoral component

Ý. Medial placement of the patellar component

Þ. Excessive resection of the patella

Ÿ. Hallux rigidus

Ā. Hallux valgus

Ā. Neuroma of the first web space

Ă. Fracture of the sesamoid

Ă. Rupture of the flexor hallucis longus

Ą. Sickle cell crisis

Ą. Idiopathic chondrolysis

Ć. Hemophilic arthropathy

Ć. Osteoid osteoma of the femoral neck

Ĉ. Legg-Calve-Perthes disease

Ĉ. Decreased ankle jerk and positive femoral nerve stretch test

Ċ. Decreased knee jerk and positive straight-leg raising sign

Ċ. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Č. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Č. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ď. Long-term administration of IV and oral antibiotics

Ď. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Đ. Immediate exchange arthroplasty with antibiotic-impregnated cement

Đ. Two-stage surgical prosthetic exchange and IV antibiotics

Ē. Resection arthroplasty and IV antibiotics

Ē. SCFE

Ĕ. MED

Ĕ. Perthes disease

Ė. Hypothyroidism

Ė. Chondrolysis

Ę. gout.

Ę. osteoporosis.

Ě. eosinophilic granuloma.

Ě. tuberculosis of the spine.

Ĝ. metastatic disease of the spine.

Ĝ. water content.

Ğ. Synthesis of type I collagen.

Ğ. Proteoglycan content.

Ġ. Activity of chondrocytes.

Ġ. Synthesis of hyaluronate.

Ģ. Lung

Ģ. Breast

Ĥ. Prostate

Ĥ. Thyroid

Ħ. Renal

Ħ. T1-low, T2-low.

Ĩ. T1-low, T2-high.

Ĩ. T1-moderate, T2-low.

Ī. T1-high, T2-low.

Ī. T1-high, T2-high.

Ĭ. hypothesis is incorrect or invalid

Ĭ. interobserver error rate is 4%.

Į. Standard deviation is 4% higher or lower than the mean.

Į. Sample size is 4% larger than required to be clinically significant.

İ. Probability that the differences noted between two study groups were due to chance alone is 4%.

I. I

Ĳ. II

Ĳ. IV

Ĵ. IX

Ĵ. X

Ķ. Cranial setting

Ķ. Cranial subluxation

ĸ. Odontoid fracture

Ĺ. Lysis of the arch of the atlas

Ĺ. Atlantoaxial subluxation

Ļ. Retrograde collapse of the endoneurial tubes

Ļ. Irreversible atrophy of the denervated muscles

Ľ. Elongation of the axons across the zone of injury

Ľ. Sprouting of the axons at the neuromuscular junction

Ŀ. Misdirection of the axons across the zone of injury

Ŀ. Maximally pronated and elbow extended

Ł. Maximally pronated and the elbow flexed

Ł. Maximally supinated and the elbow flexed

Ń. Maximally supinated and the elbow extended

Ń. In neutral rotation, with the elbow extended

Ņ. open reduction and internal fixation

Ņ. buddy taping to the adjacent index finger

Ň. early motion with application of a dynamic banjo splint

Ň. application of a cast with the hand in a “safe position” for 3 weeks.

ʼN. dorsal extension block splinting

Ŋ. The name of the manufacturer

Ŋ. The manufacturer’s potential liability

Ō. The physician’s clinical performance

Ō. The physician’s materials testing data

Ŏ. Any royalties the physician receives from the manufacturer

Ŏ. Femoral

Ő. Obturator

Ő. Inferior gluteal

Œ. Superior gluteal

Œ. Lateral femoral cutaneous

Ŕ. open biopsy and a long leg cast

Ŕ. open biopsy and wide resection of the tumor

Ŗ. a long leg cast and observation

Ŗ. intramedullary stabilization and observation

Ř. Triggering

Ř. Lateral instability

Ś. Swan-neck deformity

Ś. Boutonniere deformity

Ŝ. Loss of distal interphalangeal joint flexion

Ŝ. Peroneus brevis to peroneus longus

Ş. Peroneus tertius to extensor hallucis longus

Ş. Peroneus tertius to superficial peroneal nerve

Š. Extensor hallucis longus to deep peroneal nerve

Š. Extensor hallucis longus to extensor digitorum longus

Ţ. reassurance that Medicare will pay for the treatment.

Ţ. consent forms that patients or their guardians are able to understand.

Ť. a detailed description of the device, omitting the fact that it is part of a study.

Ť. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ŧ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ŧ. an onlay iliac crest bone graft.

Ũ. limited weightbearing and observation.

Ũ. removal of the implant and limited weightbearing.

Ū. removal of the implant and insertion of a reamed femoral nail.

Ū. removal of the implant and insertion of an unreamed femoral nail.

Ŭ. Coronal

Ŭ. Sagittal

Ů. Anteromedial, midway between the sagittal and the coronal

Ů. Proximal pins sagittal, distal pins coronal

Ű. Proximal pins coronal, distal pins sagittal

Ű. Rheumatoid arthritis

Ų. Posttraumatic arthritis

Ų. Degenerative osteoarthritis

Ŵ. Osteonecrosis of the tibial plateau

Ŵ. Osteonecrosis of the medial femoral condyle

Ŷ. Trapeziometacarpal arthrodesis

Ŷ. Osteotomy of the thumb metacarpal

Ÿ. Arthrotomy and joint debridement

Ź. Ligament reconstruction using one half of the flexor carpi radialis

Ź. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ż. Creep

Ż. Relaxation

Ž. Energy dissipation

Ž. Plastic deformation

S. Elastic deformation

Ƀ. bending

Ɓ. axial loading

Ƃ. high-speed rotation

Ƃ. direct impact from anteromedial

Ƅ. crush from anteromedial to posterolateral

Ƅ. Increase stiffness

Ɔ. Increase fracture toughness

Ƈ. Increase fatigue strength

Ƈ. Decrease mechanical strength

Ɖ. Decrease wear rate

Ɗ. disuse osteopenia

Ƌ. paraendocrine effect of the tumor

Ƌ. abnormally increased density on the right side

ƍ. side effect of the treatment of the lesion

Ǝ. extensive tumor involvement of the left hip

Ə. Sciatic nerve

Ɛ. Superior gluteal artery

Ƒ. Profunda femoris artery

Ƒ. Femoral artery and nerve

Ɠ. External iliac artery and vein

Ɣ. Length

Ƕ. Moment arm

Ɩ. Total volume

Ɨ. Physiologic cross-sectional area

Ƙ. Distribution of slow and fast twitch fibers

Ƙ. decreasing initiation of action potentials.

Ƚ. increasing action potential amplitude.

ƛ. blocking the opening of gated sodium channels.

Ɯ. decreasing the number of functional motor units.

Ɲ. slowing or stopping action potential propagation through the axon.

Ƞ. resection of the metatarsal heads of the first through fifth toes.

Ɵ. Silastic MP joint arthroplasties of the first through fifth toes.

Ơ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ơ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ƣ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ƣ. hemiarthroplasty

Ƥ. open reduction and internal fixation

Ƥ. closed reduction and percutaneous pinning

Ʀ. a sling and early pedulum exercises

Ƨ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ƨ. open acromioplasty

Ʃ. open Bankart repair

ƪ. open subscapularis tendon repair

ƫ. inferior capsular shift

Ƭ. a supervised physical therapy program

Ƭ. a sling and swathe, with pendulum exercises in 10 days

Ʈ. open reduction and internal fixation through an anterior approach

Ư. open reduction and internal fixation through a posterior approach

Ư. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ʊ. arthroscopically assisted reduction and percutaneous screw fixation

Ʋ. Repair of the rotator cuff

Ƴ. Replacement of the humeral head

Ƴ. Resection arthroplasty

Ƶ. Total shoulder arthroplasty

Ƶ. AP and lateral radiographs of the elbow

Ʒ. Diagnositc arthroscopy

Ƹ. Aspiration of joint fluid

Ƹ. An erythrocyte sedimentation rate and CBC

ƺ. A diagnostic lidocaine injection

ƻ. Insulin-like growth factor (IGF-1)

Ƽ. Fibroblast growth factor (FGF-1)

Ƽ. Platelet-derived growth factor (PDGF)

ƾ. Transforming growth factor beta (TGF-B)

Ƿ. Bone morphogenetic proteins (BMP)

ǀ. clinical history and radiographic findings.

ǁ. technetium bone scan

ǂ. flow cytometry pattern of extracted chondrocytes

ǃ. immunohistochemical staining patterns of a biopsy specimen

Ǆ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ǆ. Radial

Ǆ. Radial recurrent

Ǉ. Posterior interosseous

Ǉ. Superior ulnar recurrent

Ǉ. Superficial radial circumflex

Ǌ. Impaired hydroxylation of proline

Ǌ. Failure of cleavage in procollagen

Ǌ. Defective binding sites for hydroxyproline

Ǎ. Failure to incorporate glycine into the helix

Ǎ. Diminished production of collagen through the rough endoplasmic reticulum

Ǐ. Asking the legal staff to seek a court injunction

Ǐ. Copying the patient’s chart and giving it to him as he leaves

Ǒ. Having the patient sign a written legal contract that specifies acceptable behavior

Ǒ. Continuing care of the patient until an appropriate referral can be arranged

Ǔ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ǔ. Meta-analysis

Ǖ. Confidence interval

Ǖ. Analysis of variance (ANOVA)

Ǘ. Statistical significance (p-value)

Ǘ. Survivorship analysis (Kaplan-Meier)

Ǚ. Spinal shock

Ǚ. Neurogenic shock

Ǜ. Hypovolemic shock

Ǜ. Pulmonary embolism

Ǝ. Fat embolus syndrome

Ǟ. Lumbar spinal stenosis

Ǟ. Metastatic disease of the spine

Ǡ. Rheumatoid lumbar spondylitis

Ǡ. Isthmic spondyloloisthesis

Ǣ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǣ. Patella alta

Ǥ. A metal-backed patella

Ǥ. Varus malalignment of the knee

Ǧ. A posterior cruciate-substituting femoral component

Ǧ. Lateral subluxation of the patella on a Merchant’s view

Ǩ. The sesamoids are separated

Ǩ. The sesamoid is fractured

Ǫ. The proximal phx is on the neck of the metatarsal

Ǫ. The dislocation is dorsal and centered

Ǭ. The proximal phalanx is hyperextended

Ǭ. Patella

Ǯ. Tibial stem

Ǯ. Distal femoral interface

J̌. Posterior femoral interface

Ǳ. Sites of screw fixation for the tibia

Ǳ. Hallux rigidus

Ǳ. Fracture of the sesamoid

Ǵ. Disruption of the plantar plate

Ǵ. Osteonecrosis of the metatarsal head

Ƕ. Rupture of the flexor hallucis longus

Ƿ. Gout

Ǹ. Sepsis

Ǹ. Old trauma

Ǻ. Rheumatoid arthritis

Ǻ. Charcot arthroplasty

Ǽ. Aspiration and steroid injection

Ǽ. Biopsy, curettage, and allograft bone grafting

Ǿ. Percutaneous Kirschner wire fixation

Ǿ. Percutaneous injection of autogenous bone marrow

Ȁ. Nerve roots

Ȁ. Spinal cord

Ȃ. Sciatic nerve

Ȃ. Peroneal nerve

Ȅ. Conus medullaris

Ȅ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ȇ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ȇ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ȉ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ȉ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ȋ. Early and late infection

Ȋ. Periprosthetic fracture of the femur

Ȍ. Failure of the patellofemoral and extensor mechanisms

Ȍ. Aseptic loosening of cementing tibial components

Ȏ. Asceptic loosening of cemented femoral components

Ȏ. Acceptance of the current position of the ankle

Ȑ. Open reduction and fixation in the epiphysis only

Ȑ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ȓ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ȓ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ȕ. Resection arthroplasty and local radiation

Ȕ. In situ fusion of the hip

Ȗ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ȗ. Excision of heterotopic bone and local radiation

Ș. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ș. Closed reduction of both fractures and immediate spica casting

Ț. Bilateral skin traction for 3 weeks, followed by spica casting

Ț. External fixation of both femora

Ȝ. External fixation of the left femur and a long leg cast brace for the right femur

Ȝ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȟ. Synovial sarcoma

Ȟ. Soft-tissue abcess

Ƞ. Rhabdomyosarcoma

ȡ. Eosinophilic granuloma

Ȣ. Nodular pigmented villonodular synovitis

Ȣ. Changing to a titanium nail

Ȥ. Changing to a nonslotted nail

Ȥ. Changing the cross-sectional shape of the nail

Ȧ. Increasing the diameter of the nail by 3 mm

Ȧ. Increasing the diameter of the interlocking screws

Ȩ. Fracture healing

Ȩ. Chondrosarcoma

Ȫ. Periosteal chondroma

Ȫ. Periosteal osteosarcoma

Ȭ. Dysplasia epiphysealis hemimelica

Ȭ. Demonstrate competence in the subject of the case

Ȯ. Be fellowship trained in the subject of the case

Ȯ. Be paid on a contingency basis

Ȱ. Be board certified by the American Board of Orthopaedic Surgery

Ȱ. Have been involved in the case as a consultant

Ȳ. Diagnostic arthroscopy

Ȳ. Arthroscopy and subacromial decompression

ȴ. Reduction and fixation of the proximal humeral epiphysis

ȵ. Temporary cessation of throwing

ȶ. Physical therapy for rotator cuff strengthening

ȷ. Oblique popliteal ligament

ȸ. Lateral capsule

ȹ. Popliteal tendon

Ⱥ. Fibular collateral ligament

Ȼ. Posterior oblique ligament

Ȼ. Radial tear

Ƚ. Parrot-beak tear

Ⱦ. Vertical tear in the “red-red” zone

Ȿ. Vertical tear in the “red-white” zone

Ɀ. Vertical tear in the “white-white” zone

Ɂ. 0 degrees of abduction, with neural rotation

Ɂ. 40 degrees of flexion and 60 degrees of internal rotation

Ƀ. 45 degrees of flexion and 45 degrees of external rotation

Ʉ. 90 degrees of abduction with neutral rotation

Ʌ. 90 degrees of abduction and 90 degrees of external rotation

Ɇ. Sural

Ɇ. Saphenous and its branches

Ɉ. Posterior tibial and its branches

Ɉ. Deep peroneal and its branches

Ɋ. Superficial peroneal and its branches

Ɋ. Strength

Ɍ. Stiffness

Ɍ. Shelf life

Ɏ. Antigenicity

Ɏ. Risk of HIV transmission

Ɐ. Indemnification

Ɑ. Occurrence

Ɒ. Excess liability

Ɓ. Claims-made

Ɔ. Nose

ɕ. Lateral Y

Ɖ. Scapular AP

Ɗ. Neutral rotation AP

ɘ. Internal rotation AP

Ə. External rotation AP

ɚ. Trauma

Ɛ. Hemophilia

Ɜ. Reiter’s syndrome

ɝ. Rheumatoid arthritis

ɞ. Systemic lupus erythematosus

ɟ. Cast immobilization for 6 weeks

Ɠ. Activity modification and re-evaluation in 2 months

Ɡ. Internal fixation with or without bone grafting

ɢ. Retrograde drilling of the defect without articular cartilage penetration

Ɣ. Drilling of the defect directly through the articular cartilage

ɤ. repair or reconstruction of the medial collateral ligament

Ɥ. repair or reconstruction of the medialand lateral collateral ligaments

Ɦ. immobilization for 5 days or less

ɧ. immobilization for 14 days

Ɨ. immobilization for 25 days

Ɩ. Cystinosis

Ɪ. Hypophosphatemia

Ɫ. Renal osteodystrophy

Ɬ. Primary hyperparathyroidism

ɭ. Nutritional vitamin D deficiency

ɮ. Lateral meniscus tear

Ɯ. Popliteus tenosynovitis

ɰ. Iliotibial band friction syndrome

Ɱ. Peroneal nerve entrapment

Ɲ. Biceps tendinitis

ɳ. Observation

ɴ. Removal of the prosthetic components

Ɵ. Operative exploration and decompression of the peroneal nerve

ɶ. Nerve conduction velocity studies

ɷ. Loosening of the primary dressings and knee flexion to 30 degrees

ɸ. I

ɹ. II

ɺ. III

ɻ. decreased tissue tension

ɼ. decreased abductor lever arm

Ɽ. decreased joint reaction force

ɾ. increased body weight over lever arm

ɿ. increased polyethylene wear rate

Ʀ. recurrent traumatic anterior dislocation

ʁ. recurrent traumatic posterior dislocation

Ʂ. traumatic subluxation with no previous dislocation

Ʃ. traumatic anterior subluxation

ʄ. atraumatic involuntary subluxation

ʅ. radial

ʆ. axillary

Ʇ. suprascapular

Ʈ. thoracodorsal

Ʉ. long thoracic

Ʊ. Flexion

Ʋ. Extension

Ʌ. Axial rotation

ʍ. Left lateral bending

ʎ. Right lateral bending

ʏ. Skin

ʐ. Lung

ʑ. Brain

Ʒ. Heart

ʓ. Kidney

ʔ. Thoracoacromial, lateral thoracic, subscapular

ʕ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ʖ. Posterior humeral circumflex, subscapular, thoracacromial

ʗ. Subscapular, thoracacromial, anterior humeral circumflex

ʘ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ʙ. Respondeat superior

ʚ. Indemnity agreement

ʛ. Hold harmless agreement- attempt to shift liability from company to physician

ʜ. Comparative negligence-% of involvement

Ʝ. Contributory negligence- resident contributed to the negligence

Ʞ. t-type

ʟ. both column

ʠ. transverse

ʡ. anterior column

ʢ. anterior column posterior hemitransverse

ʣ. Posterior interosseous

ʤ. Anterior interosseous

ʥ. Radial

ʦ. Median

ʧ. Ulnar

ʨ. Shock from hypovolemia

ʩ. Associated rupture of the bladder

ʪ. Arterial bleeding on pelvic angiogram

ʫ. Presence of a hematoma in the perineum and scrotum

ʬ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Parosteal

Explanation

Question 4142

Topic: 10. Pathology and Oncology

A patient undergoes anterior spinal decompression through a left retroperitoneal approach as treatment of an L2 burst fracture. Following surgery, examination reveals the temperature of the right foot is cool when compared with the left foot. Which of the following neurologic structures has most likely been disrupted?

. Cauda equina

. Conus medullaris

. Genitofemoral nerve

. Lumbar sympathetic plexus

. Lumbar parasympathetic plexus

. Spinal pseudoarthrosis

. Spinal cord traction injury with paralysis

. Arterial and venous thromboses

. Superior mesenteric artery syndrome

. Crankshaft phenomenon

. Inversion stress radiograph

. MRI scan

. CT scan

. Nuclear bone scan

. External rotation stress radiograph

. Complex deformity with an angulation in two planes

. Single deformity less than 20 degrees, apex posterolateral

. Single deformity greater than 30 degrees, apex posterolateral

. Single deformity less than 20 degrees, apex posteromedial

. Single deformity greater than 30 degrees, apex posteromedial

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

!. Reduces technical difficulty

". Lowers donor site morbidity

#. Anterior fusion of the lumbar curve

$. Anterior and posterior fusion of the thoracic curve

%. Posterior fusion of the thoracic curve

&. Posterior fusion of the thoracic and lumbar curves

'. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

(. Subscapularis rupture

). Type III SLAP lesion

*. Disruption of capsular shift

+. Isolated traumatic subluxation

,. Injury to the axillary nerve after dislocation

-. hypophosphatemia

.. high dietary cholesterol intake

/. deficiency of lipoprotein A

0. deficiency of protein S and protein C

1. elevated levels of antithrombin III

2. Weightbearing short leg cast

3. Nonweightbearing short leg cast

4. Removable splint and early motion

5. Open reduction and internal fixation

6. Elastic compression bandage with full weightbearing

7. Breast

8. Prostate

9. Gastrointestinal

:. Kidney

;. Multiple myeloma

<. Varus stress

=. Valgus stress

>. Torsional loading

?. Hyperextension of the knee

@. Contraction of the quadriceps while axially loaded

A. Primary internal fixation at both fracture levels

B. External fixation as definitive ttt for both #

C. Skeletal traction and delayed internal fixation of both fractures

D. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

E. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

F. Heel spur

G. Plantar fascitis

H. Dysfunction of the tibialis posterior tendon

I. Compression of the first branch of the lateral plantar nerve

J. Compression of the calcaneal nerve

K. Displaced labral tear

L. Tear of the rotator cuff

M. Fracture of the glenoid rim

N. Palsy of the axillary nerve

O. Palsy of the musculocutaneus nerve

P. Enchondroma

Q. Osteoblastoma

R. Giant cell tumor

S. Aneurysmal bone cyst

T. Fibrous dysplasia

U. Arthrogram of the wrist

V. MRI scan of both wrists

W. CT scan of both wrists in the same position

X. Radiographs of the wrist in supination and pronation

Y. Radiographs of the opposite wrist in the same position

Z. Secondary hyperparathyroidism

[. Phosphate retention secondary to uremia

\. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

]. Aluminum deposition in bone from oral phosphate binders

^. Persistent acidosis aggravating the negative calcium balance

_. Posterior fusion at T10-L3 with segmental instrumentation

`. Laminectomy and fusion of T12-L2 with segmental instrumentation

A. Bed rest in a hyperextension brace

B. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

C. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

D. Positive-pressure ventilation

E. An immediate radiograph of the chest

F. Adjustment of the position of the endotrachael tube

G. Insertion of a large-bore needle into the pericardial space

H. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

I. Allowing the ends of the fracture to touch

J. Adding a second connecting bar

K. Adding one pin to each fracture fragment

L. Increasing the pin diameter from 4 mm to 6 mm

M. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

N. Osteomyelitis

O. Malignant degeneration

P. Stress fracture

Q. Local recurrence of the giant cell tumor

R. Bone resorption due to methylmethacrylate

S. Advancement of the plantar plate

T. Resection of the second metatarsal head

U. Dorsiflexion osteotomy of the second metatarsal neck

V. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

W. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

X. Sacral fracture

Y. Burst fracture of L5

Z. Cauda equina syndrome

{. Distraction-flexion injury at L3

|. Distraction-extension injury at L3

}. An MRI scan of the shoulder

~. An MRI scan of the cervical spine

. Electromyographic and nerve conduction velocity studies

. Immobilization in a sling and early passive range of motion exercises

. Immediate return to the operating room for exploration of the brachial plexus

. cerclage wiring

. tension band wiring

. removal of the patellar component

. revision of the patellar component

. immobilization of the knee and protected weightbearing

. Liposarcoma

. Nodular fasciitis

. Rabdomyosarcoma

. Malignant fibrous histiocytoma

. Extra-abdominal desmoid tumor

. Clubfeet

. Thrombocytopenia

. Congenital scoliosis

. Ventricular septal defect

. Arnold-Chiari malformation

. delayed primary closure

. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

¡. Improved osteoinduction

¢. Improved osteoconduction

£. More rapid revascularization

¤. Lower risk of disease transmission

¥. Manipulation Under Anesthesia

¦. Arthroscopic acromioplasty

§. Arthroscopic debridement of G-H joint

¨. Replacement of the humeral head

©. Lengthening of the subscapularis and release of the anterior capsule

ª. Bacteroides

«. E. coli

¬. Staph. aureus

. group A streptococcus

®. Clostridium perforingens

¯. observation and exercises

°. bracing with a thoracolumbar orthosis

±. fusion of the posterior spine

². fusion of the anterior spine

³. fusion of the anterior and posterior spine

´. Total wrist replacement and bridge grafts

Μ. palmar shelf arthroplasty and tendon transfers

¶. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

·. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

¸. Total wrist fusion and tendon transfers

¹. constrained acetabular component

º. protrusion ring with morselized graft

». cemented metal backed acetabular component

¼. cemented all-polyethylene acetabular component

½. cementless hemispherical component with screw fixation

¾. application of a hip abduction brace for 22 hours per day

¿. application of a hip spica under anesthesia

À. discontinuance of all bracing and repeat radiographs in 3 months

Á. open reduction of the hip and application of a spica cast

Â. open reduction, varus osteotomy, and application of a spica cast

Ã. Loss of skin hair on the feet

Ä. Absent pulses on vascular examination

Å. Pain that originates proximally and spreads distally

Æ. Pain that is relieved by stopping and standing

Ç. Pain that is worse when the patient walks uphill rather downhill

È. wrist flexors and finger flexors

É. elbow flexors and wrist flexors

Ê. elbow flexors and finger flexors

Ë. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

Ì. elbow extensors and wrist extensors

Í. Syndactyly

Î. Macrodactyly

Ï. Camptodactyly

Ð. Preaxial polydactyly

Ñ. Postaxial polydactyly

Ò. Arthrodesis

Ó. Rotationplasty

Ô. Above-knee amputation

Õ. Osteoarticular allograft

Ö. Endoprosthesis (custom arthroplasty)

×. Plantar fascia

Ø. Spring ligament

Ù. Deltoid ligament

Ú. Intrinsic tendons

Û. Gastorcnemius-solelus complex

Ü. Prevention of presynaptic release of acetylcholine

Ý. Prevention of synthesis of presynaptic acetylcholine

Þ. Activation of acetylcholinesterase at the motor end-plate

SS. Blockage of postsynaptic action of acetylcholine until reserves are depleted

À. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Á. stiffness of the femoral component.

Â. head offset of the femoral component.

Ã. femoral component material modulus of elasticity.

Ä. extent of the femoral component porous coating.

Å. Presence of a femoral component collar.

Æ. plantar fascia and quadratus plantae tendon.

Ç. ligamentous structures connecting the tarsal bones.

È. shape of the tarsal bones and the intervening joints.

É. activity of the intrinsic muscles of the foot.

Ê. activity of the posterior tibialis and the peroneus longus muscles.

Ë. scapulothoracic fusion

Ì. strengthening of the periscapular muscles

Í. pectoralis minor-fascia lata graft transfer to the scapula

Î. pectoralis major-fascia lata graft transfer to the scapula

Ï. exploration of the long thoracic nerve, with sural nerve graft

Ð. tricompartmental knee replacement

Ñ. unicompartmental knee replacement

Ò. medial compartment meniscal allograft

Ó. valgus-producing distal femoral osteotomy

Ô. valgus-producing proximal tibial osteotomy

Õ. Internal rotation of the femoral component

Ö. External rotation of the tibial component

÷. Lateral placement of the femoral component

Ø. Medial placement of the patellar component

Ù. Excessive resection of the patella

Ú. Hallux rigidus

Û. Hallux valgus

Ü. Neuroma of the first web space

Ý. Fracture of the sesamoid

Þ. Rupture of the flexor hallucis longus

Ÿ. Sickle cell crisis

Ā. Idiopathic chondrolysis

Ā. Hemophilic arthropathy

Ă. Osteoid osteoma of the femoral neck

Ă. Legg-Calve-Perthes disease

Ą. Decreased ankle jerk and positive femoral nerve stretch test

Ą. Decreased knee jerk and positive straight-leg raising sign

Ć. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ć. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ĉ. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ĉ. Long-term administration of IV and oral antibiotics

Ċ. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ċ. Immediate exchange arthroplasty with antibiotic-impregnated cement

Č. Two-stage surgical prosthetic exchange and IV antibiotics

Č. Resection arthroplasty and IV antibiotics

Ď. SCFE

Ď. MED

Đ. Perthes disease

Đ. Hypothyroidism

Ē. Chondrolysis

Ē. gout.

Ĕ. osteoporosis.

Ĕ. eosinophilic granuloma.

Ė. tuberculosis of the spine.

Ė. metastatic disease of the spine.

Ę. water content.

Ę. Synthesis of type I collagen.

Ě. Proteoglycan content.

Ě. Activity of chondrocytes.

Ĝ. Synthesis of hyaluronate.

Ĝ. Lung

Ğ. Breast

Ğ. Prostate

Ġ. Thyroid

Ġ. Renal

Ģ. T1-low, T2-low.

Ģ. T1-low, T2-high.

Ĥ. T1-moderate, T2-low.

Ĥ. T1-high, T2-low.

Ħ. T1-high, T2-high.

Ħ. hypothesis is incorrect or invalid

Ĩ. interobserver error rate is 4%.

Ĩ. Standard deviation is 4% higher or lower than the mean.

Ī. Sample size is 4% larger than required to be clinically significant.

Ī. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ĭ. I

Ĭ. II

Į. IV

Į. IX

İ. X

I. Cranial setting

Ĳ. Cranial subluxation

Ĳ. Odontoid fracture

Ĵ. Lysis of the arch of the atlas

Ĵ. Atlantoaxial subluxation

Ķ. Retrograde collapse of the endoneurial tubes

Ķ. Irreversible atrophy of the denervated muscles

ĸ. Elongation of the axons across the zone of injury

Ĺ. Sprouting of the axons at the neuromuscular junction

Ĺ. Misdirection of the axons across the zone of injury

Ļ. Maximally pronated and elbow extended

Ļ. Maximally pronated and the elbow flexed

Ľ. Maximally supinated and the elbow flexed

Ľ. Maximally supinated and the elbow extended

Ŀ. In neutral rotation, with the elbow extended

Ŀ. open reduction and internal fixation

Ł. buddy taping to the adjacent index finger

Ł. early motion with application of a dynamic banjo splint

Ń. application of a cast with the hand in a “safe position” for 3 weeks.

Ń. dorsal extension block splinting

Ņ. The name of the manufacturer

Ņ. The manufacturer’s potential liability

Ň. The physician’s clinical performance

Ň. The physician’s materials testing data

ʼN. Any royalties the physician receives from the manufacturer

Ŋ. Femoral

Ŋ. Obturator

Ō. Inferior gluteal

Ō. Superior gluteal

Ŏ. Lateral femoral cutaneous

Ŏ. open biopsy and a long leg cast

Ő. open biopsy and wide resection of the tumor

Ő. a long leg cast and observation

Œ. intramedullary stabilization and observation

Œ. Triggering

Ŕ. Lateral instability

Ŕ. Swan-neck deformity

Ŗ. Boutonniere deformity

Ŗ. Loss of distal interphalangeal joint flexion

Ř. Peroneus brevis to peroneus longus

Ř. Peroneus tertius to extensor hallucis longus

Ś. Peroneus tertius to superficial peroneal nerve

Ś. Extensor hallucis longus to deep peroneal nerve

Ŝ. Extensor hallucis longus to extensor digitorum longus

Ŝ. reassurance that Medicare will pay for the treatment.

Ş. consent forms that patients or their guardians are able to understand.

Ş. a detailed description of the device, omitting the fact that it is part of a study.

Š. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Š. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ţ. an onlay iliac crest bone graft.

Ţ. limited weightbearing and observation.

Ť. removal of the implant and limited weightbearing.

Ť. removal of the implant and insertion of a reamed femoral nail.

Ŧ. removal of the implant and insertion of an unreamed femoral nail.

Ŧ. Coronal

Ũ. Sagittal

Ũ. Anteromedial, midway between the sagittal and the coronal

Ū. Proximal pins sagittal, distal pins coronal

Ū. Proximal pins coronal, distal pins sagittal

Ŭ. Rheumatoid arthritis

Ŭ. Posttraumatic arthritis

Ů. Degenerative osteoarthritis

Ů. Osteonecrosis of the tibial plateau

Ű. Osteonecrosis of the medial femoral condyle

Ű. Trapeziometacarpal arthrodesis

Ų. Osteotomy of the thumb metacarpal

Ų. Arthrotomy and joint debridement

Ŵ. Ligament reconstruction using one half of the flexor carpi radialis

Ŵ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŷ. Creep

Ŷ. Relaxation

Ÿ. Energy dissipation

Ź. Plastic deformation

Ź. Elastic deformation

Ż. bending

Ż. axial loading

Ž. high-speed rotation

Ž. direct impact from anteromedial

S. crush from anteromedial to posterolateral

Ƀ. Increase stiffness

Ɓ. Increase fracture toughness

Ƃ. Increase fatigue strength

Ƃ. Decrease mechanical strength

Ƅ. Decrease wear rate

Ƅ. disuse osteopenia

Ɔ. paraendocrine effect of the tumor

Ƈ. abnormally increased density on the right side

Ƈ. side effect of the treatment of the lesion

Ɖ. extensive tumor involvement of the left hip

Ɗ. Sciatic nerve

Ƌ. Superior gluteal artery

Ƌ. Profunda femoris artery

ƍ. Femoral artery and nerve

Ǝ. External iliac artery and vein

Ə. Length

Ɛ. Moment arm

Ƒ. Total volume

Ƒ. Physiologic cross-sectional area

Ɠ. Distribution of slow and fast twitch fibers

Ɣ. decreasing initiation of action potentials.

Ƕ. increasing action potential amplitude.

Ɩ. blocking the opening of gated sodium channels.

Ɨ. decreasing the number of functional motor units.

Ƙ. slowing or stopping action potential propagation through the axon.

Ƙ. resection of the metatarsal heads of the first through fifth toes.

Ƚ. Silastic MP joint arthroplasties of the first through fifth toes.

ƛ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ɯ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ɲ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ƞ. hemiarthroplasty

Ɵ. open reduction and internal fixation

Ơ. closed reduction and percutaneous pinning

Ơ. a sling and early pedulum exercises

Ƣ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ƣ. open acromioplasty

Ƥ. open Bankart repair

Ƥ. open subscapularis tendon repair

Ʀ. inferior capsular shift

Ƨ. a supervised physical therapy program

Ƨ. a sling and swathe, with pendulum exercises in 10 days

Ʃ. open reduction and internal fixation through an anterior approach

ƪ. open reduction and internal fixation through a posterior approach

ƫ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƭ. arthroscopically assisted reduction and percutaneous screw fixation

Ƭ. Repair of the rotator cuff

Ʈ. Replacement of the humeral head

Ư. Resection arthroplasty

Ư. Total shoulder arthroplasty

Ʊ. AP and lateral radiographs of the elbow

Ʋ. Diagnositc arthroscopy

Ƴ. Aspiration of joint fluid

Ƴ. An erythrocyte sedimentation rate and CBC

Ƶ. A diagnostic lidocaine injection

Ƶ. Insulin-like growth factor (IGF-1)

Ʒ. Fibroblast growth factor (FGF-1)

Ƹ. Platelet-derived growth factor (PDGF)

Ƹ. Transforming growth factor beta (TGF-B)

ƺ. Bone morphogenetic proteins (BMP)

ƻ. clinical history and radiographic findings.

Ƽ. technetium bone scan

Ƽ. flow cytometry pattern of extracted chondrocytes

ƾ. immunohistochemical staining patterns of a biopsy specimen

Ƿ. histologic features of a biopsy specimen stained with hematoxylin-cosin

ǀ. Radial

ǁ. Radial recurrent

ǂ. Posterior interosseous

ǃ. Superior ulnar recurrent

Ǆ. Superficial radial circumflex

Ǆ. Impaired hydroxylation of proline

Ǆ. Failure of cleavage in procollagen

Ǉ. Defective binding sites for hydroxyproline

Ǉ. Failure to incorporate glycine into the helix

Ǉ. Diminished production of collagen through the rough endoplasmic reticulum

Ǌ. Asking the legal staff to seek a court injunction

Ǌ. Copying the patient’s chart and giving it to him as he leaves

Ǌ. Having the patient sign a written legal contract that specifies acceptable behavior

Ǎ. Continuing care of the patient until an appropriate referral can be arranged

Ǎ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ǐ. Meta-analysis

Ǐ. Confidence interval

Ǒ. Analysis of variance (ANOVA)

Ǒ. Statistical significance (p-value)

Ǔ. Survivorship analysis (Kaplan-Meier)

Ǔ. Spinal shock

Ǖ. Neurogenic shock

Ǖ. Hypovolemic shock

Ǘ. Pulmonary embolism

Ǘ. Fat embolus syndrome

Ǚ. Lumbar spinal stenosis

Ǚ. Metastatic disease of the spine

Ǜ. Rheumatoid lumbar spondylitis

Ǜ. Isthmic spondyloloisthesis

Ǝ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǟ. Patella alta

Ǟ. A metal-backed patella

Ǡ. Varus malalignment of the knee

Ǡ. A posterior cruciate-substituting femoral component

Ǣ. Lateral subluxation of the patella on a Merchant’s view

Ǣ. The sesamoids are separated

Ǥ. The sesamoid is fractured

Ǥ. The proximal phx is on the neck of the metatarsal

Ǧ. The dislocation is dorsal and centered

Ǧ. The proximal phalanx is hyperextended

Ǩ. Patella

Ǩ. Tibial stem

Ǫ. Distal femoral interface

Ǫ. Posterior femoral interface

Ǭ. Sites of screw fixation for the tibia

Ǭ. Hallux rigidus

Ǯ. Fracture of the sesamoid

Ǯ. Disruption of the plantar plate

J̌. Osteonecrosis of the metatarsal head

Ǳ. Rupture of the flexor hallucis longus

Ǳ. Gout

Ǳ. Sepsis

Ǵ. Old trauma

Ǵ. Rheumatoid arthritis

Ƕ. Charcot arthroplasty

Ƿ. Aspiration and steroid injection

Ǹ. Biopsy, curettage, and allograft bone grafting

Ǹ. Percutaneous Kirschner wire fixation

Ǻ. Percutaneous injection of autogenous bone marrow

Ǻ. Nerve roots

Ǽ. Spinal cord

Ǽ. Sciatic nerve

Ǿ. Peroneal nerve

Ǿ. Conus medullaris

Ȁ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ȁ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ȃ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ȃ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ȅ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ȅ. Early and late infection

Ȇ. Periprosthetic fracture of the femur

Ȇ. Failure of the patellofemoral and extensor mechanisms

Ȉ. Aseptic loosening of cementing tibial components

Ȉ. Asceptic loosening of cemented femoral components

Ȋ. Acceptance of the current position of the ankle

Ȋ. Open reduction and fixation in the epiphysis only

Ȍ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ȍ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ȏ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ȏ. Resection arthroplasty and local radiation

Ȑ. In situ fusion of the hip

Ȑ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ȓ. Excision of heterotopic bone and local radiation

Ȓ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ȕ. Closed reduction of both fractures and immediate spica casting

Ȕ. Bilateral skin traction for 3 weeks, followed by spica casting

Ȗ. External fixation of both femora

Ȗ. External fixation of the left femur and a long leg cast brace for the right femur

Ș. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ș. Synovial sarcoma

Ț. Soft-tissue abcess

Ț. Rhabdomyosarcoma

Ȝ. Eosinophilic granuloma

Ȝ. Nodular pigmented villonodular synovitis

Ȟ. Changing to a titanium nail

Ȟ. Changing to a nonslotted nail

Ƞ. Changing the cross-sectional shape of the nail

ȡ. Increasing the diameter of the nail by 3 mm

Ȣ. Increasing the diameter of the interlocking screws

Ȣ. Fracture healing

Ȥ. Chondrosarcoma

Ȥ. Periosteal chondroma

Ȧ. Periosteal osteosarcoma

Ȧ. Dysplasia epiphysealis hemimelica

Ȩ. Demonstrate competence in the subject of the case

Ȩ. Be fellowship trained in the subject of the case

Ȫ. Be paid on a contingency basis

Ȫ. Be board certified by the American Board of Orthopaedic Surgery

Ȭ. Have been involved in the case as a consultant

Ȭ. Diagnostic arthroscopy

Ȯ. Arthroscopy and subacromial decompression

Ȯ. Reduction and fixation of the proximal humeral epiphysis

Ȱ. Temporary cessation of throwing

Ȱ. Physical therapy for rotator cuff strengthening

Ȳ. Oblique popliteal ligament

Ȳ. Lateral capsule

ȴ. Popliteal tendon

ȵ. Fibular collateral ligament

ȶ. Posterior oblique ligament

ȷ. Radial tear

ȸ. Parrot-beak tear

ȹ. Vertical tear in the “red-red” zone

Ⱥ. Vertical tear in the “red-white” zone

Ȼ. Vertical tear in the “white-white” zone

Ȼ. 0 degrees of abduction, with neural rotation

Ƚ. 40 degrees of flexion and 60 degrees of internal rotation

Ⱦ. 45 degrees of flexion and 45 degrees of external rotation

Ȿ. 90 degrees of abduction with neutral rotation

Ɀ. 90 degrees of abduction and 90 degrees of external rotation

Ɂ. Sural

Ɂ. Saphenous and its branches

Ƀ. Posterior tibial and its branches

Ʉ. Deep peroneal and its branches

Ʌ. Superficial peroneal and its branches

Ɇ. Strength

Ɇ. Stiffness

Ɉ. Shelf life

Ɉ. Antigenicity

Ɋ. Risk of HIV transmission

Ɋ. Indemnification

Ɍ. Occurrence

Ɍ. Excess liability

Ɏ. Claims-made

Ɏ. Nose

Ɐ. Lateral Y

Ɑ. Scapular AP

Ɒ. Neutral rotation AP

Ɓ. Internal rotation AP

Ɔ. External rotation AP

ɕ. Trauma

Ɖ. Hemophilia

Ɗ. Reiter’s syndrome

ɘ. Rheumatoid arthritis

Ə. Systemic lupus erythematosus

ɚ. Cast immobilization for 6 weeks

Ɛ. Activity modification and re-evaluation in 2 months

Ɜ. Internal fixation with or without bone grafting

ɝ. Retrograde drilling of the defect without articular cartilage penetration

ɞ. Drilling of the defect directly through the articular cartilage

ɟ. repair or reconstruction of the medial collateral ligament

Ɠ. repair or reconstruction of the medialand lateral collateral ligaments

Ɡ. immobilization for 5 days or less

ɢ. immobilization for 14 days

Ɣ. immobilization for 25 days

ɤ. Cystinosis

Ɥ. Hypophosphatemia

Ɦ. Renal osteodystrophy

ɧ. Primary hyperparathyroidism

Ɨ. Nutritional vitamin D deficiency

Ɩ. Lateral meniscus tear

Ɪ. Popliteus tenosynovitis

Ɫ. Iliotibial band friction syndrome

Ɬ. Peroneal nerve entrapment

ɭ. Biceps tendinitis

ɮ. Observation

Ɯ. Removal of the prosthetic components

ɰ. Operative exploration and decompression of the peroneal nerve

Ɱ. Nerve conduction velocity studies

Ɲ. Loosening of the primary dressings and knee flexion to 30 degrees

ɳ. I

ɴ. II

Ɵ. III

ɶ. decreased tissue tension

ɷ. decreased abductor lever arm

ɸ. decreased joint reaction force

ɹ. increased body weight over lever arm

ɺ. increased polyethylene wear rate

ɻ. recurrent traumatic anterior dislocation

ɼ. recurrent traumatic posterior dislocation

Ɽ. traumatic subluxation with no previous dislocation

ɾ. traumatic anterior subluxation

ɿ. atraumatic involuntary subluxation

Ʀ. radial

ʁ. axillary

Ʂ. suprascapular

Ʃ. thoracodorsal

ʄ. long thoracic

ʅ. Flexion

ʆ. Extension

Ʇ. Axial rotation

Ʈ. Left lateral bending

Ʉ. Right lateral bending

Ʊ. Skin

Ʋ. Lung

Ʌ. Brain

ʍ. Heart

ʎ. Kidney

ʏ. Thoracoacromial, lateral thoracic, subscapular

ʐ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ʑ. Posterior humeral circumflex, subscapular, thoracacromial

Ʒ. Subscapular, thoracacromial, anterior humeral circumflex

ʓ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ʔ. Respondeat superior

ʕ. Indemnity agreement

ʖ. Hold harmless agreement- attempt to shift liability from company to physician

ʗ. Comparative negligence-% of involvement

ʘ. Contributory negligence- resident contributed to the negligence

ʙ. t-type

ʚ. both column

ʛ. transverse

ʜ. anterior column

Ʝ. anterior column posterior hemitransverse

Ʞ. Posterior interosseous

ʟ. Anterior interosseous

ʠ. Radial

ʡ. Median

ʢ. Ulnar

ʣ. Shock from hypovolemia

ʤ. Associated rupture of the bladder

ʥ. Arterial bleeding on pelvic angiogram

ʦ. Presence of a hematoma in the perineum and scrotum

ʧ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Cauda equina

Explanation

Question 4143

Topic: 10. Pathology and Oncology

A 14-year-old patient who has homocystinuria and is Risser 3 is referred for surgical treatment of scoliosis. In addition to the usual risks associated with posterior spinal fusion, the family should be advised that the patient ‘s underlying condition significantly increases the perioperative risk of

. Spinal pseudoarthrosis

. Spinal cord traction injury with paralysis

. Arterial and venous thromboses

. Superior mesenteric artery syndrome

. Crankshaft phenomenon

. Inversion stress radiograph

. MRI scan

. CT scan

. Nuclear bone scan

. External rotation stress radiograph

. Complex deformity with an angulation in two planes

. Single deformity less than 20 degrees, apex posterolateral

. Single deformity greater than 30 degrees, apex posterolateral

. Single deformity less than 20 degrees, apex posteromedial

. Single deformity greater than 30 degrees, apex posteromedial

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

!. Posterior fusion of the thoracic and lumbar curves

". Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

#. Subscapularis rupture

$. Type III SLAP lesion

%. Disruption of capsular shift

&. Isolated traumatic subluxation

'. Injury to the axillary nerve after dislocation

(. hypophosphatemia

). high dietary cholesterol intake

*. deficiency of lipoprotein A

+. deficiency of protein S and protein C

,. elevated levels of antithrombin III

-. Weightbearing short leg cast

.. Nonweightbearing short leg cast

/. Removable splint and early motion

0. Open reduction and internal fixation

1. Elastic compression bandage with full weightbearing

2. Breast

3. Prostate

4. Gastrointestinal

5. Kidney

6. Multiple myeloma

7. Varus stress

8. Valgus stress

9. Torsional loading

:. Hyperextension of the knee

;. Contraction of the quadriceps while axially loaded

<. Primary internal fixation at both fracture levels

=. External fixation as definitive ttt for both #

>. Skeletal traction and delayed internal fixation of both fractures

?. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

@. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

A. Heel spur

B. Plantar fascitis

C. Dysfunction of the tibialis posterior tendon

D. Compression of the first branch of the lateral plantar nerve

E. Compression of the calcaneal nerve

F. Displaced labral tear

G. Tear of the rotator cuff

H. Fracture of the glenoid rim

I. Palsy of the axillary nerve

J. Palsy of the musculocutaneus nerve

K. Enchondroma

L. Osteoblastoma

M. Giant cell tumor

N. Aneurysmal bone cyst

O. Fibrous dysplasia

P. Arthrogram of the wrist

Q. MRI scan of both wrists

R. CT scan of both wrists in the same position

S. Radiographs of the wrist in supination and pronation

T. Radiographs of the opposite wrist in the same position

U. Secondary hyperparathyroidism

V. Phosphate retention secondary to uremia

W. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

X. Aluminum deposition in bone from oral phosphate binders

Y. Persistent acidosis aggravating the negative calcium balance

Z. Posterior fusion at T10-L3 with segmental instrumentation

[. Laminectomy and fusion of T12-L2 with segmental instrumentation

\. Bed rest in a hyperextension brace

]. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

^. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

_. Positive-pressure ventilation

`. An immediate radiograph of the chest

A. Adjustment of the position of the endotrachael tube

B. Insertion of a large-bore needle into the pericardial space

C. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

D. Allowing the ends of the fracture to touch

E. Adding a second connecting bar

F. Adding one pin to each fracture fragment

G. Increasing the pin diameter from 4 mm to 6 mm

H. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

I. Osteomyelitis

J. Malignant degeneration

K. Stress fracture

L. Local recurrence of the giant cell tumor

M. Bone resorption due to methylmethacrylate

N. Advancement of the plantar plate

O. Resection of the second metatarsal head

P. Dorsiflexion osteotomy of the second metatarsal neck

Q. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

R. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

S. Sacral fracture

T. Burst fracture of L5

U. Cauda equina syndrome

V. Distraction-flexion injury at L3

W. Distraction-extension injury at L3

X. An MRI scan of the shoulder

Y. An MRI scan of the cervical spine

Z. Electromyographic and nerve conduction velocity studies

{. Immobilization in a sling and early passive range of motion exercises

|. Immediate return to the operating room for exploration of the brachial plexus

}. cerclage wiring

~. tension band wiring

. removal of the patellar component

. revision of the patellar component

. immobilization of the knee and protected weightbearing

. Liposarcoma

. Nodular fasciitis

. Rabdomyosarcoma

. Malignant fibrous histiocytoma

. Extra-abdominal desmoid tumor

. Clubfeet

. Thrombocytopenia

. Congenital scoliosis

. Ventricular septal defect

. Arnold-Chiari malformation

. delayed primary closure

. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

¡. Arthroscopic acromioplasty

¢. Arthroscopic debridement of G-H joint

£. Replacement of the humeral head

¤. Lengthening of the subscapularis and release of the anterior capsule

¥. Bacteroides

¦. E. coli

§. Staph. aureus

¨. group A streptococcus

©. Clostridium perforingens

ª. observation and exercises

«. bracing with a thoracolumbar orthosis

¬. fusion of the posterior spine

. fusion of the anterior spine

®. fusion of the anterior and posterior spine

¯. Total wrist replacement and bridge grafts

°. palmar shelf arthroplasty and tendon transfers

±. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

². Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

³. Total wrist fusion and tendon transfers

´. constrained acetabular component

Μ. protrusion ring with morselized graft

¶. cemented metal backed acetabular component

·. cemented all-polyethylene acetabular component

¸. cementless hemispherical component with screw fixation

¹. application of a hip abduction brace for 22 hours per day

º. application of a hip spica under anesthesia

». discontinuance of all bracing and repeat radiographs in 3 months

¼. open reduction of the hip and application of a spica cast

½. open reduction, varus osteotomy, and application of a spica cast

¾. Loss of skin hair on the feet

¿. Absent pulses on vascular examination

À. Pain that originates proximally and spreads distally

Á. Pain that is relieved by stopping and standing

Â. Pain that is worse when the patient walks uphill rather downhill

Ã. wrist flexors and finger flexors

Ä. elbow flexors and wrist flexors

Å. elbow flexors and finger flexors

Æ. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

Ç. elbow extensors and wrist extensors

È. Syndactyly

É. Macrodactyly

Ê. Camptodactyly

Ë. Preaxial polydactyly

Ì. Postaxial polydactyly

Í. Arthrodesis

Î. Rotationplasty

Ï. Above-knee amputation

Ð. Osteoarticular allograft

Ñ. Endoprosthesis (custom arthroplasty)

Ò. Plantar fascia

Ó. Spring ligament

Ô. Deltoid ligament

Õ. Intrinsic tendons

Ö. Gastorcnemius-solelus complex

×. Prevention of presynaptic release of acetylcholine

Ø. Prevention of synthesis of presynaptic acetylcholine

Ù. Activation of acetylcholinesterase at the motor end-plate

Ú. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Û. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Ü. stiffness of the femoral component.

Ý. head offset of the femoral component.

Þ. femoral component material modulus of elasticity.

SS. extent of the femoral component porous coating.

À. Presence of a femoral component collar.

Á. plantar fascia and quadratus plantae tendon.

Â. ligamentous structures connecting the tarsal bones.

Ã. shape of the tarsal bones and the intervening joints.

Ä. activity of the intrinsic muscles of the foot.

Å. activity of the posterior tibialis and the peroneus longus muscles.

Æ. scapulothoracic fusion

Ç. strengthening of the periscapular muscles

È. pectoralis minor-fascia lata graft transfer to the scapula

É. pectoralis major-fascia lata graft transfer to the scapula

Ê. exploration of the long thoracic nerve, with sural nerve graft

Ë. tricompartmental knee replacement

Ì. unicompartmental knee replacement

Í. medial compartment meniscal allograft

Î. valgus-producing distal femoral osteotomy

Ï. valgus-producing proximal tibial osteotomy

Ð. Internal rotation of the femoral component

Ñ. External rotation of the tibial component

Ò. Lateral placement of the femoral component

Ó. Medial placement of the patellar component

Ô. Excessive resection of the patella

Õ. Hallux rigidus

Ö. Hallux valgus

÷. Neuroma of the first web space

Ø. Fracture of the sesamoid

Ù. Rupture of the flexor hallucis longus

Ú. Sickle cell crisis

Û. Idiopathic chondrolysis

Ü. Hemophilic arthropathy

Ý. Osteoid osteoma of the femoral neck

Þ. Legg-Calve-Perthes disease

Ÿ. Decreased ankle jerk and positive femoral nerve stretch test

Ā. Decreased knee jerk and positive straight-leg raising sign

Ā. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ă. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ă. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ą. Long-term administration of IV and oral antibiotics

Ą. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ć. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ć. Two-stage surgical prosthetic exchange and IV antibiotics

Ĉ. Resection arthroplasty and IV antibiotics

Ĉ. SCFE

Ċ. MED

Ċ. Perthes disease

Č. Hypothyroidism

Č. Chondrolysis

Ď. gout.

Ď. osteoporosis.

Đ. eosinophilic granuloma.

Đ. tuberculosis of the spine.

Ē. metastatic disease of the spine.

Ē. water content.

Ĕ. Synthesis of type I collagen.

Ĕ. Proteoglycan content.

Ė. Activity of chondrocytes.

Ė. Synthesis of hyaluronate.

Ę. Lung

Ę. Breast

Ě. Prostate

Ě. Thyroid

Ĝ. Renal

Ĝ. T1-low, T2-low.

Ğ. T1-low, T2-high.

Ğ. T1-moderate, T2-low.

Ġ. T1-high, T2-low.

Ġ. T1-high, T2-high.

Ģ. hypothesis is incorrect or invalid

Ģ. interobserver error rate is 4%.

Ĥ. Standard deviation is 4% higher or lower than the mean.

Ĥ. Sample size is 4% larger than required to be clinically significant.

Ħ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ħ. I

Ĩ. II

Ĩ. IV

Ī. IX

Ī. X

Ĭ. Cranial setting

Ĭ. Cranial subluxation

Į. Odontoid fracture

Į. Lysis of the arch of the atlas

İ. Atlantoaxial subluxation

I. Retrograde collapse of the endoneurial tubes

Ĳ. Irreversible atrophy of the denervated muscles

Ĳ. Elongation of the axons across the zone of injury

Ĵ. Sprouting of the axons at the neuromuscular junction

Ĵ. Misdirection of the axons across the zone of injury

Ķ. Maximally pronated and elbow extended

Ķ. Maximally pronated and the elbow flexed

ĸ. Maximally supinated and the elbow flexed

Ĺ. Maximally supinated and the elbow extended

Ĺ. In neutral rotation, with the elbow extended

Ļ. open reduction and internal fixation

Ļ. buddy taping to the adjacent index finger

Ľ. early motion with application of a dynamic banjo splint

Ľ. application of a cast with the hand in a “safe position” for 3 weeks.

Ŀ. dorsal extension block splinting

Ŀ. The name of the manufacturer

Ł. The manufacturer’s potential liability

Ł. The physician’s clinical performance

Ń. The physician’s materials testing data

Ń. Any royalties the physician receives from the manufacturer

Ņ. Femoral

Ņ. Obturator

Ň. Inferior gluteal

Ň. Superior gluteal

ʼN. Lateral femoral cutaneous

Ŋ. open biopsy and a long leg cast

Ŋ. open biopsy and wide resection of the tumor

Ō. a long leg cast and observation

Ō. intramedullary stabilization and observation

Ŏ. Triggering

Ŏ. Lateral instability

Ő. Swan-neck deformity

Ő. Boutonniere deformity

Œ. Loss of distal interphalangeal joint flexion

Œ. Peroneus brevis to peroneus longus

Ŕ. Peroneus tertius to extensor hallucis longus

Ŕ. Peroneus tertius to superficial peroneal nerve

Ŗ. Extensor hallucis longus to deep peroneal nerve

Ŗ. Extensor hallucis longus to extensor digitorum longus

Ř. reassurance that Medicare will pay for the treatment.

Ř. consent forms that patients or their guardians are able to understand.

Ś. a detailed description of the device, omitting the fact that it is part of a study.

Ś. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ŝ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ŝ. an onlay iliac crest bone graft.

Ş. limited weightbearing and observation.

Ş. removal of the implant and limited weightbearing.

Š. removal of the implant and insertion of a reamed femoral nail.

Š. removal of the implant and insertion of an unreamed femoral nail.

Ţ. Coronal

Ţ. Sagittal

Ť. Anteromedial, midway between the sagittal and the coronal

Ť. Proximal pins sagittal, distal pins coronal

Ŧ. Proximal pins coronal, distal pins sagittal

Ŧ. Rheumatoid arthritis

Ũ. Posttraumatic arthritis

Ũ. Degenerative osteoarthritis

Ū. Osteonecrosis of the tibial plateau

Ū. Osteonecrosis of the medial femoral condyle

Ŭ. Trapeziometacarpal arthrodesis

Ŭ. Osteotomy of the thumb metacarpal

Ů. Arthrotomy and joint debridement

Ů. Ligament reconstruction using one half of the flexor carpi radialis

Ű. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ű. Creep

Ų. Relaxation

Ų. Energy dissipation

Ŵ. Plastic deformation

Ŵ. Elastic deformation

Ŷ. bending

Ŷ. axial loading

Ÿ. high-speed rotation

Ź. direct impact from anteromedial

Ź. crush from anteromedial to posterolateral

Ż. Increase stiffness

Ż. Increase fracture toughness

Ž. Increase fatigue strength

Ž. Decrease mechanical strength

S. Decrease wear rate

Ƀ. disuse osteopenia

Ɓ. paraendocrine effect of the tumor

Ƃ. abnormally increased density on the right side

Ƃ. side effect of the treatment of the lesion

Ƅ. extensive tumor involvement of the left hip

Ƅ. Sciatic nerve

Ɔ. Superior gluteal artery

Ƈ. Profunda femoris artery

Ƈ. Femoral artery and nerve

Ɖ. External iliac artery and vein

Ɗ. Length

Ƌ. Moment arm

Ƌ. Total volume

ƍ. Physiologic cross-sectional area

Ǝ. Distribution of slow and fast twitch fibers

Ə. decreasing initiation of action potentials.

Ɛ. increasing action potential amplitude.

Ƒ. blocking the opening of gated sodium channels.

Ƒ. decreasing the number of functional motor units.

Ɠ. slowing or stopping action potential propagation through the axon.

Ɣ. resection of the metatarsal heads of the first through fifth toes.

Ƕ. Silastic MP joint arthroplasties of the first through fifth toes.

Ɩ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ɨ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ƙ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ƙ. hemiarthroplasty

Ƚ. open reduction and internal fixation

ƛ. closed reduction and percutaneous pinning

Ɯ. a sling and early pedulum exercises

Ɲ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ƞ. open acromioplasty

Ɵ. open Bankart repair

Ơ. open subscapularis tendon repair

Ơ. inferior capsular shift

Ƣ. a supervised physical therapy program

Ƣ. a sling and swathe, with pendulum exercises in 10 days

Ƥ. open reduction and internal fixation through an anterior approach

Ƥ. open reduction and internal fixation through a posterior approach

Ʀ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƨ. arthroscopically assisted reduction and percutaneous screw fixation

Ƨ. Repair of the rotator cuff

Ʃ. Replacement of the humeral head

ƪ. Resection arthroplasty

ƫ. Total shoulder arthroplasty

Ƭ. AP and lateral radiographs of the elbow

Ƭ. Diagnositc arthroscopy

Ʈ. Aspiration of joint fluid

Ư. An erythrocyte sedimentation rate and CBC

Ư. A diagnostic lidocaine injection

Ʊ. Insulin-like growth factor (IGF-1)

Ʋ. Fibroblast growth factor (FGF-1)

Ƴ. Platelet-derived growth factor (PDGF)

Ƴ. Transforming growth factor beta (TGF-B)

Ƶ. Bone morphogenetic proteins (BMP)

Ƶ. clinical history and radiographic findings.

Ʒ. technetium bone scan

Ƹ. flow cytometry pattern of extracted chondrocytes

Ƹ. immunohistochemical staining patterns of a biopsy specimen

ƺ. histologic features of a biopsy specimen stained with hematoxylin-cosin

ƻ. Radial

Ƽ. Radial recurrent

Ƽ. Posterior interosseous

ƾ. Superior ulnar recurrent

Ƿ. Superficial radial circumflex

ǀ. Impaired hydroxylation of proline

ǁ. Failure of cleavage in procollagen

ǂ. Defective binding sites for hydroxyproline

ǃ. Failure to incorporate glycine into the helix

Ǆ. Diminished production of collagen through the rough endoplasmic reticulum

Ǆ. Asking the legal staff to seek a court injunction

Ǆ. Copying the patient’s chart and giving it to him as he leaves

Ǉ. Having the patient sign a written legal contract that specifies acceptable behavior

Ǉ. Continuing care of the patient until an appropriate referral can be arranged

Ǉ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ǌ. Meta-analysis

Ǌ. Confidence interval

Ǌ. Analysis of variance (ANOVA)

Ǎ. Statistical significance (p-value)

Ǎ. Survivorship analysis (Kaplan-Meier)

Ǐ. Spinal shock

Ǐ. Neurogenic shock

Ǒ. Hypovolemic shock

Ǒ. Pulmonary embolism

Ǔ. Fat embolus syndrome

Ǔ. Lumbar spinal stenosis

Ǖ. Metastatic disease of the spine

Ǖ. Rheumatoid lumbar spondylitis

Ǘ. Isthmic spondyloloisthesis

Ǘ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǚ. Patella alta

Ǚ. A metal-backed patella

Ǜ. Varus malalignment of the knee

Ǜ. A posterior cruciate-substituting femoral component

Ǝ. Lateral subluxation of the patella on a Merchant’s view

Ǟ. The sesamoids are separated

Ǟ. The sesamoid is fractured

Ǡ. The proximal phx is on the neck of the metatarsal

Ǡ. The dislocation is dorsal and centered

Ǣ. The proximal phalanx is hyperextended

Ǣ. Patella

Ǥ. Tibial stem

Ǥ. Distal femoral interface

Ǧ. Posterior femoral interface

Ǧ. Sites of screw fixation for the tibia

Ǩ. Hallux rigidus

Ǩ. Fracture of the sesamoid

Ǫ. Disruption of the plantar plate

Ǫ. Osteonecrosis of the metatarsal head

Ǭ. Rupture of the flexor hallucis longus

Ǭ. Gout

Ǯ. Sepsis

Ǯ. Old trauma

J̌. Rheumatoid arthritis

Ǳ. Charcot arthroplasty

Ǳ. Aspiration and steroid injection

Ǳ. Biopsy, curettage, and allograft bone grafting

Ǵ. Percutaneous Kirschner wire fixation

Ǵ. Percutaneous injection of autogenous bone marrow

Ƕ. Nerve roots

Ƿ. Spinal cord

Ǹ. Sciatic nerve

Ǹ. Peroneal nerve

Ǻ. Conus medullaris

Ǻ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǽ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǽ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǿ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǿ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ȁ. Early and late infection

Ȁ. Periprosthetic fracture of the femur

Ȃ. Failure of the patellofemoral and extensor mechanisms

Ȃ. Aseptic loosening of cementing tibial components

Ȅ. Asceptic loosening of cemented femoral components

Ȅ. Acceptance of the current position of the ankle

Ȇ. Open reduction and fixation in the epiphysis only

Ȇ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ȉ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ȉ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ȋ. Resection arthroplasty and local radiation

Ȋ. In situ fusion of the hip

Ȍ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ȍ. Excision of heterotopic bone and local radiation

Ȏ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ȏ. Closed reduction of both fractures and immediate spica casting

Ȑ. Bilateral skin traction for 3 weeks, followed by spica casting

Ȑ. External fixation of both femora

Ȓ. External fixation of the left femur and a long leg cast brace for the right femur

Ȓ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȕ. Synovial sarcoma

Ȕ. Soft-tissue abcess

Ȗ. Rhabdomyosarcoma

Ȗ. Eosinophilic granuloma

Ș. Nodular pigmented villonodular synovitis

Ș. Changing to a titanium nail

Ț. Changing to a nonslotted nail

Ț. Changing the cross-sectional shape of the nail

Ȝ. Increasing the diameter of the nail by 3 mm

Ȝ. Increasing the diameter of the interlocking screws

Ȟ. Fracture healing

Ȟ. Chondrosarcoma

Ƞ. Periosteal chondroma

ȡ. Periosteal osteosarcoma

Ȣ. Dysplasia epiphysealis hemimelica

Ȣ. Demonstrate competence in the subject of the case

Ȥ. Be fellowship trained in the subject of the case

Ȥ. Be paid on a contingency basis

Ȧ. Be board certified by the American Board of Orthopaedic Surgery

Ȧ. Have been involved in the case as a consultant

Ȩ. Diagnostic arthroscopy

Ȩ. Arthroscopy and subacromial decompression

Ȫ. Reduction and fixation of the proximal humeral epiphysis

Ȫ. Temporary cessation of throwing

Ȭ. Physical therapy for rotator cuff strengthening

Ȭ. Oblique popliteal ligament

Ȯ. Lateral capsule

Ȯ. Popliteal tendon

Ȱ. Fibular collateral ligament

Ȱ. Posterior oblique ligament

Ȳ. Radial tear

Ȳ. Parrot-beak tear

ȴ. Vertical tear in the “red-red” zone

ȵ. Vertical tear in the “red-white” zone

ȶ. Vertical tear in the “white-white” zone

ȷ. 0 degrees of abduction, with neural rotation

ȸ. 40 degrees of flexion and 60 degrees of internal rotation

ȹ. 45 degrees of flexion and 45 degrees of external rotation

Ⱥ. 90 degrees of abduction with neutral rotation

Ȼ. 90 degrees of abduction and 90 degrees of external rotation

Ȼ. Sural

Ƚ. Saphenous and its branches

Ⱦ. Posterior tibial and its branches

Ȿ. Deep peroneal and its branches

Ɀ. Superficial peroneal and its branches

Ɂ. Strength

Ɂ. Stiffness

Ƀ. Shelf life

Ʉ. Antigenicity

Ʌ. Risk of HIV transmission

Ɇ. Indemnification

Ɇ. Occurrence

Ɉ. Excess liability

Ɉ. Claims-made

Ɋ. Nose

Ɋ. Lateral Y

Ɍ. Scapular AP

Ɍ. Neutral rotation AP

Ɏ. Internal rotation AP

Ɏ. External rotation AP

Ɐ. Trauma

Ɑ. Hemophilia

Ɒ. Reiter’s syndrome

Ɓ. Rheumatoid arthritis

Ɔ. Systemic lupus erythematosus

ɕ. Cast immobilization for 6 weeks

Ɖ. Activity modification and re-evaluation in 2 months

Ɗ. Internal fixation with or without bone grafting

ɘ. Retrograde drilling of the defect without articular cartilage penetration

Ə. Drilling of the defect directly through the articular cartilage

ɚ. repair or reconstruction of the medial collateral ligament

Ɛ. repair or reconstruction of the medialand lateral collateral ligaments

Ɜ. immobilization for 5 days or less

ɝ. immobilization for 14 days

ɞ. immobilization for 25 days

ɟ. Cystinosis

Ɠ. Hypophosphatemia

Ɡ. Renal osteodystrophy

ɢ. Primary hyperparathyroidism

Ɣ. Nutritional vitamin D deficiency

ɤ. Lateral meniscus tear

Ɥ. Popliteus tenosynovitis

Ɦ. Iliotibial band friction syndrome

ɧ. Peroneal nerve entrapment

Ɨ. Biceps tendinitis

Ɩ. Observation

Ɪ. Removal of the prosthetic components

Ɫ. Operative exploration and decompression of the peroneal nerve

Ɬ. Nerve conduction velocity studies

ɭ. Loosening of the primary dressings and knee flexion to 30 degrees

ɮ. I

Ɯ. II

ɰ. III

Ɱ. decreased tissue tension

Ɲ. decreased abductor lever arm

ɳ. decreased joint reaction force

ɴ. increased body weight over lever arm

Ɵ. increased polyethylene wear rate

ɶ. recurrent traumatic anterior dislocation

ɷ. recurrent traumatic posterior dislocation

ɸ. traumatic subluxation with no previous dislocation

ɹ. traumatic anterior subluxation

ɺ. atraumatic involuntary subluxation

ɻ. radial

ɼ. axillary

Ɽ. suprascapular

ɾ. thoracodorsal

ɿ. long thoracic

Ʀ. Flexion

ʁ. Extension

Ʂ. Axial rotation

Ʃ. Left lateral bending

ʄ. Right lateral bending

ʅ. Skin

ʆ. Lung

Ʇ. Brain

Ʈ. Heart

Ʉ. Kidney

Ʊ. Thoracoacromial, lateral thoracic, subscapular

Ʋ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ʌ. Posterior humeral circumflex, subscapular, thoracacromial

ʍ. Subscapular, thoracacromial, anterior humeral circumflex

ʎ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ʏ. Respondeat superior

ʐ. Indemnity agreement

ʑ. Hold harmless agreement- attempt to shift liability from company to physician

Ʒ. Comparative negligence-% of involvement

ʓ. Contributory negligence- resident contributed to the negligence

ʔ. t-type

ʕ. both column

ʖ. transverse

ʗ. anterior column

ʘ. anterior column posterior hemitransverse

ʙ. Posterior interosseous

ʚ. Anterior interosseous

ʛ. Radial

ʜ. Median

Ʝ. Ulnar

Ʞ. Shock from hypovolemia

ʟ. Associated rupture of the bladder

ʠ. Arterial bleeding on pelvic angiogram

ʡ. Presence of a hematoma in the perineum and scrotum

ʢ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Spinal pseudoarthrosis

Explanation

Question 4144

Topic: 10. Pathology and Oncology

Radiographs of a 20-year-old college athlete who sustained an injury to the ankle reveal no fractures or widening of the ankle mortise. Examination shows swelling at the ankle region and pain with medial lateral compression of the distal tibiofibular joint. Which of the following studies would best help in confirming a diagnosis?

. Inversion stress radiograph

. MRI scan

. CT scan

. Nuclear bone scan

. External rotation stress radiograph

. Complex deformity with an angulation in two planes

. Single deformity less than 20 degrees, apex posterolateral

. Single deformity greater than 30 degrees, apex posterolateral

. Single deformity less than 20 degrees, apex posteromedial

. Single deformity greater than 30 degrees, apex posteromedial

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

!. Isolated traumatic subluxation

". Injury to the axillary nerve after dislocation

#. hypophosphatemia

$. high dietary cholesterol intake

%. deficiency of lipoprotein A

&. deficiency of protein S and protein C

'. elevated levels of antithrombin III

(. Weightbearing short leg cast

). Nonweightbearing short leg cast

*. Removable splint and early motion

+. Open reduction and internal fixation

,. Elastic compression bandage with full weightbearing

-. Breast

.. Prostate

/. Gastrointestinal

0. Kidney

1. Multiple myeloma

2. Varus stress

3. Valgus stress

4. Torsional loading

5. Hyperextension of the knee

6. Contraction of the quadriceps while axially loaded

7. Primary internal fixation at both fracture levels

8. External fixation as definitive ttt for both #

9. Skeletal traction and delayed internal fixation of both fractures

:. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

;. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

<. Heel spur

=. Plantar fascitis

>. Dysfunction of the tibialis posterior tendon

?. Compression of the first branch of the lateral plantar nerve

@. Compression of the calcaneal nerve

A. Displaced labral tear

B. Tear of the rotator cuff

C. Fracture of the glenoid rim

D. Palsy of the axillary nerve

E. Palsy of the musculocutaneus nerve

F. Enchondroma

G. Osteoblastoma

H. Giant cell tumor

I. Aneurysmal bone cyst

J. Fibrous dysplasia

K. Arthrogram of the wrist

L. MRI scan of both wrists

M. CT scan of both wrists in the same position

N. Radiographs of the wrist in supination and pronation

O. Radiographs of the opposite wrist in the same position

P. Secondary hyperparathyroidism

Q. Phosphate retention secondary to uremia

R. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

S. Aluminum deposition in bone from oral phosphate binders

T. Persistent acidosis aggravating the negative calcium balance

U. Posterior fusion at T10-L3 with segmental instrumentation

V. Laminectomy and fusion of T12-L2 with segmental instrumentation

W. Bed rest in a hyperextension brace

X. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

Y. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

Z. Positive-pressure ventilation

[. An immediate radiograph of the chest

\. Adjustment of the position of the endotrachael tube

]. Insertion of a large-bore needle into the pericardial space

^. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

_. Allowing the ends of the fracture to touch

`. Adding a second connecting bar

A. Adding one pin to each fracture fragment

B. Increasing the pin diameter from 4 mm to 6 mm

C. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

D. Osteomyelitis

E. Malignant degeneration

F. Stress fracture

G. Local recurrence of the giant cell tumor

H. Bone resorption due to methylmethacrylate

I. Advancement of the plantar plate

J. Resection of the second metatarsal head

K. Dorsiflexion osteotomy of the second metatarsal neck

L. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

M. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

N. Sacral fracture

O. Burst fracture of L5

P. Cauda equina syndrome

Q. Distraction-flexion injury at L3

R. Distraction-extension injury at L3

S. An MRI scan of the shoulder

T. An MRI scan of the cervical spine

U. Electromyographic and nerve conduction velocity studies

V. Immobilization in a sling and early passive range of motion exercises

W. Immediate return to the operating room for exploration of the brachial plexus

X. cerclage wiring

Y. tension band wiring

Z. removal of the patellar component

{. revision of the patellar component

|. immobilization of the knee and protected weightbearing

}. Liposarcoma

~. Nodular fasciitis

. Rabdomyosarcoma

. Malignant fibrous histiocytoma

. Extra-abdominal desmoid tumor

. Clubfeet

. Thrombocytopenia

. Congenital scoliosis

. Ventricular septal defect

. Arnold-Chiari malformation

. delayed primary closure

. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

¡. E. coli

¢. Staph. aureus

£. group A streptococcus

¤. Clostridium perforingens

¥. observation and exercises

¦. bracing with a thoracolumbar orthosis

§. fusion of the posterior spine

¨. fusion of the anterior spine

©. fusion of the anterior and posterior spine

ª. Total wrist replacement and bridge grafts

«. palmar shelf arthroplasty and tendon transfers

¬. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

®. Total wrist fusion and tendon transfers

¯. constrained acetabular component

°. protrusion ring with morselized graft

±. cemented metal backed acetabular component

². cemented all-polyethylene acetabular component

³. cementless hemispherical component with screw fixation

´. application of a hip abduction brace for 22 hours per day

Μ. application of a hip spica under anesthesia

¶. discontinuance of all bracing and repeat radiographs in 3 months

·. open reduction of the hip and application of a spica cast

¸. open reduction, varus osteotomy, and application of a spica cast

¹. Loss of skin hair on the feet

º. Absent pulses on vascular examination

». Pain that originates proximally and spreads distally

¼. Pain that is relieved by stopping and standing

½. Pain that is worse when the patient walks uphill rather downhill

¾. wrist flexors and finger flexors

¿. elbow flexors and wrist flexors

À. elbow flexors and finger flexors

Á. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

Â. elbow extensors and wrist extensors

Ã. Syndactyly

Ä. Macrodactyly

Å. Camptodactyly

Æ. Preaxial polydactyly

Ç. Postaxial polydactyly

È. Arthrodesis

É. Rotationplasty

Ê. Above-knee amputation

Ë. Osteoarticular allograft

Ì. Endoprosthesis (custom arthroplasty)

Í. Plantar fascia

Î. Spring ligament

Ï. Deltoid ligament

Ð. Intrinsic tendons

Ñ. Gastorcnemius-solelus complex

Ò. Prevention of presynaptic release of acetylcholine

Ó. Prevention of synthesis of presynaptic acetylcholine

Ô. Activation of acetylcholinesterase at the motor end-plate

Õ. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Ö. Stimulation of release of presynaptic acetylcholine until reserves are depleted

×. stiffness of the femoral component.

Ø. head offset of the femoral component.

Ù. femoral component material modulus of elasticity.

Ú. extent of the femoral component porous coating.

Û. Presence of a femoral component collar.

Ü. plantar fascia and quadratus plantae tendon.

Ý. ligamentous structures connecting the tarsal bones.

Þ. shape of the tarsal bones and the intervening joints.

SS. activity of the intrinsic muscles of the foot.

À. activity of the posterior tibialis and the peroneus longus muscles.

Á. scapulothoracic fusion

Â. strengthening of the periscapular muscles

Ã. pectoralis minor-fascia lata graft transfer to the scapula

Ä. pectoralis major-fascia lata graft transfer to the scapula

Å. exploration of the long thoracic nerve, with sural nerve graft

Æ. tricompartmental knee replacement

Ç. unicompartmental knee replacement

È. medial compartment meniscal allograft

É. valgus-producing distal femoral osteotomy

Ê. valgus-producing proximal tibial osteotomy

Ë. Internal rotation of the femoral component

Ì. External rotation of the tibial component

Í. Lateral placement of the femoral component

Î. Medial placement of the patellar component

Ï. Excessive resection of the patella

Ð. Hallux rigidus

Ñ. Hallux valgus

Ò. Neuroma of the first web space

Ó. Fracture of the sesamoid

Ô. Rupture of the flexor hallucis longus

Õ. Sickle cell crisis

Ö. Idiopathic chondrolysis

÷. Hemophilic arthropathy

Ø. Osteoid osteoma of the femoral neck

Ù. Legg-Calve-Perthes disease

Ú. Decreased ankle jerk and positive femoral nerve stretch test

Û. Decreased knee jerk and positive straight-leg raising sign

Ü. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ý. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Þ. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ÿ. Long-term administration of IV and oral antibiotics

Ā. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ā. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ă. Two-stage surgical prosthetic exchange and IV antibiotics

Ă. Resection arthroplasty and IV antibiotics

Ą. SCFE

Ą. MED

Ć. Perthes disease

Ć. Hypothyroidism

Ĉ. Chondrolysis

Ĉ. gout.

Ċ. osteoporosis.

Ċ. eosinophilic granuloma.

Č. tuberculosis of the spine.

Č. metastatic disease of the spine.

Ď. water content.

Ď. Synthesis of type I collagen.

Đ. Proteoglycan content.

Đ. Activity of chondrocytes.

Ē. Synthesis of hyaluronate.

Ē. Lung

Ĕ. Breast

Ĕ. Prostate

Ė. Thyroid

Ė. Renal

Ę. T1-low, T2-low.

Ę. T1-low, T2-high.

Ě. T1-moderate, T2-low.

Ě. T1-high, T2-low.

Ĝ. T1-high, T2-high.

Ĝ. hypothesis is incorrect or invalid

Ğ. interobserver error rate is 4%.

Ğ. Standard deviation is 4% higher or lower than the mean.

Ġ. Sample size is 4% larger than required to be clinically significant.

Ġ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ģ. I

Ģ. II

Ĥ. IV

Ĥ. IX

Ħ. X

Ħ. Cranial setting

Ĩ. Cranial subluxation

Ĩ. Odontoid fracture

Ī. Lysis of the arch of the atlas

Ī. Atlantoaxial subluxation

Ĭ. Retrograde collapse of the endoneurial tubes

Ĭ. Irreversible atrophy of the denervated muscles

Į. Elongation of the axons across the zone of injury

Į. Sprouting of the axons at the neuromuscular junction

İ. Misdirection of the axons across the zone of injury

I. Maximally pronated and elbow extended

Ĳ. Maximally pronated and the elbow flexed

Ĳ. Maximally supinated and the elbow flexed

Ĵ. Maximally supinated and the elbow extended

Ĵ. In neutral rotation, with the elbow extended

Ķ. open reduction and internal fixation

Ķ. buddy taping to the adjacent index finger

ĸ. early motion with application of a dynamic banjo splint

Ĺ. application of a cast with the hand in a “safe position” for 3 weeks.

Ĺ. dorsal extension block splinting

Ļ. The name of the manufacturer

Ļ. The manufacturer’s potential liability

Ľ. The physician’s clinical performance

Ľ. The physician’s materials testing data

Ŀ. Any royalties the physician receives from the manufacturer

Ŀ. Femoral

Ł. Obturator

Ł. Inferior gluteal

Ń. Superior gluteal

Ń. Lateral femoral cutaneous

Ņ. open biopsy and a long leg cast

Ņ. open biopsy and wide resection of the tumor

Ň. a long leg cast and observation

Ň. intramedullary stabilization and observation

ʼN. Triggering

Ŋ. Lateral instability

Ŋ. Swan-neck deformity

Ō. Boutonniere deformity

Ō. Loss of distal interphalangeal joint flexion

Ŏ. Peroneus brevis to peroneus longus

Ŏ. Peroneus tertius to extensor hallucis longus

Ő. Peroneus tertius to superficial peroneal nerve

Ő. Extensor hallucis longus to deep peroneal nerve

Œ. Extensor hallucis longus to extensor digitorum longus

Œ. reassurance that Medicare will pay for the treatment.

Ŕ. consent forms that patients or their guardians are able to understand.

Ŕ. a detailed description of the device, omitting the fact that it is part of a study.

Ŗ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ŗ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ř. an onlay iliac crest bone graft.

Ř. limited weightbearing and observation.

Ś. removal of the implant and limited weightbearing.

Ś. removal of the implant and insertion of a reamed femoral nail.

Ŝ. removal of the implant and insertion of an unreamed femoral nail.

Ŝ. Coronal

Ş. Sagittal

Ş. Anteromedial, midway between the sagittal and the coronal

Š. Proximal pins sagittal, distal pins coronal

Š. Proximal pins coronal, distal pins sagittal

Ţ. Rheumatoid arthritis

Ţ. Posttraumatic arthritis

Ť. Degenerative osteoarthritis

Ť. Osteonecrosis of the tibial plateau

Ŧ. Osteonecrosis of the medial femoral condyle

Ŧ. Trapeziometacarpal arthrodesis

Ũ. Osteotomy of the thumb metacarpal

Ũ. Arthrotomy and joint debridement

Ū. Ligament reconstruction using one half of the flexor carpi radialis

Ū. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŭ. Creep

Ŭ. Relaxation

Ů. Energy dissipation

Ů. Plastic deformation

Ű. Elastic deformation

Ű. bending

Ų. axial loading

Ų. high-speed rotation

Ŵ. direct impact from anteromedial

Ŵ. crush from anteromedial to posterolateral

Ŷ. Increase stiffness

Ŷ. Increase fracture toughness

Ÿ. Increase fatigue strength

Ź. Decrease mechanical strength

Ź. Decrease wear rate

Ż. disuse osteopenia

Ż. paraendocrine effect of the tumor

Ž. abnormally increased density on the right side

Ž. side effect of the treatment of the lesion

S. extensive tumor involvement of the left hip

Ƀ. Sciatic nerve

Ɓ. Superior gluteal artery

Ƃ. Profunda femoris artery

Ƃ. Femoral artery and nerve

Ƅ. External iliac artery and vein

Ƅ. Length

Ɔ. Moment arm

Ƈ. Total volume

Ƈ. Physiologic cross-sectional area

Ɖ. Distribution of slow and fast twitch fibers

Ɗ. decreasing initiation of action potentials.

Ƌ. increasing action potential amplitude.

Ƌ. blocking the opening of gated sodium channels.

ƍ. decreasing the number of functional motor units.

Ǝ. slowing or stopping action potential propagation through the axon.

Ə. resection of the metatarsal heads of the first through fifth toes.

Ɛ. Silastic MP joint arthroplasties of the first through fifth toes.

Ƒ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ƒ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ɠ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ɣ. hemiarthroplasty

Ƕ. open reduction and internal fixation

Ɩ. closed reduction and percutaneous pinning

Ɨ. a sling and early pedulum exercises

Ƙ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ƙ. open acromioplasty

Ƚ. open Bankart repair

ƛ. open subscapularis tendon repair

Ɯ. inferior capsular shift

Ɲ. a supervised physical therapy program

Ƞ. a sling and swathe, with pendulum exercises in 10 days

Ɵ. open reduction and internal fixation through an anterior approach

Ơ. open reduction and internal fixation through a posterior approach

Ơ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƣ. arthroscopically assisted reduction and percutaneous screw fixation

Ƣ. Repair of the rotator cuff

Ƥ. Replacement of the humeral head

Ƥ. Resection arthroplasty

Ʀ. Total shoulder arthroplasty

Ƨ. AP and lateral radiographs of the elbow

Ƨ. Diagnositc arthroscopy

Ʃ. Aspiration of joint fluid

ƪ. An erythrocyte sedimentation rate and CBC

ƫ. A diagnostic lidocaine injection

Ƭ. Insulin-like growth factor (IGF-1)

Ƭ. Fibroblast growth factor (FGF-1)

Ʈ. Platelet-derived growth factor (PDGF)

Ư. Transforming growth factor beta (TGF-B)

Ư. Bone morphogenetic proteins (BMP)

Ʊ. clinical history and radiographic findings.

Ʋ. technetium bone scan

Ƴ. flow cytometry pattern of extracted chondrocytes

Ƴ. immunohistochemical staining patterns of a biopsy specimen

Ƶ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƶ. Radial

Ʒ. Radial recurrent

Ƹ. Posterior interosseous

Ƹ. Superior ulnar recurrent

ƺ. Superficial radial circumflex

ƻ. Impaired hydroxylation of proline

Ƽ. Failure of cleavage in procollagen

Ƽ. Defective binding sites for hydroxyproline

ƾ. Failure to incorporate glycine into the helix

Ƿ. Diminished production of collagen through the rough endoplasmic reticulum

ǀ. Asking the legal staff to seek a court injunction

ǁ. Copying the patient’s chart and giving it to him as he leaves

ǂ. Having the patient sign a written legal contract that specifies acceptable behavior

ǃ. Continuing care of the patient until an appropriate referral can be arranged

Ǆ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ǆ. Meta-analysis

Ǆ. Confidence interval

Ǉ. Analysis of variance (ANOVA)

Ǉ. Statistical significance (p-value)

Ǉ. Survivorship analysis (Kaplan-Meier)

Ǌ. Spinal shock

Ǌ. Neurogenic shock

Ǌ. Hypovolemic shock

Ǎ. Pulmonary embolism

Ǎ. Fat embolus syndrome

Ǐ. Lumbar spinal stenosis

Ǐ. Metastatic disease of the spine

Ǒ. Rheumatoid lumbar spondylitis

Ǒ. Isthmic spondyloloisthesis

Ǔ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǔ. Patella alta

Ǖ. A metal-backed patella

Ǖ. Varus malalignment of the knee

Ǘ. A posterior cruciate-substituting femoral component

Ǘ. Lateral subluxation of the patella on a Merchant’s view

Ǚ. The sesamoids are separated

Ǚ. The sesamoid is fractured

Ǜ. The proximal phx is on the neck of the metatarsal

Ǜ. The dislocation is dorsal and centered

Ǝ. The proximal phalanx is hyperextended

Ǟ. Patella

Ǟ. Tibial stem

Ǡ. Distal femoral interface

Ǡ. Posterior femoral interface

Ǣ. Sites of screw fixation for the tibia

Ǣ. Hallux rigidus

Ǥ. Fracture of the sesamoid

Ǥ. Disruption of the plantar plate

Ǧ. Osteonecrosis of the metatarsal head

Ǧ. Rupture of the flexor hallucis longus

Ǩ. Gout

Ǩ. Sepsis

Ǫ. Old trauma

Ǫ. Rheumatoid arthritis

Ǭ. Charcot arthroplasty

Ǭ. Aspiration and steroid injection

Ǯ. Biopsy, curettage, and allograft bone grafting

Ǯ. Percutaneous Kirschner wire fixation

J̌. Percutaneous injection of autogenous bone marrow

Ǳ. Nerve roots

Ǳ. Spinal cord

Ǳ. Sciatic nerve

Ǵ. Peroneal nerve

Ǵ. Conus medullaris

Ƕ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ƿ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǹ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǹ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǻ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǻ. Early and late infection

Ǽ. Periprosthetic fracture of the femur

Ǽ. Failure of the patellofemoral and extensor mechanisms

Ǿ. Aseptic loosening of cementing tibial components

Ǿ. Asceptic loosening of cemented femoral components

Ȁ. Acceptance of the current position of the ankle

Ȁ. Open reduction and fixation in the epiphysis only

Ȃ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ȃ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ȅ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ȅ. Resection arthroplasty and local radiation

Ȇ. In situ fusion of the hip

Ȇ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ȉ. Excision of heterotopic bone and local radiation

Ȉ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ȋ. Closed reduction of both fractures and immediate spica casting

Ȋ. Bilateral skin traction for 3 weeks, followed by spica casting

Ȍ. External fixation of both femora

Ȍ. External fixation of the left femur and a long leg cast brace for the right femur

Ȏ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȏ. Synovial sarcoma

Ȑ. Soft-tissue abcess

Ȑ. Rhabdomyosarcoma

Ȓ. Eosinophilic granuloma

Ȓ. Nodular pigmented villonodular synovitis

Ȕ. Changing to a titanium nail

Ȕ. Changing to a nonslotted nail

Ȗ. Changing the cross-sectional shape of the nail

Ȗ. Increasing the diameter of the nail by 3 mm

Ș. Increasing the diameter of the interlocking screws

Ș. Fracture healing

Ț. Chondrosarcoma

Ț. Periosteal chondroma

Ȝ. Periosteal osteosarcoma

Ȝ. Dysplasia epiphysealis hemimelica

Ȟ. Demonstrate competence in the subject of the case

Ȟ. Be fellowship trained in the subject of the case

Ƞ. Be paid on a contingency basis

ȡ. Be board certified by the American Board of Orthopaedic Surgery

Ȣ. Have been involved in the case as a consultant

Ȣ. Diagnostic arthroscopy

Ȥ. Arthroscopy and subacromial decompression

Ȥ. Reduction and fixation of the proximal humeral epiphysis

Ȧ. Temporary cessation of throwing

Ȧ. Physical therapy for rotator cuff strengthening

Ȩ. Oblique popliteal ligament

Ȩ. Lateral capsule

Ȫ. Popliteal tendon

Ȫ. Fibular collateral ligament

Ȭ. Posterior oblique ligament

Ȭ. Radial tear

Ȯ. Parrot-beak tear

Ȯ. Vertical tear in the “red-red” zone

Ȱ. Vertical tear in the “red-white” zone

Ȱ. Vertical tear in the “white-white” zone

Ȳ. 0 degrees of abduction, with neural rotation

Ȳ. 40 degrees of flexion and 60 degrees of internal rotation

ȴ. 45 degrees of flexion and 45 degrees of external rotation

ȵ. 90 degrees of abduction with neutral rotation

ȶ. 90 degrees of abduction and 90 degrees of external rotation

ȷ. Sural

ȸ. Saphenous and its branches

ȹ. Posterior tibial and its branches

Ⱥ. Deep peroneal and its branches

Ȼ. Superficial peroneal and its branches

Ȼ. Strength

Ƚ. Stiffness

Ⱦ. Shelf life

Ȿ. Antigenicity

Ɀ. Risk of HIV transmission

Ɂ. Indemnification

Ɂ. Occurrence

Ƀ. Excess liability

Ʉ. Claims-made

Ʌ. Nose

Ɇ. Lateral Y

Ɇ. Scapular AP

Ɉ. Neutral rotation AP

Ɉ. Internal rotation AP

Ɋ. External rotation AP

Ɋ. Trauma

Ɍ. Hemophilia

Ɍ. Reiter’s syndrome

Ɏ. Rheumatoid arthritis

Ɏ. Systemic lupus erythematosus

Ɐ. Cast immobilization for 6 weeks

Ɑ. Activity modification and re-evaluation in 2 months

Ɒ. Internal fixation with or without bone grafting

Ɓ. Retrograde drilling of the defect without articular cartilage penetration

Ɔ. Drilling of the defect directly through the articular cartilage

ɕ. repair or reconstruction of the medial collateral ligament

Ɖ. repair or reconstruction of the medialand lateral collateral ligaments

Ɗ. immobilization for 5 days or less

ɘ. immobilization for 14 days

Ə. immobilization for 25 days

ɚ. Cystinosis

Ɛ. Hypophosphatemia

Ɜ. Renal osteodystrophy

ɝ. Primary hyperparathyroidism

ɞ. Nutritional vitamin D deficiency

ɟ. Lateral meniscus tear

Ɠ. Popliteus tenosynovitis

Ɡ. Iliotibial band friction syndrome

ɢ. Peroneal nerve entrapment

Ɣ. Biceps tendinitis

ɤ. Observation

Ɥ. Removal of the prosthetic components

Ɦ. Operative exploration and decompression of the peroneal nerve

ɧ. Nerve conduction velocity studies

Ɨ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɩ. I

Ɪ. II

Ɫ. III

Ɬ. decreased tissue tension

ɭ. decreased abductor lever arm

ɮ. decreased joint reaction force

Ɯ. increased body weight over lever arm

ɰ. increased polyethylene wear rate

Ɱ. recurrent traumatic anterior dislocation

Ɲ. recurrent traumatic posterior dislocation

ɳ. traumatic subluxation with no previous dislocation

ɴ. traumatic anterior subluxation

Ɵ. atraumatic involuntary subluxation

ɶ. radial

ɷ. axillary

ɸ. suprascapular

ɹ. thoracodorsal

ɺ. long thoracic

ɻ. Flexion

ɼ. Extension

Ɽ. Axial rotation

ɾ. Left lateral bending

ɿ. Right lateral bending

Ʀ. Skin

ʁ. Lung

Ʂ. Brain

Ʃ. Heart

ʄ. Kidney

ʅ. Thoracoacromial, lateral thoracic, subscapular

ʆ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ʇ. Posterior humeral circumflex, subscapular, thoracacromial

Ʈ. Subscapular, thoracacromial, anterior humeral circumflex

Ʉ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ʊ. Respondeat superior

Ʋ. Indemnity agreement

Ʌ. Hold harmless agreement- attempt to shift liability from company to physician

ʍ. Comparative negligence-% of involvement

ʎ. Contributory negligence- resident contributed to the negligence

ʏ. t-type

ʐ. both column

ʑ. transverse

Ʒ. anterior column

ʓ. anterior column posterior hemitransverse

ʔ. Posterior interosseous

ʕ. Anterior interosseous

ʖ. Radial

ʗ. Median

ʘ. Ulnar

ʙ. Shock from hypovolemia

ʚ. Associated rupture of the bladder

ʛ. Arterial bleeding on pelvic angiogram

ʜ. Presence of a hematoma in the perineum and scrotum

Ʝ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Inversion stress radiograph

Explanation

Question 4145

Topic: 10. Pathology and Oncology

A healed fracture of the tibia that demonstrates 25 degrees apex posterior angulation and 28 degrees varus angulation on AP and lateral radiographs is most accurately described as a

. Complex deformity with an angulation in two planes

. Single deformity less than 20 degrees, apex posterolateral

. Single deformity greater than 30 degrees, apex posterolateral

. Single deformity less than 20 degrees, apex posteromedial

. Single deformity greater than 30 degrees, apex posteromedial

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

!. deficiency of protein S and protein C

". elevated levels of antithrombin III

#. Weightbearing short leg cast

$. Nonweightbearing short leg cast

%. Removable splint and early motion

&. Open reduction and internal fixation

'. Elastic compression bandage with full weightbearing

(. Breast

). Prostate

*. Gastrointestinal

+. Kidney

,. Multiple myeloma

-. Varus stress

.. Valgus stress

/. Torsional loading

0. Hyperextension of the knee

1. Contraction of the quadriceps while axially loaded

2. Primary internal fixation at both fracture levels

3. External fixation as definitive ttt for both #

4. Skeletal traction and delayed internal fixation of both fractures

5. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

6. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

7. Heel spur

8. Plantar fascitis

9. Dysfunction of the tibialis posterior tendon

:. Compression of the first branch of the lateral plantar nerve

;. Compression of the calcaneal nerve

<. Displaced labral tear

=. Tear of the rotator cuff

>. Fracture of the glenoid rim

?. Palsy of the axillary nerve

@. Palsy of the musculocutaneus nerve

A. Enchondroma

B. Osteoblastoma

C. Giant cell tumor

D. Aneurysmal bone cyst

E. Fibrous dysplasia

F. Arthrogram of the wrist

G. MRI scan of both wrists

H. CT scan of both wrists in the same position

I. Radiographs of the wrist in supination and pronation

J. Radiographs of the opposite wrist in the same position

K. Secondary hyperparathyroidism

L. Phosphate retention secondary to uremia

M. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

N. Aluminum deposition in bone from oral phosphate binders

O. Persistent acidosis aggravating the negative calcium balance

P. Posterior fusion at T10-L3 with segmental instrumentation

Q. Laminectomy and fusion of T12-L2 with segmental instrumentation

R. Bed rest in a hyperextension brace

S. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

T. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

U. Positive-pressure ventilation

V. An immediate radiograph of the chest

W. Adjustment of the position of the endotrachael tube

X. Insertion of a large-bore needle into the pericardial space

Y. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

Z. Allowing the ends of the fracture to touch

[. Adding a second connecting bar

\. Adding one pin to each fracture fragment

]. Increasing the pin diameter from 4 mm to 6 mm

^. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

_. Osteomyelitis

`. Malignant degeneration

A. Stress fracture

B. Local recurrence of the giant cell tumor

C. Bone resorption due to methylmethacrylate

D. Advancement of the plantar plate

E. Resection of the second metatarsal head

F. Dorsiflexion osteotomy of the second metatarsal neck

G. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

H. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

I. Sacral fracture

J. Burst fracture of L5

K. Cauda equina syndrome

L. Distraction-flexion injury at L3

M. Distraction-extension injury at L3

N. An MRI scan of the shoulder

O. An MRI scan of the cervical spine

P. Electromyographic and nerve conduction velocity studies

Q. Immobilization in a sling and early passive range of motion exercises

R. Immediate return to the operating room for exploration of the brachial plexus

S. cerclage wiring

T. tension band wiring

U. removal of the patellar component

V. revision of the patellar component

W. immobilization of the knee and protected weightbearing

X. Liposarcoma

Y. Nodular fasciitis

Z. Rabdomyosarcoma

{. Malignant fibrous histiocytoma

|. Extra-abdominal desmoid tumor

}. Clubfeet

~. Thrombocytopenia

. Congenital scoliosis

. Ventricular septal defect

. Arnold-Chiari malformation

. delayed primary closure

. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

¡. bracing with a thoracolumbar orthosis

¢. fusion of the posterior spine

£. fusion of the anterior spine

¤. fusion of the anterior and posterior spine

¥. Total wrist replacement and bridge grafts

¦. palmar shelf arthroplasty and tendon transfers

§. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

¨. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

©. Total wrist fusion and tendon transfers

ª. constrained acetabular component

«. protrusion ring with morselized graft

¬. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

®. cementless hemispherical component with screw fixation

¯. application of a hip abduction brace for 22 hours per day

°. application of a hip spica under anesthesia

±. discontinuance of all bracing and repeat radiographs in 3 months

². open reduction of the hip and application of a spica cast

³. open reduction, varus osteotomy, and application of a spica cast

´. Loss of skin hair on the feet

Μ. Absent pulses on vascular examination

¶. Pain that originates proximally and spreads distally

·. Pain that is relieved by stopping and standing

¸. Pain that is worse when the patient walks uphill rather downhill

¹. wrist flexors and finger flexors

º. elbow flexors and wrist flexors

». elbow flexors and finger flexors

¼. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

½. elbow extensors and wrist extensors

¾. Syndactyly

¿. Macrodactyly

À. Camptodactyly

Á. Preaxial polydactyly

Â. Postaxial polydactyly

Ã. Arthrodesis

Ä. Rotationplasty

Å. Above-knee amputation

Æ. Osteoarticular allograft

Ç. Endoprosthesis (custom arthroplasty)

È. Plantar fascia

É. Spring ligament

Ê. Deltoid ligament

Ë. Intrinsic tendons

Ì. Gastorcnemius-solelus complex

Í. Prevention of presynaptic release of acetylcholine

Î. Prevention of synthesis of presynaptic acetylcholine

Ï. Activation of acetylcholinesterase at the motor end-plate

Ð. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Ñ. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Ò. stiffness of the femoral component.

Ó. head offset of the femoral component.

Ô. femoral component material modulus of elasticity.

Õ. extent of the femoral component porous coating.

Ö. Presence of a femoral component collar.

×. plantar fascia and quadratus plantae tendon.

Ø. ligamentous structures connecting the tarsal bones.

Ù. shape of the tarsal bones and the intervening joints.

Ú. activity of the intrinsic muscles of the foot.

Û. activity of the posterior tibialis and the peroneus longus muscles.

Ü. scapulothoracic fusion

Ý. strengthening of the periscapular muscles

Þ. pectoralis minor-fascia lata graft transfer to the scapula

SS. pectoralis major-fascia lata graft transfer to the scapula

À. exploration of the long thoracic nerve, with sural nerve graft

Á. tricompartmental knee replacement

Â. unicompartmental knee replacement

Ã. medial compartment meniscal allograft

Ä. valgus-producing distal femoral osteotomy

Å. valgus-producing proximal tibial osteotomy

Æ. Internal rotation of the femoral component

Ç. External rotation of the tibial component

È. Lateral placement of the femoral component

É. Medial placement of the patellar component

Ê. Excessive resection of the patella

Ë. Hallux rigidus

Ì. Hallux valgus

Í. Neuroma of the first web space

Î. Fracture of the sesamoid

Ï. Rupture of the flexor hallucis longus

Ð. Sickle cell crisis

Ñ. Idiopathic chondrolysis

Ò. Hemophilic arthropathy

Ó. Osteoid osteoma of the femoral neck

Ô. Legg-Calve-Perthes disease

Õ. Decreased ankle jerk and positive femoral nerve stretch test

Ö. Decreased knee jerk and positive straight-leg raising sign

÷. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ø. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ù. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ú. Long-term administration of IV and oral antibiotics

Û. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ü. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ý. Two-stage surgical prosthetic exchange and IV antibiotics

Þ. Resection arthroplasty and IV antibiotics

Ÿ. SCFE

Ā. MED

Ā. Perthes disease

Ă. Hypothyroidism

Ă. Chondrolysis

Ą. gout.

Ą. osteoporosis.

Ć. eosinophilic granuloma.

Ć. tuberculosis of the spine.

Ĉ. metastatic disease of the spine.

Ĉ. water content.

Ċ. Synthesis of type I collagen.

Ċ. Proteoglycan content.

Č. Activity of chondrocytes.

Č. Synthesis of hyaluronate.

Ď. Lung

Ď. Breast

Đ. Prostate

Đ. Thyroid

Ē. Renal

Ē. T1-low, T2-low.

Ĕ. T1-low, T2-high.

Ĕ. T1-moderate, T2-low.

Ė. T1-high, T2-low.

Ė. T1-high, T2-high.

Ę. hypothesis is incorrect or invalid

Ę. interobserver error rate is 4%.

Ě. Standard deviation is 4% higher or lower than the mean.

Ě. Sample size is 4% larger than required to be clinically significant.

Ĝ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ĝ. I

Ğ. II

Ğ. IV

Ġ. IX

Ġ. X

Ģ. Cranial setting

Ģ. Cranial subluxation

Ĥ. Odontoid fracture

Ĥ. Lysis of the arch of the atlas

Ħ. Atlantoaxial subluxation

Ħ. Retrograde collapse of the endoneurial tubes

Ĩ. Irreversible atrophy of the denervated muscles

Ĩ. Elongation of the axons across the zone of injury

Ī. Sprouting of the axons at the neuromuscular junction

Ī. Misdirection of the axons across the zone of injury

Ĭ. Maximally pronated and elbow extended

Ĭ. Maximally pronated and the elbow flexed

Į. Maximally supinated and the elbow flexed

Į. Maximally supinated and the elbow extended

İ. In neutral rotation, with the elbow extended

I. open reduction and internal fixation

Ĳ. buddy taping to the adjacent index finger

Ĳ. early motion with application of a dynamic banjo splint

Ĵ. application of a cast with the hand in a “safe position” for 3 weeks.

Ĵ. dorsal extension block splinting

Ķ. The name of the manufacturer

Ķ. The manufacturer’s potential liability

ĸ. The physician’s clinical performance

Ĺ. The physician’s materials testing data

Ĺ. Any royalties the physician receives from the manufacturer

Ļ. Femoral

Ļ. Obturator

Ľ. Inferior gluteal

Ľ. Superior gluteal

Ŀ. Lateral femoral cutaneous

Ŀ. open biopsy and a long leg cast

Ł. open biopsy and wide resection of the tumor

Ł. a long leg cast and observation

Ń. intramedullary stabilization and observation

Ń. Triggering

Ņ. Lateral instability

Ņ. Swan-neck deformity

Ň. Boutonniere deformity

Ň. Loss of distal interphalangeal joint flexion

ʼN. Peroneus brevis to peroneus longus

Ŋ. Peroneus tertius to extensor hallucis longus

Ŋ. Peroneus tertius to superficial peroneal nerve

Ō. Extensor hallucis longus to deep peroneal nerve

Ō. Extensor hallucis longus to extensor digitorum longus

Ŏ. reassurance that Medicare will pay for the treatment.

Ŏ. consent forms that patients or their guardians are able to understand.

Ő. a detailed description of the device, omitting the fact that it is part of a study.

Ő. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Œ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Œ. an onlay iliac crest bone graft.

Ŕ. limited weightbearing and observation.

Ŕ. removal of the implant and limited weightbearing.

Ŗ. removal of the implant and insertion of a reamed femoral nail.

Ŗ. removal of the implant and insertion of an unreamed femoral nail.

Ř. Coronal

Ř. Sagittal

Ś. Anteromedial, midway between the sagittal and the coronal

Ś. Proximal pins sagittal, distal pins coronal

Ŝ. Proximal pins coronal, distal pins sagittal

Ŝ. Rheumatoid arthritis

Ş. Posttraumatic arthritis

Ş. Degenerative osteoarthritis

Š. Osteonecrosis of the tibial plateau

Š. Osteonecrosis of the medial femoral condyle

Ţ. Trapeziometacarpal arthrodesis

Ţ. Osteotomy of the thumb metacarpal

Ť. Arthrotomy and joint debridement

Ť. Ligament reconstruction using one half of the flexor carpi radialis

Ŧ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŧ. Creep

Ũ. Relaxation

Ũ. Energy dissipation

Ū. Plastic deformation

Ū. Elastic deformation

Ŭ. bending

Ŭ. axial loading

Ů. high-speed rotation

Ů. direct impact from anteromedial

Ű. crush from anteromedial to posterolateral

Ű. Increase stiffness

Ų. Increase fracture toughness

Ų. Increase fatigue strength

Ŵ. Decrease mechanical strength

Ŵ. Decrease wear rate

Ŷ. disuse osteopenia

Ŷ. paraendocrine effect of the tumor

Ÿ. abnormally increased density on the right side

Ź. side effect of the treatment of the lesion

Ź. extensive tumor involvement of the left hip

Ż. Sciatic nerve

Ż. Superior gluteal artery

Ž. Profunda femoris artery

Ž. Femoral artery and nerve

S. External iliac artery and vein

Ƀ. Length

Ɓ. Moment arm

Ƃ. Total volume

Ƃ. Physiologic cross-sectional area

Ƅ. Distribution of slow and fast twitch fibers

Ƅ. decreasing initiation of action potentials.

Ɔ. increasing action potential amplitude.

Ƈ. blocking the opening of gated sodium channels.

Ƈ. decreasing the number of functional motor units.

Ɖ. slowing or stopping action potential propagation through the axon.

Ɗ. resection of the metatarsal heads of the first through fifth toes.

Ƌ. Silastic MP joint arthroplasties of the first through fifth toes.

Ƌ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

ƍ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ǝ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ə. hemiarthroplasty

Ɛ. open reduction and internal fixation

Ƒ. closed reduction and percutaneous pinning

Ƒ. a sling and early pedulum exercises

Ɠ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ɣ. open acromioplasty

Ƕ. open Bankart repair

Ɩ. open subscapularis tendon repair

Ɨ. inferior capsular shift

Ƙ. a supervised physical therapy program

Ƙ. a sling and swathe, with pendulum exercises in 10 days

Ƚ. open reduction and internal fixation through an anterior approach

ƛ. open reduction and internal fixation through a posterior approach

Ɯ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ɲ. arthroscopically assisted reduction and percutaneous screw fixation

Ƞ. Repair of the rotator cuff

Ɵ. Replacement of the humeral head

Ơ. Resection arthroplasty

Ơ. Total shoulder arthroplasty

Ƣ. AP and lateral radiographs of the elbow

Ƣ. Diagnositc arthroscopy

Ƥ. Aspiration of joint fluid

Ƥ. An erythrocyte sedimentation rate and CBC

Ʀ. A diagnostic lidocaine injection

Ƨ. Insulin-like growth factor (IGF-1)

Ƨ. Fibroblast growth factor (FGF-1)

Ʃ. Platelet-derived growth factor (PDGF)

ƪ. Transforming growth factor beta (TGF-B)

ƫ. Bone morphogenetic proteins (BMP)

Ƭ. clinical history and radiographic findings.

Ƭ. technetium bone scan

Ʈ. flow cytometry pattern of extracted chondrocytes

Ư. immunohistochemical staining patterns of a biopsy specimen

Ư. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ʊ. Radial

Ʋ. Radial recurrent

Ƴ. Posterior interosseous

Ƴ. Superior ulnar recurrent

Ƶ. Superficial radial circumflex

Ƶ. Impaired hydroxylation of proline

Ʒ. Failure of cleavage in procollagen

Ƹ. Defective binding sites for hydroxyproline

Ƹ. Failure to incorporate glycine into the helix

ƺ. Diminished production of collagen through the rough endoplasmic reticulum

ƻ. Asking the legal staff to seek a court injunction

Ƽ. Copying the patient’s chart and giving it to him as he leaves

Ƽ. Having the patient sign a written legal contract that specifies acceptable behavior

ƾ. Continuing care of the patient until an appropriate referral can be arranged

Ƿ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

ǀ. Meta-analysis

ǁ. Confidence interval

ǂ. Analysis of variance (ANOVA)

ǃ. Statistical significance (p-value)

Ǆ. Survivorship analysis (Kaplan-Meier)

Ǆ. Spinal shock

Ǆ. Neurogenic shock

Ǉ. Hypovolemic shock

Ǉ. Pulmonary embolism

Ǉ. Fat embolus syndrome

Ǌ. Lumbar spinal stenosis

Ǌ. Metastatic disease of the spine

Ǌ. Rheumatoid lumbar spondylitis

Ǎ. Isthmic spondyloloisthesis

Ǎ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǐ. Patella alta

Ǐ. A metal-backed patella

Ǒ. Varus malalignment of the knee

Ǒ. A posterior cruciate-substituting femoral component

Ǔ. Lateral subluxation of the patella on a Merchant’s view

Ǔ. The sesamoids are separated

Ǖ. The sesamoid is fractured

Ǖ. The proximal phx is on the neck of the metatarsal

Ǘ. The dislocation is dorsal and centered

Ǘ. The proximal phalanx is hyperextended

Ǚ. Patella

Ǚ. Tibial stem

Ǜ. Distal femoral interface

Ǜ. Posterior femoral interface

Ǝ. Sites of screw fixation for the tibia

Ǟ. Hallux rigidus

Ǟ. Fracture of the sesamoid

Ǡ. Disruption of the plantar plate

Ǡ. Osteonecrosis of the metatarsal head

Ǣ. Rupture of the flexor hallucis longus

Ǣ. Gout

Ǥ. Sepsis

Ǥ. Old trauma

Ǧ. Rheumatoid arthritis

Ǧ. Charcot arthroplasty

Ǩ. Aspiration and steroid injection

Ǩ. Biopsy, curettage, and allograft bone grafting

Ǫ. Percutaneous Kirschner wire fixation

Ǫ. Percutaneous injection of autogenous bone marrow

Ǭ. Nerve roots

Ǭ. Spinal cord

Ǯ. Sciatic nerve

Ǯ. Peroneal nerve

J̌. Conus medullaris

Ǳ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǳ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǳ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǵ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǵ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ƕ. Early and late infection

Ƿ. Periprosthetic fracture of the femur

Ǹ. Failure of the patellofemoral and extensor mechanisms

Ǹ. Aseptic loosening of cementing tibial components

Ǻ. Asceptic loosening of cemented femoral components

Ǻ. Acceptance of the current position of the ankle

Ǽ. Open reduction and fixation in the epiphysis only

Ǽ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǿ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǿ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ȁ. Resection arthroplasty and local radiation

Ȁ. In situ fusion of the hip

Ȃ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ȃ. Excision of heterotopic bone and local radiation

Ȅ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ȅ. Closed reduction of both fractures and immediate spica casting

Ȇ. Bilateral skin traction for 3 weeks, followed by spica casting

Ȇ. External fixation of both femora

Ȉ. External fixation of the left femur and a long leg cast brace for the right femur

Ȉ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȋ. Synovial sarcoma

Ȋ. Soft-tissue abcess

Ȍ. Rhabdomyosarcoma

Ȍ. Eosinophilic granuloma

Ȏ. Nodular pigmented villonodular synovitis

Ȏ. Changing to a titanium nail

Ȑ. Changing to a nonslotted nail

Ȑ. Changing the cross-sectional shape of the nail

Ȓ. Increasing the diameter of the nail by 3 mm

Ȓ. Increasing the diameter of the interlocking screws

Ȕ. Fracture healing

Ȕ. Chondrosarcoma

Ȗ. Periosteal chondroma

Ȗ. Periosteal osteosarcoma

Ș. Dysplasia epiphysealis hemimelica

Ș. Demonstrate competence in the subject of the case

Ț. Be fellowship trained in the subject of the case

Ț. Be paid on a contingency basis

Ȝ. Be board certified by the American Board of Orthopaedic Surgery

Ȝ. Have been involved in the case as a consultant

Ȟ. Diagnostic arthroscopy

Ȟ. Arthroscopy and subacromial decompression

Ƞ. Reduction and fixation of the proximal humeral epiphysis

ȡ. Temporary cessation of throwing

Ȣ. Physical therapy for rotator cuff strengthening

Ȣ. Oblique popliteal ligament

Ȥ. Lateral capsule

Ȥ. Popliteal tendon

Ȧ. Fibular collateral ligament

Ȧ. Posterior oblique ligament

Ȩ. Radial tear

Ȩ. Parrot-beak tear

Ȫ. Vertical tear in the “red-red” zone

Ȫ. Vertical tear in the “red-white” zone

Ȭ. Vertical tear in the “white-white” zone

Ȭ. 0 degrees of abduction, with neural rotation

Ȯ. 40 degrees of flexion and 60 degrees of internal rotation

Ȯ. 45 degrees of flexion and 45 degrees of external rotation

Ȱ. 90 degrees of abduction with neutral rotation

Ȱ. 90 degrees of abduction and 90 degrees of external rotation

Ȳ. Sural

Ȳ. Saphenous and its branches

ȴ. Posterior tibial and its branches

ȵ. Deep peroneal and its branches

ȶ. Superficial peroneal and its branches

ȷ. Strength

ȸ. Stiffness

ȹ. Shelf life

Ⱥ. Antigenicity

Ȼ. Risk of HIV transmission

Ȼ. Indemnification

Ƚ. Occurrence

Ⱦ. Excess liability

Ȿ. Claims-made

Ɀ. Nose

Ɂ. Lateral Y

Ɂ. Scapular AP

Ƀ. Neutral rotation AP

Ʉ. Internal rotation AP

Ʌ. External rotation AP

Ɇ. Trauma

Ɇ. Hemophilia

Ɉ. Reiter’s syndrome

Ɉ. Rheumatoid arthritis

Ɋ. Systemic lupus erythematosus

Ɋ. Cast immobilization for 6 weeks

Ɍ. Activity modification and re-evaluation in 2 months

Ɍ. Internal fixation with or without bone grafting

Ɏ. Retrograde drilling of the defect without articular cartilage penetration

Ɏ. Drilling of the defect directly through the articular cartilage

Ɐ. repair or reconstruction of the medial collateral ligament

Ɑ. repair or reconstruction of the medialand lateral collateral ligaments

Ɒ. immobilization for 5 days or less

Ɓ. immobilization for 14 days

Ɔ. immobilization for 25 days

ɕ. Cystinosis

Ɖ. Hypophosphatemia

Ɗ. Renal osteodystrophy

ɘ. Primary hyperparathyroidism

Ə. Nutritional vitamin D deficiency

ɚ. Lateral meniscus tear

Ɛ. Popliteus tenosynovitis

Ɜ. Iliotibial band friction syndrome

ɝ. Peroneal nerve entrapment

ɞ. Biceps tendinitis

ɟ. Observation

Ɠ. Removal of the prosthetic components

Ɡ. Operative exploration and decompression of the peroneal nerve

ɢ. Nerve conduction velocity studies

Ɣ. Loosening of the primary dressings and knee flexion to 30 degrees

ɤ. I

Ɥ. II

Ɦ. III

ɧ. decreased tissue tension

Ɨ. decreased abductor lever arm

Ɩ. decreased joint reaction force

Ɪ. increased body weight over lever arm

Ɫ. increased polyethylene wear rate

Ɬ. recurrent traumatic anterior dislocation

ɭ. recurrent traumatic posterior dislocation

ɮ. traumatic subluxation with no previous dislocation

Ɯ. traumatic anterior subluxation

ɰ. atraumatic involuntary subluxation

Ɱ. radial

Ɲ. axillary

ɳ. suprascapular

ɴ. thoracodorsal

Ɵ. long thoracic

ɶ. Flexion

ɷ. Extension

ɸ. Axial rotation

ɹ. Left lateral bending

ɺ. Right lateral bending

ɻ. Skin

ɼ. Lung

Ɽ. Brain

ɾ. Heart

ɿ. Kidney

Ʀ. Thoracoacromial, lateral thoracic, subscapular

ʁ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ʂ. Posterior humeral circumflex, subscapular, thoracacromial

Ʃ. Subscapular, thoracacromial, anterior humeral circumflex

ʄ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ʅ. Respondeat superior

ʆ. Indemnity agreement

Ʇ. Hold harmless agreement- attempt to shift liability from company to physician

Ʈ. Comparative negligence-% of involvement

Ʉ. Contributory negligence- resident contributed to the negligence

Ʊ. t-type

Ʋ. both column

Ʌ. transverse

ʍ. anterior column

ʎ. anterior column posterior hemitransverse

ʏ. Posterior interosseous

ʐ. Anterior interosseous

ʑ. Radial

Ʒ. Median

ʓ. Ulnar

ʔ. Shock from hypovolemia

ʕ. Associated rupture of the bladder

ʖ. Arterial bleeding on pelvic angiogram

ʗ. Presence of a hematoma in the perineum and scrotum

ʘ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Complex deformity with an angulation in two planes

Explanation

Question 4146

Topic: 10. Pathology and Oncology

A normal functioning posterior tibialis tendon is best confirmed by which of the following physical findings?

. Pronation of the foot during the stance phase of gait

. Heel inversion at the beginning of a single limb heel rise

. Active inversion of the nonweightbearing foot

. Active plantar flexion of the first ray against resistance

. Active plantar flexion of the foot during the push-off phase of gait

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

!. Open reduction and internal fixation

". Elastic compression bandage with full weightbearing

#. Breast

$. Prostate

%. Gastrointestinal

&. Kidney

'. Multiple myeloma

(. Varus stress

). Valgus stress

*. Torsional loading

+. Hyperextension of the knee

,. Contraction of the quadriceps while axially loaded

-. Primary internal fixation at both fracture levels

.. External fixation as definitive ttt for both #

/. Skeletal traction and delayed internal fixation of both fractures

0. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

1. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

2. Heel spur

3. Plantar fascitis

4. Dysfunction of the tibialis posterior tendon

5. Compression of the first branch of the lateral plantar nerve

6. Compression of the calcaneal nerve

7. Displaced labral tear

8. Tear of the rotator cuff

9. Fracture of the glenoid rim

:. Palsy of the axillary nerve

;. Palsy of the musculocutaneus nerve

<. Enchondroma

=. Osteoblastoma

>. Giant cell tumor

?. Aneurysmal bone cyst

@. Fibrous dysplasia

A. Arthrogram of the wrist

B. MRI scan of both wrists

C. CT scan of both wrists in the same position

D. Radiographs of the wrist in supination and pronation

E. Radiographs of the opposite wrist in the same position

F. Secondary hyperparathyroidism

G. Phosphate retention secondary to uremia

H. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

I. Aluminum deposition in bone from oral phosphate binders

J. Persistent acidosis aggravating the negative calcium balance

K. Posterior fusion at T10-L3 with segmental instrumentation

L. Laminectomy and fusion of T12-L2 with segmental instrumentation

M. Bed rest in a hyperextension brace

N. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

O. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

P. Positive-pressure ventilation

Q. An immediate radiograph of the chest

R. Adjustment of the position of the endotrachael tube

S. Insertion of a large-bore needle into the pericardial space

T. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

U. Allowing the ends of the fracture to touch

V. Adding a second connecting bar

W. Adding one pin to each fracture fragment

X. Increasing the pin diameter from 4 mm to 6 mm

Y. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

Z. Osteomyelitis

[. Malignant degeneration

\. Stress fracture

]. Local recurrence of the giant cell tumor

^. Bone resorption due to methylmethacrylate

_. Advancement of the plantar plate

`. Resection of the second metatarsal head

A. Dorsiflexion osteotomy of the second metatarsal neck

B. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

C. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

D. Sacral fracture

E. Burst fracture of L5

F. Cauda equina syndrome

G. Distraction-flexion injury at L3

H. Distraction-extension injury at L3

I. An MRI scan of the shoulder

J. An MRI scan of the cervical spine

K. Electromyographic and nerve conduction velocity studies

L. Immobilization in a sling and early passive range of motion exercises

M. Immediate return to the operating room for exploration of the brachial plexus

N. cerclage wiring

O. tension band wiring

P. removal of the patellar component

Q. revision of the patellar component

R. immobilization of the knee and protected weightbearing

S. Liposarcoma

T. Nodular fasciitis

U. Rabdomyosarcoma

V. Malignant fibrous histiocytoma

W. Extra-abdominal desmoid tumor

X. Clubfeet

Y. Thrombocytopenia

Z. Congenital scoliosis

{. Ventricular septal defect

|. Arnold-Chiari malformation

}. delayed primary closure

~. free flap

. pedicle groin flap

. full-thickness skin graft

. split-thickness skin graft

. Infection

. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

¡. palmar shelf arthroplasty and tendon transfers

¢. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

£. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

¤. Total wrist fusion and tendon transfers

¥. constrained acetabular component

¦. protrusion ring with morselized graft

§. cemented metal backed acetabular component

¨. cemented all-polyethylene acetabular component

©. cementless hemispherical component with screw fixation

ª. application of a hip abduction brace for 22 hours per day

«. application of a hip spica under anesthesia

¬. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

®. open reduction, varus osteotomy, and application of a spica cast

¯. Loss of skin hair on the feet

°. Absent pulses on vascular examination

±. Pain that originates proximally and spreads distally

². Pain that is relieved by stopping and standing

³. Pain that is worse when the patient walks uphill rather downhill

´. wrist flexors and finger flexors

Μ. elbow flexors and wrist flexors

¶. elbow flexors and finger flexors

·. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

¸. elbow extensors and wrist extensors

¹. Syndactyly

º. Macrodactyly

». Camptodactyly

¼. Preaxial polydactyly

½. Postaxial polydactyly

¾. Arthrodesis

¿. Rotationplasty

À. Above-knee amputation

Á. Osteoarticular allograft

Â. Endoprosthesis (custom arthroplasty)

Ã. Plantar fascia

Ä. Spring ligament

Å. Deltoid ligament

Æ. Intrinsic tendons

Ç. Gastorcnemius-solelus complex

È. Prevention of presynaptic release of acetylcholine

É. Prevention of synthesis of presynaptic acetylcholine

Ê. Activation of acetylcholinesterase at the motor end-plate

Ë. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Ì. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Í. stiffness of the femoral component.

Î. head offset of the femoral component.

Ï. femoral component material modulus of elasticity.

Ð. extent of the femoral component porous coating.

Ñ. Presence of a femoral component collar.

Ò. plantar fascia and quadratus plantae tendon.

Ó. ligamentous structures connecting the tarsal bones.

Ô. shape of the tarsal bones and the intervening joints.

Õ. activity of the intrinsic muscles of the foot.

Ö. activity of the posterior tibialis and the peroneus longus muscles.

×. scapulothoracic fusion

Ø. strengthening of the periscapular muscles

Ù. pectoralis minor-fascia lata graft transfer to the scapula

Ú. pectoralis major-fascia lata graft transfer to the scapula

Û. exploration of the long thoracic nerve, with sural nerve graft

Ü. tricompartmental knee replacement

Ý. unicompartmental knee replacement

Þ. medial compartment meniscal allograft

SS. valgus-producing distal femoral osteotomy

À. valgus-producing proximal tibial osteotomy

Á. Internal rotation of the femoral component

Â. External rotation of the tibial component

Ã. Lateral placement of the femoral component

Ä. Medial placement of the patellar component

Å. Excessive resection of the patella

Æ. Hallux rigidus

Ç. Hallux valgus

È. Neuroma of the first web space

É. Fracture of the sesamoid

Ê. Rupture of the flexor hallucis longus

Ë. Sickle cell crisis

Ì. Idiopathic chondrolysis

Í. Hemophilic arthropathy

Î. Osteoid osteoma of the femoral neck

Ï. Legg-Calve-Perthes disease

Ð. Decreased ankle jerk and positive femoral nerve stretch test

Ñ. Decreased knee jerk and positive straight-leg raising sign

Ò. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ó. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ô. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Õ. Long-term administration of IV and oral antibiotics

Ö. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

÷. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ø. Two-stage surgical prosthetic exchange and IV antibiotics

Ù. Resection arthroplasty and IV antibiotics

Ú. SCFE

Û. MED

Ü. Perthes disease

Ý. Hypothyroidism

Þ. Chondrolysis

Ÿ. gout.

Ā. osteoporosis.

Ā. eosinophilic granuloma.

Ă. tuberculosis of the spine.

Ă. metastatic disease of the spine.

Ą. water content.

Ą. Synthesis of type I collagen.

Ć. Proteoglycan content.

Ć. Activity of chondrocytes.

Ĉ. Synthesis of hyaluronate.

Ĉ. Lung

Ċ. Breast

Ċ. Prostate

Č. Thyroid

Č. Renal

Ď. T1-low, T2-low.

Ď. T1-low, T2-high.

Đ. T1-moderate, T2-low.

Đ. T1-high, T2-low.

Ē. T1-high, T2-high.

Ē. hypothesis is incorrect or invalid

Ĕ. interobserver error rate is 4%.

Ĕ. Standard deviation is 4% higher or lower than the mean.

Ė. Sample size is 4% larger than required to be clinically significant.

Ė. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ę. I

Ę. II

Ě. IV

Ě. IX

Ĝ. X

Ĝ. Cranial setting

Ğ. Cranial subluxation

Ğ. Odontoid fracture

Ġ. Lysis of the arch of the atlas

Ġ. Atlantoaxial subluxation

Ģ. Retrograde collapse of the endoneurial tubes

Ģ. Irreversible atrophy of the denervated muscles

Ĥ. Elongation of the axons across the zone of injury

Ĥ. Sprouting of the axons at the neuromuscular junction

Ħ. Misdirection of the axons across the zone of injury

Ħ. Maximally pronated and elbow extended

Ĩ. Maximally pronated and the elbow flexed

Ĩ. Maximally supinated and the elbow flexed

Ī. Maximally supinated and the elbow extended

Ī. In neutral rotation, with the elbow extended

Ĭ. open reduction and internal fixation

Ĭ. buddy taping to the adjacent index finger

Į. early motion with application of a dynamic banjo splint

Į. application of a cast with the hand in a “safe position” for 3 weeks.

İ. dorsal extension block splinting

I. The name of the manufacturer

Ĳ. The manufacturer’s potential liability

Ĳ. The physician’s clinical performance

Ĵ. The physician’s materials testing data

Ĵ. Any royalties the physician receives from the manufacturer

Ķ. Femoral

Ķ. Obturator

ĸ. Inferior gluteal

Ĺ. Superior gluteal

Ĺ. Lateral femoral cutaneous

Ļ. open biopsy and a long leg cast

Ļ. open biopsy and wide resection of the tumor

Ľ. a long leg cast and observation

Ľ. intramedullary stabilization and observation

Ŀ. Triggering

Ŀ. Lateral instability

Ł. Swan-neck deformity

Ł. Boutonniere deformity

Ń. Loss of distal interphalangeal joint flexion

Ń. Peroneus brevis to peroneus longus

Ņ. Peroneus tertius to extensor hallucis longus

Ņ. Peroneus tertius to superficial peroneal nerve

Ň. Extensor hallucis longus to deep peroneal nerve

Ň. Extensor hallucis longus to extensor digitorum longus

ʼN. reassurance that Medicare will pay for the treatment.

Ŋ. consent forms that patients or their guardians are able to understand.

Ŋ. a detailed description of the device, omitting the fact that it is part of a study.

Ō. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ō. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ŏ. an onlay iliac crest bone graft.

Ŏ. limited weightbearing and observation.

Ő. removal of the implant and limited weightbearing.

Ő. removal of the implant and insertion of a reamed femoral nail.

Œ. removal of the implant and insertion of an unreamed femoral nail.

Œ. Coronal

Ŕ. Sagittal

Ŕ. Anteromedial, midway between the sagittal and the coronal

Ŗ. Proximal pins sagittal, distal pins coronal

Ŗ. Proximal pins coronal, distal pins sagittal

Ř. Rheumatoid arthritis

Ř. Posttraumatic arthritis

Ś. Degenerative osteoarthritis

Ś. Osteonecrosis of the tibial plateau

Ŝ. Osteonecrosis of the medial femoral condyle

Ŝ. Trapeziometacarpal arthrodesis

Ş. Osteotomy of the thumb metacarpal

Ş. Arthrotomy and joint debridement

Š. Ligament reconstruction using one half of the flexor carpi radialis

Š. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ţ. Creep

Ţ. Relaxation

Ť. Energy dissipation

Ť. Plastic deformation

Ŧ. Elastic deformation

Ŧ. bending

Ũ. axial loading

Ũ. high-speed rotation

Ū. direct impact from anteromedial

Ū. crush from anteromedial to posterolateral

Ŭ. Increase stiffness

Ŭ. Increase fracture toughness

Ů. Increase fatigue strength

Ů. Decrease mechanical strength

Ű. Decrease wear rate

Ű. disuse osteopenia

Ų. paraendocrine effect of the tumor

Ų. abnormally increased density on the right side

Ŵ. side effect of the treatment of the lesion

Ŵ. extensive tumor involvement of the left hip

Ŷ. Sciatic nerve

Ŷ. Superior gluteal artery

Ÿ. Profunda femoris artery

Ź. Femoral artery and nerve

Ź. External iliac artery and vein

Ż. Length

Ż. Moment arm

Ž. Total volume

Ž. Physiologic cross-sectional area

S. Distribution of slow and fast twitch fibers

Ƀ. decreasing initiation of action potentials.

Ɓ. increasing action potential amplitude.

Ƃ. blocking the opening of gated sodium channels.

Ƃ. decreasing the number of functional motor units.

Ƅ. slowing or stopping action potential propagation through the axon.

Ƅ. resection of the metatarsal heads of the first through fifth toes.

Ɔ. Silastic MP joint arthroplasties of the first through fifth toes.

Ƈ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ƈ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ɖ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ɗ. hemiarthroplasty

Ƌ. open reduction and internal fixation

Ƌ. closed reduction and percutaneous pinning

ƍ. a sling and early pedulum exercises

Ǝ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ə. open acromioplasty

Ɛ. open Bankart repair

Ƒ. open subscapularis tendon repair

Ƒ. inferior capsular shift

Ɠ. a supervised physical therapy program

Ɣ. a sling and swathe, with pendulum exercises in 10 days

Ƕ. open reduction and internal fixation through an anterior approach

Ɩ. open reduction and internal fixation through a posterior approach

Ɨ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƙ. arthroscopically assisted reduction and percutaneous screw fixation

Ƙ. Repair of the rotator cuff

Ƚ. Replacement of the humeral head

ƛ. Resection arthroplasty

Ɯ. Total shoulder arthroplasty

Ɲ. AP and lateral radiographs of the elbow

Ƞ. Diagnositc arthroscopy

Ɵ. Aspiration of joint fluid

Ơ. An erythrocyte sedimentation rate and CBC

Ơ. A diagnostic lidocaine injection

Ƣ. Insulin-like growth factor (IGF-1)

Ƣ. Fibroblast growth factor (FGF-1)

Ƥ. Platelet-derived growth factor (PDGF)

Ƥ. Transforming growth factor beta (TGF-B)

Ʀ. Bone morphogenetic proteins (BMP)

Ƨ. clinical history and radiographic findings.

Ƨ. technetium bone scan

Ʃ. flow cytometry pattern of extracted chondrocytes

ƪ. immunohistochemical staining patterns of a biopsy specimen

ƫ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƭ. Radial

Ƭ. Radial recurrent

Ʈ. Posterior interosseous

Ư. Superior ulnar recurrent

Ư. Superficial radial circumflex

Ʊ. Impaired hydroxylation of proline

Ʋ. Failure of cleavage in procollagen

Ƴ. Defective binding sites for hydroxyproline

Ƴ. Failure to incorporate glycine into the helix

Ƶ. Diminished production of collagen through the rough endoplasmic reticulum

Ƶ. Asking the legal staff to seek a court injunction

Ʒ. Copying the patient’s chart and giving it to him as he leaves

Ƹ. Having the patient sign a written legal contract that specifies acceptable behavior

Ƹ. Continuing care of the patient until an appropriate referral can be arranged

ƺ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

ƻ. Meta-analysis

Ƽ. Confidence interval

Ƽ. Analysis of variance (ANOVA)

ƾ. Statistical significance (p-value)

Ƿ. Survivorship analysis (Kaplan-Meier)

ǀ. Spinal shock

ǁ. Neurogenic shock

ǂ. Hypovolemic shock

ǃ. Pulmonary embolism

Ǆ. Fat embolus syndrome

Ǆ. Lumbar spinal stenosis

Ǆ. Metastatic disease of the spine

Ǉ. Rheumatoid lumbar spondylitis

Ǉ. Isthmic spondyloloisthesis

Ǉ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǌ. Patella alta

Ǌ. A metal-backed patella

Ǌ. Varus malalignment of the knee

Ǎ. A posterior cruciate-substituting femoral component

Ǎ. Lateral subluxation of the patella on a Merchant’s view

Ǐ. The sesamoids are separated

Ǐ. The sesamoid is fractured

Ǒ. The proximal phx is on the neck of the metatarsal

Ǒ. The dislocation is dorsal and centered

Ǔ. The proximal phalanx is hyperextended

Ǔ. Patella

Ǖ. Tibial stem

Ǖ. Distal femoral interface

Ǘ. Posterior femoral interface

Ǘ. Sites of screw fixation for the tibia

Ǚ. Hallux rigidus

Ǚ. Fracture of the sesamoid

Ǜ. Disruption of the plantar plate

Ǜ. Osteonecrosis of the metatarsal head

Ǝ. Rupture of the flexor hallucis longus

Ǟ. Gout

Ǟ. Sepsis

Ǡ. Old trauma

Ǡ. Rheumatoid arthritis

Ǣ. Charcot arthroplasty

Ǣ. Aspiration and steroid injection

Ǥ. Biopsy, curettage, and allograft bone grafting

Ǥ. Percutaneous Kirschner wire fixation

Ǧ. Percutaneous injection of autogenous bone marrow

Ǧ. Nerve roots

Ǩ. Spinal cord

Ǩ. Sciatic nerve

Ǫ. Peroneal nerve

Ǫ. Conus medullaris

Ǭ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǭ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǯ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǯ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

J̌. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǳ. Early and late infection

Ǳ. Periprosthetic fracture of the femur

Ǳ. Failure of the patellofemoral and extensor mechanisms

Ǵ. Aseptic loosening of cementing tibial components

Ǵ. Asceptic loosening of cemented femoral components

Ƕ. Acceptance of the current position of the ankle

Ƿ. Open reduction and fixation in the epiphysis only

Ǹ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǹ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǻ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǻ. Resection arthroplasty and local radiation

Ǽ. In situ fusion of the hip

Ǽ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǿ. Excision of heterotopic bone and local radiation

Ǿ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ȁ. Closed reduction of both fractures and immediate spica casting

Ȁ. Bilateral skin traction for 3 weeks, followed by spica casting

Ȃ. External fixation of both femora

Ȃ. External fixation of the left femur and a long leg cast brace for the right femur

Ȅ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȅ. Synovial sarcoma

Ȇ. Soft-tissue abcess

Ȇ. Rhabdomyosarcoma

Ȉ. Eosinophilic granuloma

Ȉ. Nodular pigmented villonodular synovitis

Ȋ. Changing to a titanium nail

Ȋ. Changing to a nonslotted nail

Ȍ. Changing the cross-sectional shape of the nail

Ȍ. Increasing the diameter of the nail by 3 mm

Ȏ. Increasing the diameter of the interlocking screws

Ȏ. Fracture healing

Ȑ. Chondrosarcoma

Ȑ. Periosteal chondroma

Ȓ. Periosteal osteosarcoma

Ȓ. Dysplasia epiphysealis hemimelica

Ȕ. Demonstrate competence in the subject of the case

Ȕ. Be fellowship trained in the subject of the case

Ȗ. Be paid on a contingency basis

Ȗ. Be board certified by the American Board of Orthopaedic Surgery

Ș. Have been involved in the case as a consultant

Ș. Diagnostic arthroscopy

Ț. Arthroscopy and subacromial decompression

Ț. Reduction and fixation of the proximal humeral epiphysis

Ȝ. Temporary cessation of throwing

Ȝ. Physical therapy for rotator cuff strengthening

Ȟ. Oblique popliteal ligament

Ȟ. Lateral capsule

Ƞ. Popliteal tendon

ȡ. Fibular collateral ligament

Ȣ. Posterior oblique ligament

Ȣ. Radial tear

Ȥ. Parrot-beak tear

Ȥ. Vertical tear in the “red-red” zone

Ȧ. Vertical tear in the “red-white” zone

Ȧ. Vertical tear in the “white-white” zone

Ȩ. 0 degrees of abduction, with neural rotation

Ȩ. 40 degrees of flexion and 60 degrees of internal rotation

Ȫ. 45 degrees of flexion and 45 degrees of external rotation

Ȫ. 90 degrees of abduction with neutral rotation

Ȭ. 90 degrees of abduction and 90 degrees of external rotation

Ȭ. Sural

Ȯ. Saphenous and its branches

Ȯ. Posterior tibial and its branches

Ȱ. Deep peroneal and its branches

Ȱ. Superficial peroneal and its branches

Ȳ. Strength

Ȳ. Stiffness

ȴ. Shelf life

ȵ. Antigenicity

ȶ. Risk of HIV transmission

ȷ. Indemnification

ȸ. Occurrence

ȹ. Excess liability

Ⱥ. Claims-made

Ȼ. Nose

Ȼ. Lateral Y

Ƚ. Scapular AP

Ⱦ. Neutral rotation AP

Ȿ. Internal rotation AP

Ɀ. External rotation AP

Ɂ. Trauma

Ɂ. Hemophilia

Ƀ. Reiter’s syndrome

Ʉ. Rheumatoid arthritis

Ʌ. Systemic lupus erythematosus

Ɇ. Cast immobilization for 6 weeks

Ɇ. Activity modification and re-evaluation in 2 months

Ɉ. Internal fixation with or without bone grafting

Ɉ. Retrograde drilling of the defect without articular cartilage penetration

Ɋ. Drilling of the defect directly through the articular cartilage

Ɋ. repair or reconstruction of the medial collateral ligament

Ɍ. repair or reconstruction of the medialand lateral collateral ligaments

Ɍ. immobilization for 5 days or less

Ɏ. immobilization for 14 days

Ɏ. immobilization for 25 days

Ɐ. Cystinosis

Ɑ. Hypophosphatemia

Ɒ. Renal osteodystrophy

Ɓ. Primary hyperparathyroidism

Ɔ. Nutritional vitamin D deficiency

ɕ. Lateral meniscus tear

Ɖ. Popliteus tenosynovitis

Ɗ. Iliotibial band friction syndrome

ɘ. Peroneal nerve entrapment

Ə. Biceps tendinitis

ɚ. Observation

Ɛ. Removal of the prosthetic components

Ɜ. Operative exploration and decompression of the peroneal nerve

ɝ. Nerve conduction velocity studies

ɞ. Loosening of the primary dressings and knee flexion to 30 degrees

ɟ. I

Ɠ. II

Ɡ. III

ɢ. decreased tissue tension

Ɣ. decreased abductor lever arm

ɤ. decreased joint reaction force

Ɥ. increased body weight over lever arm

Ɦ. increased polyethylene wear rate

ɧ. recurrent traumatic anterior dislocation

Ɨ. recurrent traumatic posterior dislocation

Ɩ. traumatic subluxation with no previous dislocation

Ɪ. traumatic anterior subluxation

Ɫ. atraumatic involuntary subluxation

Ɬ. radial

ɭ. axillary

ɮ. suprascapular

Ɯ. thoracodorsal

ɰ. long thoracic

Ɱ. Flexion

Ɲ. Extension

ɳ. Axial rotation

ɴ. Left lateral bending

Ɵ. Right lateral bending

ɶ. Skin

ɷ. Lung

ɸ. Brain

ɹ. Heart

ɺ. Kidney

ɻ. Thoracoacromial, lateral thoracic, subscapular

ɼ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɽ. Posterior humeral circumflex, subscapular, thoracacromial

ɾ. Subscapular, thoracacromial, anterior humeral circumflex

ɿ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ʀ. Respondeat superior

ʁ. Indemnity agreement

Ʂ. Hold harmless agreement- attempt to shift liability from company to physician

Ʃ. Comparative negligence-% of involvement

ʄ. Contributory negligence- resident contributed to the negligence

ʅ. t-type

ʆ. both column

Ʇ. transverse

Ʈ. anterior column

Ʉ. anterior column posterior hemitransverse

Ʊ. Posterior interosseous

Ʋ. Anterior interosseous

Ʌ. Radial

ʍ. Median

ʎ. Ulnar

ʏ. Shock from hypovolemia

ʐ. Associated rupture of the bladder

ʑ. Arterial bleeding on pelvic angiogram

Ʒ. Presence of a hematoma in the perineum and scrotum

ʓ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Pronation of the foot during the stance phase of gait

Explanation

Question 4147

Topic: 10. Pathology and Oncology

A forward bend examination of an asymptomatic premenarchal 12-year-old girl who has waist asymmetry reveals a right thoracolumbar angle of trunk rotation of 12 degrees. The radiograph shown in Figure 26 reveals a curve that measures 31 degrees between T6 and T11 with the apex to the right. She is Risser 1 and her triradiate cartilage has closed. Management should consist of
1/. An MRI scan

. Observation and repeat radiographs in 4 months

. Application of a thoracolumbalsacral orthosis for 22 to 24 hours per day

. Electrical stimulation at night

. Physical therapy

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

!. Kidney

". Multiple myeloma

#. Varus stress

$. Valgus stress

%. Torsional loading

&. Hyperextension of the knee

'. Contraction of the quadriceps while axially loaded

(. Primary internal fixation at both fracture levels

). External fixation as definitive ttt for both #

*. Skeletal traction and delayed internal fixation of both fractures

+. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

,. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

-. Heel spur

.. Plantar fascitis

/. Dysfunction of the tibialis posterior tendon

0. Compression of the first branch of the lateral plantar nerve

1. Compression of the calcaneal nerve

2. Displaced labral tear

3. Tear of the rotator cuff

4. Fracture of the glenoid rim

5. Palsy of the axillary nerve

6. Palsy of the musculocutaneus nerve

7. Enchondroma

8. Osteoblastoma

9. Giant cell tumor

:. Aneurysmal bone cyst

;. Fibrous dysplasia

<. Arthrogram of the wrist

=. MRI scan of both wrists

>. CT scan of both wrists in the same position

?. Radiographs of the wrist in supination and pronation

@. Radiographs of the opposite wrist in the same position

A. Secondary hyperparathyroidism

B. Phosphate retention secondary to uremia

C. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

D. Aluminum deposition in bone from oral phosphate binders

E. Persistent acidosis aggravating the negative calcium balance

F. Posterior fusion at T10-L3 with segmental instrumentation

G. Laminectomy and fusion of T12-L2 with segmental instrumentation

H. Bed rest in a hyperextension brace

I. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

J. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

K. Positive-pressure ventilation

L. An immediate radiograph of the chest

M. Adjustment of the position of the endotrachael tube

N. Insertion of a large-bore needle into the pericardial space

O. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

P. Allowing the ends of the fracture to touch

Q. Adding a second connecting bar

R. Adding one pin to each fracture fragment

S. Increasing the pin diameter from 4 mm to 6 mm

T. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

U. Osteomyelitis

V. Malignant degeneration

W. Stress fracture

X. Local recurrence of the giant cell tumor

Y. Bone resorption due to methylmethacrylate

Z. Advancement of the plantar plate

[. Resection of the second metatarsal head

\. Dorsiflexion osteotomy of the second metatarsal neck

]. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

^. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

_. Sacral fracture

`. Burst fracture of L5

A. Cauda equina syndrome

B. Distraction-flexion injury at L3

C. Distraction-extension injury at L3

D. An MRI scan of the shoulder

E. An MRI scan of the cervical spine

F. Electromyographic and nerve conduction velocity studies

G. Immobilization in a sling and early passive range of motion exercises

H. Immediate return to the operating room for exploration of the brachial plexus

I. cerclage wiring

J. tension band wiring

K. removal of the patellar component

L. revision of the patellar component

M. immobilization of the knee and protected weightbearing

N. Liposarcoma

O. Nodular fasciitis

P. Rabdomyosarcoma

Q. Malignant fibrous histiocytoma

R. Extra-abdominal desmoid tumor

S. Clubfeet

T. Thrombocytopenia

U. Congenital scoliosis

V. Ventricular septal defect

W. Arnold-Chiari malformation

X. delayed primary closure

Y. free flap

Z. pedicle groin flap

{. full-thickness skin graft

|. split-thickness skin graft

}. Infection

~. Nonunion

. Improper screw length

. Osteonecrosis of the distal fragment

. Use of a cortical screw instead of a cancellous screw

. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

¡. protrusion ring with morselized graft

¢. cemented metal backed acetabular component

£. cemented all-polyethylene acetabular component

¤. cementless hemispherical component with screw fixation

¥. application of a hip abduction brace for 22 hours per day

¦. application of a hip spica under anesthesia

§. discontinuance of all bracing and repeat radiographs in 3 months

¨. open reduction of the hip and application of a spica cast

©. open reduction, varus osteotomy, and application of a spica cast

ª. Loss of skin hair on the feet

«. Absent pulses on vascular examination

¬. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

®. Pain that is worse when the patient walks uphill rather downhill

¯. wrist flexors and finger flexors

°. elbow flexors and wrist flexors

±. elbow flexors and finger flexors

². elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

³. elbow extensors and wrist extensors

´. Syndactyly

Μ. Macrodactyly

¶. Camptodactyly

·. Preaxial polydactyly

¸. Postaxial polydactyly

¹. Arthrodesis

º. Rotationplasty

». Above-knee amputation

¼. Osteoarticular allograft

½. Endoprosthesis (custom arthroplasty)

¾. Plantar fascia

¿. Spring ligament

À. Deltoid ligament

Á. Intrinsic tendons

Â. Gastorcnemius-solelus complex

Ã. Prevention of presynaptic release of acetylcholine

Ä. Prevention of synthesis of presynaptic acetylcholine

Å. Activation of acetylcholinesterase at the motor end-plate

Æ. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Ç. Stimulation of release of presynaptic acetylcholine until reserves are depleted

È. stiffness of the femoral component.

É. head offset of the femoral component.

Ê. femoral component material modulus of elasticity.

Ë. extent of the femoral component porous coating.

Ì. Presence of a femoral component collar.

Í. plantar fascia and quadratus plantae tendon.

Î. ligamentous structures connecting the tarsal bones.

Ï. shape of the tarsal bones and the intervening joints.

Ð. activity of the intrinsic muscles of the foot.

Ñ. activity of the posterior tibialis and the peroneus longus muscles.

Ò. scapulothoracic fusion

Ó. strengthening of the periscapular muscles

Ô. pectoralis minor-fascia lata graft transfer to the scapula

Õ. pectoralis major-fascia lata graft transfer to the scapula

Ö. exploration of the long thoracic nerve, with sural nerve graft

×. tricompartmental knee replacement

Ø. unicompartmental knee replacement

Ù. medial compartment meniscal allograft

Ú. valgus-producing distal femoral osteotomy

Û. valgus-producing proximal tibial osteotomy

Ü. Internal rotation of the femoral component

Ý. External rotation of the tibial component

Þ. Lateral placement of the femoral component

SS. Medial placement of the patellar component

À. Excessive resection of the patella

Á. Hallux rigidus

Â. Hallux valgus

Ã. Neuroma of the first web space

Ä. Fracture of the sesamoid

Å. Rupture of the flexor hallucis longus

Æ. Sickle cell crisis

Ç. Idiopathic chondrolysis

È. Hemophilic arthropathy

É. Osteoid osteoma of the femoral neck

Ê. Legg-Calve-Perthes disease

Ë. Decreased ankle jerk and positive femoral nerve stretch test

Ì. Decreased knee jerk and positive straight-leg raising sign

Í. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Î. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ï. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ð. Long-term administration of IV and oral antibiotics

Ñ. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ò. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ó. Two-stage surgical prosthetic exchange and IV antibiotics

Ô. Resection arthroplasty and IV antibiotics

Õ. SCFE

Ö. MED

÷. Perthes disease

Ø. Hypothyroidism

Ù. Chondrolysis

Ú. gout.

Û. osteoporosis.

Ü. eosinophilic granuloma.

Ý. tuberculosis of the spine.

Þ. metastatic disease of the spine.

Ÿ. water content.

Ā. Synthesis of type I collagen.

Ā. Proteoglycan content.

Ă. Activity of chondrocytes.

Ă. Synthesis of hyaluronate.

Ą. Lung

Ą. Breast

Ć. Prostate

Ć. Thyroid

Ĉ. Renal

Ĉ. T1-low, T2-low.

Ċ. T1-low, T2-high.

Ċ. T1-moderate, T2-low.

Č. T1-high, T2-low.

Č. T1-high, T2-high.

Ď. hypothesis is incorrect or invalid

Ď. interobserver error rate is 4%.

Đ. Standard deviation is 4% higher or lower than the mean.

Đ. Sample size is 4% larger than required to be clinically significant.

Ē. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ē. I

Ĕ. II

Ĕ. IV

Ė. IX

Ė. X

Ę. Cranial setting

Ę. Cranial subluxation

Ě. Odontoid fracture

Ě. Lysis of the arch of the atlas

Ĝ. Atlantoaxial subluxation

Ĝ. Retrograde collapse of the endoneurial tubes

Ğ. Irreversible atrophy of the denervated muscles

Ğ. Elongation of the axons across the zone of injury

Ġ. Sprouting of the axons at the neuromuscular junction

Ġ. Misdirection of the axons across the zone of injury

Ģ. Maximally pronated and elbow extended

Ģ. Maximally pronated and the elbow flexed

Ĥ. Maximally supinated and the elbow flexed

Ĥ. Maximally supinated and the elbow extended

Ħ. In neutral rotation, with the elbow extended

Ħ. open reduction and internal fixation

Ĩ. buddy taping to the adjacent index finger

Ĩ. early motion with application of a dynamic banjo splint

Ī. application of a cast with the hand in a “safe position” for 3 weeks.

Ī. dorsal extension block splinting

Ĭ. The name of the manufacturer

Ĭ. The manufacturer’s potential liability

Į. The physician’s clinical performance

Į. The physician’s materials testing data

İ. Any royalties the physician receives from the manufacturer

I. Femoral

Ĳ. Obturator

Ĳ. Inferior gluteal

Ĵ. Superior gluteal

Ĵ. Lateral femoral cutaneous

Ķ. open biopsy and a long leg cast

Ķ. open biopsy and wide resection of the tumor

ĸ. a long leg cast and observation

Ĺ. intramedullary stabilization and observation

Ĺ. Triggering

Ļ. Lateral instability

Ļ. Swan-neck deformity

Ľ. Boutonniere deformity

Ľ. Loss of distal interphalangeal joint flexion

Ŀ. Peroneus brevis to peroneus longus

Ŀ. Peroneus tertius to extensor hallucis longus

Ł. Peroneus tertius to superficial peroneal nerve

Ł. Extensor hallucis longus to deep peroneal nerve

Ń. Extensor hallucis longus to extensor digitorum longus

Ń. reassurance that Medicare will pay for the treatment.

Ņ. consent forms that patients or their guardians are able to understand.

Ņ. a detailed description of the device, omitting the fact that it is part of a study.

Ň. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ň. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

ʼN. an onlay iliac crest bone graft.

Ŋ. limited weightbearing and observation.

Ŋ. removal of the implant and limited weightbearing.

Ō. removal of the implant and insertion of a reamed femoral nail.

Ō. removal of the implant and insertion of an unreamed femoral nail.

Ŏ. Coronal

Ŏ. Sagittal

Ő. Anteromedial, midway between the sagittal and the coronal

Ő. Proximal pins sagittal, distal pins coronal

Œ. Proximal pins coronal, distal pins sagittal

Œ. Rheumatoid arthritis

Ŕ. Posttraumatic arthritis

Ŕ. Degenerative osteoarthritis

Ŗ. Osteonecrosis of the tibial plateau

Ŗ. Osteonecrosis of the medial femoral condyle

Ř. Trapeziometacarpal arthrodesis

Ř. Osteotomy of the thumb metacarpal

Ś. Arthrotomy and joint debridement

Ś. Ligament reconstruction using one half of the flexor carpi radialis

Ŝ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŝ. Creep

Ş. Relaxation

Ş. Energy dissipation

Š. Plastic deformation

Š. Elastic deformation

Ţ. bending

Ţ. axial loading

Ť. high-speed rotation

Ť. direct impact from anteromedial

Ŧ. crush from anteromedial to posterolateral

Ŧ. Increase stiffness

Ũ. Increase fracture toughness

Ũ. Increase fatigue strength

Ū. Decrease mechanical strength

Ū. Decrease wear rate

Ŭ. disuse osteopenia

Ŭ. paraendocrine effect of the tumor

Ů. abnormally increased density on the right side

Ů. side effect of the treatment of the lesion

Ű. extensive tumor involvement of the left hip

Ű. Sciatic nerve

Ų. Superior gluteal artery

Ų. Profunda femoris artery

Ŵ. Femoral artery and nerve

Ŵ. External iliac artery and vein

Ŷ. Length

Ŷ. Moment arm

Ÿ. Total volume

Ź. Physiologic cross-sectional area

Ź. Distribution of slow and fast twitch fibers

Ż. decreasing initiation of action potentials.

Ż. increasing action potential amplitude.

Ž. blocking the opening of gated sodium channels.

Ž. decreasing the number of functional motor units.

S. slowing or stopping action potential propagation through the axon.

Ƀ. resection of the metatarsal heads of the first through fifth toes.

Ɓ. Silastic MP joint arthroplasties of the first through fifth toes.

Ƃ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ƃ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ƅ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ƅ. hemiarthroplasty

Ɔ. open reduction and internal fixation

Ƈ. closed reduction and percutaneous pinning

Ƈ. a sling and early pedulum exercises

Ɖ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ɗ. open acromioplasty

Ƌ. open Bankart repair

Ƌ. open subscapularis tendon repair

ƍ. inferior capsular shift

Ǝ. a supervised physical therapy program

Ə. a sling and swathe, with pendulum exercises in 10 days

Ɛ. open reduction and internal fixation through an anterior approach

Ƒ. open reduction and internal fixation through a posterior approach

Ƒ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ɠ. arthroscopically assisted reduction and percutaneous screw fixation

Ɣ. Repair of the rotator cuff

Ƕ. Replacement of the humeral head

Ɩ. Resection arthroplasty

Ɨ. Total shoulder arthroplasty

Ƙ. AP and lateral radiographs of the elbow

Ƙ. Diagnositc arthroscopy

Ƚ. Aspiration of joint fluid

ƛ. An erythrocyte sedimentation rate and CBC

Ɯ. A diagnostic lidocaine injection

Ɲ. Insulin-like growth factor (IGF-1)

Ƞ. Fibroblast growth factor (FGF-1)

Ɵ. Platelet-derived growth factor (PDGF)

Ơ. Transforming growth factor beta (TGF-B)

Ơ. Bone morphogenetic proteins (BMP)

Ƣ. clinical history and radiographic findings.

Ƣ. technetium bone scan

Ƥ. flow cytometry pattern of extracted chondrocytes

Ƥ. immunohistochemical staining patterns of a biopsy specimen

Ʀ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƨ. Radial

Ƨ. Radial recurrent

Ʃ. Posterior interosseous

ƪ. Superior ulnar recurrent

ƫ. Superficial radial circumflex

Ƭ. Impaired hydroxylation of proline

Ƭ. Failure of cleavage in procollagen

Ʈ. Defective binding sites for hydroxyproline

Ư. Failure to incorporate glycine into the helix

Ư. Diminished production of collagen through the rough endoplasmic reticulum

Ʊ. Asking the legal staff to seek a court injunction

Ʋ. Copying the patient’s chart and giving it to him as he leaves

Ƴ. Having the patient sign a written legal contract that specifies acceptable behavior

Ƴ. Continuing care of the patient until an appropriate referral can be arranged

Ƶ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƶ. Meta-analysis

Ʒ. Confidence interval

Ƹ. Analysis of variance (ANOVA)

Ƹ. Statistical significance (p-value)

ƺ. Survivorship analysis (Kaplan-Meier)

ƻ. Spinal shock

Ƽ. Neurogenic shock

Ƽ. Hypovolemic shock

ƾ. Pulmonary embolism

Ƿ. Fat embolus syndrome

ǀ. Lumbar spinal stenosis

ǁ. Metastatic disease of the spine

ǂ. Rheumatoid lumbar spondylitis

ǃ. Isthmic spondyloloisthesis

Ǆ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ǆ. Patella alta

Ǆ. A metal-backed patella

Ǉ. Varus malalignment of the knee

Ǉ. A posterior cruciate-substituting femoral component

Ǉ. Lateral subluxation of the patella on a Merchant’s view

Ǌ. The sesamoids are separated

Ǌ. The sesamoid is fractured

Ǌ. The proximal phx is on the neck of the metatarsal

Ǎ. The dislocation is dorsal and centered

Ǎ. The proximal phalanx is hyperextended

Ǐ. Patella

Ǐ. Tibial stem

Ǒ. Distal femoral interface

Ǒ. Posterior femoral interface

Ǔ. Sites of screw fixation for the tibia

Ǔ. Hallux rigidus

Ǖ. Fracture of the sesamoid

Ǖ. Disruption of the plantar plate

Ǘ. Osteonecrosis of the metatarsal head

Ǘ. Rupture of the flexor hallucis longus

Ǚ. Gout

Ǚ. Sepsis

Ǜ. Old trauma

Ǜ. Rheumatoid arthritis

Ǝ. Charcot arthroplasty

Ǟ. Aspiration and steroid injection

Ǟ. Biopsy, curettage, and allograft bone grafting

Ǡ. Percutaneous Kirschner wire fixation

Ǡ. Percutaneous injection of autogenous bone marrow

Ǣ. Nerve roots

Ǣ. Spinal cord

Ǥ. Sciatic nerve

Ǥ. Peroneal nerve

Ǧ. Conus medullaris

Ǧ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǩ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǩ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǫ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǫ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǭ. Early and late infection

Ǭ. Periprosthetic fracture of the femur

Ǯ. Failure of the patellofemoral and extensor mechanisms

Ǯ. Aseptic loosening of cementing tibial components

J̌. Asceptic loosening of cemented femoral components

Ǳ. Acceptance of the current position of the ankle

Ǳ. Open reduction and fixation in the epiphysis only

Ǳ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǵ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǵ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ƕ. Resection arthroplasty and local radiation

Ƿ. In situ fusion of the hip

Ǹ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǹ. Excision of heterotopic bone and local radiation

Ǻ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǻ. Closed reduction of both fractures and immediate spica casting

Ǽ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǽ. External fixation of both femora

Ǿ. External fixation of the left femur and a long leg cast brace for the right femur

Ǿ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ȁ. Synovial sarcoma

Ȁ. Soft-tissue abcess

Ȃ. Rhabdomyosarcoma

Ȃ. Eosinophilic granuloma

Ȅ. Nodular pigmented villonodular synovitis

Ȅ. Changing to a titanium nail

Ȇ. Changing to a nonslotted nail

Ȇ. Changing the cross-sectional shape of the nail

Ȉ. Increasing the diameter of the nail by 3 mm

Ȉ. Increasing the diameter of the interlocking screws

Ȋ. Fracture healing

Ȋ. Chondrosarcoma

Ȍ. Periosteal chondroma

Ȍ. Periosteal osteosarcoma

Ȏ. Dysplasia epiphysealis hemimelica

Ȏ. Demonstrate competence in the subject of the case

Ȑ. Be fellowship trained in the subject of the case

Ȑ. Be paid on a contingency basis

Ȓ. Be board certified by the American Board of Orthopaedic Surgery

Ȓ. Have been involved in the case as a consultant

Ȕ. Diagnostic arthroscopy

Ȕ. Arthroscopy and subacromial decompression

Ȗ. Reduction and fixation of the proximal humeral epiphysis

Ȗ. Temporary cessation of throwing

Ș. Physical therapy for rotator cuff strengthening

Ș. Oblique popliteal ligament

Ț. Lateral capsule

Ț. Popliteal tendon

Ȝ. Fibular collateral ligament

Ȝ. Posterior oblique ligament

Ȟ. Radial tear

Ȟ. Parrot-beak tear

Ƞ. Vertical tear in the “red-red” zone

ȡ. Vertical tear in the “red-white” zone

Ȣ. Vertical tear in the “white-white” zone

Ȣ. 0 degrees of abduction, with neural rotation

Ȥ. 40 degrees of flexion and 60 degrees of internal rotation

Ȥ. 45 degrees of flexion and 45 degrees of external rotation

Ȧ. 90 degrees of abduction with neutral rotation

Ȧ. 90 degrees of abduction and 90 degrees of external rotation

Ȩ. Sural

Ȩ. Saphenous and its branches

Ȫ. Posterior tibial and its branches

Ȫ. Deep peroneal and its branches

Ȭ. Superficial peroneal and its branches

Ȭ. Strength

Ȯ. Stiffness

Ȯ. Shelf life

Ȱ. Antigenicity

Ȱ. Risk of HIV transmission

Ȳ. Indemnification

Ȳ. Occurrence

ȴ. Excess liability

ȵ. Claims-made

ȶ. Nose

ȷ. Lateral Y

ȸ. Scapular AP

ȹ. Neutral rotation AP

Ⱥ. Internal rotation AP

Ȼ. External rotation AP

Ȼ. Trauma

Ƚ. Hemophilia

Ⱦ. Reiter’s syndrome

Ȿ. Rheumatoid arthritis

Ɀ. Systemic lupus erythematosus

Ɂ. Cast immobilization for 6 weeks

Ɂ. Activity modification and re-evaluation in 2 months

Ƀ. Internal fixation with or without bone grafting

Ʉ. Retrograde drilling of the defect without articular cartilage penetration

Ʌ. Drilling of the defect directly through the articular cartilage

Ɇ. repair or reconstruction of the medial collateral ligament

Ɇ. repair or reconstruction of the medialand lateral collateral ligaments

Ɉ. immobilization for 5 days or less

Ɉ. immobilization for 14 days

Ɋ. immobilization for 25 days

Ɋ. Cystinosis

Ɍ. Hypophosphatemia

Ɍ. Renal osteodystrophy

Ɏ. Primary hyperparathyroidism

Ɏ. Nutritional vitamin D deficiency

Ɐ. Lateral meniscus tear

Ɑ. Popliteus tenosynovitis

Ɒ. Iliotibial band friction syndrome

Ɓ. Peroneal nerve entrapment

Ɔ. Biceps tendinitis

ɕ. Observation

Ɖ. Removal of the prosthetic components

Ɗ. Operative exploration and decompression of the peroneal nerve

ɘ. Nerve conduction velocity studies

Ə. Loosening of the primary dressings and knee flexion to 30 degrees

ɚ. I

Ɛ. II

Ɜ. III

ɝ. decreased tissue tension

ɞ. decreased abductor lever arm

ɟ. decreased joint reaction force

Ɠ. increased body weight over lever arm

Ɡ. increased polyethylene wear rate

ɢ. recurrent traumatic anterior dislocation

Ɣ. recurrent traumatic posterior dislocation

ɤ. traumatic subluxation with no previous dislocation

Ɥ. traumatic anterior subluxation

Ɦ. atraumatic involuntary subluxation

ɧ. radial

Ɨ. axillary

Ɩ. suprascapular

Ɪ. thoracodorsal

Ɫ. long thoracic

Ɬ. Flexion

ɭ. Extension

ɮ. Axial rotation

Ɯ. Left lateral bending

ɰ. Right lateral bending

Ɱ. Skin

Ɲ. Lung

ɳ. Brain

ɴ. Heart

Ɵ. Kidney

ɶ. Thoracoacromial, lateral thoracic, subscapular

ɷ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ɸ. Posterior humeral circumflex, subscapular, thoracacromial

ɹ. Subscapular, thoracacromial, anterior humeral circumflex

ɺ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ɻ. Respondeat superior

ɼ. Indemnity agreement

Ɽ. Hold harmless agreement- attempt to shift liability from company to physician

ɾ. Comparative negligence-% of involvement

ɿ. Contributory negligence- resident contributed to the negligence

Ʀ. t-type

ʁ. both column

Ʂ. transverse

Ʃ. anterior column

ʄ. anterior column posterior hemitransverse

ʅ. Posterior interosseous

ʆ. Anterior interosseous

Ʇ. Radial

Ʈ. Median

Ʉ. Ulnar

Ʊ. Shock from hypovolemia

Ʋ. Associated rupture of the bladder

Ʌ. Arterial bleeding on pelvic angiogram

ʍ. Presence of a hematoma in the perineum and scrotum

ʎ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Observation and repeat radiographs in 4 months

Explanation

Question 4148

Topic: 10. Pathology and Oncology

Which of the following advantages does the use of a vascularized fibula graft have over a nonvascularized fibula graft?

. Begins to remodel and hypertrophy more quickly

. Provides a better scaffold for osteoconduction

. Reduces the risk of early fracture

. Reduces technical difficulty

. Lowers donor site morbidity

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

!. Torsional loading

". Hyperextension of the knee

#. Contraction of the quadriceps while axially loaded

$. Primary internal fixation at both fracture levels

%. External fixation as definitive ttt for both #

&. Skeletal traction and delayed internal fixation of both fractures

'. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

(. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

). Heel spur

*. Plantar fascitis

+. Dysfunction of the tibialis posterior tendon

,. Compression of the first branch of the lateral plantar nerve

-. Compression of the calcaneal nerve

.. Displaced labral tear

/. Tear of the rotator cuff

0. Fracture of the glenoid rim

1. Palsy of the axillary nerve

2. Palsy of the musculocutaneus nerve

3. Enchondroma

4. Osteoblastoma

5. Giant cell tumor

6. Aneurysmal bone cyst

7. Fibrous dysplasia

8. Arthrogram of the wrist

9. MRI scan of both wrists

:. CT scan of both wrists in the same position

;. Radiographs of the wrist in supination and pronation

<. Radiographs of the opposite wrist in the same position

=. Secondary hyperparathyroidism

>. Phosphate retention secondary to uremia

?. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

@. Aluminum deposition in bone from oral phosphate binders

A. Persistent acidosis aggravating the negative calcium balance

B. Posterior fusion at T10-L3 with segmental instrumentation

C. Laminectomy and fusion of T12-L2 with segmental instrumentation

D. Bed rest in a hyperextension brace

E. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

F. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

G. Positive-pressure ventilation

H. An immediate radiograph of the chest

I. Adjustment of the position of the endotrachael tube

J. Insertion of a large-bore needle into the pericardial space

K. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

L. Allowing the ends of the fracture to touch

M. Adding a second connecting bar

N. Adding one pin to each fracture fragment

O. Increasing the pin diameter from 4 mm to 6 mm

P. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

Q. Osteomyelitis

R. Malignant degeneration

S. Stress fracture

T. Local recurrence of the giant cell tumor

U. Bone resorption due to methylmethacrylate

V. Advancement of the plantar plate

W. Resection of the second metatarsal head

X. Dorsiflexion osteotomy of the second metatarsal neck

Y. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

Z. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

[. Sacral fracture

\. Burst fracture of L5

]. Cauda equina syndrome

^. Distraction-flexion injury at L3

_. Distraction-extension injury at L3

`. An MRI scan of the shoulder

A. An MRI scan of the cervical spine

B. Electromyographic and nerve conduction velocity studies

C. Immobilization in a sling and early passive range of motion exercises

D. Immediate return to the operating room for exploration of the brachial plexus

E. cerclage wiring

F. tension band wiring

G. removal of the patellar component

H. revision of the patellar component

I. immobilization of the knee and protected weightbearing

J. Liposarcoma

K. Nodular fasciitis

L. Rabdomyosarcoma

M. Malignant fibrous histiocytoma

N. Extra-abdominal desmoid tumor

O. Clubfeet

P. Thrombocytopenia

Q. Congenital scoliosis

R. Ventricular septal defect

S. Arnold-Chiari malformation

T. delayed primary closure

U. free flap

V. pedicle groin flap

W. full-thickness skin graft

X. split-thickness skin graft

Y. Infection

Z. Nonunion

{. Improper screw length

|. Osteonecrosis of the distal fragment

}. Use of a cortical screw instead of a cancellous screw

~. Infection

. Tear of the rotator cuff

. Loosening of the humeral component

. Arthritis of the glenoid

. Arthritis of the A-C joint

. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

¡. application of a hip abduction brace for 22 hours per day

¢. application of a hip spica under anesthesia

£. discontinuance of all bracing and repeat radiographs in 3 months

¤. open reduction of the hip and application of a spica cast

¥. open reduction, varus osteotomy, and application of a spica cast

¦. Loss of skin hair on the feet

§. Absent pulses on vascular examination

¨. Pain that originates proximally and spreads distally

©. Pain that is relieved by stopping and standing

ª. Pain that is worse when the patient walks uphill rather downhill

«. wrist flexors and finger flexors

¬. elbow flexors and wrist flexors

. elbow flexors and finger flexors

®. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

¯. elbow extensors and wrist extensors

°. Syndactyly

±. Macrodactyly

². Camptodactyly

³. Preaxial polydactyly

´. Postaxial polydactyly

Μ. Arthrodesis

¶. Rotationplasty

·. Above-knee amputation

¸. Osteoarticular allograft

¹. Endoprosthesis (custom arthroplasty)

º. Plantar fascia

». Spring ligament

¼. Deltoid ligament

½. Intrinsic tendons

¾. Gastorcnemius-solelus complex

¿. Prevention of presynaptic release of acetylcholine

À. Prevention of synthesis of presynaptic acetylcholine

Á. Activation of acetylcholinesterase at the motor end-plate

Â. Blockage of postsynaptic action of acetylcholine until reserves are depleted

Ã. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Ä. stiffness of the femoral component.

Å. head offset of the femoral component.

Æ. femoral component material modulus of elasticity.

Ç. extent of the femoral component porous coating.

È. Presence of a femoral component collar.

É. plantar fascia and quadratus plantae tendon.

Ê. ligamentous structures connecting the tarsal bones.

Ë. shape of the tarsal bones and the intervening joints.

Ì. activity of the intrinsic muscles of the foot.

Í. activity of the posterior tibialis and the peroneus longus muscles.

Î. scapulothoracic fusion

Ï. strengthening of the periscapular muscles

Ð. pectoralis minor-fascia lata graft transfer to the scapula

Ñ. pectoralis major-fascia lata graft transfer to the scapula

Ò. exploration of the long thoracic nerve, with sural nerve graft

Ó. tricompartmental knee replacement

Ô. unicompartmental knee replacement

Õ. medial compartment meniscal allograft

Ö. valgus-producing distal femoral osteotomy

×. valgus-producing proximal tibial osteotomy

Ø. Internal rotation of the femoral component

Ù. External rotation of the tibial component

Ú. Lateral placement of the femoral component

Û. Medial placement of the patellar component

Ü. Excessive resection of the patella

Ý. Hallux rigidus

Þ. Hallux valgus

SS. Neuroma of the first web space

À. Fracture of the sesamoid

Á. Rupture of the flexor hallucis longus

Â. Sickle cell crisis

Ã. Idiopathic chondrolysis

Ä. Hemophilic arthropathy

Å. Osteoid osteoma of the femoral neck

Æ. Legg-Calve-Perthes disease

Ç. Decreased ankle jerk and positive femoral nerve stretch test

È. Decreased knee jerk and positive straight-leg raising sign

É. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ê. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ë. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ì. Long-term administration of IV and oral antibiotics

Í. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Î. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ï. Two-stage surgical prosthetic exchange and IV antibiotics

Ð. Resection arthroplasty and IV antibiotics

Ñ. SCFE

Ò. MED

Ó. Perthes disease

Ô. Hypothyroidism

Õ. Chondrolysis

Ö. gout.

÷. osteoporosis.

Ø. eosinophilic granuloma.

Ù. tuberculosis of the spine.

Ú. metastatic disease of the spine.

Û. water content.

Ü. Synthesis of type I collagen.

Ý. Proteoglycan content.

Þ. Activity of chondrocytes.

Ÿ. Synthesis of hyaluronate.

Ā. Lung

Ā. Breast

Ă. Prostate

Ă. Thyroid

Ą. Renal

Ą. T1-low, T2-low.

Ć. T1-low, T2-high.

Ć. T1-moderate, T2-low.

Ĉ. T1-high, T2-low.

Ĉ. T1-high, T2-high.

Ċ. hypothesis is incorrect or invalid

Ċ. interobserver error rate is 4%.

Č. Standard deviation is 4% higher or lower than the mean.

Č. Sample size is 4% larger than required to be clinically significant.

Ď. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ď. I

Đ. II

Đ. IV

Ē. IX

Ē. X

Ĕ. Cranial setting

Ĕ. Cranial subluxation

Ė. Odontoid fracture

Ė. Lysis of the arch of the atlas

Ę. Atlantoaxial subluxation

Ę. Retrograde collapse of the endoneurial tubes

Ě. Irreversible atrophy of the denervated muscles

Ě. Elongation of the axons across the zone of injury

Ĝ. Sprouting of the axons at the neuromuscular junction

Ĝ. Misdirection of the axons across the zone of injury

Ğ. Maximally pronated and elbow extended

Ğ. Maximally pronated and the elbow flexed

Ġ. Maximally supinated and the elbow flexed

Ġ. Maximally supinated and the elbow extended

Ģ. In neutral rotation, with the elbow extended

Ģ. open reduction and internal fixation

Ĥ. buddy taping to the adjacent index finger

Ĥ. early motion with application of a dynamic banjo splint

Ħ. application of a cast with the hand in a “safe position” for 3 weeks.

Ħ. dorsal extension block splinting

Ĩ. The name of the manufacturer

Ĩ. The manufacturer’s potential liability

Ī. The physician’s clinical performance

Ī. The physician’s materials testing data

Ĭ. Any royalties the physician receives from the manufacturer

Ĭ. Femoral

Į. Obturator

Į. Inferior gluteal

İ. Superior gluteal

I. Lateral femoral cutaneous

Ĳ. open biopsy and a long leg cast

Ĳ. open biopsy and wide resection of the tumor

Ĵ. a long leg cast and observation

Ĵ. intramedullary stabilization and observation

Ķ. Triggering

Ķ. Lateral instability

ĸ. Swan-neck deformity

Ĺ. Boutonniere deformity

Ĺ. Loss of distal interphalangeal joint flexion

Ļ. Peroneus brevis to peroneus longus

Ļ. Peroneus tertius to extensor hallucis longus

Ľ. Peroneus tertius to superficial peroneal nerve

Ľ. Extensor hallucis longus to deep peroneal nerve

Ŀ. Extensor hallucis longus to extensor digitorum longus

Ŀ. reassurance that Medicare will pay for the treatment.

Ł. consent forms that patients or their guardians are able to understand.

Ł. a detailed description of the device, omitting the fact that it is part of a study.

Ń. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ń. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ņ. an onlay iliac crest bone graft.

Ņ. limited weightbearing and observation.

Ň. removal of the implant and limited weightbearing.

Ň. removal of the implant and insertion of a reamed femoral nail.

ʼN. removal of the implant and insertion of an unreamed femoral nail.

Ŋ. Coronal

Ŋ. Sagittal

Ō. Anteromedial, midway between the sagittal and the coronal

Ō. Proximal pins sagittal, distal pins coronal

Ŏ. Proximal pins coronal, distal pins sagittal

Ŏ. Rheumatoid arthritis

Ő. Posttraumatic arthritis

Ő. Degenerative osteoarthritis

Œ. Osteonecrosis of the tibial plateau

Œ. Osteonecrosis of the medial femoral condyle

Ŕ. Trapeziometacarpal arthrodesis

Ŕ. Osteotomy of the thumb metacarpal

Ŗ. Arthrotomy and joint debridement

Ŗ. Ligament reconstruction using one half of the flexor carpi radialis

Ř. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ř. Creep

Ś. Relaxation

Ś. Energy dissipation

Ŝ. Plastic deformation

Ŝ. Elastic deformation

Ş. bending

Ş. axial loading

Š. high-speed rotation

Š. direct impact from anteromedial

Ţ. crush from anteromedial to posterolateral

Ţ. Increase stiffness

Ť. Increase fracture toughness

Ť. Increase fatigue strength

Ŧ. Decrease mechanical strength

Ŧ. Decrease wear rate

Ũ. disuse osteopenia

Ũ. paraendocrine effect of the tumor

Ū. abnormally increased density on the right side

Ū. side effect of the treatment of the lesion

Ŭ. extensive tumor involvement of the left hip

Ŭ. Sciatic nerve

Ů. Superior gluteal artery

Ů. Profunda femoris artery

Ű. Femoral artery and nerve

Ű. External iliac artery and vein

Ų. Length

Ų. Moment arm

Ŵ. Total volume

Ŵ. Physiologic cross-sectional area

Ŷ. Distribution of slow and fast twitch fibers

Ŷ. decreasing initiation of action potentials.

Ÿ. increasing action potential amplitude.

Ź. blocking the opening of gated sodium channels.

Ź. decreasing the number of functional motor units.

Ż. slowing or stopping action potential propagation through the axon.

Ż. resection of the metatarsal heads of the first through fifth toes.

Ž. Silastic MP joint arthroplasties of the first through fifth toes.

Ž. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

S. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ƀ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ɓ. hemiarthroplasty

Ƃ. open reduction and internal fixation

Ƃ. closed reduction and percutaneous pinning

Ƅ. a sling and early pedulum exercises

Ƅ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ɔ. open acromioplasty

Ƈ. open Bankart repair

Ƈ. open subscapularis tendon repair

Ɖ. inferior capsular shift

Ɗ. a supervised physical therapy program

Ƌ. a sling and swathe, with pendulum exercises in 10 days

Ƌ. open reduction and internal fixation through an anterior approach

ƍ. open reduction and internal fixation through a posterior approach

Ǝ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ə. arthroscopically assisted reduction and percutaneous screw fixation

Ɛ. Repair of the rotator cuff

Ƒ. Replacement of the humeral head

Ƒ. Resection arthroplasty

Ɠ. Total shoulder arthroplasty

Ɣ. AP and lateral radiographs of the elbow

Ƕ. Diagnositc arthroscopy

Ɩ. Aspiration of joint fluid

Ɨ. An erythrocyte sedimentation rate and CBC

Ƙ. A diagnostic lidocaine injection

Ƙ. Insulin-like growth factor (IGF-1)

Ƚ. Fibroblast growth factor (FGF-1)

ƛ. Platelet-derived growth factor (PDGF)

Ɯ. Transforming growth factor beta (TGF-B)

Ɲ. Bone morphogenetic proteins (BMP)

Ƞ. clinical history and radiographic findings.

Ɵ. technetium bone scan

Ơ. flow cytometry pattern of extracted chondrocytes

Ơ. immunohistochemical staining patterns of a biopsy specimen

Ƣ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƣ. Radial

Ƥ. Radial recurrent

Ƥ. Posterior interosseous

Ʀ. Superior ulnar recurrent

Ƨ. Superficial radial circumflex

Ƨ. Impaired hydroxylation of proline

Ʃ. Failure of cleavage in procollagen

ƪ. Defective binding sites for hydroxyproline

ƫ. Failure to incorporate glycine into the helix

Ƭ. Diminished production of collagen through the rough endoplasmic reticulum

Ƭ. Asking the legal staff to seek a court injunction

Ʈ. Copying the patient’s chart and giving it to him as he leaves

Ư. Having the patient sign a written legal contract that specifies acceptable behavior

Ư. Continuing care of the patient until an appropriate referral can be arranged

Ʊ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ʋ. Meta-analysis

Ƴ. Confidence interval

Ƴ. Analysis of variance (ANOVA)

Ƶ. Statistical significance (p-value)

Ƶ. Survivorship analysis (Kaplan-Meier)

Ʒ. Spinal shock

Ƹ. Neurogenic shock

Ƹ. Hypovolemic shock

ƺ. Pulmonary embolism

ƻ. Fat embolus syndrome

Ƽ. Lumbar spinal stenosis

Ƽ. Metastatic disease of the spine

ƾ. Rheumatoid lumbar spondylitis

Ƿ. Isthmic spondyloloisthesis

ǀ. Degenerative spondylolisthesis at L4-5 and L5-S1

ǁ. Patella alta

ǂ. A metal-backed patella

ǃ. Varus malalignment of the knee

Ǆ. A posterior cruciate-substituting femoral component

Ǆ. Lateral subluxation of the patella on a Merchant’s view

Ǆ. The sesamoids are separated

Ǉ. The sesamoid is fractured

Ǉ. The proximal phx is on the neck of the metatarsal

Ǉ. The dislocation is dorsal and centered

Ǌ. The proximal phalanx is hyperextended

Ǌ. Patella

Ǌ. Tibial stem

Ǎ. Distal femoral interface

Ǎ. Posterior femoral interface

Ǐ. Sites of screw fixation for the tibia

Ǐ. Hallux rigidus

Ǒ. Fracture of the sesamoid

Ǒ. Disruption of the plantar plate

Ǔ. Osteonecrosis of the metatarsal head

Ǔ. Rupture of the flexor hallucis longus

Ǖ. Gout

Ǖ. Sepsis

Ǘ. Old trauma

Ǘ. Rheumatoid arthritis

Ǚ. Charcot arthroplasty

Ǚ. Aspiration and steroid injection

Ǜ. Biopsy, curettage, and allograft bone grafting

Ǜ. Percutaneous Kirschner wire fixation

Ǝ. Percutaneous injection of autogenous bone marrow

Ǟ. Nerve roots

Ǟ. Spinal cord

Ǡ. Sciatic nerve

Ǡ. Peroneal nerve

Ǣ. Conus medullaris

Ǣ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǥ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǥ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǧ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǧ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǩ. Early and late infection

Ǩ. Periprosthetic fracture of the femur

Ǫ. Failure of the patellofemoral and extensor mechanisms

Ǫ. Aseptic loosening of cementing tibial components

Ǭ. Asceptic loosening of cemented femoral components

Ǭ. Acceptance of the current position of the ankle

Ǯ. Open reduction and fixation in the epiphysis only

Ǯ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

J̌. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǳ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǳ. Resection arthroplasty and local radiation

Ǳ. In situ fusion of the hip

Ǵ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǵ. Excision of heterotopic bone and local radiation

Ƕ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ƿ. Closed reduction of both fractures and immediate spica casting

Ǹ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǹ. External fixation of both femora

Ǻ. External fixation of the left femur and a long leg cast brace for the right femur

Ǻ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǽ. Synovial sarcoma

Ǽ. Soft-tissue abcess

Ǿ. Rhabdomyosarcoma

Ǿ. Eosinophilic granuloma

Ȁ. Nodular pigmented villonodular synovitis

Ȁ. Changing to a titanium nail

Ȃ. Changing to a nonslotted nail

Ȃ. Changing the cross-sectional shape of the nail

Ȅ. Increasing the diameter of the nail by 3 mm

Ȅ. Increasing the diameter of the interlocking screws

Ȇ. Fracture healing

Ȇ. Chondrosarcoma

Ȉ. Periosteal chondroma

Ȉ. Periosteal osteosarcoma

Ȋ. Dysplasia epiphysealis hemimelica

Ȋ. Demonstrate competence in the subject of the case

Ȍ. Be fellowship trained in the subject of the case

Ȍ. Be paid on a contingency basis

Ȏ. Be board certified by the American Board of Orthopaedic Surgery

Ȏ. Have been involved in the case as a consultant

Ȑ. Diagnostic arthroscopy

Ȑ. Arthroscopy and subacromial decompression

Ȓ. Reduction and fixation of the proximal humeral epiphysis

Ȓ. Temporary cessation of throwing

Ȕ. Physical therapy for rotator cuff strengthening

Ȕ. Oblique popliteal ligament

Ȗ. Lateral capsule

Ȗ. Popliteal tendon

Ș. Fibular collateral ligament

Ș. Posterior oblique ligament

Ț. Radial tear

Ț. Parrot-beak tear

Ȝ. Vertical tear in the “red-red” zone

Ȝ. Vertical tear in the “red-white” zone

Ȟ. Vertical tear in the “white-white” zone

Ȟ. 0 degrees of abduction, with neural rotation

Ƞ. 40 degrees of flexion and 60 degrees of internal rotation

ȡ. 45 degrees of flexion and 45 degrees of external rotation

Ȣ. 90 degrees of abduction with neutral rotation

Ȣ. 90 degrees of abduction and 90 degrees of external rotation

Ȥ. Sural

Ȥ. Saphenous and its branches

Ȧ. Posterior tibial and its branches

Ȧ. Deep peroneal and its branches

Ȩ. Superficial peroneal and its branches

Ȩ. Strength

Ȫ. Stiffness

Ȫ. Shelf life

Ȭ. Antigenicity

Ȭ. Risk of HIV transmission

Ȯ. Indemnification

Ȯ. Occurrence

Ȱ. Excess liability

Ȱ. Claims-made

Ȳ. Nose

Ȳ. Lateral Y

ȴ. Scapular AP

ȵ. Neutral rotation AP

ȶ. Internal rotation AP

ȷ. External rotation AP

ȸ. Trauma

ȹ. Hemophilia

Ⱥ. Reiter’s syndrome

Ȼ. Rheumatoid arthritis

Ȼ. Systemic lupus erythematosus

Ƚ. Cast immobilization for 6 weeks

Ⱦ. Activity modification and re-evaluation in 2 months

Ȿ. Internal fixation with or without bone grafting

Ɀ. Retrograde drilling of the defect without articular cartilage penetration

Ɂ. Drilling of the defect directly through the articular cartilage

Ɂ. repair or reconstruction of the medial collateral ligament

Ƀ. repair or reconstruction of the medialand lateral collateral ligaments

Ʉ. immobilization for 5 days or less

Ʌ. immobilization for 14 days

Ɇ. immobilization for 25 days

Ɇ. Cystinosis

Ɉ. Hypophosphatemia

Ɉ. Renal osteodystrophy

Ɋ. Primary hyperparathyroidism

Ɋ. Nutritional vitamin D deficiency

Ɍ. Lateral meniscus tear

Ɍ. Popliteus tenosynovitis

Ɏ. Iliotibial band friction syndrome

Ɏ. Peroneal nerve entrapment

Ɐ. Biceps tendinitis

Ɑ. Observation

Ɒ. Removal of the prosthetic components

Ɓ. Operative exploration and decompression of the peroneal nerve

Ɔ. Nerve conduction velocity studies

ɕ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɖ. I

Ɗ. II

ɘ. III

Ə. decreased tissue tension

ɚ. decreased abductor lever arm

Ɛ. decreased joint reaction force

Ɜ. increased body weight over lever arm

ɝ. increased polyethylene wear rate

ɞ. recurrent traumatic anterior dislocation

ɟ. recurrent traumatic posterior dislocation

Ɠ. traumatic subluxation with no previous dislocation

Ɡ. traumatic anterior subluxation

ɢ. atraumatic involuntary subluxation

Ɣ. radial

ɤ. axillary

Ɥ. suprascapular

Ɦ. thoracodorsal

ɧ. long thoracic

Ɨ. Flexion

Ɩ. Extension

Ɪ. Axial rotation

Ɫ. Left lateral bending

Ɬ. Right lateral bending

ɭ. Skin

ɮ. Lung

Ɯ. Brain

ɰ. Heart

Ɱ. Kidney

Ɲ. Thoracoacromial, lateral thoracic, subscapular

ɳ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ɴ. Posterior humeral circumflex, subscapular, thoracacromial

Ɵ. Subscapular, thoracacromial, anterior humeral circumflex

ɶ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ɷ. Respondeat superior

ɸ. Indemnity agreement

ɹ. Hold harmless agreement- attempt to shift liability from company to physician

ɺ. Comparative negligence-% of involvement

ɻ. Contributory negligence- resident contributed to the negligence

ɼ. t-type

Ɽ. both column

ɾ. transverse

ɿ. anterior column

Ʀ. anterior column posterior hemitransverse

ʁ. Posterior interosseous

Ʂ. Anterior interosseous

Ʃ. Radial

ʄ. Median

ʅ. Ulnar

ʆ. Shock from hypovolemia

Ʇ. Associated rupture of the bladder

Ʈ. Arterial bleeding on pelvic angiogram

Ʉ. Presence of a hematoma in the perineum and scrotum

Ʊ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Begins to remodel and hypertrophy more quickly

Explanation

Question 4149

Topic: 10. Pathology and Oncology

A 14-year-old girl has idiopathic scoliosis with a 52-degree right thoracic curve and a 36-degree left lumbar curve. The rotation of the apical vertebra appears greater in the thoracic curve. A sagittal view radiograph shows the spine to be virtually straight. The iliac apophyses are Risser 2. Treatment should consist of

. Anterior fusion of the lumbar curve

. Anterior and posterior fusion of the thoracic curve

. Posterior fusion of the thoracic curve

. Posterior fusion of the thoracic and lumbar curves

. Application of a brace until the iliac apophyses are Risser 4 or 5, followed by surgical correction

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

!. Skeletal traction and delayed internal fixation of both fractures

". Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

#. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

$. Heel spur

%. Plantar fascitis

&. Dysfunction of the tibialis posterior tendon

'. Compression of the first branch of the lateral plantar nerve

(. Compression of the calcaneal nerve

). Displaced labral tear

*. Tear of the rotator cuff

+. Fracture of the glenoid rim

,. Palsy of the axillary nerve

-. Palsy of the musculocutaneus nerve

.. Enchondroma

/. Osteoblastoma

0. Giant cell tumor

1. Aneurysmal bone cyst

2. Fibrous dysplasia

3. Arthrogram of the wrist

4. MRI scan of both wrists

5. CT scan of both wrists in the same position

6. Radiographs of the wrist in supination and pronation

7. Radiographs of the opposite wrist in the same position

8. Secondary hyperparathyroidism

9. Phosphate retention secondary to uremia

:. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

;. Aluminum deposition in bone from oral phosphate binders

<. Persistent acidosis aggravating the negative calcium balance

=. Posterior fusion at T10-L3 with segmental instrumentation

>. Laminectomy and fusion of T12-L2 with segmental instrumentation

?. Bed rest in a hyperextension brace

@. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

A. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

B. Positive-pressure ventilation

C. An immediate radiograph of the chest

D. Adjustment of the position of the endotrachael tube

E. Insertion of a large-bore needle into the pericardial space

F. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

G. Allowing the ends of the fracture to touch

H. Adding a second connecting bar

I. Adding one pin to each fracture fragment

J. Increasing the pin diameter from 4 mm to 6 mm

K. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

L. Osteomyelitis

M. Malignant degeneration

N. Stress fracture

O. Local recurrence of the giant cell tumor

P. Bone resorption due to methylmethacrylate

Q. Advancement of the plantar plate

R. Resection of the second metatarsal head

S. Dorsiflexion osteotomy of the second metatarsal neck

T. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

U. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

V. Sacral fracture

W. Burst fracture of L5

X. Cauda equina syndrome

Y. Distraction-flexion injury at L3

Z. Distraction-extension injury at L3

[. An MRI scan of the shoulder

\. An MRI scan of the cervical spine

]. Electromyographic and nerve conduction velocity studies

^. Immobilization in a sling and early passive range of motion exercises

_. Immediate return to the operating room for exploration of the brachial plexus

`. cerclage wiring

A. tension band wiring

B. removal of the patellar component

C. revision of the patellar component

D. immobilization of the knee and protected weightbearing

E. Liposarcoma

F. Nodular fasciitis

G. Rabdomyosarcoma

H. Malignant fibrous histiocytoma

I. Extra-abdominal desmoid tumor

J. Clubfeet

K. Thrombocytopenia

L. Congenital scoliosis

M. Ventricular septal defect

N. Arnold-Chiari malformation

O. delayed primary closure

P. free flap

Q. pedicle groin flap

R. full-thickness skin graft

S. split-thickness skin graft

T. Infection

U. Nonunion

V. Improper screw length

W. Osteonecrosis of the distal fragment

X. Use of a cortical screw instead of a cancellous screw

Y. Infection

Z. Tear of the rotator cuff

{. Loosening of the humeral component

|. Arthritis of the glenoid

}. Arthritis of the A-C joint

~. Reduced morbidity

. Improved osteoinduction

. Improved osteoconduction

. More rapid revascularization

. Lower risk of disease transmission

. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

¡. Loss of skin hair on the feet

¢. Absent pulses on vascular examination

£. Pain that originates proximally and spreads distally

¤. Pain that is relieved by stopping and standing

¥. Pain that is worse when the patient walks uphill rather downhill

¦. wrist flexors and finger flexors

§. elbow flexors and wrist flexors

¨. elbow flexors and finger flexors

©. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

ª. elbow extensors and wrist extensors

«. Syndactyly

¬. Macrodactyly

. Camptodactyly

®. Preaxial polydactyly

¯. Postaxial polydactyly

°. Arthrodesis

±. Rotationplasty

². Above-knee amputation

³. Osteoarticular allograft

´. Endoprosthesis (custom arthroplasty)

Μ. Plantar fascia

¶. Spring ligament

·. Deltoid ligament

¸. Intrinsic tendons

¹. Gastorcnemius-solelus complex

º. Prevention of presynaptic release of acetylcholine

». Prevention of synthesis of presynaptic acetylcholine

¼. Activation of acetylcholinesterase at the motor end-plate

½. Blockage of postsynaptic action of acetylcholine until reserves are depleted

¾. Stimulation of release of presynaptic acetylcholine until reserves are depleted

¿. stiffness of the femoral component.

À. head offset of the femoral component.

Á. femoral component material modulus of elasticity.

Â. extent of the femoral component porous coating.

Ã. Presence of a femoral component collar.

Ä. plantar fascia and quadratus plantae tendon.

Å. ligamentous structures connecting the tarsal bones.

Æ. shape of the tarsal bones and the intervening joints.

Ç. activity of the intrinsic muscles of the foot.

È. activity of the posterior tibialis and the peroneus longus muscles.

É. scapulothoracic fusion

Ê. strengthening of the periscapular muscles

Ë. pectoralis minor-fascia lata graft transfer to the scapula

Ì. pectoralis major-fascia lata graft transfer to the scapula

Í. exploration of the long thoracic nerve, with sural nerve graft

Î. tricompartmental knee replacement

Ï. unicompartmental knee replacement

Ð. medial compartment meniscal allograft

Ñ. valgus-producing distal femoral osteotomy

Ò. valgus-producing proximal tibial osteotomy

Ó. Internal rotation of the femoral component

Ô. External rotation of the tibial component

Õ. Lateral placement of the femoral component

Ö. Medial placement of the patellar component

×. Excessive resection of the patella

Ø. Hallux rigidus

Ù. Hallux valgus

Ú. Neuroma of the first web space

Û. Fracture of the sesamoid

Ü. Rupture of the flexor hallucis longus

Ý. Sickle cell crisis

Þ. Idiopathic chondrolysis

SS. Hemophilic arthropathy

À. Osteoid osteoma of the femoral neck

Á. Legg-Calve-Perthes disease

Â. Decreased ankle jerk and positive femoral nerve stretch test

Ã. Decreased knee jerk and positive straight-leg raising sign

Ä. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Å. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Æ. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ç. Long-term administration of IV and oral antibiotics

È. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

É. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ê. Two-stage surgical prosthetic exchange and IV antibiotics

Ë. Resection arthroplasty and IV antibiotics

Ì. SCFE

Í. MED

Î. Perthes disease

Ï. Hypothyroidism

Ð. Chondrolysis

Ñ. gout.

Ò. osteoporosis.

Ó. eosinophilic granuloma.

Ô. tuberculosis of the spine.

Õ. metastatic disease of the spine.

Ö. water content.

÷. Synthesis of type I collagen.

Ø. Proteoglycan content.

Ù. Activity of chondrocytes.

Ú. Synthesis of hyaluronate.

Û. Lung

Ü. Breast

Ý. Prostate

Þ. Thyroid

Ÿ. Renal

Ā. T1-low, T2-low.

Ā. T1-low, T2-high.

Ă. T1-moderate, T2-low.

Ă. T1-high, T2-low.

Ą. T1-high, T2-high.

Ą. hypothesis is incorrect or invalid

Ć. interobserver error rate is 4%.

Ć. Standard deviation is 4% higher or lower than the mean.

Ĉ. Sample size is 4% larger than required to be clinically significant.

Ĉ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ċ. I

Ċ. II

Č. IV

Č. IX

Ď. X

Ď. Cranial setting

Đ. Cranial subluxation

Đ. Odontoid fracture

Ē. Lysis of the arch of the atlas

Ē. Atlantoaxial subluxation

Ĕ. Retrograde collapse of the endoneurial tubes

Ĕ. Irreversible atrophy of the denervated muscles

Ė. Elongation of the axons across the zone of injury

Ė. Sprouting of the axons at the neuromuscular junction

Ę. Misdirection of the axons across the zone of injury

Ę. Maximally pronated and elbow extended

Ě. Maximally pronated and the elbow flexed

Ě. Maximally supinated and the elbow flexed

Ĝ. Maximally supinated and the elbow extended

Ĝ. In neutral rotation, with the elbow extended

Ğ. open reduction and internal fixation

Ğ. buddy taping to the adjacent index finger

Ġ. early motion with application of a dynamic banjo splint

Ġ. application of a cast with the hand in a “safe position” for 3 weeks.

Ģ. dorsal extension block splinting

Ģ. The name of the manufacturer

Ĥ. The manufacturer’s potential liability

Ĥ. The physician’s clinical performance

Ħ. The physician’s materials testing data

Ħ. Any royalties the physician receives from the manufacturer

Ĩ. Femoral

Ĩ. Obturator

Ī. Inferior gluteal

Ī. Superior gluteal

Ĭ. Lateral femoral cutaneous

Ĭ. open biopsy and a long leg cast

Į. open biopsy and wide resection of the tumor

Į. a long leg cast and observation

İ. intramedullary stabilization and observation

I. Triggering

Ĳ. Lateral instability

Ĳ. Swan-neck deformity

Ĵ. Boutonniere deformity

Ĵ. Loss of distal interphalangeal joint flexion

Ķ. Peroneus brevis to peroneus longus

Ķ. Peroneus tertius to extensor hallucis longus

ĸ. Peroneus tertius to superficial peroneal nerve

Ĺ. Extensor hallucis longus to deep peroneal nerve

Ĺ. Extensor hallucis longus to extensor digitorum longus

Ļ. reassurance that Medicare will pay for the treatment.

Ļ. consent forms that patients or their guardians are able to understand.

Ľ. a detailed description of the device, omitting the fact that it is part of a study.

Ľ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ŀ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ŀ. an onlay iliac crest bone graft.

Ł. limited weightbearing and observation.

Ł. removal of the implant and limited weightbearing.

Ń. removal of the implant and insertion of a reamed femoral nail.

Ń. removal of the implant and insertion of an unreamed femoral nail.

Ņ. Coronal

Ņ. Sagittal

Ň. Anteromedial, midway between the sagittal and the coronal

Ň. Proximal pins sagittal, distal pins coronal

ʼN. Proximal pins coronal, distal pins sagittal

Ŋ. Rheumatoid arthritis

Ŋ. Posttraumatic arthritis

Ō. Degenerative osteoarthritis

Ō. Osteonecrosis of the tibial plateau

Ŏ. Osteonecrosis of the medial femoral condyle

Ŏ. Trapeziometacarpal arthrodesis

Ő. Osteotomy of the thumb metacarpal

Ő. Arthrotomy and joint debridement

Œ. Ligament reconstruction using one half of the flexor carpi radialis

Œ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŕ. Creep

Ŕ. Relaxation

Ŗ. Energy dissipation

Ŗ. Plastic deformation

Ř. Elastic deformation

Ř. bending

Ś. axial loading

Ś. high-speed rotation

Ŝ. direct impact from anteromedial

Ŝ. crush from anteromedial to posterolateral

Ş. Increase stiffness

Ş. Increase fracture toughness

Š. Increase fatigue strength

Š. Decrease mechanical strength

Ţ. Decrease wear rate

Ţ. disuse osteopenia

Ť. paraendocrine effect of the tumor

Ť. abnormally increased density on the right side

Ŧ. side effect of the treatment of the lesion

Ŧ. extensive tumor involvement of the left hip

Ũ. Sciatic nerve

Ũ. Superior gluteal artery

Ū. Profunda femoris artery

Ū. Femoral artery and nerve

Ŭ. External iliac artery and vein

Ŭ. Length

Ů. Moment arm

Ů. Total volume

Ű. Physiologic cross-sectional area

Ű. Distribution of slow and fast twitch fibers

Ų. decreasing initiation of action potentials.

Ų. increasing action potential amplitude.

Ŵ. blocking the opening of gated sodium channels.

Ŵ. decreasing the number of functional motor units.

Ŷ. slowing or stopping action potential propagation through the axon.

Ŷ. resection of the metatarsal heads of the first through fifth toes.

Ÿ. Silastic MP joint arthroplasties of the first through fifth toes.

Ź. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ź. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ż. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ż. hemiarthroplasty

Ž. open reduction and internal fixation

Ž. closed reduction and percutaneous pinning

S. a sling and early pedulum exercises

Ƀ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ɓ. open acromioplasty

Ƃ. open Bankart repair

Ƃ. open subscapularis tendon repair

Ƅ. inferior capsular shift

Ƅ. a supervised physical therapy program

Ɔ. a sling and swathe, with pendulum exercises in 10 days

Ƈ. open reduction and internal fixation through an anterior approach

Ƈ. open reduction and internal fixation through a posterior approach

Ɖ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ɗ. arthroscopically assisted reduction and percutaneous screw fixation

Ƌ. Repair of the rotator cuff

Ƌ. Replacement of the humeral head

ƍ. Resection arthroplasty

Ǝ. Total shoulder arthroplasty

Ə. AP and lateral radiographs of the elbow

Ɛ. Diagnositc arthroscopy

Ƒ. Aspiration of joint fluid

Ƒ. An erythrocyte sedimentation rate and CBC

Ɠ. A diagnostic lidocaine injection

Ɣ. Insulin-like growth factor (IGF-1)

Ƕ. Fibroblast growth factor (FGF-1)

Ɩ. Platelet-derived growth factor (PDGF)

Ɨ. Transforming growth factor beta (TGF-B)

Ƙ. Bone morphogenetic proteins (BMP)

Ƙ. clinical history and radiographic findings.

Ƚ. technetium bone scan

ƛ. flow cytometry pattern of extracted chondrocytes

Ɯ. immunohistochemical staining patterns of a biopsy specimen

Ɲ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƞ. Radial

Ɵ. Radial recurrent

Ơ. Posterior interosseous

Ơ. Superior ulnar recurrent

Ƣ. Superficial radial circumflex

Ƣ. Impaired hydroxylation of proline

Ƥ. Failure of cleavage in procollagen

Ƥ. Defective binding sites for hydroxyproline

Ʀ. Failure to incorporate glycine into the helix

Ƨ. Diminished production of collagen through the rough endoplasmic reticulum

Ƨ. Asking the legal staff to seek a court injunction

Ʃ. Copying the patient’s chart and giving it to him as he leaves

ƪ. Having the patient sign a written legal contract that specifies acceptable behavior

ƫ. Continuing care of the patient until an appropriate referral can be arranged

Ƭ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƭ. Meta-analysis

Ʈ. Confidence interval

Ư. Analysis of variance (ANOVA)

Ư. Statistical significance (p-value)

Ʊ. Survivorship analysis (Kaplan-Meier)

Ʋ. Spinal shock

Ƴ. Neurogenic shock

Ƴ. Hypovolemic shock

Ƶ. Pulmonary embolism

Ƶ. Fat embolus syndrome

Ʒ. Lumbar spinal stenosis

Ƹ. Metastatic disease of the spine

Ƹ. Rheumatoid lumbar spondylitis

ƺ. Isthmic spondyloloisthesis

ƻ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƽ. Patella alta

Ƽ. A metal-backed patella

ƾ. Varus malalignment of the knee

Ƿ. A posterior cruciate-substituting femoral component

ǀ. Lateral subluxation of the patella on a Merchant’s view

ǁ. The sesamoids are separated

ǂ. The sesamoid is fractured

ǃ. The proximal phx is on the neck of the metatarsal

Ǆ. The dislocation is dorsal and centered

Ǆ. The proximal phalanx is hyperextended

Ǆ. Patella

Ǉ. Tibial stem

Ǉ. Distal femoral interface

Ǉ. Posterior femoral interface

Ǌ. Sites of screw fixation for the tibia

Ǌ. Hallux rigidus

Ǌ. Fracture of the sesamoid

Ǎ. Disruption of the plantar plate

Ǎ. Osteonecrosis of the metatarsal head

Ǐ. Rupture of the flexor hallucis longus

Ǐ. Gout

Ǒ. Sepsis

Ǒ. Old trauma

Ǔ. Rheumatoid arthritis

Ǔ. Charcot arthroplasty

Ǖ. Aspiration and steroid injection

Ǖ. Biopsy, curettage, and allograft bone grafting

Ǘ. Percutaneous Kirschner wire fixation

Ǘ. Percutaneous injection of autogenous bone marrow

Ǚ. Nerve roots

Ǚ. Spinal cord

Ǜ. Sciatic nerve

Ǜ. Peroneal nerve

Ǝ. Conus medullaris

Ǟ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǟ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǡ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǡ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǣ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǣ. Early and late infection

Ǥ. Periprosthetic fracture of the femur

Ǥ. Failure of the patellofemoral and extensor mechanisms

Ǧ. Aseptic loosening of cementing tibial components

Ǧ. Asceptic loosening of cemented femoral components

Ǩ. Acceptance of the current position of the ankle

Ǩ. Open reduction and fixation in the epiphysis only

Ǫ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǫ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǭ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǭ. Resection arthroplasty and local radiation

Ǯ. In situ fusion of the hip

Ǯ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

J̌. Excision of heterotopic bone and local radiation

Ǳ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǳ. Closed reduction of both fractures and immediate spica casting

Ǳ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǵ. External fixation of both femora

Ǵ. External fixation of the left femur and a long leg cast brace for the right femur

Ƕ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ƿ. Synovial sarcoma

Ǹ. Soft-tissue abcess

Ǹ. Rhabdomyosarcoma

Ǻ. Eosinophilic granuloma

Ǻ. Nodular pigmented villonodular synovitis

Ǽ. Changing to a titanium nail

Ǽ. Changing to a nonslotted nail

Ǿ. Changing the cross-sectional shape of the nail

Ǿ. Increasing the diameter of the nail by 3 mm

Ȁ. Increasing the diameter of the interlocking screws

Ȁ. Fracture healing

Ȃ. Chondrosarcoma

Ȃ. Periosteal chondroma

Ȅ. Periosteal osteosarcoma

Ȅ. Dysplasia epiphysealis hemimelica

Ȇ. Demonstrate competence in the subject of the case

Ȇ. Be fellowship trained in the subject of the case

Ȉ. Be paid on a contingency basis

Ȉ. Be board certified by the American Board of Orthopaedic Surgery

Ȋ. Have been involved in the case as a consultant

Ȋ. Diagnostic arthroscopy

Ȍ. Arthroscopy and subacromial decompression

Ȍ. Reduction and fixation of the proximal humeral epiphysis

Ȏ. Temporary cessation of throwing

Ȏ. Physical therapy for rotator cuff strengthening

Ȑ. Oblique popliteal ligament

Ȑ. Lateral capsule

Ȓ. Popliteal tendon

Ȓ. Fibular collateral ligament

Ȕ. Posterior oblique ligament

Ȕ. Radial tear

Ȗ. Parrot-beak tear

Ȗ. Vertical tear in the “red-red” zone

Ș. Vertical tear in the “red-white” zone

Ș. Vertical tear in the “white-white” zone

Ț. 0 degrees of abduction, with neural rotation

Ț. 40 degrees of flexion and 60 degrees of internal rotation

Ȝ. 45 degrees of flexion and 45 degrees of external rotation

Ȝ. 90 degrees of abduction with neutral rotation

Ȟ. 90 degrees of abduction and 90 degrees of external rotation

Ȟ. Sural

Ƞ. Saphenous and its branches

ȡ. Posterior tibial and its branches

Ȣ. Deep peroneal and its branches

Ȣ. Superficial peroneal and its branches

Ȥ. Strength

Ȥ. Stiffness

Ȧ. Shelf life

Ȧ. Antigenicity

Ȩ. Risk of HIV transmission

Ȩ. Indemnification

Ȫ. Occurrence

Ȫ. Excess liability

Ȭ. Claims-made

Ȭ. Nose

Ȯ. Lateral Y

Ȯ. Scapular AP

Ȱ. Neutral rotation AP

Ȱ. Internal rotation AP

Ȳ. External rotation AP

Ȳ. Trauma

ȴ. Hemophilia

ȵ. Reiter’s syndrome

ȶ. Rheumatoid arthritis

ȷ. Systemic lupus erythematosus

ȸ. Cast immobilization for 6 weeks

ȹ. Activity modification and re-evaluation in 2 months

Ⱥ. Internal fixation with or without bone grafting

Ȼ. Retrograde drilling of the defect without articular cartilage penetration

Ȼ. Drilling of the defect directly through the articular cartilage

Ƚ. repair or reconstruction of the medial collateral ligament

Ⱦ. repair or reconstruction of the medialand lateral collateral ligaments

Ȿ. immobilization for 5 days or less

Ɀ. immobilization for 14 days

Ɂ. immobilization for 25 days

Ɂ. Cystinosis

Ƀ. Hypophosphatemia

Ʉ. Renal osteodystrophy

Ʌ. Primary hyperparathyroidism

Ɇ. Nutritional vitamin D deficiency

Ɇ. Lateral meniscus tear

Ɉ. Popliteus tenosynovitis

Ɉ. Iliotibial band friction syndrome

Ɋ. Peroneal nerve entrapment

Ɋ. Biceps tendinitis

Ɍ. Observation

Ɍ. Removal of the prosthetic components

Ɏ. Operative exploration and decompression of the peroneal nerve

Ɏ. Nerve conduction velocity studies

Ɐ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɑ. I

Ɒ. II

Ɓ. III

Ɔ. decreased tissue tension

ɕ. decreased abductor lever arm

Ɖ. decreased joint reaction force

Ɗ. increased body weight over lever arm

ɘ. increased polyethylene wear rate

Ə. recurrent traumatic anterior dislocation

ɚ. recurrent traumatic posterior dislocation

Ɛ. traumatic subluxation with no previous dislocation

Ɜ. traumatic anterior subluxation

ɝ. atraumatic involuntary subluxation

ɞ. radial

ɟ. axillary

Ɠ. suprascapular

Ɡ. thoracodorsal

ɢ. long thoracic

Ɣ. Flexion

ɤ. Extension

Ɥ. Axial rotation

Ɦ. Left lateral bending

ɧ. Right lateral bending

Ɨ. Skin

Ɩ. Lung

Ɪ. Brain

Ɫ. Heart

Ɬ. Kidney

ɭ. Thoracoacromial, lateral thoracic, subscapular

ɮ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɯ. Posterior humeral circumflex, subscapular, thoracacromial

ɰ. Subscapular, thoracacromial, anterior humeral circumflex

Ɱ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɲ. Respondeat superior

ɳ. Indemnity agreement

ɴ. Hold harmless agreement- attempt to shift liability from company to physician

Ɵ. Comparative negligence-% of involvement

ɶ. Contributory negligence- resident contributed to the negligence

ɷ. t-type

ɸ. both column

ɹ. transverse

ɺ. anterior column

ɻ. anterior column posterior hemitransverse

ɼ. Posterior interosseous

Ɽ. Anterior interosseous

ɾ. Radial

ɿ. Median

Ʀ. Ulnar

ʁ. Shock from hypovolemia

Ʂ. Associated rupture of the bladder

Ʃ. Arterial bleeding on pelvic angiogram

ʄ. Presence of a hematoma in the perineum and scrotum

ʅ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Anterior fusion of the lumbar curve

Explanation

Question 4150

Topic: 10. Pathology and Oncology

A 20-year-old college football player sustains a forceful hyperextension injury to his shoulder 4 months after undergoing an anterior capsular shift. Examination 2 weeks later reveals anterior tenderness. He is unable to lift the dorsum of his hand away from his back. What is the most likely diagnosis?

. Subscapularis rupture

. Type III SLAP lesion

. Disruption of capsular shift

. Isolated traumatic subluxation

. Injury to the axillary nerve after dislocation

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

!. Dysfunction of the tibialis posterior tendon

". Compression of the first branch of the lateral plantar nerve

#. Compression of the calcaneal nerve

$. Displaced labral tear

%. Tear of the rotator cuff

&. Fracture of the glenoid rim

'. Palsy of the axillary nerve

(. Palsy of the musculocutaneus nerve

). Enchondroma

*. Osteoblastoma

+. Giant cell tumor

,. Aneurysmal bone cyst

-. Fibrous dysplasia

.. Arthrogram of the wrist

/. MRI scan of both wrists

0. CT scan of both wrists in the same position

1. Radiographs of the wrist in supination and pronation

2. Radiographs of the opposite wrist in the same position

3. Secondary hyperparathyroidism

4. Phosphate retention secondary to uremia

5. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

6. Aluminum deposition in bone from oral phosphate binders

7. Persistent acidosis aggravating the negative calcium balance

8. Posterior fusion at T10-L3 with segmental instrumentation

9. Laminectomy and fusion of T12-L2 with segmental instrumentation

:. Bed rest in a hyperextension brace

;. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

<. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

=. Positive-pressure ventilation

>. An immediate radiograph of the chest

?. Adjustment of the position of the endotrachael tube

@. Insertion of a large-bore needle into the pericardial space

A. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

B. Allowing the ends of the fracture to touch

C. Adding a second connecting bar

D. Adding one pin to each fracture fragment

E. Increasing the pin diameter from 4 mm to 6 mm

F. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

G. Osteomyelitis

H. Malignant degeneration

I. Stress fracture

J. Local recurrence of the giant cell tumor

K. Bone resorption due to methylmethacrylate

L. Advancement of the plantar plate

M. Resection of the second metatarsal head

N. Dorsiflexion osteotomy of the second metatarsal neck

O. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

P. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

Q. Sacral fracture

R. Burst fracture of L5

S. Cauda equina syndrome

T. Distraction-flexion injury at L3

U. Distraction-extension injury at L3

V. An MRI scan of the shoulder

W. An MRI scan of the cervical spine

X. Electromyographic and nerve conduction velocity studies

Y. Immobilization in a sling and early passive range of motion exercises

Z. Immediate return to the operating room for exploration of the brachial plexus

[. cerclage wiring

\. tension band wiring

]. removal of the patellar component

^. revision of the patellar component

_. immobilization of the knee and protected weightbearing

`. Liposarcoma

A. Nodular fasciitis

B. Rabdomyosarcoma

C. Malignant fibrous histiocytoma

D. Extra-abdominal desmoid tumor

E. Clubfeet

F. Thrombocytopenia

G. Congenital scoliosis

H. Ventricular septal defect

I. Arnold-Chiari malformation

J. delayed primary closure

K. free flap

L. pedicle groin flap

M. full-thickness skin graft

N. split-thickness skin graft

O. Infection

P. Nonunion

Q. Improper screw length

R. Osteonecrosis of the distal fragment

S. Use of a cortical screw instead of a cancellous screw

T. Infection

U. Tear of the rotator cuff

V. Loosening of the humeral component

W. Arthritis of the glenoid

X. Arthritis of the A-C joint

Y. Reduced morbidity

Z. Improved osteoinduction

{. Improved osteoconduction

|. More rapid revascularization

}. Lower risk of disease transmission

~. Manipulation Under Anesthesia

. Arthroscopic acromioplasty

. Arthroscopic debridement of G-H joint

. Replacement of the humeral head

. Lengthening of the subscapularis and release of the anterior capsule

. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

¡. wrist flexors and finger flexors

¢. elbow flexors and wrist flexors

£. elbow flexors and finger flexors

¤. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

¥. elbow extensors and wrist extensors

¦. Syndactyly

§. Macrodactyly

¨. Camptodactyly

©. Preaxial polydactyly

ª. Postaxial polydactyly

«. Arthrodesis

¬. Rotationplasty

. Above-knee amputation

®. Osteoarticular allograft

¯. Endoprosthesis (custom arthroplasty)

°. Plantar fascia

±. Spring ligament

². Deltoid ligament

³. Intrinsic tendons

´. Gastorcnemius-solelus complex

Μ. Prevention of presynaptic release of acetylcholine

¶. Prevention of synthesis of presynaptic acetylcholine

·. Activation of acetylcholinesterase at the motor end-plate

¸. Blockage of postsynaptic action of acetylcholine until reserves are depleted

¹. Stimulation of release of presynaptic acetylcholine until reserves are depleted

º. stiffness of the femoral component.

». head offset of the femoral component.

¼. femoral component material modulus of elasticity.

½. extent of the femoral component porous coating.

¾. Presence of a femoral component collar.

¿. plantar fascia and quadratus plantae tendon.

À. ligamentous structures connecting the tarsal bones.

Á. shape of the tarsal bones and the intervening joints.

Â. activity of the intrinsic muscles of the foot.

Ã. activity of the posterior tibialis and the peroneus longus muscles.

Ä. scapulothoracic fusion

Å. strengthening of the periscapular muscles

Æ. pectoralis minor-fascia lata graft transfer to the scapula

Ç. pectoralis major-fascia lata graft transfer to the scapula

È. exploration of the long thoracic nerve, with sural nerve graft

É. tricompartmental knee replacement

Ê. unicompartmental knee replacement

Ë. medial compartment meniscal allograft

Ì. valgus-producing distal femoral osteotomy

Í. valgus-producing proximal tibial osteotomy

Î. Internal rotation of the femoral component

Ï. External rotation of the tibial component

Ð. Lateral placement of the femoral component

Ñ. Medial placement of the patellar component

Ò. Excessive resection of the patella

Ó. Hallux rigidus

Ô. Hallux valgus

Õ. Neuroma of the first web space

Ö. Fracture of the sesamoid

×. Rupture of the flexor hallucis longus

Ø. Sickle cell crisis

Ù. Idiopathic chondrolysis

Ú. Hemophilic arthropathy

Û. Osteoid osteoma of the femoral neck

Ü. Legg-Calve-Perthes disease

Ý. Decreased ankle jerk and positive femoral nerve stretch test

Þ. Decreased knee jerk and positive straight-leg raising sign

SS. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

À. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Á. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Â. Long-term administration of IV and oral antibiotics

Ã. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ä. Immediate exchange arthroplasty with antibiotic-impregnated cement

Å. Two-stage surgical prosthetic exchange and IV antibiotics

Æ. Resection arthroplasty and IV antibiotics

Ç. SCFE

È. MED

É. Perthes disease

Ê. Hypothyroidism

Ë. Chondrolysis

Ì. gout.

Í. osteoporosis.

Î. eosinophilic granuloma.

Ï. tuberculosis of the spine.

Ð. metastatic disease of the spine.

Ñ. water content.

Ò. Synthesis of type I collagen.

Ó. Proteoglycan content.

Ô. Activity of chondrocytes.

Õ. Synthesis of hyaluronate.

Ö. Lung

÷. Breast

Ø. Prostate

Ù. Thyroid

Ú. Renal

Û. T1-low, T2-low.

Ü. T1-low, T2-high.

Ý. T1-moderate, T2-low.

Þ. T1-high, T2-low.

Ÿ. T1-high, T2-high.

Ā. hypothesis is incorrect or invalid

Ā. interobserver error rate is 4%.

Ă. Standard deviation is 4% higher or lower than the mean.

Ă. Sample size is 4% larger than required to be clinically significant.

Ą. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ą. I

Ć. II

Ć. IV

Ĉ. IX

Ĉ. X

Ċ. Cranial setting

Ċ. Cranial subluxation

Č. Odontoid fracture

Č. Lysis of the arch of the atlas

Ď. Atlantoaxial subluxation

Ď. Retrograde collapse of the endoneurial tubes

Đ. Irreversible atrophy of the denervated muscles

Đ. Elongation of the axons across the zone of injury

Ē. Sprouting of the axons at the neuromuscular junction

Ē. Misdirection of the axons across the zone of injury

Ĕ. Maximally pronated and elbow extended

Ĕ. Maximally pronated and the elbow flexed

Ė. Maximally supinated and the elbow flexed

Ė. Maximally supinated and the elbow extended

Ę. In neutral rotation, with the elbow extended

Ę. open reduction and internal fixation

Ě. buddy taping to the adjacent index finger

Ě. early motion with application of a dynamic banjo splint

Ĝ. application of a cast with the hand in a “safe position” for 3 weeks.

Ĝ. dorsal extension block splinting

Ğ. The name of the manufacturer

Ğ. The manufacturer’s potential liability

Ġ. The physician’s clinical performance

Ġ. The physician’s materials testing data

Ģ. Any royalties the physician receives from the manufacturer

Ģ. Femoral

Ĥ. Obturator

Ĥ. Inferior gluteal

Ħ. Superior gluteal

Ħ. Lateral femoral cutaneous

Ĩ. open biopsy and a long leg cast

Ĩ. open biopsy and wide resection of the tumor

Ī. a long leg cast and observation

Ī. intramedullary stabilization and observation

Ĭ. Triggering

Ĭ. Lateral instability

Į. Swan-neck deformity

Į. Boutonniere deformity

İ. Loss of distal interphalangeal joint flexion

I. Peroneus brevis to peroneus longus

Ĳ. Peroneus tertius to extensor hallucis longus

Ĳ. Peroneus tertius to superficial peroneal nerve

Ĵ. Extensor hallucis longus to deep peroneal nerve

Ĵ. Extensor hallucis longus to extensor digitorum longus

Ķ. reassurance that Medicare will pay for the treatment.

Ķ. consent forms that patients or their guardians are able to understand.

ĸ. a detailed description of the device, omitting the fact that it is part of a study.

Ĺ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ĺ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ļ. an onlay iliac crest bone graft.

Ļ. limited weightbearing and observation.

Ľ. removal of the implant and limited weightbearing.

Ľ. removal of the implant and insertion of a reamed femoral nail.

Ŀ. removal of the implant and insertion of an unreamed femoral nail.

Ŀ. Coronal

Ł. Sagittal

Ł. Anteromedial, midway between the sagittal and the coronal

Ń. Proximal pins sagittal, distal pins coronal

Ń. Proximal pins coronal, distal pins sagittal

Ņ. Rheumatoid arthritis

Ņ. Posttraumatic arthritis

Ň. Degenerative osteoarthritis

Ň. Osteonecrosis of the tibial plateau

ʼN. Osteonecrosis of the medial femoral condyle

Ŋ. Trapeziometacarpal arthrodesis

Ŋ. Osteotomy of the thumb metacarpal

Ō. Arthrotomy and joint debridement

Ō. Ligament reconstruction using one half of the flexor carpi radialis

Ŏ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŏ. Creep

Ő. Relaxation

Ő. Energy dissipation

Œ. Plastic deformation

Œ. Elastic deformation

Ŕ. bending

Ŕ. axial loading

Ŗ. high-speed rotation

Ŗ. direct impact from anteromedial

Ř. crush from anteromedial to posterolateral

Ř. Increase stiffness

Ś. Increase fracture toughness

Ś. Increase fatigue strength

Ŝ. Decrease mechanical strength

Ŝ. Decrease wear rate

Ş. disuse osteopenia

Ş. paraendocrine effect of the tumor

Š. abnormally increased density on the right side

Š. side effect of the treatment of the lesion

Ţ. extensive tumor involvement of the left hip

Ţ. Sciatic nerve

Ť. Superior gluteal artery

Ť. Profunda femoris artery

Ŧ. Femoral artery and nerve

Ŧ. External iliac artery and vein

Ũ. Length

Ũ. Moment arm

Ū. Total volume

Ū. Physiologic cross-sectional area

Ŭ. Distribution of slow and fast twitch fibers

Ŭ. decreasing initiation of action potentials.

Ů. increasing action potential amplitude.

Ů. blocking the opening of gated sodium channels.

Ű. decreasing the number of functional motor units.

Ű. slowing or stopping action potential propagation through the axon.

Ų. resection of the metatarsal heads of the first through fifth toes.

Ų. Silastic MP joint arthroplasties of the first through fifth toes.

Ŵ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ŵ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ŷ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ŷ. hemiarthroplasty

Ÿ. open reduction and internal fixation

Ź. closed reduction and percutaneous pinning

Ź. a sling and early pedulum exercises

Ż. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ż. open acromioplasty

Ž. open Bankart repair

Ž. open subscapularis tendon repair

S. inferior capsular shift

Ƀ. a supervised physical therapy program

Ɓ. a sling and swathe, with pendulum exercises in 10 days

Ƃ. open reduction and internal fixation through an anterior approach

Ƃ. open reduction and internal fixation through a posterior approach

Ƅ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƅ. arthroscopically assisted reduction and percutaneous screw fixation

Ɔ. Repair of the rotator cuff

Ƈ. Replacement of the humeral head

Ƈ. Resection arthroplasty

Ɖ. Total shoulder arthroplasty

Ɗ. AP and lateral radiographs of the elbow

Ƌ. Diagnositc arthroscopy

Ƌ. Aspiration of joint fluid

ƍ. An erythrocyte sedimentation rate and CBC

Ǝ. A diagnostic lidocaine injection

Ə. Insulin-like growth factor (IGF-1)

Ɛ. Fibroblast growth factor (FGF-1)

Ƒ. Platelet-derived growth factor (PDGF)

Ƒ. Transforming growth factor beta (TGF-B)

Ɠ. Bone morphogenetic proteins (BMP)

Ɣ. clinical history and radiographic findings.

Ƕ. technetium bone scan

Ɩ. flow cytometry pattern of extracted chondrocytes

Ɨ. immunohistochemical staining patterns of a biopsy specimen

Ƙ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƙ. Radial

Ƚ. Radial recurrent

ƛ. Posterior interosseous

Ɯ. Superior ulnar recurrent

Ɲ. Superficial radial circumflex

Ƞ. Impaired hydroxylation of proline

Ɵ. Failure of cleavage in procollagen

Ơ. Defective binding sites for hydroxyproline

Ơ. Failure to incorporate glycine into the helix

Ƣ. Diminished production of collagen through the rough endoplasmic reticulum

Ƣ. Asking the legal staff to seek a court injunction

Ƥ. Copying the patient’s chart and giving it to him as he leaves

Ƥ. Having the patient sign a written legal contract that specifies acceptable behavior

Ʀ. Continuing care of the patient until an appropriate referral can be arranged

Ƨ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƨ. Meta-analysis

Ʃ. Confidence interval

ƪ. Analysis of variance (ANOVA)

ƫ. Statistical significance (p-value)

Ƭ. Survivorship analysis (Kaplan-Meier)

Ƭ. Spinal shock

Ʈ. Neurogenic shock

Ư. Hypovolemic shock

Ư. Pulmonary embolism

Ʊ. Fat embolus syndrome

Ʋ. Lumbar spinal stenosis

Ƴ. Metastatic disease of the spine

Ƴ. Rheumatoid lumbar spondylitis

Ƶ. Isthmic spondyloloisthesis

Ƶ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ʒ. Patella alta

Ƹ. A metal-backed patella

Ƹ. Varus malalignment of the knee

ƺ. A posterior cruciate-substituting femoral component

ƻ. Lateral subluxation of the patella on a Merchant’s view

Ƽ. The sesamoids are separated

Ƽ. The sesamoid is fractured

ƾ. The proximal phx is on the neck of the metatarsal

Ƿ. The dislocation is dorsal and centered

ǀ. The proximal phalanx is hyperextended

ǁ. Patella

ǂ. Tibial stem

ǃ. Distal femoral interface

Ǆ. Posterior femoral interface

Ǆ. Sites of screw fixation for the tibia

Ǆ. Hallux rigidus

Ǉ. Fracture of the sesamoid

Ǉ. Disruption of the plantar plate

Ǉ. Osteonecrosis of the metatarsal head

Ǌ. Rupture of the flexor hallucis longus

Ǌ. Gout

Ǌ. Sepsis

Ǎ. Old trauma

Ǎ. Rheumatoid arthritis

Ǐ. Charcot arthroplasty

Ǐ. Aspiration and steroid injection

Ǒ. Biopsy, curettage, and allograft bone grafting

Ǒ. Percutaneous Kirschner wire fixation

Ǔ. Percutaneous injection of autogenous bone marrow

Ǔ. Nerve roots

Ǖ. Spinal cord

Ǖ. Sciatic nerve

Ǘ. Peroneal nerve

Ǘ. Conus medullaris

Ǚ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǚ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǜ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǜ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǝ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǟ. Early and late infection

Ǟ. Periprosthetic fracture of the femur

Ǡ. Failure of the patellofemoral and extensor mechanisms

Ǡ. Aseptic loosening of cementing tibial components

Ǣ. Asceptic loosening of cemented femoral components

Ǣ. Acceptance of the current position of the ankle

Ǥ. Open reduction and fixation in the epiphysis only

Ǥ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǧ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǧ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǩ. Resection arthroplasty and local radiation

Ǩ. In situ fusion of the hip

Ǫ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǫ. Excision of heterotopic bone and local radiation

Ǭ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǭ. Closed reduction of both fractures and immediate spica casting

Ǯ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǯ. External fixation of both femora

J̌. External fixation of the left femur and a long leg cast brace for the right femur

Ǳ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǳ. Synovial sarcoma

Ǳ. Soft-tissue abcess

Ǵ. Rhabdomyosarcoma

Ǵ. Eosinophilic granuloma

Ƕ. Nodular pigmented villonodular synovitis

Ƿ. Changing to a titanium nail

Ǹ. Changing to a nonslotted nail

Ǹ. Changing the cross-sectional shape of the nail

Ǻ. Increasing the diameter of the nail by 3 mm

Ǻ. Increasing the diameter of the interlocking screws

Ǽ. Fracture healing

Ǽ. Chondrosarcoma

Ǿ. Periosteal chondroma

Ǿ. Periosteal osteosarcoma

Ȁ. Dysplasia epiphysealis hemimelica

Ȁ. Demonstrate competence in the subject of the case

Ȃ. Be fellowship trained in the subject of the case

Ȃ. Be paid on a contingency basis

Ȅ. Be board certified by the American Board of Orthopaedic Surgery

Ȅ. Have been involved in the case as a consultant

Ȇ. Diagnostic arthroscopy

Ȇ. Arthroscopy and subacromial decompression

Ȉ. Reduction and fixation of the proximal humeral epiphysis

Ȉ. Temporary cessation of throwing

Ȋ. Physical therapy for rotator cuff strengthening

Ȋ. Oblique popliteal ligament

Ȍ. Lateral capsule

Ȍ. Popliteal tendon

Ȏ. Fibular collateral ligament

Ȏ. Posterior oblique ligament

Ȑ. Radial tear

Ȑ. Parrot-beak tear

Ȓ. Vertical tear in the “red-red” zone

Ȓ. Vertical tear in the “red-white” zone

Ȕ. Vertical tear in the “white-white” zone

Ȕ. 0 degrees of abduction, with neural rotation

Ȗ. 40 degrees of flexion and 60 degrees of internal rotation

Ȗ. 45 degrees of flexion and 45 degrees of external rotation

Ș. 90 degrees of abduction with neutral rotation

Ș. 90 degrees of abduction and 90 degrees of external rotation

Ț. Sural

Ț. Saphenous and its branches

Ȝ. Posterior tibial and its branches

Ȝ. Deep peroneal and its branches

Ȟ. Superficial peroneal and its branches

Ȟ. Strength

Ƞ. Stiffness

ȡ. Shelf life

Ȣ. Antigenicity

Ȣ. Risk of HIV transmission

Ȥ. Indemnification

Ȥ. Occurrence

Ȧ. Excess liability

Ȧ. Claims-made

Ȩ. Nose

Ȩ. Lateral Y

Ȫ. Scapular AP

Ȫ. Neutral rotation AP

Ȭ. Internal rotation AP

Ȭ. External rotation AP

Ȯ. Trauma

Ȯ. Hemophilia

Ȱ. Reiter’s syndrome

Ȱ. Rheumatoid arthritis

Ȳ. Systemic lupus erythematosus

Ȳ. Cast immobilization for 6 weeks

ȴ. Activity modification and re-evaluation in 2 months

ȵ. Internal fixation with or without bone grafting

ȶ. Retrograde drilling of the defect without articular cartilage penetration

ȷ. Drilling of the defect directly through the articular cartilage

ȸ. repair or reconstruction of the medial collateral ligament

ȹ. repair or reconstruction of the medialand lateral collateral ligaments

Ⱥ. immobilization for 5 days or less

Ȼ. immobilization for 14 days

Ȼ. immobilization for 25 days

Ƚ. Cystinosis

Ⱦ. Hypophosphatemia

Ȿ. Renal osteodystrophy

Ɀ. Primary hyperparathyroidism

Ɂ. Nutritional vitamin D deficiency

Ɂ. Lateral meniscus tear

Ƀ. Popliteus tenosynovitis

Ʉ. Iliotibial band friction syndrome

Ʌ. Peroneal nerve entrapment

Ɇ. Biceps tendinitis

Ɇ. Observation

Ɉ. Removal of the prosthetic components

Ɉ. Operative exploration and decompression of the peroneal nerve

Ɋ. Nerve conduction velocity studies

Ɋ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɍ. I

Ɍ. II

Ɏ. III

Ɏ. decreased tissue tension

Ɐ. decreased abductor lever arm

Ɑ. decreased joint reaction force

Ɒ. increased body weight over lever arm

Ɓ. increased polyethylene wear rate

Ɔ. recurrent traumatic anterior dislocation

ɕ. recurrent traumatic posterior dislocation

Ɖ. traumatic subluxation with no previous dislocation

Ɗ. traumatic anterior subluxation

ɘ. atraumatic involuntary subluxation

Ə. radial

ɚ. axillary

Ɛ. suprascapular

Ɜ. thoracodorsal

ɝ. long thoracic

ɞ. Flexion

ɟ. Extension

Ɠ. Axial rotation

Ɡ. Left lateral bending

ɢ. Right lateral bending

Ɣ. Skin

ɤ. Lung

Ɥ. Brain

Ɦ. Heart

ɧ. Kidney

Ɨ. Thoracoacromial, lateral thoracic, subscapular

Ɩ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɪ. Posterior humeral circumflex, subscapular, thoracacromial

Ɫ. Subscapular, thoracacromial, anterior humeral circumflex

Ɬ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ɭ. Respondeat superior

ɮ. Indemnity agreement

Ɯ. Hold harmless agreement- attempt to shift liability from company to physician

ɰ. Comparative negligence-% of involvement

Ɱ. Contributory negligence- resident contributed to the negligence

Ɲ. t-type

ɳ. both column

ɴ. transverse

Ɵ. anterior column

ɶ. anterior column posterior hemitransverse

ɷ. Posterior interosseous

ɸ. Anterior interosseous

ɹ. Radial

ɺ. Median

ɻ. Ulnar

ɼ. Shock from hypovolemia

Ɽ. Associated rupture of the bladder

ɾ. Arterial bleeding on pelvic angiogram

ɿ. Presence of a hematoma in the perineum and scrotum

Ʀ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Subscapularis rupture

Explanation

Question 4151

Topic: 10. Pathology and Oncology

The familial occurrence of Legg-Calve-Perthes disease may, in some cases, be attributed to

. hypophosphatemia

. high dietary cholesterol intake

. deficiency of lipoprotein A

. deficiency of protein S and protein C

. elevated levels of antithrombin III

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

!. Fracture of the glenoid rim

". Palsy of the axillary nerve

#. Palsy of the musculocutaneus nerve

$. Enchondroma

%. Osteoblastoma

&. Giant cell tumor

'. Aneurysmal bone cyst

(. Fibrous dysplasia

). Arthrogram of the wrist

*. MRI scan of both wrists

+. CT scan of both wrists in the same position

,. Radiographs of the wrist in supination and pronation

-. Radiographs of the opposite wrist in the same position

.. Secondary hyperparathyroidism

/. Phosphate retention secondary to uremia

0. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

1. Aluminum deposition in bone from oral phosphate binders

2. Persistent acidosis aggravating the negative calcium balance

3. Posterior fusion at T10-L3 with segmental instrumentation

4. Laminectomy and fusion of T12-L2 with segmental instrumentation

5. Bed rest in a hyperextension brace

6. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

7. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

8. Positive-pressure ventilation

9. An immediate radiograph of the chest

:. Adjustment of the position of the endotrachael tube

;. Insertion of a large-bore needle into the pericardial space

<. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

=. Allowing the ends of the fracture to touch

>. Adding a second connecting bar

?. Adding one pin to each fracture fragment

@. Increasing the pin diameter from 4 mm to 6 mm

A. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

B. Osteomyelitis

C. Malignant degeneration

D. Stress fracture

E. Local recurrence of the giant cell tumor

F. Bone resorption due to methylmethacrylate

G. Advancement of the plantar plate

H. Resection of the second metatarsal head

I. Dorsiflexion osteotomy of the second metatarsal neck

J. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

K. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

L. Sacral fracture

M. Burst fracture of L5

N. Cauda equina syndrome

O. Distraction-flexion injury at L3

P. Distraction-extension injury at L3

Q. An MRI scan of the shoulder

R. An MRI scan of the cervical spine

S. Electromyographic and nerve conduction velocity studies

T. Immobilization in a sling and early passive range of motion exercises

U. Immediate return to the operating room for exploration of the brachial plexus

V. cerclage wiring

W. tension band wiring

X. removal of the patellar component

Y. revision of the patellar component

Z. immobilization of the knee and protected weightbearing

[. Liposarcoma

\. Nodular fasciitis

]. Rabdomyosarcoma

^. Malignant fibrous histiocytoma

_. Extra-abdominal desmoid tumor

`. Clubfeet

A. Thrombocytopenia

B. Congenital scoliosis

C. Ventricular septal defect

D. Arnold-Chiari malformation

E. delayed primary closure

F. free flap

G. pedicle groin flap

H. full-thickness skin graft

I. split-thickness skin graft

J. Infection

K. Nonunion

L. Improper screw length

M. Osteonecrosis of the distal fragment

N. Use of a cortical screw instead of a cancellous screw

O. Infection

P. Tear of the rotator cuff

Q. Loosening of the humeral component

R. Arthritis of the glenoid

S. Arthritis of the A-C joint

T. Reduced morbidity

U. Improved osteoinduction

V. Improved osteoconduction

W. More rapid revascularization

X. Lower risk of disease transmission

Y. Manipulation Under Anesthesia

Z. Arthroscopic acromioplasty

{. Arthroscopic debridement of G-H joint

|. Replacement of the humeral head

}. Lengthening of the subscapularis and release of the anterior capsule

~. Bacteroides

. E. coli

. Staph. aureus

. group A streptococcus

. Clostridium perforingens

. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

¡. Syndactyly

¢. Macrodactyly

£. Camptodactyly

¤. Preaxial polydactyly

¥. Postaxial polydactyly

¦. Arthrodesis

§. Rotationplasty

¨. Above-knee amputation

©. Osteoarticular allograft

ª. Endoprosthesis (custom arthroplasty)

«. Plantar fascia

¬. Spring ligament

. Deltoid ligament

®. Intrinsic tendons

¯. Gastorcnemius-solelus complex

°. Prevention of presynaptic release of acetylcholine

±. Prevention of synthesis of presynaptic acetylcholine

². Activation of acetylcholinesterase at the motor end-plate

³. Blockage of postsynaptic action of acetylcholine until reserves are depleted

´. Stimulation of release of presynaptic acetylcholine until reserves are depleted

Μ. stiffness of the femoral component.

¶. head offset of the femoral component.

·. femoral component material modulus of elasticity.

¸. extent of the femoral component porous coating.

¹. Presence of a femoral component collar.

º. plantar fascia and quadratus plantae tendon.

». ligamentous structures connecting the tarsal bones.

¼. shape of the tarsal bones and the intervening joints.

½. activity of the intrinsic muscles of the foot.

¾. activity of the posterior tibialis and the peroneus longus muscles.

¿. scapulothoracic fusion

À. strengthening of the periscapular muscles

Á. pectoralis minor-fascia lata graft transfer to the scapula

Â. pectoralis major-fascia lata graft transfer to the scapula

Ã. exploration of the long thoracic nerve, with sural nerve graft

Ä. tricompartmental knee replacement

Å. unicompartmental knee replacement

Æ. medial compartment meniscal allograft

Ç. valgus-producing distal femoral osteotomy

È. valgus-producing proximal tibial osteotomy

É. Internal rotation of the femoral component

Ê. External rotation of the tibial component

Ë. Lateral placement of the femoral component

Ì. Medial placement of the patellar component

Í. Excessive resection of the patella

Î. Hallux rigidus

Ï. Hallux valgus

Ð. Neuroma of the first web space

Ñ. Fracture of the sesamoid

Ò. Rupture of the flexor hallucis longus

Ó. Sickle cell crisis

Ô. Idiopathic chondrolysis

Õ. Hemophilic arthropathy

Ö. Osteoid osteoma of the femoral neck

×. Legg-Calve-Perthes disease

Ø. Decreased ankle jerk and positive femoral nerve stretch test

Ù. Decreased knee jerk and positive straight-leg raising sign

Ú. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Û. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ü. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ý. Long-term administration of IV and oral antibiotics

Þ. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

SS. Immediate exchange arthroplasty with antibiotic-impregnated cement

À. Two-stage surgical prosthetic exchange and IV antibiotics

Á. Resection arthroplasty and IV antibiotics

Â. SCFE

Ã. MED

Ä. Perthes disease

Å. Hypothyroidism

Æ. Chondrolysis

Ç. gout.

È. osteoporosis.

É. eosinophilic granuloma.

Ê. tuberculosis of the spine.

Ë. metastatic disease of the spine.

Ì. water content.

Í. Synthesis of type I collagen.

Î. Proteoglycan content.

Ï. Activity of chondrocytes.

Ð. Synthesis of hyaluronate.

Ñ. Lung

Ò. Breast

Ó. Prostate

Ô. Thyroid

Õ. Renal

Ö. T1-low, T2-low.

÷. T1-low, T2-high.

Ø. T1-moderate, T2-low.

Ù. T1-high, T2-low.

Ú. T1-high, T2-high.

Û. hypothesis is incorrect or invalid

Ü. interobserver error rate is 4%.

Ý. Standard deviation is 4% higher or lower than the mean.

Þ. Sample size is 4% larger than required to be clinically significant.

Ÿ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ā. I

Ā. II

Ă. IV

Ă. IX

Ą. X

Ą. Cranial setting

Ć. Cranial subluxation

Ć. Odontoid fracture

Ĉ. Lysis of the arch of the atlas

Ĉ. Atlantoaxial subluxation

Ċ. Retrograde collapse of the endoneurial tubes

Ċ. Irreversible atrophy of the denervated muscles

Č. Elongation of the axons across the zone of injury

Č. Sprouting of the axons at the neuromuscular junction

Ď. Misdirection of the axons across the zone of injury

Ď. Maximally pronated and elbow extended

Đ. Maximally pronated and the elbow flexed

Đ. Maximally supinated and the elbow flexed

Ē. Maximally supinated and the elbow extended

Ē. In neutral rotation, with the elbow extended

Ĕ. open reduction and internal fixation

Ĕ. buddy taping to the adjacent index finger

Ė. early motion with application of a dynamic banjo splint

Ė. application of a cast with the hand in a “safe position” for 3 weeks.

Ę. dorsal extension block splinting

Ę. The name of the manufacturer

Ě. The manufacturer’s potential liability

Ě. The physician’s clinical performance

Ĝ. The physician’s materials testing data

Ĝ. Any royalties the physician receives from the manufacturer

Ğ. Femoral

Ğ. Obturator

Ġ. Inferior gluteal

Ġ. Superior gluteal

Ģ. Lateral femoral cutaneous

Ģ. open biopsy and a long leg cast

Ĥ. open biopsy and wide resection of the tumor

Ĥ. a long leg cast and observation

Ħ. intramedullary stabilization and observation

Ħ. Triggering

Ĩ. Lateral instability

Ĩ. Swan-neck deformity

Ī. Boutonniere deformity

Ī. Loss of distal interphalangeal joint flexion

Ĭ. Peroneus brevis to peroneus longus

Ĭ. Peroneus tertius to extensor hallucis longus

Į. Peroneus tertius to superficial peroneal nerve

Į. Extensor hallucis longus to deep peroneal nerve

İ. Extensor hallucis longus to extensor digitorum longus

I. reassurance that Medicare will pay for the treatment.

Ĳ. consent forms that patients or their guardians are able to understand.

Ĳ. a detailed description of the device, omitting the fact that it is part of a study.

Ĵ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ĵ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ķ. an onlay iliac crest bone graft.

Ķ. limited weightbearing and observation.

ĸ. removal of the implant and limited weightbearing.

Ĺ. removal of the implant and insertion of a reamed femoral nail.

Ĺ. removal of the implant and insertion of an unreamed femoral nail.

Ļ. Coronal

Ļ. Sagittal

Ľ. Anteromedial, midway between the sagittal and the coronal

Ľ. Proximal pins sagittal, distal pins coronal

Ŀ. Proximal pins coronal, distal pins sagittal

Ŀ. Rheumatoid arthritis

Ł. Posttraumatic arthritis

Ł. Degenerative osteoarthritis

Ń. Osteonecrosis of the tibial plateau

Ń. Osteonecrosis of the medial femoral condyle

Ņ. Trapeziometacarpal arthrodesis

Ņ. Osteotomy of the thumb metacarpal

Ň. Arthrotomy and joint debridement

Ň. Ligament reconstruction using one half of the flexor carpi radialis

ʼN. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŋ. Creep

Ŋ. Relaxation

Ō. Energy dissipation

Ō. Plastic deformation

Ŏ. Elastic deformation

Ŏ. bending

Ő. axial loading

Ő. high-speed rotation

Œ. direct impact from anteromedial

Œ. crush from anteromedial to posterolateral

Ŕ. Increase stiffness

Ŕ. Increase fracture toughness

Ŗ. Increase fatigue strength

Ŗ. Decrease mechanical strength

Ř. Decrease wear rate

Ř. disuse osteopenia

Ś. paraendocrine effect of the tumor

Ś. abnormally increased density on the right side

Ŝ. side effect of the treatment of the lesion

Ŝ. extensive tumor involvement of the left hip

Ş. Sciatic nerve

Ş. Superior gluteal artery

Š. Profunda femoris artery

Š. Femoral artery and nerve

Ţ. External iliac artery and vein

Ţ. Length

Ť. Moment arm

Ť. Total volume

Ŧ. Physiologic cross-sectional area

Ŧ. Distribution of slow and fast twitch fibers

Ũ. decreasing initiation of action potentials.

Ũ. increasing action potential amplitude.

Ū. blocking the opening of gated sodium channels.

Ū. decreasing the number of functional motor units.

Ŭ. slowing or stopping action potential propagation through the axon.

Ŭ. resection of the metatarsal heads of the first through fifth toes.

Ů. Silastic MP joint arthroplasties of the first through fifth toes.

Ů. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ű. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ű. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ų. hemiarthroplasty

Ų. open reduction and internal fixation

Ŵ. closed reduction and percutaneous pinning

Ŵ. a sling and early pedulum exercises

Ŷ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ŷ. open acromioplasty

Ÿ. open Bankart repair

Ź. open subscapularis tendon repair

Ź. inferior capsular shift

Ż. a supervised physical therapy program

Ż. a sling and swathe, with pendulum exercises in 10 days

Ž. open reduction and internal fixation through an anterior approach

Ž. open reduction and internal fixation through a posterior approach

S. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ƀ. arthroscopically assisted reduction and percutaneous screw fixation

Ɓ. Repair of the rotator cuff

Ƃ. Replacement of the humeral head

Ƃ. Resection arthroplasty

Ƅ. Total shoulder arthroplasty

Ƅ. AP and lateral radiographs of the elbow

Ɔ. Diagnositc arthroscopy

Ƈ. Aspiration of joint fluid

Ƈ. An erythrocyte sedimentation rate and CBC

Ɖ. A diagnostic lidocaine injection

Ɗ. Insulin-like growth factor (IGF-1)

Ƌ. Fibroblast growth factor (FGF-1)

Ƌ. Platelet-derived growth factor (PDGF)

ƍ. Transforming growth factor beta (TGF-B)

Ǝ. Bone morphogenetic proteins (BMP)

Ə. clinical history and radiographic findings.

Ɛ. technetium bone scan

Ƒ. flow cytometry pattern of extracted chondrocytes

Ƒ. immunohistochemical staining patterns of a biopsy specimen

Ɠ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ɣ. Radial

Ƕ. Radial recurrent

Ɩ. Posterior interosseous

Ɨ. Superior ulnar recurrent

Ƙ. Superficial radial circumflex

Ƙ. Impaired hydroxylation of proline

Ƚ. Failure of cleavage in procollagen

ƛ. Defective binding sites for hydroxyproline

Ɯ. Failure to incorporate glycine into the helix

Ɲ. Diminished production of collagen through the rough endoplasmic reticulum

Ƞ. Asking the legal staff to seek a court injunction

Ɵ. Copying the patient’s chart and giving it to him as he leaves

Ơ. Having the patient sign a written legal contract that specifies acceptable behavior

Ơ. Continuing care of the patient until an appropriate referral can be arranged

Ƣ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƣ. Meta-analysis

Ƥ. Confidence interval

Ƥ. Analysis of variance (ANOVA)

Ʀ. Statistical significance (p-value)

Ƨ. Survivorship analysis (Kaplan-Meier)

Ƨ. Spinal shock

Ʃ. Neurogenic shock

ƪ. Hypovolemic shock

ƫ. Pulmonary embolism

Ƭ. Fat embolus syndrome

Ƭ. Lumbar spinal stenosis

Ʈ. Metastatic disease of the spine

Ư. Rheumatoid lumbar spondylitis

Ư. Isthmic spondyloloisthesis

Ʊ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ʋ. Patella alta

Ƴ. A metal-backed patella

Ƴ. Varus malalignment of the knee

Ƶ. A posterior cruciate-substituting femoral component

Ƶ. Lateral subluxation of the patella on a Merchant’s view

Ʒ. The sesamoids are separated

Ƹ. The sesamoid is fractured

Ƹ. The proximal phx is on the neck of the metatarsal

ƺ. The dislocation is dorsal and centered

ƻ. The proximal phalanx is hyperextended

Ƽ. Patella

Ƽ. Tibial stem

ƾ. Distal femoral interface

Ƿ. Posterior femoral interface

ǀ. Sites of screw fixation for the tibia

ǁ. Hallux rigidus

ǂ. Fracture of the sesamoid

ǃ. Disruption of the plantar plate

Ǆ. Osteonecrosis of the metatarsal head

Ǆ. Rupture of the flexor hallucis longus

Ǆ. Gout

Ǉ. Sepsis

Ǉ. Old trauma

Ǉ. Rheumatoid arthritis

Ǌ. Charcot arthroplasty

Ǌ. Aspiration and steroid injection

Ǌ. Biopsy, curettage, and allograft bone grafting

Ǎ. Percutaneous Kirschner wire fixation

Ǎ. Percutaneous injection of autogenous bone marrow

Ǐ. Nerve roots

Ǐ. Spinal cord

Ǒ. Sciatic nerve

Ǒ. Peroneal nerve

Ǔ. Conus medullaris

Ǔ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǖ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǖ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǘ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǘ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǚ. Early and late infection

Ǚ. Periprosthetic fracture of the femur

Ǜ. Failure of the patellofemoral and extensor mechanisms

Ǜ. Aseptic loosening of cementing tibial components

Ǝ. Asceptic loosening of cemented femoral components

Ǟ. Acceptance of the current position of the ankle

Ǟ. Open reduction and fixation in the epiphysis only

Ǡ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǡ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǣ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǣ. Resection arthroplasty and local radiation

Ǥ. In situ fusion of the hip

Ǥ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǧ. Excision of heterotopic bone and local radiation

Ǧ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǩ. Closed reduction of both fractures and immediate spica casting

Ǩ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǫ. External fixation of both femora

Ǫ. External fixation of the left femur and a long leg cast brace for the right femur

Ǭ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǭ. Synovial sarcoma

Ǯ. Soft-tissue abcess

Ǯ. Rhabdomyosarcoma

J̌. Eosinophilic granuloma

Ǳ. Nodular pigmented villonodular synovitis

Ǳ. Changing to a titanium nail

Ǳ. Changing to a nonslotted nail

Ǵ. Changing the cross-sectional shape of the nail

Ǵ. Increasing the diameter of the nail by 3 mm

Ƕ. Increasing the diameter of the interlocking screws

Ƿ. Fracture healing

Ǹ. Chondrosarcoma

Ǹ. Periosteal chondroma

Ǻ. Periosteal osteosarcoma

Ǻ. Dysplasia epiphysealis hemimelica

Ǽ. Demonstrate competence in the subject of the case

Ǽ. Be fellowship trained in the subject of the case

Ǿ. Be paid on a contingency basis

Ǿ. Be board certified by the American Board of Orthopaedic Surgery

Ȁ. Have been involved in the case as a consultant

Ȁ. Diagnostic arthroscopy

Ȃ. Arthroscopy and subacromial decompression

Ȃ. Reduction and fixation of the proximal humeral epiphysis

Ȅ. Temporary cessation of throwing

Ȅ. Physical therapy for rotator cuff strengthening

Ȇ. Oblique popliteal ligament

Ȇ. Lateral capsule

Ȉ. Popliteal tendon

Ȉ. Fibular collateral ligament

Ȋ. Posterior oblique ligament

Ȋ. Radial tear

Ȍ. Parrot-beak tear

Ȍ. Vertical tear in the “red-red” zone

Ȏ. Vertical tear in the “red-white” zone

Ȏ. Vertical tear in the “white-white” zone

Ȑ. 0 degrees of abduction, with neural rotation

Ȑ. 40 degrees of flexion and 60 degrees of internal rotation

Ȓ. 45 degrees of flexion and 45 degrees of external rotation

Ȓ. 90 degrees of abduction with neutral rotation

Ȕ. 90 degrees of abduction and 90 degrees of external rotation

Ȕ. Sural

Ȗ. Saphenous and its branches

Ȗ. Posterior tibial and its branches

Ș. Deep peroneal and its branches

Ș. Superficial peroneal and its branches

Ț. Strength

Ț. Stiffness

Ȝ. Shelf life

Ȝ. Antigenicity

Ȟ. Risk of HIV transmission

Ȟ. Indemnification

Ƞ. Occurrence

ȡ. Excess liability

Ȣ. Claims-made

Ȣ. Nose

Ȥ. Lateral Y

Ȥ. Scapular AP

Ȧ. Neutral rotation AP

Ȧ. Internal rotation AP

Ȩ. External rotation AP

Ȩ. Trauma

Ȫ. Hemophilia

Ȫ. Reiter’s syndrome

Ȭ. Rheumatoid arthritis

Ȭ. Systemic lupus erythematosus

Ȯ. Cast immobilization for 6 weeks

Ȯ. Activity modification and re-evaluation in 2 months

Ȱ. Internal fixation with or without bone grafting

Ȱ. Retrograde drilling of the defect without articular cartilage penetration

Ȳ. Drilling of the defect directly through the articular cartilage

Ȳ. repair or reconstruction of the medial collateral ligament

ȴ. repair or reconstruction of the medialand lateral collateral ligaments

ȵ. immobilization for 5 days or less

ȶ. immobilization for 14 days

ȷ. immobilization for 25 days

ȸ. Cystinosis

ȹ. Hypophosphatemia

Ⱥ. Renal osteodystrophy

Ȼ. Primary hyperparathyroidism

Ȼ. Nutritional vitamin D deficiency

Ƚ. Lateral meniscus tear

Ⱦ. Popliteus tenosynovitis

Ȿ. Iliotibial band friction syndrome

Ɀ. Peroneal nerve entrapment

Ɂ. Biceps tendinitis

Ɂ. Observation

Ƀ. Removal of the prosthetic components

Ʉ. Operative exploration and decompression of the peroneal nerve

Ʌ. Nerve conduction velocity studies

Ɇ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɇ. I

Ɉ. II

Ɉ. III

Ɋ. decreased tissue tension

Ɋ. decreased abductor lever arm

Ɍ. decreased joint reaction force

Ɍ. increased body weight over lever arm

Ɏ. increased polyethylene wear rate

Ɏ. recurrent traumatic anterior dislocation

Ɐ. recurrent traumatic posterior dislocation

Ɑ. traumatic subluxation with no previous dislocation

Ɒ. traumatic anterior subluxation

Ɓ. atraumatic involuntary subluxation

Ɔ. radial

ɕ. axillary

Ɖ. suprascapular

Ɗ. thoracodorsal

ɘ. long thoracic

Ə. Flexion

ɚ. Extension

Ɛ. Axial rotation

Ɜ. Left lateral bending

ɝ. Right lateral bending

ɞ. Skin

ɟ. Lung

Ɠ. Brain

Ɡ. Heart

ɢ. Kidney

Ɣ. Thoracoacromial, lateral thoracic, subscapular

ɤ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɥ. Posterior humeral circumflex, subscapular, thoracacromial

Ɦ. Subscapular, thoracacromial, anterior humeral circumflex

ɧ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɨ. Respondeat superior

Ɩ. Indemnity agreement

Ɪ. Hold harmless agreement- attempt to shift liability from company to physician

Ɫ. Comparative negligence-% of involvement

Ɬ. Contributory negligence- resident contributed to the negligence

ɭ. t-type

ɮ. both column

Ɯ. transverse

ɰ. anterior column

Ɱ. anterior column posterior hemitransverse

Ɲ. Posterior interosseous

ɳ. Anterior interosseous

ɴ. Radial

Ɵ. Median

ɶ. Ulnar

ɷ. Shock from hypovolemia

ɸ. Associated rupture of the bladder

ɹ. Arterial bleeding on pelvic angiogram

ɺ. Presence of a hematoma in the perineum and scrotum

ɻ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. hypophosphatemia

Explanation

Question 4152

Topic: 10. Pathology and Oncology

Which of the following methods of treatment of a displaced Lisfranc fracture-dislocation will most reliably lead to good functional results?

. Weightbearing short leg cast

. Nonweightbearing short leg cast

. Removable splint and early motion

. Open reduction and internal fixation

. Elastic compression bandage with full weightbearing

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

!. Giant cell tumor

". Aneurysmal bone cyst

#. Fibrous dysplasia

$. Arthrogram of the wrist

%. MRI scan of both wrists

&. CT scan of both wrists in the same position

'. Radiographs of the wrist in supination and pronation

(. Radiographs of the opposite wrist in the same position

). Secondary hyperparathyroidism

*. Phosphate retention secondary to uremia

+. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

,. Aluminum deposition in bone from oral phosphate binders

-. Persistent acidosis aggravating the negative calcium balance

.. Posterior fusion at T10-L3 with segmental instrumentation

/. Laminectomy and fusion of T12-L2 with segmental instrumentation

0. Bed rest in a hyperextension brace

1. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

2. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

3. Positive-pressure ventilation

4. An immediate radiograph of the chest

5. Adjustment of the position of the endotrachael tube

6. Insertion of a large-bore needle into the pericardial space

7. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

8. Allowing the ends of the fracture to touch

9. Adding a second connecting bar

:. Adding one pin to each fracture fragment

;. Increasing the pin diameter from 4 mm to 6 mm

<. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

=. Osteomyelitis

>. Malignant degeneration

?. Stress fracture

@. Local recurrence of the giant cell tumor

A. Bone resorption due to methylmethacrylate

B. Advancement of the plantar plate

C. Resection of the second metatarsal head

D. Dorsiflexion osteotomy of the second metatarsal neck

E. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

F. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

G. Sacral fracture

H. Burst fracture of L5

I. Cauda equina syndrome

J. Distraction-flexion injury at L3

K. Distraction-extension injury at L3

L. An MRI scan of the shoulder

M. An MRI scan of the cervical spine

N. Electromyographic and nerve conduction velocity studies

O. Immobilization in a sling and early passive range of motion exercises

P. Immediate return to the operating room for exploration of the brachial plexus

Q. cerclage wiring

R. tension band wiring

S. removal of the patellar component

T. revision of the patellar component

U. immobilization of the knee and protected weightbearing

V. Liposarcoma

W. Nodular fasciitis

X. Rabdomyosarcoma

Y. Malignant fibrous histiocytoma

Z. Extra-abdominal desmoid tumor

[. Clubfeet

\. Thrombocytopenia

]. Congenital scoliosis

^. Ventricular septal defect

_. Arnold-Chiari malformation

`. delayed primary closure

A. free flap

B. pedicle groin flap

C. full-thickness skin graft

D. split-thickness skin graft

E. Infection

F. Nonunion

G. Improper screw length

H. Osteonecrosis of the distal fragment

I. Use of a cortical screw instead of a cancellous screw

J. Infection

K. Tear of the rotator cuff

L. Loosening of the humeral component

M. Arthritis of the glenoid

N. Arthritis of the A-C joint

O. Reduced morbidity

P. Improved osteoinduction

Q. Improved osteoconduction

R. More rapid revascularization

S. Lower risk of disease transmission

T. Manipulation Under Anesthesia

U. Arthroscopic acromioplasty

V. Arthroscopic debridement of G-H joint

W. Replacement of the humeral head

X. Lengthening of the subscapularis and release of the anterior capsule

Y. Bacteroides

Z. E. coli

{. Staph. aureus

|. group A streptococcus

}. Clostridium perforingens

~. observation and exercises

. bracing with a thoracolumbar orthosis

. fusion of the posterior spine

. fusion of the anterior spine

. fusion of the anterior and posterior spine

. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

¡. Arthrodesis

¢. Rotationplasty

£. Above-knee amputation

¤. Osteoarticular allograft

¥. Endoprosthesis (custom arthroplasty)

¦. Plantar fascia

§. Spring ligament

¨. Deltoid ligament

©. Intrinsic tendons

ª. Gastorcnemius-solelus complex

«. Prevention of presynaptic release of acetylcholine

¬. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

®. Blockage of postsynaptic action of acetylcholine until reserves are depleted

¯. Stimulation of release of presynaptic acetylcholine until reserves are depleted

°. stiffness of the femoral component.

±. head offset of the femoral component.

². femoral component material modulus of elasticity.

³. extent of the femoral component porous coating.

´. Presence of a femoral component collar.

Μ. plantar fascia and quadratus plantae tendon.

¶. ligamentous structures connecting the tarsal bones.

·. shape of the tarsal bones and the intervening joints.

¸. activity of the intrinsic muscles of the foot.

¹. activity of the posterior tibialis and the peroneus longus muscles.

º. scapulothoracic fusion

». strengthening of the periscapular muscles

¼. pectoralis minor-fascia lata graft transfer to the scapula

½. pectoralis major-fascia lata graft transfer to the scapula

¾. exploration of the long thoracic nerve, with sural nerve graft

¿. tricompartmental knee replacement

À. unicompartmental knee replacement

Á. medial compartment meniscal allograft

Â. valgus-producing distal femoral osteotomy

Ã. valgus-producing proximal tibial osteotomy

Ä. Internal rotation of the femoral component

Å. External rotation of the tibial component

Æ. Lateral placement of the femoral component

Ç. Medial placement of the patellar component

È. Excessive resection of the patella

É. Hallux rigidus

Ê. Hallux valgus

Ë. Neuroma of the first web space

Ì. Fracture of the sesamoid

Í. Rupture of the flexor hallucis longus

Î. Sickle cell crisis

Ï. Idiopathic chondrolysis

Ð. Hemophilic arthropathy

Ñ. Osteoid osteoma of the femoral neck

Ò. Legg-Calve-Perthes disease

Ó. Decreased ankle jerk and positive femoral nerve stretch test

Ô. Decreased knee jerk and positive straight-leg raising sign

Õ. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ö. Weakness of the extensor hallucis longus and positive straight-leg raising sign

×. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ø. Long-term administration of IV and oral antibiotics

Ù. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ú. Immediate exchange arthroplasty with antibiotic-impregnated cement

Û. Two-stage surgical prosthetic exchange and IV antibiotics

Ü. Resection arthroplasty and IV antibiotics

Ý. SCFE

Þ. MED

SS. Perthes disease

À. Hypothyroidism

Á. Chondrolysis

Â. gout.

Ã. osteoporosis.

Ä. eosinophilic granuloma.

Å. tuberculosis of the spine.

Æ. metastatic disease of the spine.

Ç. water content.

È. Synthesis of type I collagen.

É. Proteoglycan content.

Ê. Activity of chondrocytes.

Ë. Synthesis of hyaluronate.

Ì. Lung

Í. Breast

Î. Prostate

Ï. Thyroid

Ð. Renal

Ñ. T1-low, T2-low.

Ò. T1-low, T2-high.

Ó. T1-moderate, T2-low.

Ô. T1-high, T2-low.

Õ. T1-high, T2-high.

Ö. hypothesis is incorrect or invalid

÷. interobserver error rate is 4%.

Ø. Standard deviation is 4% higher or lower than the mean.

Ù. Sample size is 4% larger than required to be clinically significant.

Ú. Probability that the differences noted between two study groups were due to chance alone is 4%.

Û. I

Ü. II

Ý. IV

Þ. IX

Ÿ. X

Ā. Cranial setting

Ā. Cranial subluxation

Ă. Odontoid fracture

Ă. Lysis of the arch of the atlas

Ą. Atlantoaxial subluxation

Ą. Retrograde collapse of the endoneurial tubes

Ć. Irreversible atrophy of the denervated muscles

Ć. Elongation of the axons across the zone of injury

Ĉ. Sprouting of the axons at the neuromuscular junction

Ĉ. Misdirection of the axons across the zone of injury

Ċ. Maximally pronated and elbow extended

Ċ. Maximally pronated and the elbow flexed

Č. Maximally supinated and the elbow flexed

Č. Maximally supinated and the elbow extended

Ď. In neutral rotation, with the elbow extended

Ď. open reduction and internal fixation

Đ. buddy taping to the adjacent index finger

Đ. early motion with application of a dynamic banjo splint

Ē. application of a cast with the hand in a “safe position” for 3 weeks.

Ē. dorsal extension block splinting

Ĕ. The name of the manufacturer

Ĕ. The manufacturer’s potential liability

Ė. The physician’s clinical performance

Ė. The physician’s materials testing data

Ę. Any royalties the physician receives from the manufacturer

Ę. Femoral

Ě. Obturator

Ě. Inferior gluteal

Ĝ. Superior gluteal

Ĝ. Lateral femoral cutaneous

Ğ. open biopsy and a long leg cast

Ğ. open biopsy and wide resection of the tumor

Ġ. a long leg cast and observation

Ġ. intramedullary stabilization and observation

Ģ. Triggering

Ģ. Lateral instability

Ĥ. Swan-neck deformity

Ĥ. Boutonniere deformity

Ħ. Loss of distal interphalangeal joint flexion

Ħ. Peroneus brevis to peroneus longus

Ĩ. Peroneus tertius to extensor hallucis longus

Ĩ. Peroneus tertius to superficial peroneal nerve

Ī. Extensor hallucis longus to deep peroneal nerve

Ī. Extensor hallucis longus to extensor digitorum longus

Ĭ. reassurance that Medicare will pay for the treatment.

Ĭ. consent forms that patients or their guardians are able to understand.

Į. a detailed description of the device, omitting the fact that it is part of a study.

Į. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

İ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

I. an onlay iliac crest bone graft.

Ĳ. limited weightbearing and observation.

Ĳ. removal of the implant and limited weightbearing.

Ĵ. removal of the implant and insertion of a reamed femoral nail.

Ĵ. removal of the implant and insertion of an unreamed femoral nail.

Ķ. Coronal

Ķ. Sagittal

ĸ. Anteromedial, midway between the sagittal and the coronal

Ĺ. Proximal pins sagittal, distal pins coronal

Ĺ. Proximal pins coronal, distal pins sagittal

Ļ. Rheumatoid arthritis

Ļ. Posttraumatic arthritis

Ľ. Degenerative osteoarthritis

Ľ. Osteonecrosis of the tibial plateau

Ŀ. Osteonecrosis of the medial femoral condyle

Ŀ. Trapeziometacarpal arthrodesis

Ł. Osteotomy of the thumb metacarpal

Ł. Arthrotomy and joint debridement

Ń. Ligament reconstruction using one half of the flexor carpi radialis

Ń. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ņ. Creep

Ņ. Relaxation

Ň. Energy dissipation

Ň. Plastic deformation

ʼN. Elastic deformation

Ŋ. bending

Ŋ. axial loading

Ō. high-speed rotation

Ō. direct impact from anteromedial

Ŏ. crush from anteromedial to posterolateral

Ŏ. Increase stiffness

Ő. Increase fracture toughness

Ő. Increase fatigue strength

Œ. Decrease mechanical strength

Œ. Decrease wear rate

Ŕ. disuse osteopenia

Ŕ. paraendocrine effect of the tumor

Ŗ. abnormally increased density on the right side

Ŗ. side effect of the treatment of the lesion

Ř. extensive tumor involvement of the left hip

Ř. Sciatic nerve

Ś. Superior gluteal artery

Ś. Profunda femoris artery

Ŝ. Femoral artery and nerve

Ŝ. External iliac artery and vein

Ş. Length

Ş. Moment arm

Š. Total volume

Š. Physiologic cross-sectional area

Ţ. Distribution of slow and fast twitch fibers

Ţ. decreasing initiation of action potentials.

Ť. increasing action potential amplitude.

Ť. blocking the opening of gated sodium channels.

Ŧ. decreasing the number of functional motor units.

Ŧ. slowing or stopping action potential propagation through the axon.

Ũ. resection of the metatarsal heads of the first through fifth toes.

Ũ. Silastic MP joint arthroplasties of the first through fifth toes.

Ū. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ū. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ŭ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ŭ. hemiarthroplasty

Ů. open reduction and internal fixation

Ů. closed reduction and percutaneous pinning

Ű. a sling and early pedulum exercises

Ű. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ų. open acromioplasty

Ų. open Bankart repair

Ŵ. open subscapularis tendon repair

Ŵ. inferior capsular shift

Ŷ. a supervised physical therapy program

Ŷ. a sling and swathe, with pendulum exercises in 10 days

Ÿ. open reduction and internal fixation through an anterior approach

Ź. open reduction and internal fixation through a posterior approach

Ź. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ż. arthroscopically assisted reduction and percutaneous screw fixation

Ż. Repair of the rotator cuff

Ž. Replacement of the humeral head

Ž. Resection arthroplasty

S. Total shoulder arthroplasty

Ƀ. AP and lateral radiographs of the elbow

Ɓ. Diagnositc arthroscopy

Ƃ. Aspiration of joint fluid

Ƃ. An erythrocyte sedimentation rate and CBC

Ƅ. A diagnostic lidocaine injection

Ƅ. Insulin-like growth factor (IGF-1)

Ɔ. Fibroblast growth factor (FGF-1)

Ƈ. Platelet-derived growth factor (PDGF)

Ƈ. Transforming growth factor beta (TGF-B)

Ɖ. Bone morphogenetic proteins (BMP)

Ɗ. clinical history and radiographic findings.

Ƌ. technetium bone scan

Ƌ. flow cytometry pattern of extracted chondrocytes

ƍ. immunohistochemical staining patterns of a biopsy specimen

Ǝ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ə. Radial

Ɛ. Radial recurrent

Ƒ. Posterior interosseous

Ƒ. Superior ulnar recurrent

Ɠ. Superficial radial circumflex

Ɣ. Impaired hydroxylation of proline

Ƕ. Failure of cleavage in procollagen

Ɩ. Defective binding sites for hydroxyproline

Ɨ. Failure to incorporate glycine into the helix

Ƙ. Diminished production of collagen through the rough endoplasmic reticulum

Ƙ. Asking the legal staff to seek a court injunction

Ƚ. Copying the patient’s chart and giving it to him as he leaves

ƛ. Having the patient sign a written legal contract that specifies acceptable behavior

Ɯ. Continuing care of the patient until an appropriate referral can be arranged

Ɲ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƞ. Meta-analysis

Ɵ. Confidence interval

Ơ. Analysis of variance (ANOVA)

Ơ. Statistical significance (p-value)

Ƣ. Survivorship analysis (Kaplan-Meier)

Ƣ. Spinal shock

Ƥ. Neurogenic shock

Ƥ. Hypovolemic shock

Ʀ. Pulmonary embolism

Ƨ. Fat embolus syndrome

Ƨ. Lumbar spinal stenosis

Ʃ. Metastatic disease of the spine

ƪ. Rheumatoid lumbar spondylitis

ƫ. Isthmic spondyloloisthesis

Ƭ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƭ. Patella alta

Ʈ. A metal-backed patella

Ư. Varus malalignment of the knee

Ư. A posterior cruciate-substituting femoral component

Ʊ. Lateral subluxation of the patella on a Merchant’s view

Ʋ. The sesamoids are separated

Ƴ. The sesamoid is fractured

Ƴ. The proximal phx is on the neck of the metatarsal

Ƶ. The dislocation is dorsal and centered

Ƶ. The proximal phalanx is hyperextended

Ʒ. Patella

Ƹ. Tibial stem

Ƹ. Distal femoral interface

ƺ. Posterior femoral interface

ƻ. Sites of screw fixation for the tibia

Ƽ. Hallux rigidus

Ƽ. Fracture of the sesamoid

ƾ. Disruption of the plantar plate

Ƿ. Osteonecrosis of the metatarsal head

ǀ. Rupture of the flexor hallucis longus

ǁ. Gout

ǂ. Sepsis

ǃ. Old trauma

Ǆ. Rheumatoid arthritis

Ǆ. Charcot arthroplasty

Ǆ. Aspiration and steroid injection

Ǉ. Biopsy, curettage, and allograft bone grafting

Ǉ. Percutaneous Kirschner wire fixation

Ǉ. Percutaneous injection of autogenous bone marrow

Ǌ. Nerve roots

Ǌ. Spinal cord

Ǌ. Sciatic nerve

Ǎ. Peroneal nerve

Ǎ. Conus medullaris

Ǐ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǐ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǒ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǒ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǔ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǔ. Early and late infection

Ǖ. Periprosthetic fracture of the femur

Ǖ. Failure of the patellofemoral and extensor mechanisms

Ǘ. Aseptic loosening of cementing tibial components

Ǘ. Asceptic loosening of cemented femoral components

Ǚ. Acceptance of the current position of the ankle

Ǚ. Open reduction and fixation in the epiphysis only

Ǜ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǜ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǝ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǟ. Resection arthroplasty and local radiation

Ǟ. In situ fusion of the hip

Ǡ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǡ. Excision of heterotopic bone and local radiation

Ǣ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǣ. Closed reduction of both fractures and immediate spica casting

Ǥ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǥ. External fixation of both femora

Ǧ. External fixation of the left femur and a long leg cast brace for the right femur

Ǧ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǩ. Synovial sarcoma

Ǩ. Soft-tissue abcess

Ǫ. Rhabdomyosarcoma

Ǫ. Eosinophilic granuloma

Ǭ. Nodular pigmented villonodular synovitis

Ǭ. Changing to a titanium nail

Ǯ. Changing to a nonslotted nail

Ǯ. Changing the cross-sectional shape of the nail

J̌. Increasing the diameter of the nail by 3 mm

Ǳ. Increasing the diameter of the interlocking screws

Ǳ. Fracture healing

Ǳ. Chondrosarcoma

Ǵ. Periosteal chondroma

Ǵ. Periosteal osteosarcoma

Ƕ. Dysplasia epiphysealis hemimelica

Ƿ. Demonstrate competence in the subject of the case

Ǹ. Be fellowship trained in the subject of the case

Ǹ. Be paid on a contingency basis

Ǻ. Be board certified by the American Board of Orthopaedic Surgery

Ǻ. Have been involved in the case as a consultant

Ǽ. Diagnostic arthroscopy

Ǽ. Arthroscopy and subacromial decompression

Ǿ. Reduction and fixation of the proximal humeral epiphysis

Ǿ. Temporary cessation of throwing

Ȁ. Physical therapy for rotator cuff strengthening

Ȁ. Oblique popliteal ligament

Ȃ. Lateral capsule

Ȃ. Popliteal tendon

Ȅ. Fibular collateral ligament

Ȅ. Posterior oblique ligament

Ȇ. Radial tear

Ȇ. Parrot-beak tear

Ȉ. Vertical tear in the “red-red” zone

Ȉ. Vertical tear in the “red-white” zone

Ȋ. Vertical tear in the “white-white” zone

Ȋ. 0 degrees of abduction, with neural rotation

Ȍ. 40 degrees of flexion and 60 degrees of internal rotation

Ȍ. 45 degrees of flexion and 45 degrees of external rotation

Ȏ. 90 degrees of abduction with neutral rotation

Ȏ. 90 degrees of abduction and 90 degrees of external rotation

Ȑ. Sural

Ȑ. Saphenous and its branches

Ȓ. Posterior tibial and its branches

Ȓ. Deep peroneal and its branches

Ȕ. Superficial peroneal and its branches

Ȕ. Strength

Ȗ. Stiffness

Ȗ. Shelf life

Ș. Antigenicity

Ș. Risk of HIV transmission

Ț. Indemnification

Ț. Occurrence

Ȝ. Excess liability

Ȝ. Claims-made

Ȟ. Nose

Ȟ. Lateral Y

Ƞ. Scapular AP

ȡ. Neutral rotation AP

Ȣ. Internal rotation AP

Ȣ. External rotation AP

Ȥ. Trauma

Ȥ. Hemophilia

Ȧ. Reiter’s syndrome

Ȧ. Rheumatoid arthritis

Ȩ. Systemic lupus erythematosus

Ȩ. Cast immobilization for 6 weeks

Ȫ. Activity modification and re-evaluation in 2 months

Ȫ. Internal fixation with or without bone grafting

Ȭ. Retrograde drilling of the defect without articular cartilage penetration

Ȭ. Drilling of the defect directly through the articular cartilage

Ȯ. repair or reconstruction of the medial collateral ligament

Ȯ. repair or reconstruction of the medialand lateral collateral ligaments

Ȱ. immobilization for 5 days or less

Ȱ. immobilization for 14 days

Ȳ. immobilization for 25 days

Ȳ. Cystinosis

ȴ. Hypophosphatemia

ȵ. Renal osteodystrophy

ȶ. Primary hyperparathyroidism

ȷ. Nutritional vitamin D deficiency

ȸ. Lateral meniscus tear

ȹ. Popliteus tenosynovitis

Ⱥ. Iliotibial band friction syndrome

Ȼ. Peroneal nerve entrapment

Ȼ. Biceps tendinitis

Ƚ. Observation

Ⱦ. Removal of the prosthetic components

Ȿ. Operative exploration and decompression of the peroneal nerve

Ɀ. Nerve conduction velocity studies

Ɂ. Loosening of the primary dressings and knee flexion to 30 degrees

Ɂ. I

Ƀ. II

Ʉ. III

Ʌ. decreased tissue tension

Ɇ. decreased abductor lever arm

Ɇ. decreased joint reaction force

Ɉ. increased body weight over lever arm

Ɉ. increased polyethylene wear rate

Ɋ. recurrent traumatic anterior dislocation

Ɋ. recurrent traumatic posterior dislocation

Ɍ. traumatic subluxation with no previous dislocation

Ɍ. traumatic anterior subluxation

Ɏ. atraumatic involuntary subluxation

Ɏ. radial

Ɐ. axillary

Ɑ. suprascapular

Ɒ. thoracodorsal

Ɓ. long thoracic

Ɔ. Flexion

ɕ. Extension

Ɖ. Axial rotation

Ɗ. Left lateral bending

ɘ. Right lateral bending

Ə. Skin

ɚ. Lung

Ɛ. Brain

Ɜ. Heart

ɝ. Kidney

ɞ. Thoracoacromial, lateral thoracic, subscapular

ɟ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɠ. Posterior humeral circumflex, subscapular, thoracacromial

Ɡ. Subscapular, thoracacromial, anterior humeral circumflex

ɢ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɣ. Respondeat superior

ɤ. Indemnity agreement

Ɥ. Hold harmless agreement- attempt to shift liability from company to physician

Ɦ. Comparative negligence-% of involvement

ɧ. Contributory negligence- resident contributed to the negligence

Ɨ. t-type

Ɩ. both column

Ɪ. transverse

Ɫ. anterior column

Ɬ. anterior column posterior hemitransverse

ɭ. Posterior interosseous

ɮ. Anterior interosseous

Ɯ. Radial

ɰ. Median

Ɱ. Ulnar

Ɲ. Shock from hypovolemia

ɳ. Associated rupture of the bladder

ɴ. Arterial bleeding on pelvic angiogram

Ɵ. Presence of a hematoma in the perineum and scrotum

ɶ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Weightbearing short leg cast

Explanation

Question 4153

Topic: 10. Pathology and Oncology

Which of the following metastatic tumors to bone carries the greatest risk of complications from intraoperative bleeding?

. Breast

. Prostate

. Gastrointestinal

. Kidney

. Multiple myeloma

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

!. CT scan of both wrists in the same position

". Radiographs of the wrist in supination and pronation

#. Radiographs of the opposite wrist in the same position

$. Secondary hyperparathyroidism

%. Phosphate retention secondary to uremia

&. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

'. Aluminum deposition in bone from oral phosphate binders

(. Persistent acidosis aggravating the negative calcium balance

). Posterior fusion at T10-L3 with segmental instrumentation

*. Laminectomy and fusion of T12-L2 with segmental instrumentation

+. Bed rest in a hyperextension brace

,. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

-. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

.. Positive-pressure ventilation

/. An immediate radiograph of the chest

0. Adjustment of the position of the endotrachael tube

1. Insertion of a large-bore needle into the pericardial space

2. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

3. Allowing the ends of the fracture to touch

4. Adding a second connecting bar

5. Adding one pin to each fracture fragment

6. Increasing the pin diameter from 4 mm to 6 mm

7. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

8. Osteomyelitis

9. Malignant degeneration

:. Stress fracture

;. Local recurrence of the giant cell tumor

<. Bone resorption due to methylmethacrylate

=. Advancement of the plantar plate

>. Resection of the second metatarsal head

?. Dorsiflexion osteotomy of the second metatarsal neck

@. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

A. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

B. Sacral fracture

C. Burst fracture of L5

D. Cauda equina syndrome

E. Distraction-flexion injury at L3

F. Distraction-extension injury at L3

G. An MRI scan of the shoulder

H. An MRI scan of the cervical spine

I. Electromyographic and nerve conduction velocity studies

J. Immobilization in a sling and early passive range of motion exercises

K. Immediate return to the operating room for exploration of the brachial plexus

L. cerclage wiring

M. tension band wiring

N. removal of the patellar component

O. revision of the patellar component

P. immobilization of the knee and protected weightbearing

Q. Liposarcoma

R. Nodular fasciitis

S. Rabdomyosarcoma

T. Malignant fibrous histiocytoma

U. Extra-abdominal desmoid tumor

V. Clubfeet

W. Thrombocytopenia

X. Congenital scoliosis

Y. Ventricular septal defect

Z. Arnold-Chiari malformation

[. delayed primary closure

\. free flap

]. pedicle groin flap

^. full-thickness skin graft

_. split-thickness skin graft

`. Infection

A. Nonunion

B. Improper screw length

C. Osteonecrosis of the distal fragment

D. Use of a cortical screw instead of a cancellous screw

E. Infection

F. Tear of the rotator cuff

G. Loosening of the humeral component

H. Arthritis of the glenoid

I. Arthritis of the A-C joint

J. Reduced morbidity

K. Improved osteoinduction

L. Improved osteoconduction

M. More rapid revascularization

N. Lower risk of disease transmission

O. Manipulation Under Anesthesia

P. Arthroscopic acromioplasty

Q. Arthroscopic debridement of G-H joint

R. Replacement of the humeral head

S. Lengthening of the subscapularis and release of the anterior capsule

T. Bacteroides

U. E. coli

V. Staph. aureus

W. group A streptococcus

X. Clostridium perforingens

Y. observation and exercises

Z. bracing with a thoracolumbar orthosis

{. fusion of the posterior spine

|. fusion of the anterior spine

}. fusion of the anterior and posterior spine

~. Total wrist replacement and bridge grafts

. palmar shelf arthroplasty and tendon transfers

. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

. Total wrist fusion and tendon transfers

. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

¡. Plantar fascia

¢. Spring ligament

£. Deltoid ligament

¤. Intrinsic tendons

¥. Gastorcnemius-solelus complex

¦. Prevention of presynaptic release of acetylcholine

§. Prevention of synthesis of presynaptic acetylcholine

¨. Activation of acetylcholinesterase at the motor end-plate

©. Blockage of postsynaptic action of acetylcholine until reserves are depleted

ª. Stimulation of release of presynaptic acetylcholine until reserves are depleted

«. stiffness of the femoral component.

¬. head offset of the femoral component.

. femoral component material modulus of elasticity.

®. extent of the femoral component porous coating.

¯. Presence of a femoral component collar.

°. plantar fascia and quadratus plantae tendon.

±. ligamentous structures connecting the tarsal bones.

². shape of the tarsal bones and the intervening joints.

³. activity of the intrinsic muscles of the foot.

´. activity of the posterior tibialis and the peroneus longus muscles.

Μ. scapulothoracic fusion

¶. strengthening of the periscapular muscles

·. pectoralis minor-fascia lata graft transfer to the scapula

¸. pectoralis major-fascia lata graft transfer to the scapula

¹. exploration of the long thoracic nerve, with sural nerve graft

º. tricompartmental knee replacement

». unicompartmental knee replacement

¼. medial compartment meniscal allograft

½. valgus-producing distal femoral osteotomy

¾. valgus-producing proximal tibial osteotomy

¿. Internal rotation of the femoral component

À. External rotation of the tibial component

Á. Lateral placement of the femoral component

Â. Medial placement of the patellar component

Ã. Excessive resection of the patella

Ä. Hallux rigidus

Å. Hallux valgus

Æ. Neuroma of the first web space

Ç. Fracture of the sesamoid

È. Rupture of the flexor hallucis longus

É. Sickle cell crisis

Ê. Idiopathic chondrolysis

Ë. Hemophilic arthropathy

Ì. Osteoid osteoma of the femoral neck

Í. Legg-Calve-Perthes disease

Î. Decreased ankle jerk and positive femoral nerve stretch test

Ï. Decreased knee jerk and positive straight-leg raising sign

Ð. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ñ. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ò. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ó. Long-term administration of IV and oral antibiotics

Ô. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Õ. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ö. Two-stage surgical prosthetic exchange and IV antibiotics

×. Resection arthroplasty and IV antibiotics

Ø. SCFE

Ù. MED

Ú. Perthes disease

Û. Hypothyroidism

Ü. Chondrolysis

Ý. gout.

Þ. osteoporosis.

SS. eosinophilic granuloma.

À. tuberculosis of the spine.

Á. metastatic disease of the spine.

Â. water content.

Ã. Synthesis of type I collagen.

Ä. Proteoglycan content.

Å. Activity of chondrocytes.

Æ. Synthesis of hyaluronate.

Ç. Lung

È. Breast

É. Prostate

Ê. Thyroid

Ë. Renal

Ì. T1-low, T2-low.

Í. T1-low, T2-high.

Î. T1-moderate, T2-low.

Ï. T1-high, T2-low.

Ð. T1-high, T2-high.

Ñ. hypothesis is incorrect or invalid

Ò. interobserver error rate is 4%.

Ó. Standard deviation is 4% higher or lower than the mean.

Ô. Sample size is 4% larger than required to be clinically significant.

Õ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ö. I

÷. II

Ø. IV

Ù. IX

Ú. X

Û. Cranial setting

Ü. Cranial subluxation

Ý. Odontoid fracture

Þ. Lysis of the arch of the atlas

Ÿ. Atlantoaxial subluxation

Ā. Retrograde collapse of the endoneurial tubes

Ā. Irreversible atrophy of the denervated muscles

Ă. Elongation of the axons across the zone of injury

Ă. Sprouting of the axons at the neuromuscular junction

Ą. Misdirection of the axons across the zone of injury

Ą. Maximally pronated and elbow extended

Ć. Maximally pronated and the elbow flexed

Ć. Maximally supinated and the elbow flexed

Ĉ. Maximally supinated and the elbow extended

Ĉ. In neutral rotation, with the elbow extended

Ċ. open reduction and internal fixation

Ċ. buddy taping to the adjacent index finger

Č. early motion with application of a dynamic banjo splint

Č. application of a cast with the hand in a “safe position” for 3 weeks.

Ď. dorsal extension block splinting

Ď. The name of the manufacturer

Đ. The manufacturer’s potential liability

Đ. The physician’s clinical performance

Ē. The physician’s materials testing data

Ē. Any royalties the physician receives from the manufacturer

Ĕ. Femoral

Ĕ. Obturator

Ė. Inferior gluteal

Ė. Superior gluteal

Ę. Lateral femoral cutaneous

Ę. open biopsy and a long leg cast

Ě. open biopsy and wide resection of the tumor

Ě. a long leg cast and observation

Ĝ. intramedullary stabilization and observation

Ĝ. Triggering

Ğ. Lateral instability

Ğ. Swan-neck deformity

Ġ. Boutonniere deformity

Ġ. Loss of distal interphalangeal joint flexion

Ģ. Peroneus brevis to peroneus longus

Ģ. Peroneus tertius to extensor hallucis longus

Ĥ. Peroneus tertius to superficial peroneal nerve

Ĥ. Extensor hallucis longus to deep peroneal nerve

Ħ. Extensor hallucis longus to extensor digitorum longus

Ħ. reassurance that Medicare will pay for the treatment.

Ĩ. consent forms that patients or their guardians are able to understand.

Ĩ. a detailed description of the device, omitting the fact that it is part of a study.

Ī. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ī. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ĭ. an onlay iliac crest bone graft.

Ĭ. limited weightbearing and observation.

Į. removal of the implant and limited weightbearing.

Į. removal of the implant and insertion of a reamed femoral nail.

İ. removal of the implant and insertion of an unreamed femoral nail.

I. Coronal

Ĳ. Sagittal

Ĳ. Anteromedial, midway between the sagittal and the coronal

Ĵ. Proximal pins sagittal, distal pins coronal

Ĵ. Proximal pins coronal, distal pins sagittal

Ķ. Rheumatoid arthritis

Ķ. Posttraumatic arthritis

ĸ. Degenerative osteoarthritis

Ĺ. Osteonecrosis of the tibial plateau

Ĺ. Osteonecrosis of the medial femoral condyle

Ļ. Trapeziometacarpal arthrodesis

Ļ. Osteotomy of the thumb metacarpal

Ľ. Arthrotomy and joint debridement

Ľ. Ligament reconstruction using one half of the flexor carpi radialis

Ŀ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ŀ. Creep

Ł. Relaxation

Ł. Energy dissipation

Ń. Plastic deformation

Ń. Elastic deformation

Ņ. bending

Ņ. axial loading

Ň. high-speed rotation

Ň. direct impact from anteromedial

ʼN. crush from anteromedial to posterolateral

Ŋ. Increase stiffness

Ŋ. Increase fracture toughness

Ō. Increase fatigue strength

Ō. Decrease mechanical strength

Ŏ. Decrease wear rate

Ŏ. disuse osteopenia

Ő. paraendocrine effect of the tumor

Ő. abnormally increased density on the right side

Œ. side effect of the treatment of the lesion

Œ. extensive tumor involvement of the left hip

Ŕ. Sciatic nerve

Ŕ. Superior gluteal artery

Ŗ. Profunda femoris artery

Ŗ. Femoral artery and nerve

Ř. External iliac artery and vein

Ř. Length

Ś. Moment arm

Ś. Total volume

Ŝ. Physiologic cross-sectional area

Ŝ. Distribution of slow and fast twitch fibers

Ş. decreasing initiation of action potentials.

Ş. increasing action potential amplitude.

Š. blocking the opening of gated sodium channels.

Š. decreasing the number of functional motor units.

Ţ. slowing or stopping action potential propagation through the axon.

Ţ. resection of the metatarsal heads of the first through fifth toes.

Ť. Silastic MP joint arthroplasties of the first through fifth toes.

Ť. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ŧ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ŧ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ũ. hemiarthroplasty

Ũ. open reduction and internal fixation

Ū. closed reduction and percutaneous pinning

Ū. a sling and early pedulum exercises

Ŭ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ŭ. open acromioplasty

Ů. open Bankart repair

Ů. open subscapularis tendon repair

Ű. inferior capsular shift

Ű. a supervised physical therapy program

Ų. a sling and swathe, with pendulum exercises in 10 days

Ų. open reduction and internal fixation through an anterior approach

Ŵ. open reduction and internal fixation through a posterior approach

Ŵ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ŷ. arthroscopically assisted reduction and percutaneous screw fixation

Ŷ. Repair of the rotator cuff

Ÿ. Replacement of the humeral head

Ź. Resection arthroplasty

Ź. Total shoulder arthroplasty

Ż. AP and lateral radiographs of the elbow

Ż. Diagnositc arthroscopy

Ž. Aspiration of joint fluid

Ž. An erythrocyte sedimentation rate and CBC

S. A diagnostic lidocaine injection

Ƀ. Insulin-like growth factor (IGF-1)

Ɓ. Fibroblast growth factor (FGF-1)

Ƃ. Platelet-derived growth factor (PDGF)

Ƃ. Transforming growth factor beta (TGF-B)

Ƅ. Bone morphogenetic proteins (BMP)

Ƅ. clinical history and radiographic findings.

Ɔ. technetium bone scan

Ƈ. flow cytometry pattern of extracted chondrocytes

Ƈ. immunohistochemical staining patterns of a biopsy specimen

Ɖ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ɗ. Radial

Ƌ. Radial recurrent

Ƌ. Posterior interosseous

ƍ. Superior ulnar recurrent

Ǝ. Superficial radial circumflex

Ə. Impaired hydroxylation of proline

Ɛ. Failure of cleavage in procollagen

Ƒ. Defective binding sites for hydroxyproline

Ƒ. Failure to incorporate glycine into the helix

Ɠ. Diminished production of collagen through the rough endoplasmic reticulum

Ɣ. Asking the legal staff to seek a court injunction

Ƕ. Copying the patient’s chart and giving it to him as he leaves

Ɩ. Having the patient sign a written legal contract that specifies acceptable behavior

Ɨ. Continuing care of the patient until an appropriate referral can be arranged

Ƙ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƙ. Meta-analysis

Ƚ. Confidence interval

ƛ. Analysis of variance (ANOVA)

Ɯ. Statistical significance (p-value)

Ɲ. Survivorship analysis (Kaplan-Meier)

Ƞ. Spinal shock

Ɵ. Neurogenic shock

Ơ. Hypovolemic shock

Ơ. Pulmonary embolism

Ƣ. Fat embolus syndrome

Ƣ. Lumbar spinal stenosis

Ƥ. Metastatic disease of the spine

Ƥ. Rheumatoid lumbar spondylitis

Ʀ. Isthmic spondyloloisthesis

Ƨ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƨ. Patella alta

Ʃ. A metal-backed patella

ƪ. Varus malalignment of the knee

ƫ. A posterior cruciate-substituting femoral component

Ƭ. Lateral subluxation of the patella on a Merchant’s view

Ƭ. The sesamoids are separated

Ʈ. The sesamoid is fractured

Ư. The proximal phx is on the neck of the metatarsal

Ư. The dislocation is dorsal and centered

Ʊ. The proximal phalanx is hyperextended

Ʋ. Patella

Ƴ. Tibial stem

Ƴ. Distal femoral interface

Ƶ. Posterior femoral interface

Ƶ. Sites of screw fixation for the tibia

Ʒ. Hallux rigidus

Ƹ. Fracture of the sesamoid

Ƹ. Disruption of the plantar plate

ƺ. Osteonecrosis of the metatarsal head

ƻ. Rupture of the flexor hallucis longus

Ƽ. Gout

Ƽ. Sepsis

ƾ. Old trauma

Ƿ. Rheumatoid arthritis

ǀ. Charcot arthroplasty

ǁ. Aspiration and steroid injection

ǂ. Biopsy, curettage, and allograft bone grafting

ǃ. Percutaneous Kirschner wire fixation

Ǆ. Percutaneous injection of autogenous bone marrow

Ǆ. Nerve roots

Ǆ. Spinal cord

Ǉ. Sciatic nerve

Ǉ. Peroneal nerve

Ǉ. Conus medullaris

Ǌ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǌ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǌ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǎ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǎ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǐ. Early and late infection

Ǐ. Periprosthetic fracture of the femur

Ǒ. Failure of the patellofemoral and extensor mechanisms

Ǒ. Aseptic loosening of cementing tibial components

Ǔ. Asceptic loosening of cemented femoral components

Ǔ. Acceptance of the current position of the ankle

Ǖ. Open reduction and fixation in the epiphysis only

Ǖ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǘ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǘ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǚ. Resection arthroplasty and local radiation

Ǚ. In situ fusion of the hip

Ǜ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǜ. Excision of heterotopic bone and local radiation

Ǝ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǟ. Closed reduction of both fractures and immediate spica casting

Ǟ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǡ. External fixation of both femora

Ǡ. External fixation of the left femur and a long leg cast brace for the right femur

Ǣ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǣ. Synovial sarcoma

Ǥ. Soft-tissue abcess

Ǥ. Rhabdomyosarcoma

Ǧ. Eosinophilic granuloma

Ǧ. Nodular pigmented villonodular synovitis

Ǩ. Changing to a titanium nail

Ǩ. Changing to a nonslotted nail

Ǫ. Changing the cross-sectional shape of the nail

Ǫ. Increasing the diameter of the nail by 3 mm

Ǭ. Increasing the diameter of the interlocking screws

Ǭ. Fracture healing

Ǯ. Chondrosarcoma

Ǯ. Periosteal chondroma

J̌. Periosteal osteosarcoma

Ǳ. Dysplasia epiphysealis hemimelica

Ǳ. Demonstrate competence in the subject of the case

Ǳ. Be fellowship trained in the subject of the case

Ǵ. Be paid on a contingency basis

Ǵ. Be board certified by the American Board of Orthopaedic Surgery

Ƕ. Have been involved in the case as a consultant

Ƿ. Diagnostic arthroscopy

Ǹ. Arthroscopy and subacromial decompression

Ǹ. Reduction and fixation of the proximal humeral epiphysis

Ǻ. Temporary cessation of throwing

Ǻ. Physical therapy for rotator cuff strengthening

Ǽ. Oblique popliteal ligament

Ǽ. Lateral capsule

Ǿ. Popliteal tendon

Ǿ. Fibular collateral ligament

Ȁ. Posterior oblique ligament

Ȁ. Radial tear

Ȃ. Parrot-beak tear

Ȃ. Vertical tear in the “red-red” zone

Ȅ. Vertical tear in the “red-white” zone

Ȅ. Vertical tear in the “white-white” zone

Ȇ. 0 degrees of abduction, with neural rotation

Ȇ. 40 degrees of flexion and 60 degrees of internal rotation

Ȉ. 45 degrees of flexion and 45 degrees of external rotation

Ȉ. 90 degrees of abduction with neutral rotation

Ȋ. 90 degrees of abduction and 90 degrees of external rotation

Ȋ. Sural

Ȍ. Saphenous and its branches

Ȍ. Posterior tibial and its branches

Ȏ. Deep peroneal and its branches

Ȏ. Superficial peroneal and its branches

Ȑ. Strength

Ȑ. Stiffness

Ȓ. Shelf life

Ȓ. Antigenicity

Ȕ. Risk of HIV transmission

Ȕ. Indemnification

Ȗ. Occurrence

Ȗ. Excess liability

Ș. Claims-made

Ș. Nose

Ț. Lateral Y

Ț. Scapular AP

Ȝ. Neutral rotation AP

Ȝ. Internal rotation AP

Ȟ. External rotation AP

Ȟ. Trauma

Ƞ. Hemophilia

ȡ. Reiter’s syndrome

Ȣ. Rheumatoid arthritis

Ȣ. Systemic lupus erythematosus

Ȥ. Cast immobilization for 6 weeks

Ȥ. Activity modification and re-evaluation in 2 months

Ȧ. Internal fixation with or without bone grafting

Ȧ. Retrograde drilling of the defect without articular cartilage penetration

Ȩ. Drilling of the defect directly through the articular cartilage

Ȩ. repair or reconstruction of the medial collateral ligament

Ȫ. repair or reconstruction of the medialand lateral collateral ligaments

Ȫ. immobilization for 5 days or less

Ȭ. immobilization for 14 days

Ȭ. immobilization for 25 days

Ȯ. Cystinosis

Ȯ. Hypophosphatemia

Ȱ. Renal osteodystrophy

Ȱ. Primary hyperparathyroidism

Ȳ. Nutritional vitamin D deficiency

Ȳ. Lateral meniscus tear

ȴ. Popliteus tenosynovitis

ȵ. Iliotibial band friction syndrome

ȶ. Peroneal nerve entrapment

ȷ. Biceps tendinitis

ȸ. Observation

ȹ. Removal of the prosthetic components

Ⱥ. Operative exploration and decompression of the peroneal nerve

Ȼ. Nerve conduction velocity studies

Ȼ. Loosening of the primary dressings and knee flexion to 30 degrees

Ƚ. I

Ⱦ. II

Ȿ. III

Ɀ. decreased tissue tension

Ɂ. decreased abductor lever arm

Ɂ. decreased joint reaction force

Ƀ. increased body weight over lever arm

Ʉ. increased polyethylene wear rate

Ʌ. recurrent traumatic anterior dislocation

Ɇ. recurrent traumatic posterior dislocation

Ɇ. traumatic subluxation with no previous dislocation

Ɉ. traumatic anterior subluxation

Ɉ. atraumatic involuntary subluxation

Ɋ. radial

Ɋ. axillary

Ɍ. suprascapular

Ɍ. thoracodorsal

Ɏ. long thoracic

Ɏ. Flexion

Ɐ. Extension

Ɑ. Axial rotation

Ɒ. Left lateral bending

Ɓ. Right lateral bending

Ɔ. Skin

ɕ. Lung

Ɖ. Brain

Ɗ. Heart

ɘ. Kidney

Ə. Thoracoacromial, lateral thoracic, subscapular

ɚ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɛ. Posterior humeral circumflex, subscapular, thoracacromial

Ɜ. Subscapular, thoracacromial, anterior humeral circumflex

ɝ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ɞ. Respondeat superior

ɟ. Indemnity agreement

Ɠ. Hold harmless agreement- attempt to shift liability from company to physician

Ɡ. Comparative negligence-% of involvement

ɢ. Contributory negligence- resident contributed to the negligence

Ɣ. t-type

ɤ. both column

Ɥ. transverse

Ɦ. anterior column

ɧ. anterior column posterior hemitransverse

Ɨ. Posterior interosseous

Ɩ. Anterior interosseous

Ɪ. Radial

Ɫ. Median

Ɬ. Ulnar

ɭ. Shock from hypovolemia

ɮ. Associated rupture of the bladder

Ɯ. Arterial bleeding on pelvic angiogram

ɰ. Presence of a hematoma in the perineum and scrotum

Ɱ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Breast

Explanation

Question 4154

Topic: 10. Pathology and Oncology

A 15-year-old boy has a fracture of the proximal tibia extending from the apophysis of the tubercle up through the posterior part of the proximal tibial epiphysis and into the joint. What is the most likely mechanism of injury?

. Varus stress

. Valgus stress

. Torsional loading

. Hyperextension of the knee

. Contraction of the quadriceps while axially loaded

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

!. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

". Aluminum deposition in bone from oral phosphate binders

#. Persistent acidosis aggravating the negative calcium balance

$. Posterior fusion at T10-L3 with segmental instrumentation

%. Laminectomy and fusion of T12-L2 with segmental instrumentation

&. Bed rest in a hyperextension brace

'. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

(. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

). Positive-pressure ventilation

*. An immediate radiograph of the chest

+. Adjustment of the position of the endotrachael tube

,. Insertion of a large-bore needle into the pericardial space

-. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

.. Allowing the ends of the fracture to touch

/. Adding a second connecting bar

0. Adding one pin to each fracture fragment

1. Increasing the pin diameter from 4 mm to 6 mm

2. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

3. Osteomyelitis

4. Malignant degeneration

5. Stress fracture

6. Local recurrence of the giant cell tumor

7. Bone resorption due to methylmethacrylate

8. Advancement of the plantar plate

9. Resection of the second metatarsal head

:. Dorsiflexion osteotomy of the second metatarsal neck

;. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

<. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

=. Sacral fracture

>. Burst fracture of L5

?. Cauda equina syndrome

@. Distraction-flexion injury at L3

A. Distraction-extension injury at L3

B. An MRI scan of the shoulder

C. An MRI scan of the cervical spine

D. Electromyographic and nerve conduction velocity studies

E. Immobilization in a sling and early passive range of motion exercises

F. Immediate return to the operating room for exploration of the brachial plexus

G. cerclage wiring

H. tension band wiring

I. removal of the patellar component

J. revision of the patellar component

K. immobilization of the knee and protected weightbearing

L. Liposarcoma

M. Nodular fasciitis

N. Rabdomyosarcoma

O. Malignant fibrous histiocytoma

P. Extra-abdominal desmoid tumor

Q. Clubfeet

R. Thrombocytopenia

S. Congenital scoliosis

T. Ventricular septal defect

U. Arnold-Chiari malformation

V. delayed primary closure

W. free flap

X. pedicle groin flap

Y. full-thickness skin graft

Z. split-thickness skin graft

[. Infection

\. Nonunion

]. Improper screw length

^. Osteonecrosis of the distal fragment

_. Use of a cortical screw instead of a cancellous screw

`. Infection

A. Tear of the rotator cuff

B. Loosening of the humeral component

C. Arthritis of the glenoid

D. Arthritis of the A-C joint

E. Reduced morbidity

F. Improved osteoinduction

G. Improved osteoconduction

H. More rapid revascularization

I. Lower risk of disease transmission

J. Manipulation Under Anesthesia

K. Arthroscopic acromioplasty

L. Arthroscopic debridement of G-H joint

M. Replacement of the humeral head

N. Lengthening of the subscapularis and release of the anterior capsule

O. Bacteroides

P. E. coli

Q. Staph. aureus

R. group A streptococcus

S. Clostridium perforingens

T. observation and exercises

U. bracing with a thoracolumbar orthosis

V. fusion of the posterior spine

W. fusion of the anterior spine

X. fusion of the anterior and posterior spine

Y. Total wrist replacement and bridge grafts

Z. palmar shelf arthroplasty and tendon transfers

{. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

|. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

}. Total wrist fusion and tendon transfers

~. constrained acetabular component

. protrusion ring with morselized graft

. cemented metal backed acetabular component

. cemented all-polyethylene acetabular component

. cementless hemispherical component with screw fixation

. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

¡. Prevention of presynaptic release of acetylcholine

¢. Prevention of synthesis of presynaptic acetylcholine

£. Activation of acetylcholinesterase at the motor end-plate

¤. Blockage of postsynaptic action of acetylcholine until reserves are depleted

¥. Stimulation of release of presynaptic acetylcholine until reserves are depleted

¦. stiffness of the femoral component.

§. head offset of the femoral component.

¨. femoral component material modulus of elasticity.

©. extent of the femoral component porous coating.

ª. Presence of a femoral component collar.

«. plantar fascia and quadratus plantae tendon.

¬. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

®. activity of the intrinsic muscles of the foot.

¯. activity of the posterior tibialis and the peroneus longus muscles.

°. scapulothoracic fusion

±. strengthening of the periscapular muscles

². pectoralis minor-fascia lata graft transfer to the scapula

³. pectoralis major-fascia lata graft transfer to the scapula

´. exploration of the long thoracic nerve, with sural nerve graft

Μ. tricompartmental knee replacement

¶. unicompartmental knee replacement

·. medial compartment meniscal allograft

¸. valgus-producing distal femoral osteotomy

¹. valgus-producing proximal tibial osteotomy

º. Internal rotation of the femoral component

». External rotation of the tibial component

¼. Lateral placement of the femoral component

½. Medial placement of the patellar component

¾. Excessive resection of the patella

¿. Hallux rigidus

À. Hallux valgus

Á. Neuroma of the first web space

Â. Fracture of the sesamoid

Ã. Rupture of the flexor hallucis longus

Ä. Sickle cell crisis

Å. Idiopathic chondrolysis

Æ. Hemophilic arthropathy

Ç. Osteoid osteoma of the femoral neck

È. Legg-Calve-Perthes disease

É. Decreased ankle jerk and positive femoral nerve stretch test

Ê. Decreased knee jerk and positive straight-leg raising sign

Ë. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ì. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Í. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Î. Long-term administration of IV and oral antibiotics

Ï. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ð. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ñ. Two-stage surgical prosthetic exchange and IV antibiotics

Ò. Resection arthroplasty and IV antibiotics

Ó. SCFE

Ô. MED

Õ. Perthes disease

Ö. Hypothyroidism

×. Chondrolysis

Ø. gout.

Ù. osteoporosis.

Ú. eosinophilic granuloma.

Û. tuberculosis of the spine.

Ü. metastatic disease of the spine.

Ý. water content.

Þ. Synthesis of type I collagen.

SS. Proteoglycan content.

À. Activity of chondrocytes.

Á. Synthesis of hyaluronate.

Â. Lung

Ã. Breast

Ä. Prostate

Å. Thyroid

Æ. Renal

Ç. T1-low, T2-low.

È. T1-low, T2-high.

É. T1-moderate, T2-low.

Ê. T1-high, T2-low.

Ë. T1-high, T2-high.

Ì. hypothesis is incorrect or invalid

Í. interobserver error rate is 4%.

Î. Standard deviation is 4% higher or lower than the mean.

Ï. Sample size is 4% larger than required to be clinically significant.

Ð. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ñ. I

Ò. II

Ó. IV

Ô. IX

Õ. X

Ö. Cranial setting

÷. Cranial subluxation

Ø. Odontoid fracture

Ù. Lysis of the arch of the atlas

Ú. Atlantoaxial subluxation

Û. Retrograde collapse of the endoneurial tubes

Ü. Irreversible atrophy of the denervated muscles

Ý. Elongation of the axons across the zone of injury

Þ. Sprouting of the axons at the neuromuscular junction

Ÿ. Misdirection of the axons across the zone of injury

Ā. Maximally pronated and elbow extended

Ā. Maximally pronated and the elbow flexed

Ă. Maximally supinated and the elbow flexed

Ă. Maximally supinated and the elbow extended

Ą. In neutral rotation, with the elbow extended

Ą. open reduction and internal fixation

Ć. buddy taping to the adjacent index finger

Ć. early motion with application of a dynamic banjo splint

Ĉ. application of a cast with the hand in a “safe position” for 3 weeks.

Ĉ. dorsal extension block splinting

Ċ. The name of the manufacturer

Ċ. The manufacturer’s potential liability

Č. The physician’s clinical performance

Č. The physician’s materials testing data

Ď. Any royalties the physician receives from the manufacturer

Ď. Femoral

Đ. Obturator

Đ. Inferior gluteal

Ē. Superior gluteal

Ē. Lateral femoral cutaneous

Ĕ. open biopsy and a long leg cast

Ĕ. open biopsy and wide resection of the tumor

Ė. a long leg cast and observation

Ė. intramedullary stabilization and observation

Ę. Triggering

Ę. Lateral instability

Ě. Swan-neck deformity

Ě. Boutonniere deformity

Ĝ. Loss of distal interphalangeal joint flexion

Ĝ. Peroneus brevis to peroneus longus

Ğ. Peroneus tertius to extensor hallucis longus

Ğ. Peroneus tertius to superficial peroneal nerve

Ġ. Extensor hallucis longus to deep peroneal nerve

Ġ. Extensor hallucis longus to extensor digitorum longus

Ģ. reassurance that Medicare will pay for the treatment.

Ģ. consent forms that patients or their guardians are able to understand.

Ĥ. a detailed description of the device, omitting the fact that it is part of a study.

Ĥ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ħ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ħ. an onlay iliac crest bone graft.

Ĩ. limited weightbearing and observation.

Ĩ. removal of the implant and limited weightbearing.

Ī. removal of the implant and insertion of a reamed femoral nail.

Ī. removal of the implant and insertion of an unreamed femoral nail.

Ĭ. Coronal

Ĭ. Sagittal

Į. Anteromedial, midway between the sagittal and the coronal

Į. Proximal pins sagittal, distal pins coronal

İ. Proximal pins coronal, distal pins sagittal

I. Rheumatoid arthritis

Ĳ. Posttraumatic arthritis

Ĳ. Degenerative osteoarthritis

Ĵ. Osteonecrosis of the tibial plateau

Ĵ. Osteonecrosis of the medial femoral condyle

Ķ. Trapeziometacarpal arthrodesis

Ķ. Osteotomy of the thumb metacarpal

ĸ. Arthrotomy and joint debridement

Ĺ. Ligament reconstruction using one half of the flexor carpi radialis

Ĺ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ļ. Creep

Ļ. Relaxation

Ľ. Energy dissipation

Ľ. Plastic deformation

Ŀ. Elastic deformation

Ŀ. bending

Ł. axial loading

Ł. high-speed rotation

Ń. direct impact from anteromedial

Ń. crush from anteromedial to posterolateral

Ņ. Increase stiffness

Ņ. Increase fracture toughness

Ň. Increase fatigue strength

Ň. Decrease mechanical strength

ʼN. Decrease wear rate

Ŋ. disuse osteopenia

Ŋ. paraendocrine effect of the tumor

Ō. abnormally increased density on the right side

Ō. side effect of the treatment of the lesion

Ŏ. extensive tumor involvement of the left hip

Ŏ. Sciatic nerve

Ő. Superior gluteal artery

Ő. Profunda femoris artery

Œ. Femoral artery and nerve

Œ. External iliac artery and vein

Ŕ. Length

Ŕ. Moment arm

Ŗ. Total volume

Ŗ. Physiologic cross-sectional area

Ř. Distribution of slow and fast twitch fibers

Ř. decreasing initiation of action potentials.

Ś. increasing action potential amplitude.

Ś. blocking the opening of gated sodium channels.

Ŝ. decreasing the number of functional motor units.

Ŝ. slowing or stopping action potential propagation through the axon.

Ş. resection of the metatarsal heads of the first through fifth toes.

Ş. Silastic MP joint arthroplasties of the first through fifth toes.

Š. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Š. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ţ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ţ. hemiarthroplasty

Ť. open reduction and internal fixation

Ť. closed reduction and percutaneous pinning

Ŧ. a sling and early pedulum exercises

Ŧ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ũ. open acromioplasty

Ũ. open Bankart repair

Ū. open subscapularis tendon repair

Ū. inferior capsular shift

Ŭ. a supervised physical therapy program

Ŭ. a sling and swathe, with pendulum exercises in 10 days

Ů. open reduction and internal fixation through an anterior approach

Ů. open reduction and internal fixation through a posterior approach

Ű. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ű. arthroscopically assisted reduction and percutaneous screw fixation

Ų. Repair of the rotator cuff

Ų. Replacement of the humeral head

Ŵ. Resection arthroplasty

Ŵ. Total shoulder arthroplasty

Ŷ. AP and lateral radiographs of the elbow

Ŷ. Diagnositc arthroscopy

Ÿ. Aspiration of joint fluid

Ź. An erythrocyte sedimentation rate and CBC

Ź. A diagnostic lidocaine injection

Ż. Insulin-like growth factor (IGF-1)

Ż. Fibroblast growth factor (FGF-1)

Ž. Platelet-derived growth factor (PDGF)

Ž. Transforming growth factor beta (TGF-B)

S. Bone morphogenetic proteins (BMP)

Ƀ. clinical history and radiographic findings.

Ɓ. technetium bone scan

Ƃ. flow cytometry pattern of extracted chondrocytes

Ƃ. immunohistochemical staining patterns of a biopsy specimen

Ƅ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƅ. Radial

Ɔ. Radial recurrent

Ƈ. Posterior interosseous

Ƈ. Superior ulnar recurrent

Ɖ. Superficial radial circumflex

Ɗ. Impaired hydroxylation of proline

Ƌ. Failure of cleavage in procollagen

Ƌ. Defective binding sites for hydroxyproline

ƍ. Failure to incorporate glycine into the helix

Ǝ. Diminished production of collagen through the rough endoplasmic reticulum

Ə. Asking the legal staff to seek a court injunction

Ɛ. Copying the patient’s chart and giving it to him as he leaves

Ƒ. Having the patient sign a written legal contract that specifies acceptable behavior

Ƒ. Continuing care of the patient until an appropriate referral can be arranged

Ɠ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ɣ. Meta-analysis

Ƕ. Confidence interval

Ɩ. Analysis of variance (ANOVA)

Ɨ. Statistical significance (p-value)

Ƙ. Survivorship analysis (Kaplan-Meier)

Ƙ. Spinal shock

Ƚ. Neurogenic shock

ƛ. Hypovolemic shock

Ɯ. Pulmonary embolism

Ɲ. Fat embolus syndrome

Ƞ. Lumbar spinal stenosis

Ɵ. Metastatic disease of the spine

Ơ. Rheumatoid lumbar spondylitis

Ơ. Isthmic spondyloloisthesis

Ƣ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƣ. Patella alta

Ƥ. A metal-backed patella

Ƥ. Varus malalignment of the knee

Ʀ. A posterior cruciate-substituting femoral component

Ƨ. Lateral subluxation of the patella on a Merchant’s view

Ƨ. The sesamoids are separated

Ʃ. The sesamoid is fractured

ƪ. The proximal phx is on the neck of the metatarsal

ƫ. The dislocation is dorsal and centered

Ƭ. The proximal phalanx is hyperextended

Ƭ. Patella

Ʈ. Tibial stem

Ư. Distal femoral interface

Ư. Posterior femoral interface

Ʊ. Sites of screw fixation for the tibia

Ʋ. Hallux rigidus

Ƴ. Fracture of the sesamoid

Ƴ. Disruption of the plantar plate

Ƶ. Osteonecrosis of the metatarsal head

Ƶ. Rupture of the flexor hallucis longus

Ʒ. Gout

Ƹ. Sepsis

Ƹ. Old trauma

ƺ. Rheumatoid arthritis

ƻ. Charcot arthroplasty

Ƽ. Aspiration and steroid injection

Ƽ. Biopsy, curettage, and allograft bone grafting

ƾ. Percutaneous Kirschner wire fixation

Ƿ. Percutaneous injection of autogenous bone marrow

ǀ. Nerve roots

ǁ. Spinal cord

ǂ. Sciatic nerve

ǃ. Peroneal nerve

Ǆ. Conus medullaris

Ǆ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ǆ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ǉ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ǉ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǉ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǌ. Early and late infection

Ǌ. Periprosthetic fracture of the femur

Ǌ. Failure of the patellofemoral and extensor mechanisms

Ǎ. Aseptic loosening of cementing tibial components

Ǎ. Asceptic loosening of cemented femoral components

Ǐ. Acceptance of the current position of the ankle

Ǐ. Open reduction and fixation in the epiphysis only

Ǒ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǒ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǔ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǔ. Resection arthroplasty and local radiation

Ǖ. In situ fusion of the hip

Ǖ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǘ. Excision of heterotopic bone and local radiation

Ǘ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǚ. Closed reduction of both fractures and immediate spica casting

Ǚ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǜ. External fixation of both femora

Ǜ. External fixation of the left femur and a long leg cast brace for the right femur

Ǝ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǟ. Synovial sarcoma

Ǟ. Soft-tissue abcess

Ǡ. Rhabdomyosarcoma

Ǡ. Eosinophilic granuloma

Ǣ. Nodular pigmented villonodular synovitis

Ǣ. Changing to a titanium nail

Ǥ. Changing to a nonslotted nail

Ǥ. Changing the cross-sectional shape of the nail

Ǧ. Increasing the diameter of the nail by 3 mm

Ǧ. Increasing the diameter of the interlocking screws

Ǩ. Fracture healing

Ǩ. Chondrosarcoma

Ǫ. Periosteal chondroma

Ǫ. Periosteal osteosarcoma

Ǭ. Dysplasia epiphysealis hemimelica

Ǭ. Demonstrate competence in the subject of the case

Ǯ. Be fellowship trained in the subject of the case

Ǯ. Be paid on a contingency basis

J̌. Be board certified by the American Board of Orthopaedic Surgery

Ǳ. Have been involved in the case as a consultant

Ǳ. Diagnostic arthroscopy

Ǳ. Arthroscopy and subacromial decompression

Ǵ. Reduction and fixation of the proximal humeral epiphysis

Ǵ. Temporary cessation of throwing

Ƕ. Physical therapy for rotator cuff strengthening

Ƿ. Oblique popliteal ligament

Ǹ. Lateral capsule

Ǹ. Popliteal tendon

Ǻ. Fibular collateral ligament

Ǻ. Posterior oblique ligament

Ǽ. Radial tear

Ǽ. Parrot-beak tear

Ǿ. Vertical tear in the “red-red” zone

Ǿ. Vertical tear in the “red-white” zone

Ȁ. Vertical tear in the “white-white” zone

Ȁ. 0 degrees of abduction, with neural rotation

Ȃ. 40 degrees of flexion and 60 degrees of internal rotation

Ȃ. 45 degrees of flexion and 45 degrees of external rotation

Ȅ. 90 degrees of abduction with neutral rotation

Ȅ. 90 degrees of abduction and 90 degrees of external rotation

Ȇ. Sural

Ȇ. Saphenous and its branches

Ȉ. Posterior tibial and its branches

Ȉ. Deep peroneal and its branches

Ȋ. Superficial peroneal and its branches

Ȋ. Strength

Ȍ. Stiffness

Ȍ. Shelf life

Ȏ. Antigenicity

Ȏ. Risk of HIV transmission

Ȑ. Indemnification

Ȑ. Occurrence

Ȓ. Excess liability

Ȓ. Claims-made

Ȕ. Nose

Ȕ. Lateral Y

Ȗ. Scapular AP

Ȗ. Neutral rotation AP

Ș. Internal rotation AP

Ș. External rotation AP

Ț. Trauma

Ț. Hemophilia

Ȝ. Reiter’s syndrome

Ȝ. Rheumatoid arthritis

Ȟ. Systemic lupus erythematosus

Ȟ. Cast immobilization for 6 weeks

Ƞ. Activity modification and re-evaluation in 2 months

ȡ. Internal fixation with or without bone grafting

Ȣ. Retrograde drilling of the defect without articular cartilage penetration

Ȣ. Drilling of the defect directly through the articular cartilage

Ȥ. repair or reconstruction of the medial collateral ligament

Ȥ. repair or reconstruction of the medialand lateral collateral ligaments

Ȧ. immobilization for 5 days or less

Ȧ. immobilization for 14 days

Ȩ. immobilization for 25 days

Ȩ. Cystinosis

Ȫ. Hypophosphatemia

Ȫ. Renal osteodystrophy

Ȭ. Primary hyperparathyroidism

Ȭ. Nutritional vitamin D deficiency

Ȯ. Lateral meniscus tear

Ȯ. Popliteus tenosynovitis

Ȱ. Iliotibial band friction syndrome

Ȱ. Peroneal nerve entrapment

Ȳ. Biceps tendinitis

Ȳ. Observation

ȴ. Removal of the prosthetic components

ȵ. Operative exploration and decompression of the peroneal nerve

ȶ. Nerve conduction velocity studies

ȷ. Loosening of the primary dressings and knee flexion to 30 degrees

ȸ. I

ȹ. II

Ⱥ. III

Ȼ. decreased tissue tension

Ȼ. decreased abductor lever arm

Ƚ. decreased joint reaction force

Ⱦ. increased body weight over lever arm

Ȿ. increased polyethylene wear rate

Ɀ. recurrent traumatic anterior dislocation

Ɂ. recurrent traumatic posterior dislocation

Ɂ. traumatic subluxation with no previous dislocation

Ƀ. traumatic anterior subluxation

Ʉ. atraumatic involuntary subluxation

Ʌ. radial

Ɇ. axillary

Ɇ. suprascapular

Ɉ. thoracodorsal

Ɉ. long thoracic

Ɋ. Flexion

Ɋ. Extension

Ɍ. Axial rotation

Ɍ. Left lateral bending

Ɏ. Right lateral bending

Ɏ. Skin

Ɐ. Lung

Ɑ. Brain

Ɒ. Heart

Ɓ. Kidney

Ɔ. Thoracoacromial, lateral thoracic, subscapular

ɕ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɖ. Posterior humeral circumflex, subscapular, thoracacromial

Ɗ. Subscapular, thoracacromial, anterior humeral circumflex

ɘ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ə. Respondeat superior

ɚ. Indemnity agreement

Ɛ. Hold harmless agreement- attempt to shift liability from company to physician

Ɜ. Comparative negligence-% of involvement

ɝ. Contributory negligence- resident contributed to the negligence

ɞ. t-type

ɟ. both column

Ɠ. transverse

Ɡ. anterior column

ɢ. anterior column posterior hemitransverse

Ɣ. Posterior interosseous

ɤ. Anterior interosseous

Ɥ. Radial

Ɦ. Median

ɧ. Ulnar

Ɨ. Shock from hypovolemia

Ɩ. Associated rupture of the bladder

Ɪ. Arterial bleeding on pelvic angiogram

Ɫ. Presence of a hematoma in the perineum and scrotum

Ɬ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Varus stress

Explanation

Question 4155

Topic: 10. Pathology and Oncology

-
Figures 27a through 27c show the radiographs of the femur of a 46-year-old man who has a fracture of the right humerus, multiple rib fractures, and fractures of the right femur as a result of a motor vehicle accident. There is a 10-cm clean wound over the anteromedial thigh that communicates with the femoral shaft fracture. The

neurovascular examination of the right leg is normal. After meticulous irrigation and debridement, management of the femoral fractures should consist of

. Primary internal fixation at both fracture levels

. External fixation as definitive ttt for both #

. Skeletal traction and delayed internal fixation of both fractures

. Primary internal fixation of the proximal fracture and delayed fixation of the femoral fracture

. Primary internal fixation of the femoral shaft fracture and delayed fixation of the proximal #

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

!. Bed rest in a hyperextension brace

". L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

#. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

$. Positive-pressure ventilation

%. An immediate radiograph of the chest

&. Adjustment of the position of the endotrachael tube

'. Insertion of a large-bore needle into the pericardial space

(. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

). Allowing the ends of the fracture to touch

*. Adding a second connecting bar

+. Adding one pin to each fracture fragment

,. Increasing the pin diameter from 4 mm to 6 mm

-. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

.. Osteomyelitis

/. Malignant degeneration

0. Stress fracture

1. Local recurrence of the giant cell tumor

2. Bone resorption due to methylmethacrylate

3. Advancement of the plantar plate

4. Resection of the second metatarsal head

5. Dorsiflexion osteotomy of the second metatarsal neck

6. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

7. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

8. Sacral fracture

9. Burst fracture of L5

:. Cauda equina syndrome

;. Distraction-flexion injury at L3

<. Distraction-extension injury at L3

=. An MRI scan of the shoulder

>. An MRI scan of the cervical spine

?. Electromyographic and nerve conduction velocity studies

@. Immobilization in a sling and early passive range of motion exercises

A. Immediate return to the operating room for exploration of the brachial plexus

B. cerclage wiring

C. tension band wiring

D. removal of the patellar component

E. revision of the patellar component

F. immobilization of the knee and protected weightbearing

G. Liposarcoma

H. Nodular fasciitis

I. Rabdomyosarcoma

J. Malignant fibrous histiocytoma

K. Extra-abdominal desmoid tumor

L. Clubfeet

M. Thrombocytopenia

N. Congenital scoliosis

O. Ventricular septal defect

P. Arnold-Chiari malformation

Q. delayed primary closure

R. free flap

S. pedicle groin flap

T. full-thickness skin graft

U. split-thickness skin graft

V. Infection

W. Nonunion

X. Improper screw length

Y. Osteonecrosis of the distal fragment

Z. Use of a cortical screw instead of a cancellous screw

[. Infection

\. Tear of the rotator cuff

]. Loosening of the humeral component

^. Arthritis of the glenoid

_. Arthritis of the A-C joint

`. Reduced morbidity

A. Improved osteoinduction

B. Improved osteoconduction

C. More rapid revascularization

D. Lower risk of disease transmission

E. Manipulation Under Anesthesia

F. Arthroscopic acromioplasty

G. Arthroscopic debridement of G-H joint

H. Replacement of the humeral head

I. Lengthening of the subscapularis and release of the anterior capsule

J. Bacteroides

K. E. coli

L. Staph. aureus

M. group A streptococcus

N. Clostridium perforingens

O. observation and exercises

P. bracing with a thoracolumbar orthosis

Q. fusion of the posterior spine

R. fusion of the anterior spine

S. fusion of the anterior and posterior spine

T. Total wrist replacement and bridge grafts

U. palmar shelf arthroplasty and tendon transfers

V. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

W. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

X. Total wrist fusion and tendon transfers

Y. constrained acetabular component

Z. protrusion ring with morselized graft

{. cemented metal backed acetabular component

|. cemented all-polyethylene acetabular component

}. cementless hemispherical component with screw fixation

~. application of a hip abduction brace for 22 hours per day

. application of a hip spica under anesthesia

. discontinuance of all bracing and repeat radiographs in 3 months

. open reduction of the hip and application of a spica cast

. open reduction, varus osteotomy, and application of a spica cast

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

¡. stiffness of the femoral component.

¢. head offset of the femoral component.

£. femoral component material modulus of elasticity.

¤. extent of the femoral component porous coating.

¥. Presence of a femoral component collar.

¦. plantar fascia and quadratus plantae tendon.

§. ligamentous structures connecting the tarsal bones.

¨. shape of the tarsal bones and the intervening joints.

ª. activity of the posterior tibialis and the peroneus longus muscles.

«. scapulothoracic fusion

¬. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

®. pectoralis major-fascia lata graft transfer to the scapula

¯. exploration of the long thoracic nerve, with sural nerve graft

°. tricompartmental knee replacement

±. unicompartmental knee replacement

². medial compartment meniscal allograft

³. valgus-producing distal femoral osteotomy

´. valgus-producing proximal tibial osteotomy

Μ. Internal rotation of the femoral component

¶. External rotation of the tibial component

·. Lateral placement of the femoral component

¸. Medial placement of the patellar component

¹. Excessive resection of the patella

º. Hallux rigidus

». Hallux valgus

¼. Neuroma of the first web space

½. Fracture of the sesamoid

¾. Rupture of the flexor hallucis longus

¿. Sickle cell crisis

À. Idiopathic chondrolysis

Á. Hemophilic arthropathy

Â. Osteoid osteoma of the femoral neck

Ã. Legg-Calve-Perthes disease

Ä. Decreased ankle jerk and positive femoral nerve stretch test

Å. Decreased knee jerk and positive straight-leg raising sign

Æ. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Ç. Weakness of the extensor hallucis longus and positive straight-leg raising sign

È. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

É. Long-term administration of IV and oral antibiotics

Ê. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Ë. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ì. Two-stage surgical prosthetic exchange and IV antibiotics

Í. Resection arthroplasty and IV antibiotics

Î. SCFE

Ï. MED

Ð. Perthes disease

Ñ. Hypothyroidism

Ò. Chondrolysis

Ó. gout.

Ô. osteoporosis.

Õ. eosinophilic granuloma.

Ö. tuberculosis of the spine.

×. metastatic disease of the spine.

Ø. water content.

Ù. Synthesis of type I collagen.

Ú. Proteoglycan content.

Û. Activity of chondrocytes.

Ü. Synthesis of hyaluronate.

Ý. Lung

Þ. Breast

SS. Prostate

À. Thyroid

Á. Renal

Â. T1-low, T2-low.

Ã. T1-low, T2-high.

Ä. T1-moderate, T2-low.

Å. T1-high, T2-low.

Æ. T1-high, T2-high.

Ç. hypothesis is incorrect or invalid

È. interobserver error rate is 4%.

É. Standard deviation is 4% higher or lower than the mean.

Ê. Sample size is 4% larger than required to be clinically significant.

Ë. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ì. I

Í. II

Î. IV

Ï. IX

Ð. X

Ñ. Cranial setting

Ò. Cranial subluxation

Ó. Odontoid fracture

Ô. Lysis of the arch of the atlas

Õ. Atlantoaxial subluxation

Ö. Retrograde collapse of the endoneurial tubes

÷. Irreversible atrophy of the denervated muscles

Ø. Elongation of the axons across the zone of injury

Ù. Sprouting of the axons at the neuromuscular junction

Ú. Misdirection of the axons across the zone of injury

Û. Maximally pronated and elbow extended

Ü. Maximally pronated and the elbow flexed

Ý. Maximally supinated and the elbow flexed

Þ. Maximally supinated and the elbow extended

Ÿ. In neutral rotation, with the elbow extended

Ā. open reduction and internal fixation

Ā. buddy taping to the adjacent index finger

Ă. early motion with application of a dynamic banjo splint

Ă. application of a cast with the hand in a “safe position” for 3 weeks.

Ą. dorsal extension block splinting

Ą. The name of the manufacturer

Ć. The manufacturer’s potential liability

Ć. The physician’s clinical performance

Ĉ. The physician’s materials testing data

Ĉ. Any royalties the physician receives from the manufacturer

Ċ. Femoral

Ċ. Obturator

Č. Inferior gluteal

Č. Superior gluteal

Ď. Lateral femoral cutaneous

Ď. open biopsy and a long leg cast

Đ. open biopsy and wide resection of the tumor

Đ. a long leg cast and observation

Ē. intramedullary stabilization and observation

Ē. Triggering

Ĕ. Lateral instability

Ĕ. Swan-neck deformity

Ė. Boutonniere deformity

Ė. Loss of distal interphalangeal joint flexion

Ę. Peroneus brevis to peroneus longus

Ę. Peroneus tertius to extensor hallucis longus

Ě. Peroneus tertius to superficial peroneal nerve

Ě. Extensor hallucis longus to deep peroneal nerve

Ĝ. Extensor hallucis longus to extensor digitorum longus

Ĝ. reassurance that Medicare will pay for the treatment.

Ğ. consent forms that patients or their guardians are able to understand.

Ğ. a detailed description of the device, omitting the fact that it is part of a study.

Ġ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ġ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ģ. an onlay iliac crest bone graft.

Ģ. limited weightbearing and observation.

Ĥ. removal of the implant and limited weightbearing.

Ĥ. removal of the implant and insertion of a reamed femoral nail.

Ħ. removal of the implant and insertion of an unreamed femoral nail.

Ħ. Coronal

Ĩ. Sagittal

Ĩ. Anteromedial, midway between the sagittal and the coronal

Ī. Proximal pins sagittal, distal pins coronal

Ī. Proximal pins coronal, distal pins sagittal

Ĭ. Rheumatoid arthritis

Ĭ. Posttraumatic arthritis

Į. Degenerative osteoarthritis

Į. Osteonecrosis of the tibial plateau

İ. Osteonecrosis of the medial femoral condyle

I. Trapeziometacarpal arthrodesis

Ĳ. Osteotomy of the thumb metacarpal

Ĳ. Arthrotomy and joint debridement

Ĵ. Ligament reconstruction using one half of the flexor carpi radialis

Ĵ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ķ. Creep

Ķ. Relaxation

ĸ. Energy dissipation

Ĺ. Plastic deformation

Ĺ. Elastic deformation

Ļ. bending

Ļ. axial loading

Ľ. high-speed rotation

Ľ. direct impact from anteromedial

Ŀ. crush from anteromedial to posterolateral

Ŀ. Increase stiffness

Ł. Increase fracture toughness

Ł. Increase fatigue strength

Ń. Decrease mechanical strength

Ń. Decrease wear rate

Ņ. disuse osteopenia

Ņ. paraendocrine effect of the tumor

Ň. abnormally increased density on the right side

Ň. side effect of the treatment of the lesion

ʼN. extensive tumor involvement of the left hip

Ŋ. Sciatic nerve

Ŋ. Superior gluteal artery

Ō. Profunda femoris artery

Ō. Femoral artery and nerve

Ŏ. External iliac artery and vein

Ŏ. Length

Ő. Moment arm

Ő. Total volume

Œ. Physiologic cross-sectional area

Œ. Distribution of slow and fast twitch fibers

Ŕ. decreasing initiation of action potentials.

Ŕ. increasing action potential amplitude.

Ŗ. blocking the opening of gated sodium channels.

Ŗ. decreasing the number of functional motor units.

Ř. slowing or stopping action potential propagation through the axon.

Ř. resection of the metatarsal heads of the first through fifth toes.

Ś. Silastic MP joint arthroplasties of the first through fifth toes.

Ś. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ŝ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ŝ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ş. hemiarthroplasty

Ş. open reduction and internal fixation

Š. closed reduction and percutaneous pinning

Š. a sling and early pedulum exercises

Ţ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ţ. open acromioplasty

Ť. open Bankart repair

Ť. open subscapularis tendon repair

Ŧ. inferior capsular shift

Ŧ. a supervised physical therapy program

Ũ. a sling and swathe, with pendulum exercises in 10 days

Ũ. open reduction and internal fixation through an anterior approach

Ū. open reduction and internal fixation through a posterior approach

Ū. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ŭ. arthroscopically assisted reduction and percutaneous screw fixation

Ŭ. Repair of the rotator cuff

Ů. Replacement of the humeral head

Ů. Resection arthroplasty

Ű. Total shoulder arthroplasty

Ű. AP and lateral radiographs of the elbow

Ų. Diagnositc arthroscopy

Ų. Aspiration of joint fluid

Ŵ. An erythrocyte sedimentation rate and CBC

Ŵ. A diagnostic lidocaine injection

Ŷ. Insulin-like growth factor (IGF-1)

Ŷ. Fibroblast growth factor (FGF-1)

Ÿ. Platelet-derived growth factor (PDGF)

Ź. Transforming growth factor beta (TGF-B)

Ź. Bone morphogenetic proteins (BMP)

Ż. clinical history and radiographic findings.

Ż. technetium bone scan

Ž. flow cytometry pattern of extracted chondrocytes

Ž. immunohistochemical staining patterns of a biopsy specimen

S. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ƀ. Radial

Ɓ. Radial recurrent

Ƃ. Posterior interosseous

Ƃ. Superior ulnar recurrent

Ƅ. Superficial radial circumflex

Ƅ. Impaired hydroxylation of proline

Ɔ. Failure of cleavage in procollagen

Ƈ. Defective binding sites for hydroxyproline

Ƈ. Failure to incorporate glycine into the helix

Ɖ. Diminished production of collagen through the rough endoplasmic reticulum

Ɗ. Asking the legal staff to seek a court injunction

Ƌ. Copying the patient’s chart and giving it to him as he leaves

Ƌ. Having the patient sign a written legal contract that specifies acceptable behavior

ƍ. Continuing care of the patient until an appropriate referral can be arranged

Ǝ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ə. Meta-analysis

Ɛ. Confidence interval

Ƒ. Analysis of variance (ANOVA)

Ƒ. Statistical significance (p-value)

Ɠ. Survivorship analysis (Kaplan-Meier)

Ɣ. Spinal shock

Ƕ. Neurogenic shock

Ɩ. Hypovolemic shock

Ɨ. Pulmonary embolism

Ƙ. Fat embolus syndrome

Ƙ. Lumbar spinal stenosis

Ƚ. Metastatic disease of the spine

ƛ. Rheumatoid lumbar spondylitis

Ɯ. Isthmic spondyloloisthesis

Ɲ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƞ. Patella alta

Ɵ. A metal-backed patella

Ơ. Varus malalignment of the knee

Ơ. A posterior cruciate-substituting femoral component

Ƣ. Lateral subluxation of the patella on a Merchant’s view

Ƣ. The sesamoids are separated

Ƥ. The sesamoid is fractured

Ƥ. The proximal phx is on the neck of the metatarsal

Ʀ. The dislocation is dorsal and centered

Ƨ. The proximal phalanx is hyperextended

Ƨ. Patella

Ʃ. Tibial stem

ƪ. Distal femoral interface

ƫ. Posterior femoral interface

Ƭ. Sites of screw fixation for the tibia

Ƭ. Hallux rigidus

Ʈ. Fracture of the sesamoid

Ư. Disruption of the plantar plate

Ư. Osteonecrosis of the metatarsal head

Ʊ. Rupture of the flexor hallucis longus

Ʋ. Gout

Ƴ. Sepsis

Ƴ. Old trauma

Ƶ. Rheumatoid arthritis

Ƶ. Charcot arthroplasty

Ʒ. Aspiration and steroid injection

Ƹ. Biopsy, curettage, and allograft bone grafting

Ƹ. Percutaneous Kirschner wire fixation

ƺ. Percutaneous injection of autogenous bone marrow

ƻ. Nerve roots

Ƽ. Spinal cord

Ƽ. Sciatic nerve

ƾ. Peroneal nerve

Ƿ. Conus medullaris

ǀ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

ǁ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

ǂ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

ǃ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ǆ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ǆ. Early and late infection

Ǆ. Periprosthetic fracture of the femur

Ǉ. Failure of the patellofemoral and extensor mechanisms

Ǉ. Aseptic loosening of cementing tibial components

Ǉ. Asceptic loosening of cemented femoral components

Ǌ. Acceptance of the current position of the ankle

Ǌ. Open reduction and fixation in the epiphysis only

Ǌ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǎ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǎ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǐ. Resection arthroplasty and local radiation

Ǐ. In situ fusion of the hip

Ǒ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǒ. Excision of heterotopic bone and local radiation

Ǔ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǔ. Closed reduction of both fractures and immediate spica casting

Ǖ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǖ. External fixation of both femora

Ǘ. External fixation of the left femur and a long leg cast brace for the right femur

Ǘ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǚ. Synovial sarcoma

Ǚ. Soft-tissue abcess

Ǜ. Rhabdomyosarcoma

Ǜ. Eosinophilic granuloma

Ǝ. Nodular pigmented villonodular synovitis

Ǟ. Changing to a titanium nail

Ǟ. Changing to a nonslotted nail

Ǡ. Changing the cross-sectional shape of the nail

Ǡ. Increasing the diameter of the nail by 3 mm

Ǣ. Increasing the diameter of the interlocking screws

Ǣ. Fracture healing

Ǥ. Chondrosarcoma

Ǥ. Periosteal chondroma

Ǧ. Periosteal osteosarcoma

Ǧ. Dysplasia epiphysealis hemimelica

Ǩ. Demonstrate competence in the subject of the case

Ǩ. Be fellowship trained in the subject of the case

Ǫ. Be paid on a contingency basis

Ǫ. Be board certified by the American Board of Orthopaedic Surgery

Ǭ. Have been involved in the case as a consultant

Ǭ. Diagnostic arthroscopy

Ǯ. Arthroscopy and subacromial decompression

Ǯ. Reduction and fixation of the proximal humeral epiphysis

J̌. Temporary cessation of throwing

Ǳ. Physical therapy for rotator cuff strengthening

Ǳ. Oblique popliteal ligament

Ǳ. Lateral capsule

Ǵ. Popliteal tendon

Ǵ. Fibular collateral ligament

Ƕ. Posterior oblique ligament

Ƿ. Radial tear

Ǹ. Parrot-beak tear

Ǹ. Vertical tear in the “red-red” zone

Ǻ. Vertical tear in the “red-white” zone

Ǻ. Vertical tear in the “white-white” zone

Ǽ. 0 degrees of abduction, with neural rotation

Ǽ. 40 degrees of flexion and 60 degrees of internal rotation

Ǿ. 45 degrees of flexion and 45 degrees of external rotation

Ǿ. 90 degrees of abduction with neutral rotation

Ȁ. 90 degrees of abduction and 90 degrees of external rotation

Ȁ. Sural

Ȃ. Saphenous and its branches

Ȃ. Posterior tibial and its branches

Ȅ. Deep peroneal and its branches

Ȅ. Superficial peroneal and its branches

Ȇ. Strength

Ȇ. Stiffness

Ȉ. Shelf life

Ȉ. Antigenicity

Ȋ. Risk of HIV transmission

Ȋ. Indemnification

Ȍ. Occurrence

Ȍ. Excess liability

Ȏ. Claims-made

Ȏ. Nose

Ȑ. Lateral Y

Ȑ. Scapular AP

Ȓ. Neutral rotation AP

Ȓ. Internal rotation AP

Ȕ. External rotation AP

Ȕ. Trauma

Ȗ. Hemophilia

Ȗ. Reiter’s syndrome

Ș. Rheumatoid arthritis

Ș. Systemic lupus erythematosus

Ț. Cast immobilization for 6 weeks

Ț. Activity modification and re-evaluation in 2 months

Ȝ. Internal fixation with or without bone grafting

Ȝ. Retrograde drilling of the defect without articular cartilage penetration

Ȟ. Drilling of the defect directly through the articular cartilage

Ȟ. repair or reconstruction of the medial collateral ligament

Ƞ. repair or reconstruction of the medialand lateral collateral ligaments

ȡ. immobilization for 5 days or less

Ȣ. immobilization for 14 days

Ȣ. immobilization for 25 days

Ȥ. Cystinosis

Ȥ. Hypophosphatemia

Ȧ. Renal osteodystrophy

Ȧ. Primary hyperparathyroidism

Ȩ. Nutritional vitamin D deficiency

Ȩ. Lateral meniscus tear

Ȫ. Popliteus tenosynovitis

Ȫ. Iliotibial band friction syndrome

Ȭ. Peroneal nerve entrapment

Ȭ. Biceps tendinitis

Ȯ. Observation

Ȯ. Removal of the prosthetic components

Ȱ. Operative exploration and decompression of the peroneal nerve

Ȱ. Nerve conduction velocity studies

Ȳ. Loosening of the primary dressings and knee flexion to 30 degrees

Ȳ. I

ȴ. II

ȵ. III

ȶ. decreased tissue tension

ȷ. decreased abductor lever arm

ȸ. decreased joint reaction force

ȹ. increased body weight over lever arm

Ⱥ. increased polyethylene wear rate

Ȼ. recurrent traumatic anterior dislocation

Ȼ. recurrent traumatic posterior dislocation

Ƚ. traumatic subluxation with no previous dislocation

Ⱦ. traumatic anterior subluxation

Ȿ. atraumatic involuntary subluxation

Ɀ. radial

Ɂ. axillary

Ɂ. suprascapular

Ƀ. thoracodorsal

Ʉ. long thoracic

Ʌ. Flexion

Ɇ. Extension

Ɇ. Axial rotation

Ɉ. Left lateral bending

Ɉ. Right lateral bending

Ɋ. Skin

Ɋ. Lung

Ɍ. Brain

Ɍ. Heart

Ɏ. Kidney

Ɏ. Thoracoacromial, lateral thoracic, subscapular

Ɐ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɑ. Posterior humeral circumflex, subscapular, thoracacromial

Ɒ. Subscapular, thoracacromial, anterior humeral circumflex

Ɓ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɔ. Respondeat superior

ɕ. Indemnity agreement

Ɖ. Hold harmless agreement- attempt to shift liability from company to physician

Ɗ. Comparative negligence-% of involvement

ɘ. Contributory negligence- resident contributed to the negligence

Ə. t-type

ɚ. both column

Ɛ. transverse

Ɜ. anterior column

ɝ. anterior column posterior hemitransverse

ɞ. Posterior interosseous

ɟ. Anterior interosseous

Ɠ. Radial

Ɡ. Median

ɢ. Ulnar

Ɣ. Shock from hypovolemia

ɤ. Associated rupture of the bladder

Ɥ. Arterial bleeding on pelvic angiogram

Ɦ. Presence of a hematoma in the perineum and scrotum

ɧ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Primary internal fixation at both fracture levels

Explanation

Question 4156

Topic: 10. Pathology and Oncology

A high school distance runner reports a 3-week history of heel pain while running. Examination elicits no pain with dorsiflexion or with palpitation of the plantar fascia; however, pain is evident with palpitation over the muscular origin of the abductor hallucis. What is the most likely etiology of the pain?

. Heel spur

. Plantar fascitis

. Dysfunction of the tibialis posterior tendon

. Compression of the first branch of the lateral plantar nerve

. Compression of the calcaneal nerve

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

. Bed rest in a hyperextension brace

. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

. Positive-pressure ventilation

. An immediate radiograph of the chest

!. Adjustment of the position of the endotrachael tube

". Insertion of a large-bore needle into the pericardial space

#. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

$. Allowing the ends of the fracture to touch

%. Adding a second connecting bar

&. Adding one pin to each fracture fragment

'. Increasing the pin diameter from 4 mm to 6 mm

(. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

). Osteomyelitis

*. Malignant degeneration

+. Stress fracture

,. Local recurrence of the giant cell tumor

-. Bone resorption due to methylmethacrylate

.. Advancement of the plantar plate

/. Resection of the second metatarsal head

0. Dorsiflexion osteotomy of the second metatarsal neck

1. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

2. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

3. Sacral fracture

4. Burst fracture of L5

5. Cauda equina syndrome

6. Distraction-flexion injury at L3

7. Distraction-extension injury at L3

8. An MRI scan of the shoulder

9. An MRI scan of the cervical spine

:. Electromyographic and nerve conduction velocity studies

;. Immobilization in a sling and early passive range of motion exercises

<. Immediate return to the operating room for exploration of the brachial plexus

=. cerclage wiring

>. tension band wiring

?. removal of the patellar component

@. revision of the patellar component

A. immobilization of the knee and protected weightbearing

B. Liposarcoma

C. Nodular fasciitis

D. Rabdomyosarcoma

E. Malignant fibrous histiocytoma

F. Extra-abdominal desmoid tumor

G. Clubfeet

H. Thrombocytopenia

I. Congenital scoliosis

J. Ventricular septal defect

K. Arnold-Chiari malformation

L. delayed primary closure

M. free flap

N. pedicle groin flap

O. full-thickness skin graft

P. split-thickness skin graft

Q. Infection

R. Nonunion

S. Improper screw length

T. Osteonecrosis of the distal fragment

U. Use of a cortical screw instead of a cancellous screw

V. Infection

W. Tear of the rotator cuff

X. Loosening of the humeral component

Y. Arthritis of the glenoid

Z. Arthritis of the A-C joint

[. Reduced morbidity

\. Improved osteoinduction

]. Improved osteoconduction

^. More rapid revascularization

_. Lower risk of disease transmission

`. Manipulation Under Anesthesia

A. Arthroscopic acromioplasty

B. Arthroscopic debridement of G-H joint

C. Replacement of the humeral head

D. Lengthening of the subscapularis and release of the anterior capsule

E. Bacteroides

F. E. coli

G. Staph. aureus

H. group A streptococcus

I. Clostridium perforingens

J. observation and exercises

K. bracing with a thoracolumbar orthosis

L. fusion of the posterior spine

M. fusion of the anterior spine

N. fusion of the anterior and posterior spine

O. Total wrist replacement and bridge grafts

P. palmar shelf arthroplasty and tendon transfers

Q. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

R. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

S. Total wrist fusion and tendon transfers

T. constrained acetabular component

U. protrusion ring with morselized graft

V. cemented metal backed acetabular component

W. cemented all-polyethylene acetabular component

X. cementless hemispherical component with screw fixation

Y. application of a hip abduction brace for 22 hours per day

Z. application of a hip spica under anesthesia

{. discontinuance of all bracing and repeat radiographs in 3 months

|. open reduction of the hip and application of a spica cast

}. open reduction, varus osteotomy, and application of a spica cast

~. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

. Pain that is worse when the patient walks uphill rather downhill

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

¡. plantar fascia and quadratus plantae tendon.

¢. ligamentous structures connecting the tarsal bones.

£. shape of the tarsal bones and the intervening joints.

¤. activity of the intrinsic muscles of the foot.

¥. activity of the posterior tibialis and the peroneus longus muscles.

¦. scapulothoracic fusion

§. strengthening of the periscapular muscles

¨. pectoralis minor-fascia lata graft transfer to the scapula

ª. exploration of the long thoracic nerve, with sural nerve graft

«. tricompartmental knee replacement

¬. unicompartmental knee replacement

. medial compartment meniscal allograft

®. valgus-producing distal femoral osteotomy

¯. valgus-producing proximal tibial osteotomy

°. Internal rotation of the femoral component

±. External rotation of the tibial component

². Lateral placement of the femoral component

³. Medial placement of the patellar component

´. Excessive resection of the patella

Μ. Hallux rigidus

¶. Hallux valgus

·. Neuroma of the first web space

¸. Fracture of the sesamoid

¹. Rupture of the flexor hallucis longus

º. Sickle cell crisis

». Idiopathic chondrolysis

¼. Hemophilic arthropathy

½. Osteoid osteoma of the femoral neck

¾. Legg-Calve-Perthes disease

¿. Decreased ankle jerk and positive femoral nerve stretch test

À. Decreased knee jerk and positive straight-leg raising sign

Á. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Â. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Ã. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Ä. Long-term administration of IV and oral antibiotics

Å. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Æ. Immediate exchange arthroplasty with antibiotic-impregnated cement

Ç. Two-stage surgical prosthetic exchange and IV antibiotics

È. Resection arthroplasty and IV antibiotics

É. SCFE

Ê. MED

Ë. Perthes disease

Ì. Hypothyroidism

Í. Chondrolysis

Î. gout.

Ï. osteoporosis.

Ð. eosinophilic granuloma.

Ñ. tuberculosis of the spine.

Ò. metastatic disease of the spine.

Ó. water content.

Ô. Synthesis of type I collagen.

Õ. Proteoglycan content.

Ö. Activity of chondrocytes.

×. Synthesis of hyaluronate.

Ø. Lung

Ù. Breast

Ú. Prostate

Û. Thyroid

Ü. Renal

Ý. T1-low, T2-low.

Þ. T1-low, T2-high.

SS. T1-moderate, T2-low.

À. T1-high, T2-low.

Á. T1-high, T2-high.

Â. hypothesis is incorrect or invalid

Ã. interobserver error rate is 4%.

Ä. Standard deviation is 4% higher or lower than the mean.

Å. Sample size is 4% larger than required to be clinically significant.

Æ. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ç. I

È. II

É. IV

Ê. IX

Ë. X

Ì. Cranial setting

Í. Cranial subluxation

Î. Odontoid fracture

Ï. Lysis of the arch of the atlas

Ð. Atlantoaxial subluxation

Ñ. Retrograde collapse of the endoneurial tubes

Ò. Irreversible atrophy of the denervated muscles

Ó. Elongation of the axons across the zone of injury

Ô. Sprouting of the axons at the neuromuscular junction

Õ. Misdirection of the axons across the zone of injury

Ö. Maximally pronated and elbow extended

÷. Maximally pronated and the elbow flexed

Ø. Maximally supinated and the elbow flexed

Ù. Maximally supinated and the elbow extended

Ú. In neutral rotation, with the elbow extended

Û. open reduction and internal fixation

Ü. buddy taping to the adjacent index finger

Ý. early motion with application of a dynamic banjo splint

Þ. application of a cast with the hand in a “safe position” for 3 weeks.

Ÿ. dorsal extension block splinting

Ā. The name of the manufacturer

Ā. The manufacturer’s potential liability

Ă. The physician’s clinical performance

Ă. The physician’s materials testing data

Ą. Any royalties the physician receives from the manufacturer

Ą. Femoral

Ć. Obturator

Ć. Inferior gluteal

Ĉ. Superior gluteal

Ĉ. Lateral femoral cutaneous

Ċ. open biopsy and a long leg cast

Ċ. open biopsy and wide resection of the tumor

Č. a long leg cast and observation

Č. intramedullary stabilization and observation

Ď. Triggering

Ď. Lateral instability

Đ. Swan-neck deformity

Đ. Boutonniere deformity

Ē. Loss of distal interphalangeal joint flexion

Ē. Peroneus brevis to peroneus longus

Ĕ. Peroneus tertius to extensor hallucis longus

Ĕ. Peroneus tertius to superficial peroneal nerve

Ė. Extensor hallucis longus to deep peroneal nerve

Ė. Extensor hallucis longus to extensor digitorum longus

Ę. reassurance that Medicare will pay for the treatment.

Ę. consent forms that patients or their guardians are able to understand.

Ě. a detailed description of the device, omitting the fact that it is part of a study.

Ě. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ĝ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ĝ. an onlay iliac crest bone graft.

Ğ. limited weightbearing and observation.

Ğ. removal of the implant and limited weightbearing.

Ġ. removal of the implant and insertion of a reamed femoral nail.

Ġ. removal of the implant and insertion of an unreamed femoral nail.

Ģ. Coronal

Ģ. Sagittal

Ĥ. Anteromedial, midway between the sagittal and the coronal

Ĥ. Proximal pins sagittal, distal pins coronal

Ħ. Proximal pins coronal, distal pins sagittal

Ħ. Rheumatoid arthritis

Ĩ. Posttraumatic arthritis

Ĩ. Degenerative osteoarthritis

Ī. Osteonecrosis of the tibial plateau

Ī. Osteonecrosis of the medial femoral condyle

Ĭ. Trapeziometacarpal arthrodesis

Ĭ. Osteotomy of the thumb metacarpal

Į. Arthrotomy and joint debridement

Į. Ligament reconstruction using one half of the flexor carpi radialis

İ. Trapezium resection, tendon interposition, and reconstruction of the ligament

I. Creep

Ĳ. Relaxation

Ĳ. Energy dissipation

Ĵ. Plastic deformation

Ĵ. Elastic deformation

Ķ. bending

Ķ. axial loading

ĸ. high-speed rotation

Ĺ. direct impact from anteromedial

Ĺ. crush from anteromedial to posterolateral

Ļ. Increase stiffness

Ļ. Increase fracture toughness

Ľ. Increase fatigue strength

Ľ. Decrease mechanical strength

Ŀ. Decrease wear rate

Ŀ. disuse osteopenia

Ł. paraendocrine effect of the tumor

Ł. abnormally increased density on the right side

Ń. side effect of the treatment of the lesion

Ń. extensive tumor involvement of the left hip

Ņ. Sciatic nerve

Ņ. Superior gluteal artery

Ň. Profunda femoris artery

Ň. Femoral artery and nerve

ʼN. External iliac artery and vein

Ŋ. Length

Ŋ. Moment arm

Ō. Total volume

Ō. Physiologic cross-sectional area

Ŏ. Distribution of slow and fast twitch fibers

Ŏ. decreasing initiation of action potentials.

Ő. increasing action potential amplitude.

Ő. blocking the opening of gated sodium channels.

Œ. decreasing the number of functional motor units.

Œ. slowing or stopping action potential propagation through the axon.

Ŕ. resection of the metatarsal heads of the first through fifth toes.

Ŕ. Silastic MP joint arthroplasties of the first through fifth toes.

Ŗ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ŗ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ř. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ř. hemiarthroplasty

Ś. open reduction and internal fixation

Ś. closed reduction and percutaneous pinning

Ŝ. a sling and early pedulum exercises

Ŝ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ş. open acromioplasty

Ş. open Bankart repair

Š. open subscapularis tendon repair

Š. inferior capsular shift

Ţ. a supervised physical therapy program

Ţ. a sling and swathe, with pendulum exercises in 10 days

Ť. open reduction and internal fixation through an anterior approach

Ť. open reduction and internal fixation through a posterior approach

Ŧ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ŧ. arthroscopically assisted reduction and percutaneous screw fixation

Ũ. Repair of the rotator cuff

Ũ. Replacement of the humeral head

Ū. Resection arthroplasty

Ū. Total shoulder arthroplasty

Ŭ. AP and lateral radiographs of the elbow

Ŭ. Diagnositc arthroscopy

Ů. Aspiration of joint fluid

Ů. An erythrocyte sedimentation rate and CBC

Ű. A diagnostic lidocaine injection

Ű. Insulin-like growth factor (IGF-1)

Ų. Fibroblast growth factor (FGF-1)

Ų. Platelet-derived growth factor (PDGF)

Ŵ. Transforming growth factor beta (TGF-B)

Ŵ. Bone morphogenetic proteins (BMP)

Ŷ. clinical history and radiographic findings.

Ŷ. technetium bone scan

Ÿ. flow cytometry pattern of extracted chondrocytes

Ź. immunohistochemical staining patterns of a biopsy specimen

Ź. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ż. Radial

Ż. Radial recurrent

Ž. Posterior interosseous

Ž. Superior ulnar recurrent

S. Superficial radial circumflex

Ƀ. Impaired hydroxylation of proline

Ɓ. Failure of cleavage in procollagen

Ƃ. Defective binding sites for hydroxyproline

Ƃ. Failure to incorporate glycine into the helix

Ƅ. Diminished production of collagen through the rough endoplasmic reticulum

Ƅ. Asking the legal staff to seek a court injunction

Ɔ. Copying the patient’s chart and giving it to him as he leaves

Ƈ. Having the patient sign a written legal contract that specifies acceptable behavior

Ƈ. Continuing care of the patient until an appropriate referral can be arranged

Ɖ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ɗ. Meta-analysis

Ƌ. Confidence interval

Ƌ. Analysis of variance (ANOVA)

ƍ. Statistical significance (p-value)

Ǝ. Survivorship analysis (Kaplan-Meier)

Ə. Spinal shock

Ɛ. Neurogenic shock

Ƒ. Hypovolemic shock

Ƒ. Pulmonary embolism

Ɠ. Fat embolus syndrome

Ɣ. Lumbar spinal stenosis

Ƕ. Metastatic disease of the spine

Ɩ. Rheumatoid lumbar spondylitis

Ɨ. Isthmic spondyloloisthesis

Ƙ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƙ. Patella alta

Ƚ. A metal-backed patella

ƛ. Varus malalignment of the knee

Ɯ. A posterior cruciate-substituting femoral component

Ɲ. Lateral subluxation of the patella on a Merchant’s view

Ƞ. The sesamoids are separated

Ɵ. The sesamoid is fractured

Ơ. The proximal phx is on the neck of the metatarsal

Ơ. The dislocation is dorsal and centered

Ƣ. The proximal phalanx is hyperextended

Ƣ. Patella

Ƥ. Tibial stem

Ƥ. Distal femoral interface

Ʀ. Posterior femoral interface

Ƨ. Sites of screw fixation for the tibia

Ƨ. Hallux rigidus

Ʃ. Fracture of the sesamoid

ƪ. Disruption of the plantar plate

ƫ. Osteonecrosis of the metatarsal head

Ƭ. Rupture of the flexor hallucis longus

Ƭ. Gout

Ʈ. Sepsis

Ư. Old trauma

Ư. Rheumatoid arthritis

Ʊ. Charcot arthroplasty

Ʋ. Aspiration and steroid injection

Ƴ. Biopsy, curettage, and allograft bone grafting

Ƴ. Percutaneous Kirschner wire fixation

Ƶ. Percutaneous injection of autogenous bone marrow

Ƶ. Nerve roots

Ʒ. Spinal cord

Ƹ. Sciatic nerve

Ƹ. Peroneal nerve

ƺ. Conus medullaris

ƻ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ƽ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ƽ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

ƾ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ƿ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

ǀ. Early and late infection

ǁ. Periprosthetic fracture of the femur

ǂ. Failure of the patellofemoral and extensor mechanisms

ǃ. Aseptic loosening of cementing tibial components

Ǆ. Asceptic loosening of cemented femoral components

Ǆ. Acceptance of the current position of the ankle

Ǆ. Open reduction and fixation in the epiphysis only

Ǉ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ǉ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǉ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǌ. Resection arthroplasty and local radiation

Ǌ. In situ fusion of the hip

Ǌ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǎ. Excision of heterotopic bone and local radiation

Ǎ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǐ. Closed reduction of both fractures and immediate spica casting

Ǐ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǒ. External fixation of both femora

Ǒ. External fixation of the left femur and a long leg cast brace for the right femur

Ǔ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǔ. Synovial sarcoma

Ǖ. Soft-tissue abcess

Ǖ. Rhabdomyosarcoma

Ǘ. Eosinophilic granuloma

Ǘ. Nodular pigmented villonodular synovitis

Ǚ. Changing to a titanium nail

Ǚ. Changing to a nonslotted nail

Ǜ. Changing the cross-sectional shape of the nail

Ǜ. Increasing the diameter of the nail by 3 mm

Ǝ. Increasing the diameter of the interlocking screws

Ǟ. Fracture healing

Ǟ. Chondrosarcoma

Ǡ. Periosteal chondroma

Ǡ. Periosteal osteosarcoma

Ǣ. Dysplasia epiphysealis hemimelica

Ǣ. Demonstrate competence in the subject of the case

Ǥ. Be fellowship trained in the subject of the case

Ǥ. Be paid on a contingency basis

Ǧ. Be board certified by the American Board of Orthopaedic Surgery

Ǧ. Have been involved in the case as a consultant

Ǩ. Diagnostic arthroscopy

Ǩ. Arthroscopy and subacromial decompression

Ǫ. Reduction and fixation of the proximal humeral epiphysis

Ǫ. Temporary cessation of throwing

Ǭ. Physical therapy for rotator cuff strengthening

Ǭ. Oblique popliteal ligament

Ǯ. Lateral capsule

Ǯ. Popliteal tendon

J̌. Fibular collateral ligament

Ǳ. Posterior oblique ligament

Ǳ. Radial tear

Ǳ. Parrot-beak tear

Ǵ. Vertical tear in the “red-red” zone

Ǵ. Vertical tear in the “red-white” zone

Ƕ. Vertical tear in the “white-white” zone

Ƿ. 0 degrees of abduction, with neural rotation

Ǹ. 40 degrees of flexion and 60 degrees of internal rotation

Ǹ. 45 degrees of flexion and 45 degrees of external rotation

Ǻ. 90 degrees of abduction with neutral rotation

Ǻ. 90 degrees of abduction and 90 degrees of external rotation

Ǽ. Sural

Ǽ. Saphenous and its branches

Ǿ. Posterior tibial and its branches

Ǿ. Deep peroneal and its branches

Ȁ. Superficial peroneal and its branches

Ȁ. Strength

Ȃ. Stiffness

Ȃ. Shelf life

Ȅ. Antigenicity

Ȅ. Risk of HIV transmission

Ȇ. Indemnification

Ȇ. Occurrence

Ȉ. Excess liability

Ȉ. Claims-made

Ȋ. Nose

Ȋ. Lateral Y

Ȍ. Scapular AP

Ȍ. Neutral rotation AP

Ȏ. Internal rotation AP

Ȏ. External rotation AP

Ȑ. Trauma

Ȑ. Hemophilia

Ȓ. Reiter’s syndrome

Ȓ. Rheumatoid arthritis

Ȕ. Systemic lupus erythematosus

Ȕ. Cast immobilization for 6 weeks

Ȗ. Activity modification and re-evaluation in 2 months

Ȗ. Internal fixation with or without bone grafting

Ș. Retrograde drilling of the defect without articular cartilage penetration

Ș. Drilling of the defect directly through the articular cartilage

Ț. repair or reconstruction of the medial collateral ligament

Ț. repair or reconstruction of the medialand lateral collateral ligaments

Ȝ. immobilization for 5 days or less

Ȝ. immobilization for 14 days

Ȟ. immobilization for 25 days

Ȟ. Cystinosis

Ƞ. Hypophosphatemia

ȡ. Renal osteodystrophy

Ȣ. Primary hyperparathyroidism

Ȣ. Nutritional vitamin D deficiency

Ȥ. Lateral meniscus tear

Ȥ. Popliteus tenosynovitis

Ȧ. Iliotibial band friction syndrome

Ȧ. Peroneal nerve entrapment

Ȩ. Biceps tendinitis

Ȩ. Observation

Ȫ. Removal of the prosthetic components

Ȫ. Operative exploration and decompression of the peroneal nerve

Ȭ. Nerve conduction velocity studies

Ȭ. Loosening of the primary dressings and knee flexion to 30 degrees

Ȯ. I

Ȯ. II

Ȱ. III

Ȱ. decreased tissue tension

Ȳ. decreased abductor lever arm

Ȳ. decreased joint reaction force

ȴ. increased body weight over lever arm

ȵ. increased polyethylene wear rate

ȶ. recurrent traumatic anterior dislocation

ȷ. recurrent traumatic posterior dislocation

ȸ. traumatic subluxation with no previous dislocation

ȹ. traumatic anterior subluxation

Ⱥ. atraumatic involuntary subluxation

Ȼ. radial

Ȼ. axillary

Ƚ. suprascapular

Ⱦ. thoracodorsal

Ȿ. long thoracic

Ɀ. Flexion

Ɂ. Extension

Ɂ. Axial rotation

Ƀ. Left lateral bending

Ʉ. Right lateral bending

Ʌ. Skin

Ɇ. Lung

Ɇ. Brain

Ɉ. Heart

Ɉ. Kidney

Ɋ. Thoracoacromial, lateral thoracic, subscapular

Ɋ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɍ. Posterior humeral circumflex, subscapular, thoracacromial

Ɍ. Subscapular, thoracacromial, anterior humeral circumflex

Ɏ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɏ. Respondeat superior

Ɐ. Indemnity agreement

Ɑ. Hold harmless agreement- attempt to shift liability from company to physician

Ɒ. Comparative negligence-% of involvement

Ɓ. Contributory negligence- resident contributed to the negligence

Ɔ. t-type

ɕ. both column

Ɖ. transverse

Ɗ. anterior column

ɘ. anterior column posterior hemitransverse

Ə. Posterior interosseous

ɚ. Anterior interosseous

Ɛ. Radial

Ɜ. Median

ɝ. Ulnar

ɞ. Shock from hypovolemia

ɟ. Associated rupture of the bladder

Ɠ. Arterial bleeding on pelvic angiogram

Ɡ. Presence of a hematoma in the perineum and scrotum

ɢ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Heel spur

Explanation

Question 4157

Topic: 10. Pathology and Oncology

A 56-year-old laborer sustained a subcoracoid dislocation of the shoulder as a result of falling off a scaffold 3 weeks ago. He now is unable to actively raise his arm and has constant pain. What is the most likely diagnosis?

. Displaced labral tear

. Tear of the rotator cuff

. Fracture of the glenoid rim

. Palsy of the axillary nerve

. Palsy of the musculocutaneus nerve

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

. Bed rest in a hyperextension brace

. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

. Positive-pressure ventilation

. An immediate radiograph of the chest

. Adjustment of the position of the endotrachael tube

. Insertion of a large-bore needle into the pericardial space

. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

. Allowing the ends of the fracture to touch

. Adding a second connecting bar

!. Adding one pin to each fracture fragment

". Increasing the pin diameter from 4 mm to 6 mm

#. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

$. Osteomyelitis

%. Malignant degeneration

&. Stress fracture

'. Local recurrence of the giant cell tumor

(. Bone resorption due to methylmethacrylate

). Advancement of the plantar plate

*. Resection of the second metatarsal head

+. Dorsiflexion osteotomy of the second metatarsal neck

,. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

-. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

.. Sacral fracture

/. Burst fracture of L5

0. Cauda equina syndrome

1. Distraction-flexion injury at L3

2. Distraction-extension injury at L3

3. An MRI scan of the shoulder

4. An MRI scan of the cervical spine

5. Electromyographic and nerve conduction velocity studies

6. Immobilization in a sling and early passive range of motion exercises

7. Immediate return to the operating room for exploration of the brachial plexus

8. cerclage wiring

9. tension band wiring

:. removal of the patellar component

;. revision of the patellar component

<. immobilization of the knee and protected weightbearing

=. Liposarcoma

>. Nodular fasciitis

?. Rabdomyosarcoma

@. Malignant fibrous histiocytoma

A. Extra-abdominal desmoid tumor

B. Clubfeet

C. Thrombocytopenia

D. Congenital scoliosis

E. Ventricular septal defect

F. Arnold-Chiari malformation

G. delayed primary closure

H. free flap

I. pedicle groin flap

J. full-thickness skin graft

K. split-thickness skin graft

L. Infection

M. Nonunion

N. Improper screw length

O. Osteonecrosis of the distal fragment

P. Use of a cortical screw instead of a cancellous screw

Q. Infection

R. Tear of the rotator cuff

S. Loosening of the humeral component

T. Arthritis of the glenoid

U. Arthritis of the A-C joint

V. Reduced morbidity

W. Improved osteoinduction

X. Improved osteoconduction

Y. More rapid revascularization

Z. Lower risk of disease transmission

[. Manipulation Under Anesthesia

\. Arthroscopic acromioplasty

]. Arthroscopic debridement of G-H joint

^. Replacement of the humeral head

_. Lengthening of the subscapularis and release of the anterior capsule

`. Bacteroides

A. E. coli

B. Staph. aureus

C. group A streptococcus

D. Clostridium perforingens

E. observation and exercises

F. bracing with a thoracolumbar orthosis

G. fusion of the posterior spine

H. fusion of the anterior spine

I. fusion of the anterior and posterior spine

J. Total wrist replacement and bridge grafts

K. palmar shelf arthroplasty and tendon transfers

L. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

M. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

N. Total wrist fusion and tendon transfers

O. constrained acetabular component

P. protrusion ring with morselized graft

Q. cemented metal backed acetabular component

R. cemented all-polyethylene acetabular component

S. cementless hemispherical component with screw fixation

T. application of a hip abduction brace for 22 hours per day

U. application of a hip spica under anesthesia

V. discontinuance of all bracing and repeat radiographs in 3 months

W. open reduction of the hip and application of a spica cast

X. open reduction, varus osteotomy, and application of a spica cast

Y. Loss of skin hair on the feet

Z. Absent pulses on vascular examination

{. Pain that originates proximally and spreads distally

|. Pain that is relieved by stopping and standing

}. Pain that is worse when the patient walks uphill rather downhill

~. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

. activity of the posterior tibialis and the peroneus longus muscles.

¡. scapulothoracic fusion

¢. strengthening of the periscapular muscles

£. pectoralis minor-fascia lata graft transfer to the scapula

¤. pectoralis major-fascia lata graft transfer to the scapula

¥. exploration of the long thoracic nerve, with sural nerve graft

¦. tricompartmental knee replacement

§. unicompartmental knee replacement

¨. medial compartment meniscal allograft

ª. valgus-producing proximal tibial osteotomy

«. Internal rotation of the femoral component

¬. External rotation of the tibial component

. Lateral placement of the femoral component

®. Medial placement of the patellar component

¯. Excessive resection of the patella

°. Hallux rigidus

±. Hallux valgus

². Neuroma of the first web space

³. Fracture of the sesamoid

´. Rupture of the flexor hallucis longus

Μ. Sickle cell crisis

¶. Idiopathic chondrolysis

·. Hemophilic arthropathy

¸. Osteoid osteoma of the femoral neck

¹. Legg-Calve-Perthes disease

º. Decreased ankle jerk and positive femoral nerve stretch test

». Decreased knee jerk and positive straight-leg raising sign

¼. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

½. Weakness of the extensor hallucis longus and positive straight-leg raising sign

¾. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

¿. Long-term administration of IV and oral antibiotics

À. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

Á. Immediate exchange arthroplasty with antibiotic-impregnated cement

Â. Two-stage surgical prosthetic exchange and IV antibiotics

Ã. Resection arthroplasty and IV antibiotics

Ä. SCFE

Å. MED

Æ. Perthes disease

Ç. Hypothyroidism

È. Chondrolysis

É. gout.

Ê. osteoporosis.

Ë. eosinophilic granuloma.

Ì. tuberculosis of the spine.

Í. metastatic disease of the spine.

Î. water content.

Ï. Synthesis of type I collagen.

Ð. Proteoglycan content.

Ñ. Activity of chondrocytes.

Ò. Synthesis of hyaluronate.

Ó. Lung

Ô. Breast

Õ. Prostate

Ö. Thyroid

×. Renal

Ø. T1-low, T2-low.

Ù. T1-low, T2-high.

Ú. T1-moderate, T2-low.

Û. T1-high, T2-low.

Ü. T1-high, T2-high.

Ý. hypothesis is incorrect or invalid

Þ. interobserver error rate is 4%.

SS. Standard deviation is 4% higher or lower than the mean.

À. Sample size is 4% larger than required to be clinically significant.

Á. Probability that the differences noted between two study groups were due to chance alone is 4%.

Â. I

Ã. II

Ä. IV

Å. IX

Æ. X

Ç. Cranial setting

È. Cranial subluxation

É. Odontoid fracture

Ê. Lysis of the arch of the atlas

Ë. Atlantoaxial subluxation

Ì. Retrograde collapse of the endoneurial tubes

Í. Irreversible atrophy of the denervated muscles

Î. Elongation of the axons across the zone of injury

Ï. Sprouting of the axons at the neuromuscular junction

Ð. Misdirection of the axons across the zone of injury

Ñ. Maximally pronated and elbow extended

Ò. Maximally pronated and the elbow flexed

Ó. Maximally supinated and the elbow flexed

Ô. Maximally supinated and the elbow extended

Õ. In neutral rotation, with the elbow extended

Ö. open reduction and internal fixation

÷. buddy taping to the adjacent index finger

Ø. early motion with application of a dynamic banjo splint

Ù. application of a cast with the hand in a “safe position” for 3 weeks.

Ú. dorsal extension block splinting

Û. The name of the manufacturer

Ü. The manufacturer’s potential liability

Ý. The physician’s clinical performance

Þ. The physician’s materials testing data

Ÿ. Any royalties the physician receives from the manufacturer

Ā. Femoral

Ā. Obturator

Ă. Inferior gluteal

Ă. Superior gluteal

Ą. Lateral femoral cutaneous

Ą. open biopsy and a long leg cast

Ć. open biopsy and wide resection of the tumor

Ć. a long leg cast and observation

Ĉ. intramedullary stabilization and observation

Ĉ. Triggering

Ċ. Lateral instability

Ċ. Swan-neck deformity

Č. Boutonniere deformity

Č. Loss of distal interphalangeal joint flexion

Ď. Peroneus brevis to peroneus longus

Ď. Peroneus tertius to extensor hallucis longus

Đ. Peroneus tertius to superficial peroneal nerve

Đ. Extensor hallucis longus to deep peroneal nerve

Ē. Extensor hallucis longus to extensor digitorum longus

Ē. reassurance that Medicare will pay for the treatment.

Ĕ. consent forms that patients or their guardians are able to understand.

Ĕ. a detailed description of the device, omitting the fact that it is part of a study.

Ė. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ė. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ę. an onlay iliac crest bone graft.

Ę. limited weightbearing and observation.

Ě. removal of the implant and limited weightbearing.

Ě. removal of the implant and insertion of a reamed femoral nail.

Ĝ. removal of the implant and insertion of an unreamed femoral nail.

Ĝ. Coronal

Ğ. Sagittal

Ğ. Anteromedial, midway between the sagittal and the coronal

Ġ. Proximal pins sagittal, distal pins coronal

Ġ. Proximal pins coronal, distal pins sagittal

Ģ. Rheumatoid arthritis

Ģ. Posttraumatic arthritis

Ĥ. Degenerative osteoarthritis

Ĥ. Osteonecrosis of the tibial plateau

Ħ. Osteonecrosis of the medial femoral condyle

Ħ. Trapeziometacarpal arthrodesis

Ĩ. Osteotomy of the thumb metacarpal

Ĩ. Arthrotomy and joint debridement

Ī. Ligament reconstruction using one half of the flexor carpi radialis

Ī. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ĭ. Creep

Ĭ. Relaxation

Į. Energy dissipation

Į. Plastic deformation

İ. Elastic deformation

I. bending

Ĳ. axial loading

Ĳ. high-speed rotation

Ĵ. direct impact from anteromedial

Ĵ. crush from anteromedial to posterolateral

Ķ. Increase stiffness

Ķ. Increase fracture toughness

ĸ. Increase fatigue strength

Ĺ. Decrease mechanical strength

Ĺ. Decrease wear rate

Ļ. disuse osteopenia

Ļ. paraendocrine effect of the tumor

Ľ. abnormally increased density on the right side

Ľ. side effect of the treatment of the lesion

Ŀ. extensive tumor involvement of the left hip

Ŀ. Sciatic nerve

Ł. Superior gluteal artery

Ł. Profunda femoris artery

Ń. Femoral artery and nerve

Ń. External iliac artery and vein

Ņ. Length

Ņ. Moment arm

Ň. Total volume

Ň. Physiologic cross-sectional area

ʼN. Distribution of slow and fast twitch fibers

Ŋ. decreasing initiation of action potentials.

Ŋ. increasing action potential amplitude.

Ō. blocking the opening of gated sodium channels.

Ō. decreasing the number of functional motor units.

Ŏ. slowing or stopping action potential propagation through the axon.

Ŏ. resection of the metatarsal heads of the first through fifth toes.

Ő. Silastic MP joint arthroplasties of the first through fifth toes.

Ő. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Œ. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Œ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ŕ. hemiarthroplasty

Ŕ. open reduction and internal fixation

Ŗ. closed reduction and percutaneous pinning

Ŗ. a sling and early pedulum exercises

Ř. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ř. open acromioplasty

Ś. open Bankart repair

Ś. open subscapularis tendon repair

Ŝ. inferior capsular shift

Ŝ. a supervised physical therapy program

Ş. a sling and swathe, with pendulum exercises in 10 days

Ş. open reduction and internal fixation through an anterior approach

Š. open reduction and internal fixation through a posterior approach

Š. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ţ. arthroscopically assisted reduction and percutaneous screw fixation

Ţ. Repair of the rotator cuff

Ť. Replacement of the humeral head

Ť. Resection arthroplasty

Ŧ. Total shoulder arthroplasty

Ŧ. AP and lateral radiographs of the elbow

Ũ. Diagnositc arthroscopy

Ũ. Aspiration of joint fluid

Ū. An erythrocyte sedimentation rate and CBC

Ū. A diagnostic lidocaine injection

Ŭ. Insulin-like growth factor (IGF-1)

Ŭ. Fibroblast growth factor (FGF-1)

Ů. Platelet-derived growth factor (PDGF)

Ů. Transforming growth factor beta (TGF-B)

Ű. Bone morphogenetic proteins (BMP)

Ű. clinical history and radiographic findings.

Ų. technetium bone scan

Ų. flow cytometry pattern of extracted chondrocytes

Ŵ. immunohistochemical staining patterns of a biopsy specimen

Ŵ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ŷ. Radial

Ŷ. Radial recurrent

Ÿ. Posterior interosseous

Ź. Superior ulnar recurrent

Ź. Superficial radial circumflex

Ż. Impaired hydroxylation of proline

Ż. Failure of cleavage in procollagen

Ž. Defective binding sites for hydroxyproline

Ž. Failure to incorporate glycine into the helix

S. Diminished production of collagen through the rough endoplasmic reticulum

Ƀ. Asking the legal staff to seek a court injunction

Ɓ. Copying the patient’s chart and giving it to him as he leaves

Ƃ. Having the patient sign a written legal contract that specifies acceptable behavior

Ƃ. Continuing care of the patient until an appropriate referral can be arranged

Ƅ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƅ. Meta-analysis

Ɔ. Confidence interval

Ƈ. Analysis of variance (ANOVA)

Ƈ. Statistical significance (p-value)

Ɖ. Survivorship analysis (Kaplan-Meier)

Ɗ. Spinal shock

Ƌ. Neurogenic shock

Ƌ. Hypovolemic shock

ƍ. Pulmonary embolism

Ǝ. Fat embolus syndrome

Ə. Lumbar spinal stenosis

Ɛ. Metastatic disease of the spine

Ƒ. Rheumatoid lumbar spondylitis

Ƒ. Isthmic spondyloloisthesis

Ɠ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ɣ. Patella alta

Ƕ. A metal-backed patella

Ɩ. Varus malalignment of the knee

Ɨ. A posterior cruciate-substituting femoral component

Ƙ. Lateral subluxation of the patella on a Merchant’s view

Ƙ. The sesamoids are separated

Ƚ. The sesamoid is fractured

ƛ. The proximal phx is on the neck of the metatarsal

Ɯ. The dislocation is dorsal and centered

Ɲ. The proximal phalanx is hyperextended

Ƞ. Patella

Ɵ. Tibial stem

Ơ. Distal femoral interface

Ơ. Posterior femoral interface

Ƣ. Sites of screw fixation for the tibia

Ƣ. Hallux rigidus

Ƥ. Fracture of the sesamoid

Ƥ. Disruption of the plantar plate

Ʀ. Osteonecrosis of the metatarsal head

Ƨ. Rupture of the flexor hallucis longus

Ƨ. Gout

Ʃ. Sepsis

ƪ. Old trauma

ƫ. Rheumatoid arthritis

Ƭ. Charcot arthroplasty

Ƭ. Aspiration and steroid injection

Ʈ. Biopsy, curettage, and allograft bone grafting

Ư. Percutaneous Kirschner wire fixation

Ư. Percutaneous injection of autogenous bone marrow

Ʊ. Nerve roots

Ʋ. Spinal cord

Ƴ. Sciatic nerve

Ƴ. Peroneal nerve

Ƶ. Conus medullaris

Ƶ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ʒ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ƹ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ƹ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

ƺ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

ƻ. Early and late infection

Ƽ. Periprosthetic fracture of the femur

Ƽ. Failure of the patellofemoral and extensor mechanisms

ƾ. Aseptic loosening of cementing tibial components

Ƿ. Asceptic loosening of cemented femoral components

ǀ. Acceptance of the current position of the ankle

ǁ. Open reduction and fixation in the epiphysis only

ǂ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

ǃ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ǆ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ǆ. Resection arthroplasty and local radiation

Ǆ. In situ fusion of the hip

Ǉ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ǉ. Excision of heterotopic bone and local radiation

Ǉ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǌ. Closed reduction of both fractures and immediate spica casting

Ǌ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǌ. External fixation of both femora

Ǎ. External fixation of the left femur and a long leg cast brace for the right femur

Ǎ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǐ. Synovial sarcoma

Ǐ. Soft-tissue abcess

Ǒ. Rhabdomyosarcoma

Ǒ. Eosinophilic granuloma

Ǔ. Nodular pigmented villonodular synovitis

Ǔ. Changing to a titanium nail

Ǖ. Changing to a nonslotted nail

Ǖ. Changing the cross-sectional shape of the nail

Ǘ. Increasing the diameter of the nail by 3 mm

Ǘ. Increasing the diameter of the interlocking screws

Ǚ. Fracture healing

Ǚ. Chondrosarcoma

Ǜ. Periosteal chondroma

Ǜ. Periosteal osteosarcoma

Ǝ. Dysplasia epiphysealis hemimelica

Ǟ. Demonstrate competence in the subject of the case

Ǟ. Be fellowship trained in the subject of the case

Ǡ. Be paid on a contingency basis

Ǡ. Be board certified by the American Board of Orthopaedic Surgery

Ǣ. Have been involved in the case as a consultant

Ǣ. Diagnostic arthroscopy

Ǥ. Arthroscopy and subacromial decompression

Ǥ. Reduction and fixation of the proximal humeral epiphysis

Ǧ. Temporary cessation of throwing

Ǧ. Physical therapy for rotator cuff strengthening

Ǩ. Oblique popliteal ligament

Ǩ. Lateral capsule

Ǫ. Popliteal tendon

Ǫ. Fibular collateral ligament

Ǭ. Posterior oblique ligament

Ǭ. Radial tear

Ǯ. Parrot-beak tear

Ǯ. Vertical tear in the “red-red” zone

J̌. Vertical tear in the “red-white” zone

Ǳ. Vertical tear in the “white-white” zone

Ǳ. 0 degrees of abduction, with neural rotation

Ǳ. 40 degrees of flexion and 60 degrees of internal rotation

Ǵ. 45 degrees of flexion and 45 degrees of external rotation

Ǵ. 90 degrees of abduction with neutral rotation

Ƕ. 90 degrees of abduction and 90 degrees of external rotation

Ƿ. Sural

Ǹ. Saphenous and its branches

Ǹ. Posterior tibial and its branches

Ǻ. Deep peroneal and its branches

Ǻ. Superficial peroneal and its branches

Ǽ. Strength

Ǽ. Stiffness

Ǿ. Shelf life

Ǿ. Antigenicity

Ȁ. Risk of HIV transmission

Ȁ. Indemnification

Ȃ. Occurrence

Ȃ. Excess liability

Ȅ. Claims-made

Ȅ. Nose

Ȇ. Lateral Y

Ȇ. Scapular AP

Ȉ. Neutral rotation AP

Ȉ. Internal rotation AP

Ȋ. External rotation AP

Ȋ. Trauma

Ȍ. Hemophilia

Ȍ. Reiter’s syndrome

Ȏ. Rheumatoid arthritis

Ȏ. Systemic lupus erythematosus

Ȑ. Cast immobilization for 6 weeks

Ȑ. Activity modification and re-evaluation in 2 months

Ȓ. Internal fixation with or without bone grafting

Ȓ. Retrograde drilling of the defect without articular cartilage penetration

Ȕ. Drilling of the defect directly through the articular cartilage

Ȕ. repair or reconstruction of the medial collateral ligament

Ȗ. repair or reconstruction of the medialand lateral collateral ligaments

Ȗ. immobilization for 5 days or less

Ș. immobilization for 14 days

Ș. immobilization for 25 days

Ț. Cystinosis

Ț. Hypophosphatemia

Ȝ. Renal osteodystrophy

Ȝ. Primary hyperparathyroidism

Ȟ. Nutritional vitamin D deficiency

Ȟ. Lateral meniscus tear

Ƞ. Popliteus tenosynovitis

ȡ. Iliotibial band friction syndrome

Ȣ. Peroneal nerve entrapment

Ȣ. Biceps tendinitis

Ȥ. Observation

Ȥ. Removal of the prosthetic components

Ȧ. Operative exploration and decompression of the peroneal nerve

Ȧ. Nerve conduction velocity studies

Ȩ. Loosening of the primary dressings and knee flexion to 30 degrees

Ȩ. I

Ȫ. II

Ȫ. III

Ȭ. decreased tissue tension

Ȭ. decreased abductor lever arm

Ȯ. decreased joint reaction force

Ȯ. increased body weight over lever arm

Ȱ. increased polyethylene wear rate

Ȱ. recurrent traumatic anterior dislocation

Ȳ. recurrent traumatic posterior dislocation

Ȳ. traumatic subluxation with no previous dislocation

ȴ. traumatic anterior subluxation

ȵ. atraumatic involuntary subluxation

ȶ. radial

ȷ. axillary

ȸ. suprascapular

ȹ. thoracodorsal

Ⱥ. long thoracic

Ȼ. Flexion

Ȼ. Extension

Ƚ. Axial rotation

Ⱦ. Left lateral bending

Ȿ. Right lateral bending

Ɀ. Skin

Ɂ. Lung

Ɂ. Brain

Ƀ. Heart

Ʉ. Kidney

Ʌ. Thoracoacromial, lateral thoracic, subscapular

Ɇ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɇ. Posterior humeral circumflex, subscapular, thoracacromial

Ɉ. Subscapular, thoracacromial, anterior humeral circumflex

Ɉ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɋ. Respondeat superior

Ɋ. Indemnity agreement

Ɍ. Hold harmless agreement- attempt to shift liability from company to physician

Ɍ. Comparative negligence-% of involvement

Ɏ. Contributory negligence- resident contributed to the negligence

Ɏ. t-type

Ɐ. both column

Ɑ. transverse

Ɒ. anterior column

Ɓ. anterior column posterior hemitransverse

Ɔ. Posterior interosseous

ɕ. Anterior interosseous

Ɖ. Radial

Ɗ. Median

ɘ. Ulnar

Ə. Shock from hypovolemia

ɚ. Associated rupture of the bladder

Ɛ. Arterial bleeding on pelvic angiogram

Ɜ. Presence of a hematoma in the perineum and scrotum

ɝ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Displaced labral tear

Explanation

Question 4158

Topic: 10. Pathology and Oncology

A 40-year-old woman has progressive pain and limited range of motion in her long finger. Figure 28a shows the radiograph, and Figure 28b shows a biopsy specimen of the same lesion. What is the most likely diagnosis?

. Enchondroma

. Osteoblastoma

. Giant cell tumor

. Aneurysmal bone cyst

. Fibrous dysplasia

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

. Bed rest in a hyperextension brace

. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

. Positive-pressure ventilation

. An immediate radiograph of the chest

. Adjustment of the position of the endotrachael tube

. Insertion of a large-bore needle into the pericardial space

. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

. Allowing the ends of the fracture to touch

. Adding a second connecting bar

. Adding one pin to each fracture fragment

. Increasing the pin diameter from 4 mm to 6 mm

. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

. Osteomyelitis

. Malignant degeneration

!. Stress fracture

". Local recurrence of the giant cell tumor

#. Bone resorption due to methylmethacrylate

$. Advancement of the plantar plate

%. Resection of the second metatarsal head

&. Dorsiflexion osteotomy of the second metatarsal neck

'. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

(. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

). Sacral fracture

*. Burst fracture of L5

+. Cauda equina syndrome

,. Distraction-flexion injury at L3

-. Distraction-extension injury at L3

.. An MRI scan of the shoulder

/. An MRI scan of the cervical spine

0. Electromyographic and nerve conduction velocity studies

1. Immobilization in a sling and early passive range of motion exercises

2. Immediate return to the operating room for exploration of the brachial plexus

3. cerclage wiring

4. tension band wiring

5. removal of the patellar component

6. revision of the patellar component

7. immobilization of the knee and protected weightbearing

8. Liposarcoma

9. Nodular fasciitis

:. Rabdomyosarcoma

;. Malignant fibrous histiocytoma

<. Extra-abdominal desmoid tumor

=. Clubfeet

>. Thrombocytopenia

?. Congenital scoliosis

@. Ventricular septal defect

A. Arnold-Chiari malformation

B. delayed primary closure

C. free flap

D. pedicle groin flap

E. full-thickness skin graft

F. split-thickness skin graft

G. Infection

H. Nonunion

I. Improper screw length

J. Osteonecrosis of the distal fragment

K. Use of a cortical screw instead of a cancellous screw

L. Infection

M. Tear of the rotator cuff

N. Loosening of the humeral component

O. Arthritis of the glenoid

P. Arthritis of the A-C joint

Q. Reduced morbidity

R. Improved osteoinduction

S. Improved osteoconduction

T. More rapid revascularization

U. Lower risk of disease transmission

V. Manipulation Under Anesthesia

W. Arthroscopic acromioplasty

X. Arthroscopic debridement of G-H joint

Y. Replacement of the humeral head

Z. Lengthening of the subscapularis and release of the anterior capsule

[. Bacteroides

\. E. coli

]. Staph. aureus

^. group A streptococcus

_. Clostridium perforingens

`. observation and exercises

A. bracing with a thoracolumbar orthosis

B. fusion of the posterior spine

C. fusion of the anterior spine

D. fusion of the anterior and posterior spine

E. Total wrist replacement and bridge grafts

F. palmar shelf arthroplasty and tendon transfers

G. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

H. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

I. Total wrist fusion and tendon transfers

J. constrained acetabular component

K. protrusion ring with morselized graft

L. cemented metal backed acetabular component

M. cemented all-polyethylene acetabular component

N. cementless hemispherical component with screw fixation

O. application of a hip abduction brace for 22 hours per day

P. application of a hip spica under anesthesia

Q. discontinuance of all bracing and repeat radiographs in 3 months

R. open reduction of the hip and application of a spica cast

S. open reduction, varus osteotomy, and application of a spica cast

T. Loss of skin hair on the feet

U. Absent pulses on vascular examination

V. Pain that originates proximally and spreads distally

W. Pain that is relieved by stopping and standing

X. Pain that is worse when the patient walks uphill rather downhill

Y. wrist flexors and finger flexors

Z. elbow flexors and wrist flexors

{. elbow flexors and finger flexors

|. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

}. elbow extensors and wrist extensors

~. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

. activity of the posterior tibialis and the peroneus longus muscles.

. scapulothoracic fusion

. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

. pectoralis major-fascia lata graft transfer to the scapula

. exploration of the long thoracic nerve, with sural nerve graft

¡. tricompartmental knee replacement

¢. unicompartmental knee replacement

£. medial compartment meniscal allograft

¤. valgus-producing distal femoral osteotomy

¥. valgus-producing proximal tibial osteotomy

¦. Internal rotation of the femoral component

§. External rotation of the tibial component

¨. Lateral placement of the femoral component

ª. Excessive resection of the patella

«. Hallux rigidus

¬. Hallux valgus

. Neuroma of the first web space

®. Fracture of the sesamoid

¯. Rupture of the flexor hallucis longus

°. Sickle cell crisis

±. Idiopathic chondrolysis

². Hemophilic arthropathy

³. Osteoid osteoma of the femoral neck

´. Legg-Calve-Perthes disease

Μ. Decreased ankle jerk and positive femoral nerve stretch test

¶. Decreased knee jerk and positive straight-leg raising sign

·. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

¸. Weakness of the extensor hallucis longus and positive straight-leg raising sign

¹. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

º. Long-term administration of IV and oral antibiotics

». Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

¼. Immediate exchange arthroplasty with antibiotic-impregnated cement

½. Two-stage surgical prosthetic exchange and IV antibiotics

¾. Resection arthroplasty and IV antibiotics

¿. SCFE

À. MED

Á. Perthes disease

Â. Hypothyroidism

Ã. Chondrolysis

Ä. gout.

Å. osteoporosis.

Æ. eosinophilic granuloma.

Ç. tuberculosis of the spine.

È. metastatic disease of the spine.

É. water content.

Ê. Synthesis of type I collagen.

Ë. Proteoglycan content.

Ì. Activity of chondrocytes.

Í. Synthesis of hyaluronate.

Î. Lung

Ï. Breast

Ð. Prostate

Ñ. Thyroid

Ò. Renal

Ó. T1-low, T2-low.

Ô. T1-low, T2-high.

Õ. T1-moderate, T2-low.

Ö. T1-high, T2-low.

×. T1-high, T2-high.

Ø. hypothesis is incorrect or invalid

Ù. interobserver error rate is 4%.

Ú. Standard deviation is 4% higher or lower than the mean.

Û. Sample size is 4% larger than required to be clinically significant.

Ü. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ý. I

Þ. II

SS. IV

À. IX

Á. X

Â. Cranial setting

Ã. Cranial subluxation

Ä. Odontoid fracture

Å. Lysis of the arch of the atlas

Æ. Atlantoaxial subluxation

Ç. Retrograde collapse of the endoneurial tubes

È. Irreversible atrophy of the denervated muscles

É. Elongation of the axons across the zone of injury

Ê. Sprouting of the axons at the neuromuscular junction

Ë. Misdirection of the axons across the zone of injury

Ì. Maximally pronated and elbow extended

Í. Maximally pronated and the elbow flexed

Î. Maximally supinated and the elbow flexed

Ï. Maximally supinated and the elbow extended

Ð. In neutral rotation, with the elbow extended

Ñ. open reduction and internal fixation

Ò. buddy taping to the adjacent index finger

Ó. early motion with application of a dynamic banjo splint

Ô. application of a cast with the hand in a “safe position” for 3 weeks.

Õ. dorsal extension block splinting

Ö. The name of the manufacturer

÷. The manufacturer’s potential liability

Ø. The physician’s clinical performance

Ù. The physician’s materials testing data

Ú. Any royalties the physician receives from the manufacturer

Û. Femoral

Ü. Obturator

Ý. Inferior gluteal

Þ. Superior gluteal

Ÿ. Lateral femoral cutaneous

Ā. open biopsy and a long leg cast

Ā. open biopsy and wide resection of the tumor

Ă. a long leg cast and observation

Ă. intramedullary stabilization and observation

Ą. Triggering

Ą. Lateral instability

Ć. Swan-neck deformity

Ć. Boutonniere deformity

Ĉ. Loss of distal interphalangeal joint flexion

Ĉ. Peroneus brevis to peroneus longus

Ċ. Peroneus tertius to extensor hallucis longus

Ċ. Peroneus tertius to superficial peroneal nerve

Č. Extensor hallucis longus to deep peroneal nerve

Č. Extensor hallucis longus to extensor digitorum longus

Ď. reassurance that Medicare will pay for the treatment.

Ď. consent forms that patients or their guardians are able to understand.

Đ. a detailed description of the device, omitting the fact that it is part of a study.

Đ. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ē. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ē. an onlay iliac crest bone graft.

Ĕ. limited weightbearing and observation.

Ĕ. removal of the implant and limited weightbearing.

Ė. removal of the implant and insertion of a reamed femoral nail.

Ė. removal of the implant and insertion of an unreamed femoral nail.

Ę. Coronal

Ę. Sagittal

Ě. Anteromedial, midway between the sagittal and the coronal

Ě. Proximal pins sagittal, distal pins coronal

Ĝ. Proximal pins coronal, distal pins sagittal

Ĝ. Rheumatoid arthritis

Ğ. Posttraumatic arthritis

Ğ. Degenerative osteoarthritis

Ġ. Osteonecrosis of the tibial plateau

Ġ. Osteonecrosis of the medial femoral condyle

Ģ. Trapeziometacarpal arthrodesis

Ģ. Osteotomy of the thumb metacarpal

Ĥ. Arthrotomy and joint debridement

Ĥ. Ligament reconstruction using one half of the flexor carpi radialis

Ħ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ħ. Creep

Ĩ. Relaxation

Ĩ. Energy dissipation

Ī. Plastic deformation

Ī. Elastic deformation

Ĭ. bending

Ĭ. axial loading

Į. high-speed rotation

Į. direct impact from anteromedial

İ. crush from anteromedial to posterolateral

I. Increase stiffness

Ĳ. Increase fracture toughness

Ĳ. Increase fatigue strength

Ĵ. Decrease mechanical strength

Ĵ. Decrease wear rate

Ķ. disuse osteopenia

Ķ. paraendocrine effect of the tumor

ĸ. abnormally increased density on the right side

Ĺ. side effect of the treatment of the lesion

Ĺ. extensive tumor involvement of the left hip

Ļ. Sciatic nerve

Ļ. Superior gluteal artery

Ľ. Profunda femoris artery

Ľ. Femoral artery and nerve

Ŀ. External iliac artery and vein

Ŀ. Length

Ł. Moment arm

Ł. Total volume

Ń. Physiologic cross-sectional area

Ń. Distribution of slow and fast twitch fibers

Ņ. decreasing initiation of action potentials.

Ņ. increasing action potential amplitude.

Ň. blocking the opening of gated sodium channels.

Ň. decreasing the number of functional motor units.

ʼN. slowing or stopping action potential propagation through the axon.

Ŋ. resection of the metatarsal heads of the first through fifth toes.

Ŋ. Silastic MP joint arthroplasties of the first through fifth toes.

Ō. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ō. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ŏ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ŏ. hemiarthroplasty

Ő. open reduction and internal fixation

Ő. closed reduction and percutaneous pinning

Œ. a sling and early pedulum exercises

Œ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ŕ. open acromioplasty

Ŕ. open Bankart repair

Ŗ. open subscapularis tendon repair

Ŗ. inferior capsular shift

Ř. a supervised physical therapy program

Ř. a sling and swathe, with pendulum exercises in 10 days

Ś. open reduction and internal fixation through an anterior approach

Ś. open reduction and internal fixation through a posterior approach

Ŝ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ŝ. arthroscopically assisted reduction and percutaneous screw fixation

Ş. Repair of the rotator cuff

Ş. Replacement of the humeral head

Š. Resection arthroplasty

Š. Total shoulder arthroplasty

Ţ. AP and lateral radiographs of the elbow

Ţ. Diagnositc arthroscopy

Ť. Aspiration of joint fluid

Ť. An erythrocyte sedimentation rate and CBC

Ŧ. A diagnostic lidocaine injection

Ŧ. Insulin-like growth factor (IGF-1)

Ũ. Fibroblast growth factor (FGF-1)

Ũ. Platelet-derived growth factor (PDGF)

Ū. Transforming growth factor beta (TGF-B)

Ū. Bone morphogenetic proteins (BMP)

Ŭ. clinical history and radiographic findings.

Ŭ. technetium bone scan

Ů. flow cytometry pattern of extracted chondrocytes

Ů. immunohistochemical staining patterns of a biopsy specimen

Ű. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ű. Radial

Ų. Radial recurrent

Ų. Posterior interosseous

Ŵ. Superior ulnar recurrent

Ŵ. Superficial radial circumflex

Ŷ. Impaired hydroxylation of proline

Ŷ. Failure of cleavage in procollagen

Ÿ. Defective binding sites for hydroxyproline

Ź. Failure to incorporate glycine into the helix

Ź. Diminished production of collagen through the rough endoplasmic reticulum

Ż. Asking the legal staff to seek a court injunction

Ż. Copying the patient’s chart and giving it to him as he leaves

Ž. Having the patient sign a written legal contract that specifies acceptable behavior

Ž. Continuing care of the patient until an appropriate referral can be arranged

S. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ƀ. Meta-analysis

Ɓ. Confidence interval

Ƃ. Analysis of variance (ANOVA)

Ƃ. Statistical significance (p-value)

Ƅ. Survivorship analysis (Kaplan-Meier)

Ƅ. Spinal shock

Ɔ. Neurogenic shock

Ƈ. Hypovolemic shock

Ƈ. Pulmonary embolism

Ɖ. Fat embolus syndrome

Ɗ. Lumbar spinal stenosis

Ƌ. Metastatic disease of the spine

Ƌ. Rheumatoid lumbar spondylitis

ƍ. Isthmic spondyloloisthesis

Ǝ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ə. Patella alta

Ɛ. A metal-backed patella

Ƒ. Varus malalignment of the knee

Ƒ. A posterior cruciate-substituting femoral component

Ɠ. Lateral subluxation of the patella on a Merchant’s view

Ɣ. The sesamoids are separated

Ƕ. The sesamoid is fractured

Ɩ. The proximal phx is on the neck of the metatarsal

Ɨ. The dislocation is dorsal and centered

Ƙ. The proximal phalanx is hyperextended

Ƙ. Patella

Ƚ. Tibial stem

ƛ. Distal femoral interface

Ɯ. Posterior femoral interface

Ɲ. Sites of screw fixation for the tibia

Ƞ. Hallux rigidus

Ɵ. Fracture of the sesamoid

Ơ. Disruption of the plantar plate

Ơ. Osteonecrosis of the metatarsal head

Ƣ. Rupture of the flexor hallucis longus

Ƣ. Gout

Ƥ. Sepsis

Ƥ. Old trauma

Ʀ. Rheumatoid arthritis

Ƨ. Charcot arthroplasty

Ƨ. Aspiration and steroid injection

Ʃ. Biopsy, curettage, and allograft bone grafting

ƪ. Percutaneous Kirschner wire fixation

ƫ. Percutaneous injection of autogenous bone marrow

Ƭ. Nerve roots

Ƭ. Spinal cord

Ʈ. Sciatic nerve

Ư. Peroneal nerve

Ư. Conus medullaris

Ʊ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ʋ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ƴ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ƴ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ƶ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ƶ. Early and late infection

Ʒ. Periprosthetic fracture of the femur

Ƹ. Failure of the patellofemoral and extensor mechanisms

Ƹ. Aseptic loosening of cementing tibial components

ƺ. Asceptic loosening of cemented femoral components

ƻ. Acceptance of the current position of the ankle

Ƽ. Open reduction and fixation in the epiphysis only

Ƽ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

ƾ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ƿ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

ǀ. Resection arthroplasty and local radiation

ǁ. In situ fusion of the hip

ǂ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

ǃ. Excision of heterotopic bone and local radiation

Ǆ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ǆ. Closed reduction of both fractures and immediate spica casting

Ǆ. Bilateral skin traction for 3 weeks, followed by spica casting

Ǉ. External fixation of both femora

Ǉ. External fixation of the left femur and a long leg cast brace for the right femur

Ǉ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǌ. Synovial sarcoma

Ǌ. Soft-tissue abcess

Ǌ. Rhabdomyosarcoma

Ǎ. Eosinophilic granuloma

Ǎ. Nodular pigmented villonodular synovitis

Ǐ. Changing to a titanium nail

Ǐ. Changing to a nonslotted nail

Ǒ. Changing the cross-sectional shape of the nail

Ǒ. Increasing the diameter of the nail by 3 mm

Ǔ. Increasing the diameter of the interlocking screws

Ǔ. Fracture healing

Ǖ. Chondrosarcoma

Ǖ. Periosteal chondroma

Ǘ. Periosteal osteosarcoma

Ǘ. Dysplasia epiphysealis hemimelica

Ǚ. Demonstrate competence in the subject of the case

Ǚ. Be fellowship trained in the subject of the case

Ǜ. Be paid on a contingency basis

Ǜ. Be board certified by the American Board of Orthopaedic Surgery

Ǝ. Have been involved in the case as a consultant

Ǟ. Diagnostic arthroscopy

Ǟ. Arthroscopy and subacromial decompression

Ǡ. Reduction and fixation of the proximal humeral epiphysis

Ǡ. Temporary cessation of throwing

Ǣ. Physical therapy for rotator cuff strengthening

Ǣ. Oblique popliteal ligament

Ǥ. Lateral capsule

Ǥ. Popliteal tendon

Ǧ. Fibular collateral ligament

Ǧ. Posterior oblique ligament

Ǩ. Radial tear

Ǩ. Parrot-beak tear

Ǫ. Vertical tear in the “red-red” zone

Ǫ. Vertical tear in the “red-white” zone

Ǭ. Vertical tear in the “white-white” zone

Ǭ. 0 degrees of abduction, with neural rotation

Ǯ. 40 degrees of flexion and 60 degrees of internal rotation

Ǯ. 45 degrees of flexion and 45 degrees of external rotation

J̌. 90 degrees of abduction with neutral rotation

Ǳ. 90 degrees of abduction and 90 degrees of external rotation

Ǳ. Sural

Ǳ. Saphenous and its branches

Ǵ. Posterior tibial and its branches

Ǵ. Deep peroneal and its branches

Ƕ. Superficial peroneal and its branches

Ƿ. Strength

Ǹ. Stiffness

Ǹ. Shelf life

Ǻ. Antigenicity

Ǻ. Risk of HIV transmission

Ǽ. Indemnification

Ǽ. Occurrence

Ǿ. Excess liability

Ǿ. Claims-made

Ȁ. Nose

Ȁ. Lateral Y

Ȃ. Scapular AP

Ȃ. Neutral rotation AP

Ȅ. Internal rotation AP

Ȅ. External rotation AP

Ȇ. Trauma

Ȇ. Hemophilia

Ȉ. Reiter’s syndrome

Ȉ. Rheumatoid arthritis

Ȋ. Systemic lupus erythematosus

Ȋ. Cast immobilization for 6 weeks

Ȍ. Activity modification and re-evaluation in 2 months

Ȍ. Internal fixation with or without bone grafting

Ȏ. Retrograde drilling of the defect without articular cartilage penetration

Ȏ. Drilling of the defect directly through the articular cartilage

Ȑ. repair or reconstruction of the medial collateral ligament

Ȑ. repair or reconstruction of the medialand lateral collateral ligaments

Ȓ. immobilization for 5 days or less

Ȓ. immobilization for 14 days

Ȕ. immobilization for 25 days

Ȕ. Cystinosis

Ȗ. Hypophosphatemia

Ȗ. Renal osteodystrophy

Ș. Primary hyperparathyroidism

Ș. Nutritional vitamin D deficiency

Ț. Lateral meniscus tear

Ț. Popliteus tenosynovitis

Ȝ. Iliotibial band friction syndrome

Ȝ. Peroneal nerve entrapment

Ȟ. Biceps tendinitis

Ȟ. Observation

Ƞ. Removal of the prosthetic components

ȡ. Operative exploration and decompression of the peroneal nerve

Ȣ. Nerve conduction velocity studies

Ȣ. Loosening of the primary dressings and knee flexion to 30 degrees

Ȥ. I

Ȥ. II

Ȧ. III

Ȧ. decreased tissue tension

Ȩ. decreased abductor lever arm

Ȩ. decreased joint reaction force

Ȫ. increased body weight over lever arm

Ȫ. increased polyethylene wear rate

Ȭ. recurrent traumatic anterior dislocation

Ȭ. recurrent traumatic posterior dislocation

Ȯ. traumatic subluxation with no previous dislocation

Ȯ. traumatic anterior subluxation

Ȱ. atraumatic involuntary subluxation

Ȱ. radial

Ȳ. axillary

Ȳ. suprascapular

ȴ. thoracodorsal

ȵ. long thoracic

ȶ. Flexion

ȷ. Extension

ȸ. Axial rotation

ȹ. Left lateral bending

Ⱥ. Right lateral bending

Ȼ. Skin

Ȼ. Lung

Ƚ. Brain

Ⱦ. Heart

Ȿ. Kidney

Ɀ. Thoracoacromial, lateral thoracic, subscapular

Ɂ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɂ. Posterior humeral circumflex, subscapular, thoracacromial

Ƀ. Subscapular, thoracacromial, anterior humeral circumflex

Ʉ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ʌ. Respondeat superior

Ɇ. Indemnity agreement

Ɇ. Hold harmless agreement- attempt to shift liability from company to physician

Ɉ. Comparative negligence-% of involvement

Ɉ. Contributory negligence- resident contributed to the negligence

Ɋ. t-type

Ɋ. both column

Ɍ. transverse

Ɍ. anterior column

Ɏ. anterior column posterior hemitransverse

Ɏ. Posterior interosseous

Ɐ. Anterior interosseous

Ɑ. Radial

Ɒ. Median

Ɓ. Ulnar

Ɔ. Shock from hypovolemia

ɕ. Associated rupture of the bladder

Ɖ. Arterial bleeding on pelvic angiogram

Ɗ. Presence of a hematoma in the perineum and scrotum

ɘ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Enchondroma

Explanation

Question 4159

Topic: 10. Pathology and Oncology

A patient reports persistent pain in the wrist 6 months after undergoing open reduction and internal fixation of a Galleazi fracture. Radiographs of the wrist in a neutral position are normal. Which of the following studies would best evaluate the reduction of the distal radioulnar joint?

. Arthrogram of the wrist

. MRI scan of both wrists

. CT scan of both wrists in the same position

. Radiographs of the wrist in supination and pronation

. Radiographs of the opposite wrist in the same position

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

. Bed rest in a hyperextension brace

. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

. Positive-pressure ventilation

. An immediate radiograph of the chest

. Adjustment of the position of the endotrachael tube

. Insertion of a large-bore needle into the pericardial space

. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

. Allowing the ends of the fracture to touch

. Adding a second connecting bar

. Adding one pin to each fracture fragment

. Increasing the pin diameter from 4 mm to 6 mm

. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

. Osteomyelitis

. Malignant degeneration

. Stress fracture

. Local recurrence of the giant cell tumor

. Bone resorption due to methylmethacrylate

. Advancement of the plantar plate

. Resection of the second metatarsal head

!. Dorsiflexion osteotomy of the second metatarsal neck

". Transfer of the flexor digitorum longus tendon to the dorsum of the toe

#. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

$. Sacral fracture

%. Burst fracture of L5

&. Cauda equina syndrome

'. Distraction-flexion injury at L3

(. Distraction-extension injury at L3

). An MRI scan of the shoulder

*. An MRI scan of the cervical spine

+. Electromyographic and nerve conduction velocity studies

,. Immobilization in a sling and early passive range of motion exercises

-. Immediate return to the operating room for exploration of the brachial plexus

.. cerclage wiring

/. tension band wiring

0. removal of the patellar component

1. revision of the patellar component

2. immobilization of the knee and protected weightbearing

3. Liposarcoma

4. Nodular fasciitis

5. Rabdomyosarcoma

6. Malignant fibrous histiocytoma

7. Extra-abdominal desmoid tumor

8. Clubfeet

9. Thrombocytopenia

:. Congenital scoliosis

;. Ventricular septal defect

<. Arnold-Chiari malformation

=. delayed primary closure

>. free flap

?. pedicle groin flap

@. full-thickness skin graft

A. split-thickness skin graft

B. Infection

C. Nonunion

D. Improper screw length

E. Osteonecrosis of the distal fragment

F. Use of a cortical screw instead of a cancellous screw

G. Infection

H. Tear of the rotator cuff

I. Loosening of the humeral component

J. Arthritis of the glenoid

K. Arthritis of the A-C joint

L. Reduced morbidity

M. Improved osteoinduction

N. Improved osteoconduction

O. More rapid revascularization

P. Lower risk of disease transmission

Q. Manipulation Under Anesthesia

R. Arthroscopic acromioplasty

S. Arthroscopic debridement of G-H joint

T. Replacement of the humeral head

U. Lengthening of the subscapularis and release of the anterior capsule

V. Bacteroides

W. E. coli

X. Staph. aureus

Y. group A streptococcus

Z. Clostridium perforingens

[. observation and exercises

\. bracing with a thoracolumbar orthosis

]. fusion of the posterior spine

^. fusion of the anterior spine

_. fusion of the anterior and posterior spine

`. Total wrist replacement and bridge grafts

A. palmar shelf arthroplasty and tendon transfers

B. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

C. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

D. Total wrist fusion and tendon transfers

E. constrained acetabular component

F. protrusion ring with morselized graft

G. cemented metal backed acetabular component

H. cemented all-polyethylene acetabular component

I. cementless hemispherical component with screw fixation

J. application of a hip abduction brace for 22 hours per day

K. application of a hip spica under anesthesia

L. discontinuance of all bracing and repeat radiographs in 3 months

M. open reduction of the hip and application of a spica cast

N. open reduction, varus osteotomy, and application of a spica cast

O. Loss of skin hair on the feet

P. Absent pulses on vascular examination

Q. Pain that originates proximally and spreads distally

R. Pain that is relieved by stopping and standing

S. Pain that is worse when the patient walks uphill rather downhill

T. wrist flexors and finger flexors

U. elbow flexors and wrist flexors

V. elbow flexors and finger flexors

W. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

X. elbow extensors and wrist extensors

Y. Syndactyly

Z. Macrodactyly

{. Camptodactyly

|. Preaxial polydactyly

}. Postaxial polydactyly

~. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

. activity of the posterior tibialis and the peroneus longus muscles.

. scapulothoracic fusion

. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

. pectoralis major-fascia lata graft transfer to the scapula

. exploration of the long thoracic nerve, with sural nerve graft

. tricompartmental knee replacement

. unicompartmental knee replacement

. medial compartment meniscal allograft

. valgus-producing distal femoral osteotomy

. valgus-producing proximal tibial osteotomy

¡. Internal rotation of the femoral component

¢. External rotation of the tibial component

£. Lateral placement of the femoral component

¤. Medial placement of the patellar component

¥. Excessive resection of the patella

¦. Hallux rigidus

§. Hallux valgus

¨. Neuroma of the first web space

ª. Rupture of the flexor hallucis longus

«. Sickle cell crisis

¬. Idiopathic chondrolysis

. Hemophilic arthropathy

®. Osteoid osteoma of the femoral neck

¯. Legg-Calve-Perthes disease

°. Decreased ankle jerk and positive femoral nerve stretch test

±. Decreased knee jerk and positive straight-leg raising sign

². Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

³. Weakness of the extensor hallucis longus and positive straight-leg raising sign

´. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Μ. Long-term administration of IV and oral antibiotics

¶. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

·. Immediate exchange arthroplasty with antibiotic-impregnated cement

¸. Two-stage surgical prosthetic exchange and IV antibiotics

¹. Resection arthroplasty and IV antibiotics

º. SCFE

». MED

¼. Perthes disease

½. Hypothyroidism

¾. Chondrolysis

¿. gout.

À. osteoporosis.

Á. eosinophilic granuloma.

Â. tuberculosis of the spine.

Ã. metastatic disease of the spine.

Ä. water content.

Å. Synthesis of type I collagen.

Æ. Proteoglycan content.

Ç. Activity of chondrocytes.

È. Synthesis of hyaluronate.

É. Lung

Ê. Breast

Ë. Prostate

Ì. Thyroid

Í. Renal

Î. T1-low, T2-low.

Ï. T1-low, T2-high.

Ð. T1-moderate, T2-low.

Ñ. T1-high, T2-low.

Ò. T1-high, T2-high.

Ó. hypothesis is incorrect or invalid

Ô. interobserver error rate is 4%.

Õ. Standard deviation is 4% higher or lower than the mean.

Ö. Sample size is 4% larger than required to be clinically significant.

×. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ø. I

Ù. II

Ú. IV

Û. IX

Ü. X

Ý. Cranial setting

Þ. Cranial subluxation

SS. Odontoid fracture

À. Lysis of the arch of the atlas

Á. Atlantoaxial subluxation

Â. Retrograde collapse of the endoneurial tubes

Ã. Irreversible atrophy of the denervated muscles

Ä. Elongation of the axons across the zone of injury

Å. Sprouting of the axons at the neuromuscular junction

Æ. Misdirection of the axons across the zone of injury

Ç. Maximally pronated and elbow extended

È. Maximally pronated and the elbow flexed

É. Maximally supinated and the elbow flexed

Ê. Maximally supinated and the elbow extended

Ë. In neutral rotation, with the elbow extended

Ì. open reduction and internal fixation

Í. buddy taping to the adjacent index finger

Î. early motion with application of a dynamic banjo splint

Ï. application of a cast with the hand in a “safe position” for 3 weeks.

Ð. dorsal extension block splinting

Ñ. The name of the manufacturer

Ò. The manufacturer’s potential liability

Ó. The physician’s clinical performance

Ô. The physician’s materials testing data

Õ. Any royalties the physician receives from the manufacturer

Ö. Femoral

÷. Obturator

Ø. Inferior gluteal

Ù. Superior gluteal

Ú. Lateral femoral cutaneous

Û. open biopsy and a long leg cast

Ü. open biopsy and wide resection of the tumor

Ý. a long leg cast and observation

Þ. intramedullary stabilization and observation

Ÿ. Triggering

Ā. Lateral instability

Ā. Swan-neck deformity

Ă. Boutonniere deformity

Ă. Loss of distal interphalangeal joint flexion

Ą. Peroneus brevis to peroneus longus

Ą. Peroneus tertius to extensor hallucis longus

Ć. Peroneus tertius to superficial peroneal nerve

Ć. Extensor hallucis longus to deep peroneal nerve

Ĉ. Extensor hallucis longus to extensor digitorum longus

Ĉ. reassurance that Medicare will pay for the treatment.

Ċ. consent forms that patients or their guardians are able to understand.

Ċ. a detailed description of the device, omitting the fact that it is part of a study.

Č. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Č. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ď. an onlay iliac crest bone graft.

Ď. limited weightbearing and observation.

Đ. removal of the implant and limited weightbearing.

Đ. removal of the implant and insertion of a reamed femoral nail.

Ē. removal of the implant and insertion of an unreamed femoral nail.

Ē. Coronal

Ĕ. Sagittal

Ĕ. Anteromedial, midway between the sagittal and the coronal

Ė. Proximal pins sagittal, distal pins coronal

Ė. Proximal pins coronal, distal pins sagittal

Ę. Rheumatoid arthritis

Ę. Posttraumatic arthritis

Ě. Degenerative osteoarthritis

Ě. Osteonecrosis of the tibial plateau

Ĝ. Osteonecrosis of the medial femoral condyle

Ĝ. Trapeziometacarpal arthrodesis

Ğ. Osteotomy of the thumb metacarpal

Ğ. Arthrotomy and joint debridement

Ġ. Ligament reconstruction using one half of the flexor carpi radialis

Ġ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ģ. Creep

Ģ. Relaxation

Ĥ. Energy dissipation

Ĥ. Plastic deformation

Ħ. Elastic deformation

Ħ. bending

Ĩ. axial loading

Ĩ. high-speed rotation

Ī. direct impact from anteromedial

Ī. crush from anteromedial to posterolateral

Ĭ. Increase stiffness

Ĭ. Increase fracture toughness

Į. Increase fatigue strength

Į. Decrease mechanical strength

İ. Decrease wear rate

I. disuse osteopenia

Ĳ. paraendocrine effect of the tumor

Ĳ. abnormally increased density on the right side

Ĵ. side effect of the treatment of the lesion

Ĵ. extensive tumor involvement of the left hip

Ķ. Sciatic nerve

Ķ. Superior gluteal artery

ĸ. Profunda femoris artery

Ĺ. Femoral artery and nerve

Ĺ. External iliac artery and vein

Ļ. Length

Ļ. Moment arm

Ľ. Total volume

Ľ. Physiologic cross-sectional area

Ŀ. Distribution of slow and fast twitch fibers

Ŀ. decreasing initiation of action potentials.

Ł. increasing action potential amplitude.

Ł. blocking the opening of gated sodium channels.

Ń. decreasing the number of functional motor units.

Ń. slowing or stopping action potential propagation through the axon.

Ņ. resection of the metatarsal heads of the first through fifth toes.

Ņ. Silastic MP joint arthroplasties of the first through fifth toes.

Ň. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ň. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

ʼN. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ŋ. hemiarthroplasty

Ŋ. open reduction and internal fixation

Ō. closed reduction and percutaneous pinning

Ō. a sling and early pedulum exercises

Ŏ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ŏ. open acromioplasty

Ő. open Bankart repair

Ő. open subscapularis tendon repair

Œ. inferior capsular shift

Œ. a supervised physical therapy program

Ŕ. a sling and swathe, with pendulum exercises in 10 days

Ŕ. open reduction and internal fixation through an anterior approach

Ŗ. open reduction and internal fixation through a posterior approach

Ŗ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ř. arthroscopically assisted reduction and percutaneous screw fixation

Ř. Repair of the rotator cuff

Ś. Replacement of the humeral head

Ś. Resection arthroplasty

Ŝ. Total shoulder arthroplasty

Ŝ. AP and lateral radiographs of the elbow

Ş. Diagnositc arthroscopy

Ş. Aspiration of joint fluid

Š. An erythrocyte sedimentation rate and CBC

Š. A diagnostic lidocaine injection

Ţ. Insulin-like growth factor (IGF-1)

Ţ. Fibroblast growth factor (FGF-1)

Ť. Platelet-derived growth factor (PDGF)

Ť. Transforming growth factor beta (TGF-B)

Ŧ. Bone morphogenetic proteins (BMP)

Ŧ. clinical history and radiographic findings.

Ũ. technetium bone scan

Ũ. flow cytometry pattern of extracted chondrocytes

Ū. immunohistochemical staining patterns of a biopsy specimen

Ū. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ŭ. Radial

Ŭ. Radial recurrent

Ů. Posterior interosseous

Ů. Superior ulnar recurrent

Ű. Superficial radial circumflex

Ű. Impaired hydroxylation of proline

Ų. Failure of cleavage in procollagen

Ų. Defective binding sites for hydroxyproline

Ŵ. Failure to incorporate glycine into the helix

Ŵ. Diminished production of collagen through the rough endoplasmic reticulum

Ŷ. Asking the legal staff to seek a court injunction

Ŷ. Copying the patient’s chart and giving it to him as he leaves

Ÿ. Having the patient sign a written legal contract that specifies acceptable behavior

Ź. Continuing care of the patient until an appropriate referral can be arranged

Ź. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ż. Meta-analysis

Ż. Confidence interval

Ž. Analysis of variance (ANOVA)

Ž. Statistical significance (p-value)

S. Survivorship analysis (Kaplan-Meier)

Ƀ. Spinal shock

Ɓ. Neurogenic shock

Ƃ. Hypovolemic shock

Ƃ. Pulmonary embolism

Ƅ. Fat embolus syndrome

Ƅ. Lumbar spinal stenosis

Ɔ. Metastatic disease of the spine

Ƈ. Rheumatoid lumbar spondylitis

Ƈ. Isthmic spondyloloisthesis

Ɖ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ɗ. Patella alta

Ƌ. A metal-backed patella

Ƌ. Varus malalignment of the knee

ƍ. A posterior cruciate-substituting femoral component

Ǝ. Lateral subluxation of the patella on a Merchant’s view

Ə. The sesamoids are separated

Ɛ. The sesamoid is fractured

Ƒ. The proximal phx is on the neck of the metatarsal

Ƒ. The dislocation is dorsal and centered

Ɠ. The proximal phalanx is hyperextended

Ɣ. Patella

Ƕ. Tibial stem

Ɩ. Distal femoral interface

Ɨ. Posterior femoral interface

Ƙ. Sites of screw fixation for the tibia

Ƙ. Hallux rigidus

Ƚ. Fracture of the sesamoid

ƛ. Disruption of the plantar plate

Ɯ. Osteonecrosis of the metatarsal head

Ɲ. Rupture of the flexor hallucis longus

Ƞ. Gout

Ɵ. Sepsis

Ơ. Old trauma

Ơ. Rheumatoid arthritis

Ƣ. Charcot arthroplasty

Ƣ. Aspiration and steroid injection

Ƥ. Biopsy, curettage, and allograft bone grafting

Ƥ. Percutaneous Kirschner wire fixation

Ʀ. Percutaneous injection of autogenous bone marrow

Ƨ. Nerve roots

Ƨ. Spinal cord

Ʃ. Sciatic nerve

ƪ. Peroneal nerve

ƫ. Conus medullaris

Ƭ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ƭ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ʈ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ư. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ư. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ʊ. Early and late infection

Ʋ. Periprosthetic fracture of the femur

Ƴ. Failure of the patellofemoral and extensor mechanisms

Ƴ. Aseptic loosening of cementing tibial components

Ƶ. Asceptic loosening of cemented femoral components

Ƶ. Acceptance of the current position of the ankle

Ʒ. Open reduction and fixation in the epiphysis only

Ƹ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ƹ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

ƺ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

ƻ. Resection arthroplasty and local radiation

Ƽ. In situ fusion of the hip

Ƽ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

ƾ. Excision of heterotopic bone and local radiation

Ƿ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

ǀ. Closed reduction of both fractures and immediate spica casting

ǁ. Bilateral skin traction for 3 weeks, followed by spica casting

ǂ. External fixation of both femora

ǃ. External fixation of the left femur and a long leg cast brace for the right femur

Ǆ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ǆ. Synovial sarcoma

Ǆ. Soft-tissue abcess

Ǉ. Rhabdomyosarcoma

Ǉ. Eosinophilic granuloma

Ǉ. Nodular pigmented villonodular synovitis

Ǌ. Changing to a titanium nail

Ǌ. Changing to a nonslotted nail

Ǌ. Changing the cross-sectional shape of the nail

Ǎ. Increasing the diameter of the nail by 3 mm

Ǎ. Increasing the diameter of the interlocking screws

Ǐ. Fracture healing

Ǐ. Chondrosarcoma

Ǒ. Periosteal chondroma

Ǒ. Periosteal osteosarcoma

Ǔ. Dysplasia epiphysealis hemimelica

Ǔ. Demonstrate competence in the subject of the case

Ǖ. Be fellowship trained in the subject of the case

Ǖ. Be paid on a contingency basis

Ǘ. Be board certified by the American Board of Orthopaedic Surgery

Ǘ. Have been involved in the case as a consultant

Ǚ. Diagnostic arthroscopy

Ǚ. Arthroscopy and subacromial decompression

Ǜ. Reduction and fixation of the proximal humeral epiphysis

Ǜ. Temporary cessation of throwing

Ǝ. Physical therapy for rotator cuff strengthening

Ǟ. Oblique popliteal ligament

Ǟ. Lateral capsule

Ǡ. Popliteal tendon

Ǡ. Fibular collateral ligament

Ǣ. Posterior oblique ligament

Ǣ. Radial tear

Ǥ. Parrot-beak tear

Ǥ. Vertical tear in the “red-red” zone

Ǧ. Vertical tear in the “red-white” zone

Ǧ. Vertical tear in the “white-white” zone

Ǩ. 0 degrees of abduction, with neural rotation

Ǩ. 40 degrees of flexion and 60 degrees of internal rotation

Ǫ. 45 degrees of flexion and 45 degrees of external rotation

Ǫ. 90 degrees of abduction with neutral rotation

Ǭ. 90 degrees of abduction and 90 degrees of external rotation

Ǭ. Sural

Ǯ. Saphenous and its branches

Ǯ. Posterior tibial and its branches

J̌. Deep peroneal and its branches

Ǳ. Superficial peroneal and its branches

Ǳ. Strength

Ǳ. Stiffness

Ǵ. Shelf life

Ǵ. Antigenicity

Ƕ. Risk of HIV transmission

Ƿ. Indemnification

Ǹ. Occurrence

Ǹ. Excess liability

Ǻ. Claims-made

Ǻ. Nose

Ǽ. Lateral Y

Ǽ. Scapular AP

Ǿ. Neutral rotation AP

Ǿ. Internal rotation AP

Ȁ. External rotation AP

Ȁ. Trauma

Ȃ. Hemophilia

Ȃ. Reiter’s syndrome

Ȅ. Rheumatoid arthritis

Ȅ. Systemic lupus erythematosus

Ȇ. Cast immobilization for 6 weeks

Ȇ. Activity modification and re-evaluation in 2 months

Ȉ. Internal fixation with or without bone grafting

Ȉ. Retrograde drilling of the defect without articular cartilage penetration

Ȋ. Drilling of the defect directly through the articular cartilage

Ȋ. repair or reconstruction of the medial collateral ligament

Ȍ. repair or reconstruction of the medialand lateral collateral ligaments

Ȍ. immobilization for 5 days or less

Ȏ. immobilization for 14 days

Ȏ. immobilization for 25 days

Ȑ. Cystinosis

Ȑ. Hypophosphatemia

Ȓ. Renal osteodystrophy

Ȓ. Primary hyperparathyroidism

Ȕ. Nutritional vitamin D deficiency

Ȕ. Lateral meniscus tear

Ȗ. Popliteus tenosynovitis

Ȗ. Iliotibial band friction syndrome

Ș. Peroneal nerve entrapment

Ș. Biceps tendinitis

Ț. Observation

Ț. Removal of the prosthetic components

Ȝ. Operative exploration and decompression of the peroneal nerve

Ȝ. Nerve conduction velocity studies

Ȟ. Loosening of the primary dressings and knee flexion to 30 degrees

Ȟ. I

Ƞ. II

ȡ. III

Ȣ. decreased tissue tension

Ȣ. decreased abductor lever arm

Ȥ. decreased joint reaction force

Ȥ. increased body weight over lever arm

Ȧ. increased polyethylene wear rate

Ȧ. recurrent traumatic anterior dislocation

Ȩ. recurrent traumatic posterior dislocation

Ȩ. traumatic subluxation with no previous dislocation

Ȫ. traumatic anterior subluxation

Ȫ. atraumatic involuntary subluxation

Ȭ. radial

Ȭ. axillary

Ȯ. suprascapular

Ȯ. thoracodorsal

Ȱ. long thoracic

Ȱ. Flexion

Ȳ. Extension

Ȳ. Axial rotation

ȴ. Left lateral bending

ȵ. Right lateral bending

ȶ. Skin

ȷ. Lung

ȸ. Brain

ȹ. Heart

Ⱥ. Kidney

Ȼ. Thoracoacromial, lateral thoracic, subscapular

Ȼ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƚ. Posterior humeral circumflex, subscapular, thoracacromial

Ⱦ. Subscapular, thoracacromial, anterior humeral circumflex

Ȿ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɀ. Respondeat superior

Ɂ. Indemnity agreement

Ɂ. Hold harmless agreement- attempt to shift liability from company to physician

Ƀ. Comparative negligence-% of involvement

Ʉ. Contributory negligence- resident contributed to the negligence

Ʌ. t-type

Ɇ. both column

Ɇ. transverse

Ɉ. anterior column

Ɉ. anterior column posterior hemitransverse

Ɋ. Posterior interosseous

Ɋ. Anterior interosseous

Ɍ. Radial

Ɍ. Median

Ɏ. Ulnar

Ɏ. Shock from hypovolemia

Ɐ. Associated rupture of the bladder

Ɑ. Arterial bleeding on pelvic angiogram

Ɒ. Presence of a hematoma in the perineum and scrotum

Ɓ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Arthrogram of the wrist

Explanation

Question 4160

Topic: 10. Pathology and Oncology

A form of renal osteodystrophy that is characterized by pure osteomalacia is caused by

. Secondary hyperparathyroidism

. Phosphate retention secondary to uremia

. Insufficient renal synthesis of 1, 25 dihydroxy vitamin D

. Aluminum deposition in bone from oral phosphate binders

. Persistent acidosis aggravating the negative calcium balance

. Posterior fusion at T10-L3 with segmental instrumentation

. Laminectomy and fusion of T12-L2 with segmental instrumentation

. Bed rest in a hyperextension brace

. L1 vertebrectomy and anterior decompression with strut graft fusion and instrumentation

. Progressive ambulation as tolerated in a custom-molded thoracolumbosacral orthosis

. Positive-pressure ventilation

. An immediate radiograph of the chest

. Adjustment of the position of the endotrachael tube

. Insertion of a large-bore needle into the pericardial space

. Insertion of a large-bore needle in the right second intercostal space, midclavicular line

. Allowing the ends of the fracture to touch

. Adding a second connecting bar

. Adding one pin to each fracture fragment

. Increasing the pin diameter from 4 mm to 6 mm

. Decreasing the connecting bar-to-bone distance from 6 cm to 4 cm

. Osteomyelitis

. Malignant degeneration

. Stress fracture

. Local recurrence of the giant cell tumor

. Bone resorption due to methylmethacrylate

. Advancement of the plantar plate

. Resection of the second metatarsal head

. Dorsiflexion osteotomy of the second metatarsal neck

. Transfer of the flexor digitorum longus tendon to the dorsum of the toe

. Transfer of the extensor digitorum comminus tendon to the metatarsal neck

. Sacral fracture

. Burst fracture of L5

!. Cauda equina syndrome

". Distraction-flexion injury at L3

#. Distraction-extension injury at L3

$. An MRI scan of the shoulder

%. An MRI scan of the cervical spine

&. Electromyographic and nerve conduction velocity studies

'. Immobilization in a sling and early passive range of motion exercises

(. Immediate return to the operating room for exploration of the brachial plexus

). cerclage wiring

*. tension band wiring

+. removal of the patellar component

,. revision of the patellar component

-. immobilization of the knee and protected weightbearing

.. Liposarcoma

/. Nodular fasciitis

0. Rabdomyosarcoma

1. Malignant fibrous histiocytoma

2. Extra-abdominal desmoid tumor

3. Clubfeet

4. Thrombocytopenia

5. Congenital scoliosis

6. Ventricular septal defect

7. Arnold-Chiari malformation

8. delayed primary closure

9. free flap

:. pedicle groin flap

;. full-thickness skin graft

<. split-thickness skin graft

=. Infection

>. Nonunion

?. Improper screw length

@. Osteonecrosis of the distal fragment

A. Use of a cortical screw instead of a cancellous screw

B. Infection

C. Tear of the rotator cuff

D. Loosening of the humeral component

E. Arthritis of the glenoid

F. Arthritis of the A-C joint

G. Reduced morbidity

H. Improved osteoinduction

I. Improved osteoconduction

J. More rapid revascularization

K. Lower risk of disease transmission

L. Manipulation Under Anesthesia

M. Arthroscopic acromioplasty

N. Arthroscopic debridement of G-H joint

O. Replacement of the humeral head

P. Lengthening of the subscapularis and release of the anterior capsule

Q. Bacteroides

R. E. coli

S. Staph. aureus

T. group A streptococcus

U. Clostridium perforingens

V. observation and exercises

W. bracing with a thoracolumbar orthosis

X. fusion of the posterior spine

Y. fusion of the anterior spine

Z. fusion of the anterior and posterior spine

[. Total wrist replacement and bridge grafts

\. palmar shelf arthroplasty and tendon transfers

]. Darrach distal ulna resection, dorsal tenosynosynovectomy, and tendon transfers

^. Radioscaphate fusion, extensor tenodesis, and Darrach distal ulna resection

_. Total wrist fusion and tendon transfers

`. constrained acetabular component

A. protrusion ring with morselized graft

B. cemented metal backed acetabular component

C. cemented all-polyethylene acetabular component

D. cementless hemispherical component with screw fixation

E. application of a hip abduction brace for 22 hours per day

F. application of a hip spica under anesthesia

G. discontinuance of all bracing and repeat radiographs in 3 months

H. open reduction of the hip and application of a spica cast

I. open reduction, varus osteotomy, and application of a spica cast

J. Loss of skin hair on the feet

K. Absent pulses on vascular examination

L. Pain that originates proximally and spreads distally

M. Pain that is relieved by stopping and standing

N. Pain that is worse when the patient walks uphill rather downhill

O. wrist flexors and finger flexors

P. elbow flexors and wrist flexors

Q. elbow flexors and finger flexors

R. elbow extensors and wrist flexorst Level Key Muscles4 DiaphragmDeltoid, elbow flexors, diaphragmElbow flexors, wrist extensorsElbow extensors, wrist flexorsFinger flexors (distal phalanx of middlefinger)Finger abductors (5th digit), intrinsics of hand2 Segmental innervation to intercostal muscles, abdominal and paraspinal muscles) L1, L2, L3 Hip flexors3, L4 QuadricepsTibialis anteriorToe extensors, hip abductorsAnkle plantarflexors, peronei

S. elbow extensors and wrist extensors

T. Syndactyly

U. Macrodactyly

V. Camptodactyly

W. Preaxial polydactyly

X. Postaxial polydactyly

Y. Arthrodesis

Z. Rotationplasty

{. Above-knee amputation

|. Osteoarticular allograft

}. Endoprosthesis (custom arthroplasty)

~. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

. activity of the posterior tibialis and the peroneus longus muscles.

. scapulothoracic fusion

. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

. pectoralis major-fascia lata graft transfer to the scapula

. exploration of the long thoracic nerve, with sural nerve graft

. tricompartmental knee replacement

. unicompartmental knee replacement

. medial compartment meniscal allograft

. valgus-producing distal femoral osteotomy

. valgus-producing proximal tibial osteotomy

. Internal rotation of the femoral component

. External rotation of the tibial component

. Lateral placement of the femoral component

. Medial placement of the patellar component

. Excessive resection of the patella

¡. Hallux rigidus

¢. Hallux valgus

£. Neuroma of the first web space

¤. Fracture of the sesamoid

¥. Rupture of the flexor hallucis longus

¦. Sickle cell crisis

§. Idiopathic chondrolysis

¨. Hemophilic arthropathy

ª. Legg-Calve-Perthes disease

«. Decreased ankle jerk and positive femoral nerve stretch test

¬. Decreased knee jerk and positive straight-leg raising sign

. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

®. Weakness of the extensor hallucis longus and positive straight-leg raising sign

¯. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

°. Long-term administration of IV and oral antibiotics

±. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

². Immediate exchange arthroplasty with antibiotic-impregnated cement

³. Two-stage surgical prosthetic exchange and IV antibiotics

´. Resection arthroplasty and IV antibiotics

Μ. SCFE

¶. MED

·. Perthes disease

¸. Hypothyroidism

¹. Chondrolysis

º. gout.

». osteoporosis.

¼. eosinophilic granuloma.

½. tuberculosis of the spine.

¾. metastatic disease of the spine.

¿. water content.

À. Synthesis of type I collagen.

Á. Proteoglycan content.

Â. Activity of chondrocytes.

Ã. Synthesis of hyaluronate.

Ä. Lung

Å. Breast

Æ. Prostate

Ç. Thyroid

È. Renal

É. T1-low, T2-low.

Ê. T1-low, T2-high.

Ë. T1-moderate, T2-low.

Ì. T1-high, T2-low.

Í. T1-high, T2-high.

Î. hypothesis is incorrect or invalid

Ï. interobserver error rate is 4%.

Ð. Standard deviation is 4% higher or lower than the mean.

Ñ. Sample size is 4% larger than required to be clinically significant.

Ò. Probability that the differences noted between two study groups were due to chance alone is 4%.

Ó. I

Ô. II

Õ. IV

Ö. IX

×. X

Ø. Cranial setting

Ù. Cranial subluxation

Ú. Odontoid fracture

Û. Lysis of the arch of the atlas

Ü. Atlantoaxial subluxation

Ý. Retrograde collapse of the endoneurial tubes

Þ. Irreversible atrophy of the denervated muscles

SS. Elongation of the axons across the zone of injury

À. Sprouting of the axons at the neuromuscular junction

Á. Misdirection of the axons across the zone of injury

Â. Maximally pronated and elbow extended

Ã. Maximally pronated and the elbow flexed

Ä. Maximally supinated and the elbow flexed

Å. Maximally supinated and the elbow extended

Æ. In neutral rotation, with the elbow extended

Ç. open reduction and internal fixation

È. buddy taping to the adjacent index finger

É. early motion with application of a dynamic banjo splint

Ê. application of a cast with the hand in a “safe position” for 3 weeks.

Ë. dorsal extension block splinting

Ì. The name of the manufacturer

Í. The manufacturer’s potential liability

Î. The physician’s clinical performance

Ï. The physician’s materials testing data

Ð. Any royalties the physician receives from the manufacturer

Ñ. Femoral

Ò. Obturator

Ó. Inferior gluteal

Ô. Superior gluteal

Õ. Lateral femoral cutaneous

Ö. open biopsy and a long leg cast

÷. open biopsy and wide resection of the tumor

Ø. a long leg cast and observation

Ù. intramedullary stabilization and observation

Ú. Triggering

Û. Lateral instability

Ü. Swan-neck deformity

Ý. Boutonniere deformity

Þ. Loss of distal interphalangeal joint flexion

Ÿ. Peroneus brevis to peroneus longus

Ā. Peroneus tertius to extensor hallucis longus

Ā. Peroneus tertius to superficial peroneal nerve

Ă. Extensor hallucis longus to deep peroneal nerve

Ă. Extensor hallucis longus to extensor digitorum longus

Ą. reassurance that Medicare will pay for the treatment.

Ą. consent forms that patients or their guardians are able to understand.

Ć. a detailed description of the device, omitting the fact that it is part of a study.

Ć. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

Ĉ. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

Ĉ. an onlay iliac crest bone graft.

Ċ. limited weightbearing and observation.

Ċ. removal of the implant and limited weightbearing.

Č. removal of the implant and insertion of a reamed femoral nail.

Č. removal of the implant and insertion of an unreamed femoral nail.

Ď. Coronal

Ď. Sagittal

Đ. Anteromedial, midway between the sagittal and the coronal

Đ. Proximal pins sagittal, distal pins coronal

Ē. Proximal pins coronal, distal pins sagittal

Ē. Rheumatoid arthritis

Ĕ. Posttraumatic arthritis

Ĕ. Degenerative osteoarthritis

Ė. Osteonecrosis of the tibial plateau

Ė. Osteonecrosis of the medial femoral condyle

Ę. Trapeziometacarpal arthrodesis

Ę. Osteotomy of the thumb metacarpal

Ě. Arthrotomy and joint debridement

Ě. Ligament reconstruction using one half of the flexor carpi radialis

Ĝ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ĝ. Creep

Ğ. Relaxation

Ğ. Energy dissipation

Ġ. Plastic deformation

Ġ. Elastic deformation

Ģ. bending

Ģ. axial loading

Ĥ. high-speed rotation

Ĥ. direct impact from anteromedial

Ħ. crush from anteromedial to posterolateral

Ħ. Increase stiffness

Ĩ. Increase fracture toughness

Ĩ. Increase fatigue strength

Ī. Decrease mechanical strength

Ī. Decrease wear rate

Ĭ. disuse osteopenia

Ĭ. paraendocrine effect of the tumor

Į. abnormally increased density on the right side

Į. side effect of the treatment of the lesion

İ. extensive tumor involvement of the left hip

I. Sciatic nerve

Ĳ. Superior gluteal artery

Ĳ. Profunda femoris artery

Ĵ. Femoral artery and nerve

Ĵ. External iliac artery and vein

Ķ. Length

Ķ. Moment arm

ĸ. Total volume

Ĺ. Physiologic cross-sectional area

Ĺ. Distribution of slow and fast twitch fibers

Ļ. decreasing initiation of action potentials.

Ļ. increasing action potential amplitude.

Ľ. blocking the opening of gated sodium channels.

Ľ. decreasing the number of functional motor units.

Ŀ. slowing or stopping action potential propagation through the axon.

Ŀ. resection of the metatarsal heads of the first through fifth toes.

Ł. Silastic MP joint arthroplasties of the first through fifth toes.

Ł. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ń. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ń. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ņ. hemiarthroplasty

Ņ. open reduction and internal fixation

Ň. closed reduction and percutaneous pinning

Ň. a sling and early pedulum exercises

ʼN. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ŋ. open acromioplasty

Ŋ. open Bankart repair

Ō. open subscapularis tendon repair

Ō. inferior capsular shift

Ŏ. a supervised physical therapy program

Ŏ. a sling and swathe, with pendulum exercises in 10 days

Ő. open reduction and internal fixation through an anterior approach

Ő. open reduction and internal fixation through a posterior approach

Œ. immobilization with a splint in 45 degrees of abduction for 6 weeks

Œ. arthroscopically assisted reduction and percutaneous screw fixation

Ŕ. Repair of the rotator cuff

Ŕ. Replacement of the humeral head

Ŗ. Resection arthroplasty

Ŗ. Total shoulder arthroplasty

Ř. AP and lateral radiographs of the elbow

Ř. Diagnositc arthroscopy

Ś. Aspiration of joint fluid

Ś. An erythrocyte sedimentation rate and CBC

Ŝ. A diagnostic lidocaine injection

Ŝ. Insulin-like growth factor (IGF-1)

Ş. Fibroblast growth factor (FGF-1)

Ş. Platelet-derived growth factor (PDGF)

Š. Transforming growth factor beta (TGF-B)

Š. Bone morphogenetic proteins (BMP)

Ţ. clinical history and radiographic findings.

Ţ. technetium bone scan

Ť. flow cytometry pattern of extracted chondrocytes

Ť. immunohistochemical staining patterns of a biopsy specimen

Ŧ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ŧ. Radial

Ũ. Radial recurrent

Ũ. Posterior interosseous

Ū. Superior ulnar recurrent

Ū. Superficial radial circumflex

Ŭ. Impaired hydroxylation of proline

Ŭ. Failure of cleavage in procollagen

Ů. Defective binding sites for hydroxyproline

Ů. Failure to incorporate glycine into the helix

Ű. Diminished production of collagen through the rough endoplasmic reticulum

Ű. Asking the legal staff to seek a court injunction

Ų. Copying the patient’s chart and giving it to him as he leaves

Ų. Having the patient sign a written legal contract that specifies acceptable behavior

Ŵ. Continuing care of the patient until an appropriate referral can be arranged

Ŵ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ŷ. Meta-analysis

Ŷ. Confidence interval

Ÿ. Analysis of variance (ANOVA)

Ź. Statistical significance (p-value)

Ź. Survivorship analysis (Kaplan-Meier)

Ż. Spinal shock

Ż. Neurogenic shock

Ž. Hypovolemic shock

Ž. Pulmonary embolism

S. Fat embolus syndrome

Ƀ. Lumbar spinal stenosis

Ɓ. Metastatic disease of the spine

Ƃ. Rheumatoid lumbar spondylitis

Ƃ. Isthmic spondyloloisthesis

Ƅ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ƅ. Patella alta

Ɔ. A metal-backed patella

Ƈ. Varus malalignment of the knee

Ƈ. A posterior cruciate-substituting femoral component

Ɖ. Lateral subluxation of the patella on a Merchant’s view

Ɗ. The sesamoids are separated

Ƌ. The sesamoid is fractured

Ƌ. The proximal phx is on the neck of the metatarsal

ƍ. The dislocation is dorsal and centered

Ǝ. The proximal phalanx is hyperextended

Ə. Patella

Ɛ. Tibial stem

Ƒ. Distal femoral interface

Ƒ. Posterior femoral interface

Ɠ. Sites of screw fixation for the tibia

Ɣ. Hallux rigidus

Ƕ. Fracture of the sesamoid

Ɩ. Disruption of the plantar plate

Ɨ. Osteonecrosis of the metatarsal head

Ƙ. Rupture of the flexor hallucis longus

Ƙ. Gout

Ƚ. Sepsis

ƛ. Old trauma

Ɯ. Rheumatoid arthritis

Ɲ. Charcot arthroplasty

Ƞ. Aspiration and steroid injection

Ɵ. Biopsy, curettage, and allograft bone grafting

Ơ. Percutaneous Kirschner wire fixation

Ơ. Percutaneous injection of autogenous bone marrow

Ƣ. Nerve roots

Ƣ. Spinal cord

Ƥ. Sciatic nerve

Ƥ. Peroneal nerve

Ʀ. Conus medullaris

Ƨ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ƨ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ʃ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

ƪ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

ƫ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ƭ. Early and late infection

Ƭ. Periprosthetic fracture of the femur

Ʈ. Failure of the patellofemoral and extensor mechanisms

Ư. Aseptic loosening of cementing tibial components

Ư. Asceptic loosening of cemented femoral components

Ʊ. Acceptance of the current position of the ankle

Ʋ. Open reduction and fixation in the epiphysis only

Ƴ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ƴ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ƶ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ƶ. Resection arthroplasty and local radiation

Ʒ. In situ fusion of the hip

Ƹ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ƹ. Excision of heterotopic bone and local radiation

ƺ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

ƻ. Closed reduction of both fractures and immediate spica casting

Ƽ. Bilateral skin traction for 3 weeks, followed by spica casting

Ƽ. External fixation of both femora

ƾ. External fixation of the left femur and a long leg cast brace for the right femur

Ƿ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

ǀ. Synovial sarcoma

ǁ. Soft-tissue abcess

ǂ. Rhabdomyosarcoma

ǃ. Eosinophilic granuloma

Ǆ. Nodular pigmented villonodular synovitis

Ǆ. Changing to a titanium nail

Ǆ. Changing to a nonslotted nail

Ǉ. Changing the cross-sectional shape of the nail

Ǉ. Increasing the diameter of the nail by 3 mm

Ǉ. Increasing the diameter of the interlocking screws

Ǌ. Fracture healing

Ǌ. Chondrosarcoma

Ǌ. Periosteal chondroma

Ǎ. Periosteal osteosarcoma

Ǎ. Dysplasia epiphysealis hemimelica

Ǐ. Demonstrate competence in the subject of the case

Ǐ. Be fellowship trained in the subject of the case

Ǒ. Be paid on a contingency basis

Ǒ. Be board certified by the American Board of Orthopaedic Surgery

Ǔ. Have been involved in the case as a consultant

Ǔ. Diagnostic arthroscopy

Ǖ. Arthroscopy and subacromial decompression

Ǖ. Reduction and fixation of the proximal humeral epiphysis

Ǘ. Temporary cessation of throwing

Ǘ. Physical therapy for rotator cuff strengthening

Ǚ. Oblique popliteal ligament

Ǚ. Lateral capsule

Ǜ. Popliteal tendon

Ǜ. Fibular collateral ligament

Ǝ. Posterior oblique ligament

Ǟ. Radial tear

Ǟ. Parrot-beak tear

Ǡ. Vertical tear in the “red-red” zone

Ǡ. Vertical tear in the “red-white” zone

Ǣ. Vertical tear in the “white-white” zone

Ǣ. 0 degrees of abduction, with neural rotation

Ǥ. 40 degrees of flexion and 60 degrees of internal rotation

Ǥ. 45 degrees of flexion and 45 degrees of external rotation

Ǧ. 90 degrees of abduction with neutral rotation

Ǧ. 90 degrees of abduction and 90 degrees of external rotation

Ǩ. Sural

Ǩ. Saphenous and its branches

Ǫ. Posterior tibial and its branches

Ǫ. Deep peroneal and its branches

Ǭ. Superficial peroneal and its branches

Ǭ. Strength

Ǯ. Stiffness

Ǯ. Shelf life

J̌. Antigenicity

Ǳ. Risk of HIV transmission

Ǳ. Indemnification

Ǳ. Occurrence

Ǵ. Excess liability

Ǵ. Claims-made

Ƕ. Nose

Ƿ. Lateral Y

Ǹ. Scapular AP

Ǹ. Neutral rotation AP

Ǻ. Internal rotation AP

Ǻ. External rotation AP

Ǽ. Trauma

Ǽ. Hemophilia

Ǿ. Reiter’s syndrome

Ǿ. Rheumatoid arthritis

Ȁ. Systemic lupus erythematosus

Ȁ. Cast immobilization for 6 weeks

Ȃ. Activity modification and re-evaluation in 2 months

Ȃ. Internal fixation with or without bone grafting

Ȅ. Retrograde drilling of the defect without articular cartilage penetration

Ȅ. Drilling of the defect directly through the articular cartilage

Ȇ. repair or reconstruction of the medial collateral ligament

Ȇ. repair or reconstruction of the medialand lateral collateral ligaments

Ȉ. immobilization for 5 days or less

Ȉ. immobilization for 14 days

Ȋ. immobilization for 25 days

Ȋ. Cystinosis

Ȍ. Hypophosphatemia

Ȍ. Renal osteodystrophy

Ȏ. Primary hyperparathyroidism

Ȏ. Nutritional vitamin D deficiency

Ȑ. Lateral meniscus tear

Ȑ. Popliteus tenosynovitis

Ȓ. Iliotibial band friction syndrome

Ȓ. Peroneal nerve entrapment

Ȕ. Biceps tendinitis

Ȕ. Observation

Ȗ. Removal of the prosthetic components

Ȗ. Operative exploration and decompression of the peroneal nerve

Ș. Nerve conduction velocity studies

Ș. Loosening of the primary dressings and knee flexion to 30 degrees

Ț. I

Ț. II

Ȝ. III

Ȝ. decreased tissue tension

Ȟ. decreased abductor lever arm

Ȟ. decreased joint reaction force

Ƞ. increased body weight over lever arm

ȡ. increased polyethylene wear rate

Ȣ. recurrent traumatic anterior dislocation

Ȣ. recurrent traumatic posterior dislocation

Ȥ. traumatic subluxation with no previous dislocation

Ȥ. traumatic anterior subluxation

Ȧ. atraumatic involuntary subluxation

Ȧ. radial

Ȩ. axillary

Ȩ. suprascapular

Ȫ. thoracodorsal

Ȫ. long thoracic

Ȭ. Flexion

Ȭ. Extension

Ȯ. Axial rotation

Ȯ. Left lateral bending

Ȱ. Right lateral bending

Ȱ. Skin

Ȳ. Lung

Ȳ. Brain

ȴ. Heart

ȵ. Kidney

ȶ. Thoracoacromial, lateral thoracic, subscapular

ȷ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ȸ. Posterior humeral circumflex, subscapular, thoracacromial

ȹ. Subscapular, thoracacromial, anterior humeral circumflex

Ⱥ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȼ. Respondeat superior

Ȼ. Indemnity agreement

Ƚ. Hold harmless agreement- attempt to shift liability from company to physician

Ⱦ. Comparative negligence-% of involvement

Ȿ. Contributory negligence- resident contributed to the negligence

Ɀ. t-type

Ɂ. both column

Ɂ. transverse

Ƀ. anterior column

Ʉ. anterior column posterior hemitransverse

Ʌ. Posterior interosseous

Ɇ. Anterior interosseous

Ɇ. Radial

Ɉ. Median

Ɉ. Ulnar

Ɋ. Shock from hypovolemia

Ɋ. Associated rupture of the bladder

Ɍ. Arterial bleeding on pelvic angiogram

Ɍ. Presence of a hematoma in the perineum and scrotum

Ɏ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Secondary hyperparathyroidism

Menu

10. Pathology and Oncology MCQs

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Correct Answer & Explanation

Explanation

Test Yourself