A patient is in respiratory distress as a result of a high-speed motor vehicle accident. After emergent intubation, the arterial blood is poorly oxygenated, and examination shows left-sided tracheal

Correct Answer: Positive-pressure ventilation. Explanation:

A 40-year-old woman has had pain in the metatarsophal joint of the second toe for the past 6 months despite nonsurgical treatment. A dorsalplantar stress test reproduces the pain, and there is 10 mm

Correct Answer: Advancement of the plantar plate. Explanation:

A 25-year-old patient who was wearing a seat belt in the back chair of a car involved in a head-on collision undergoes a laparotomy. During surgery, an injury to the sigmoid colon is identified and t

Correct Answer: Sacral fracture. Explanation:

A 76-year-old woman who underwent primary total knee arthroplasty 9 months ago falls and sustains a transverse fracture of the proximal third of the patella that is displaced 5 mm. Although the knee

Correct Answer: cerclage wiring. Explanation:

A 35-year-old machinist sustains a crush injury to the forearm in an industrial accident. Figure 34 shows the arm following skeletal stabilization and fasciotomy. Wound closure is best accomplished b

Correct Answer: delayed primary closure. Explanation:

Figure 35 shows a postoperative radiograph of a femur fracture proximal to a total knee prosthesis that was treated by open reduction and blade plate fixation 9 months ago. What is the most likely re

Correct Answer: Infection. Explanation:

Figures 37a & 37b show radiographs of a right handed, 78 year old man who had painful G-H arthritis, moderate limitation of motion, and good strength prior to replacement of the humeral head 2 ye

Correct Answer: Infection. Explanation:

What is the primary reason for choosing a bone graft substitute rather than an autologous cancellous graft in the treatment of distal radius fractures with metaphyseal comminution and impaction?

Correct Answer: Reduced morbidity. Explanation:

A 50-year-old alcoholic man has erythema and swelling in his entire dominant upper extremity. He has a WBC of 15,000/mm3, a temp of 101 oF (38.3 oC), and a blood pressure of 90/60 mm Hg. After hemody

Correct Answer: Bacteroides. Explanation:

A 15-year-old girl has a thoracic kyphosis that causes mild pain. Examination reveals a sagittal curve measuring 55 degrees and wedging of the eighth through tenth vertebrae. The iliac apophyses are

Correct Answer: observation and exercises. Explanation:

A 75-year-old woman who has groin pain states that she had total hip arthroplasty 15 years ago. The radiograph shown in Figure 40 reveals that the left acetabular component is grossly loose. Revision

Correct Answer: constrained acetabular component. Explanation:

Clinic OS

Q: A 25-yo man sustains the injury shown in Figures 29a and 29b as a result of high-speed trauma. Examination reveals diffuse weakness in the lower extremities that is slightly worse on the right side,

Correct Answer: Posterior fusion at T10-L3 with segmental instrumentation. Explanation:

Q: The axial stability of a 4-pin uniplanar external fixator used to treat a patient who has a transverse midthird fracture of the tibia with a 5-mm fracture gap can be most greatly increased by

Correct Answer: Allowing the ends of the fracture to touch. Explanation:

Q: Figure 30 shows the current radiograph of a 32-year-old woman who had a giant cell tumor of the distal radius that was treated with curettage/burring and packed with polymethylmethacrylate 2 years ago

Correct Answer: Osteomyelitis. Explanation:

Q: A 65-year-old man undergoes total shoulder arthroplasty. Examination in the recovery room reveals the absence of voluntary deltoid and biceps contraction, weakness of wrist extension, and absence of s

Correct Answer: An MRI scan of the shoulder. Explanation:

Q: Lymphatic metastasis is a common feature of which of the following lesions?

Correct Answer: Liposarcoma. Explanation:

Q: Which of the following conditions is most commonly associated with the congenital hand problem shown in Figure 33?

Correct Answer: Clubfeet. Explanation:

Question 4161

Topic: 10. Pathology and Oncology

A 25-yo man sustains the injury shown in Figures 29a and 29b as a result of high-speed trauma. Examination reveals diffuse weakness in the lower extremities that is slightly worse on the right side, and decreased rectal tone and sensation. A CT scan is shown in figures 29c and 29d. Definitive treatment of the injury to the spine is delayed because of a severe pulmonary contusion. At 15 days after the injury, the patient’s neurological status remains unchanged. Management should now consist of

. 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

+. Rabdomyosarcoma

,. Malignant fibrous histiocytoma

-. Extra-abdominal desmoid tumor

.. Clubfeet

/. Thrombocytopenia

0. Congenital scoliosis

1. Ventricular septal defect

2. Arnold-Chiari malformation

3. delayed primary closure

4. free flap

5. pedicle groin flap

6. full-thickness skin graft

7. split-thickness skin graft

8. Infection

9. 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

A. Arthritis of the A-C joint

B. Reduced morbidity

C. Improved osteoinduction

D. Improved osteoconduction

E. More rapid revascularization

F. Lower risk of disease transmission

G. Manipulation Under Anesthesia

H. Arthroscopic acromioplasty

I. Arthroscopic debridement of G-H joint

J. Replacement of the humeral head

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

L. Bacteroides

M. E. coli

N. Staph. aureus

O. group A streptococcus

P. Clostridium perforingens

Q. observation and exercises

R. bracing with a thoracolumbar orthosis

S. fusion of the posterior spine

T. fusion of the anterior spine

U. fusion of the anterior and posterior spine

V. Total wrist replacement and bridge grafts

W. palmar shelf arthroplasty and tendon transfers

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

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

Z. 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

A. application of a hip spica under anesthesia

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

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

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

E. Loss of skin hair on the feet

F. Absent pulses on vascular examination

G. Pain that originates proximally and spreads distally

H. Pain that is relieved by stopping and standing

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

J. wrist flexors and finger flexors

K. elbow flexors and wrist flexors

L. elbow flexors and finger flexors

M. 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

N. elbow extensors and wrist extensors

O. Syndactyly

P. Macrodactyly

Q. Camptodactyly

R. Preaxial polydactyly

S. Postaxial polydactyly

T. Arthrodesis

U. Rotationplasty

V. Above-knee amputation

W. Osteoarticular allograft

X. Endoprosthesis (custom arthroplasty)

Y. Plantar fascia

Z. 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

¤. 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

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

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

ª. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

®. Two-stage surgical prosthetic exchange and IV antibiotics

¯. Resection arthroplasty and IV antibiotics

°. SCFE

±. MED

². Perthes disease

³. Hypothyroidism

´. Chondrolysis

Μ. gout.

¶. osteoporosis.

·. eosinophilic granuloma.

¸. tuberculosis of the spine.

¹. metastatic disease of the spine.

º. water content.

». Synthesis of type I collagen.

¼. Proteoglycan content.

½. Activity of chondrocytes.

¾. Synthesis of hyaluronate.

¿. Lung

À. Breast

Á. Prostate

Â. Thyroid

Ã. Renal

Ä. T1-low, T2-low.

Å. T1-low, T2-high.

Æ. T1-moderate, T2-low.

Ç. T1-high, T2-low.

È. T1-high, T2-high.

É. hypothesis is incorrect or invalid

Ê. interobserver error rate is 4%.

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

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

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

Î. I

Ï. II

Ð. IV

Ñ. IX

Ò. X

Ó. Cranial setting

Ô. Cranial subluxation

Õ. Odontoid fracture

Ö. Lysis of the arch of the atlas

×. Atlantoaxial subluxation

Ø. Retrograde collapse of the endoneurial tubes

Ù. Irreversible atrophy of the denervated muscles

Ú. Elongation of the axons across the zone of injury

Û. Sprouting of the axons at the neuromuscular junction

Ü. Misdirection of the axons across the zone of injury

Ý. Maximally pronated and elbow extended

Þ. Maximally pronated and the elbow flexed

SS. Maximally supinated and the elbow flexed

À. Maximally supinated and the elbow extended

Á. In neutral rotation, with the elbow extended

Â. open reduction and internal fixation

Ã. buddy taping to the adjacent index finger

Ä. early motion with application of a dynamic banjo splint

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

Æ. dorsal extension block splinting

Ç. The name of the manufacturer

È. The manufacturer’s potential liability

É. The physician’s clinical performance

Ê. The physician’s materials testing data

Ë. Any royalties the physician receives from the manufacturer

Ì. Femoral

Í. Obturator

Î. Inferior gluteal

Ï. Superior gluteal

Ð. Lateral femoral cutaneous

Ñ. open biopsy and a long leg cast

Ò. open biopsy and wide resection of the tumor

Ó. a long leg cast and observation

Ô. intramedullary stabilization and observation

Õ. Triggering

Ö. Lateral instability

÷. Swan-neck deformity

Ø. Boutonniere deformity

Ù. Loss of distal interphalangeal joint flexion

Ú. Peroneus brevis to peroneus longus

Û. Peroneus tertius to extensor hallucis longus

Ü. Peroneus tertius to superficial peroneal nerve

Ý. Extensor hallucis longus to deep peroneal nerve

Þ. Extensor hallucis longus to extensor digitorum longus

Ÿ. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ą. an onlay iliac crest bone graft.

Ą. limited weightbearing and observation.

Ć. removal of the implant and limited weightbearing.

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

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

Ĉ. Coronal

Ċ. Sagittal

Ċ. Anteromedial, midway between the sagittal and the coronal

Č. Proximal pins sagittal, distal pins coronal

Č. Proximal pins coronal, distal pins sagittal

Ď. Rheumatoid arthritis

Ď. Posttraumatic arthritis

Đ. Degenerative osteoarthritis

Đ. Osteonecrosis of the tibial plateau

Ē. Osteonecrosis of the medial femoral condyle

Ē. Trapeziometacarpal arthrodesis

Ĕ. Osteotomy of the thumb metacarpal

Ĕ. Arthrotomy and joint debridement

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

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

Ę. Creep

Ę. Relaxation

Ě. Energy dissipation

Ě. Plastic deformation

Ĝ. Elastic deformation

Ĝ. bending

Ğ. axial loading

Ğ. high-speed rotation

Ġ. direct impact from anteromedial

Ġ. crush from anteromedial to posterolateral

Ģ. Increase stiffness

Ģ. Increase fracture toughness

Ĥ. Increase fatigue strength

Ĥ. Decrease mechanical strength

Ħ. Decrease wear rate

Ħ. disuse osteopenia

Ĩ. paraendocrine effect of the tumor

Ĩ. abnormally increased density on the right side

Ī. side effect of the treatment of the lesion

Ī. extensive tumor involvement of the left hip

Ĭ. Sciatic nerve

Ĭ. Superior gluteal artery

Į. Profunda femoris artery

Į. Femoral artery and nerve

İ. External iliac artery and vein

I. Length

Ĳ. Moment arm

Ĳ. Total volume

Ĵ. Physiologic cross-sectional area

Ĵ. Distribution of slow and fast twitch fibers

Ķ. decreasing initiation of action potentials.

Ķ. increasing action potential amplitude.

ĸ. blocking the opening of gated sodium channels.

Ĺ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ŀ. hemiarthroplasty

Ł. open reduction and internal fixation

Ł. closed reduction and percutaneous pinning

Ń. a sling and early pedulum exercises

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

Ņ. open acromioplasty

Ņ. open Bankart repair

Ň. open subscapularis tendon repair

Ň. inferior capsular shift

ʼN. a supervised physical therapy program

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

Ŋ. open reduction and internal fixation through an anterior approach

Ō. open reduction and internal fixation through a posterior approach

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

Ŏ. arthroscopically assisted reduction and percutaneous screw fixation

Ŏ. Repair of the rotator cuff

Ő. Replacement of the humeral head

Ő. Resection arthroplasty

Œ. Total shoulder arthroplasty

Œ. AP and lateral radiographs of the elbow

Ŕ. Diagnositc arthroscopy

Ŕ. Aspiration of joint fluid

Ŗ. An erythrocyte sedimentation rate and CBC

Ŗ. A diagnostic lidocaine injection

Ř. Insulin-like growth factor (IGF-1)

Ř. Fibroblast growth factor (FGF-1)

Ś. Platelet-derived growth factor (PDGF)

Ś. Transforming growth factor beta (TGF-B)

Ŝ. Bone morphogenetic proteins (BMP)

Ŝ. clinical history and radiographic findings.

Ş. technetium bone scan

Ş. flow cytometry pattern of extracted chondrocytes

Š. immunohistochemical staining patterns of a biopsy specimen

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

Ţ. Radial

Ţ. Radial recurrent

Ť. Posterior interosseous

Ť. Superior ulnar recurrent

Ŧ. Superficial radial circumflex

Ŧ. Impaired hydroxylation of proline

Ũ. Failure of cleavage in procollagen

Ũ. Defective binding sites for hydroxyproline

Ū. Failure to incorporate glycine into the helix

Ū. Diminished production of collagen through the rough endoplasmic reticulum

Ŭ. Asking the legal staff to seek a court injunction

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

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

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

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

Ű. Meta-analysis

Ų. Confidence interval

Ų. Analysis of variance (ANOVA)

Ŵ. Statistical significance (p-value)

Ŵ. Survivorship analysis (Kaplan-Meier)

Ŷ. Spinal shock

Ŷ. Neurogenic shock

Ÿ. Hypovolemic shock

Ź. Pulmonary embolism

Ź. Fat embolus syndrome

Ż. Lumbar spinal stenosis

Ż. Metastatic disease of the spine

Ž. Rheumatoid lumbar spondylitis

Ž. Isthmic spondyloloisthesis

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

Ƀ. Patella alta

Ɓ. A metal-backed patella

Ƃ. Varus malalignment of the knee

Ƃ. A posterior cruciate-substituting femoral component

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

Ƅ. The sesamoids are separated

Ɔ. The sesamoid is fractured

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

Ƈ. The dislocation is dorsal and centered

Ɖ. The proximal phalanx is hyperextended

Ɗ. Patella

Ƌ. Tibial stem

Ƌ. Distal femoral interface

ƍ. Posterior femoral interface

Ǝ. Sites of screw fixation for the tibia

Ə. Hallux rigidus

Ɛ. Fracture of the sesamoid

Ƒ. Disruption of the plantar plate

Ƒ. Osteonecrosis of the metatarsal head

Ɠ. Rupture of the flexor hallucis longus

Ɣ. Gout

Ƕ. Sepsis

Ɩ. Old trauma

Ɨ. Rheumatoid arthritis

Ƙ. Charcot arthroplasty

Ƙ. Aspiration and steroid injection

Ƚ. Biopsy, curettage, and allograft bone grafting

ƛ. Percutaneous Kirschner wire fixation

Ɯ. Percutaneous injection of autogenous bone marrow

Ɲ. Nerve roots

Ƞ. Spinal cord

Ɵ. Sciatic nerve

Ơ. Peroneal nerve

Ơ. Conus medullaris

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

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

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

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

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

Ƨ. Early and late infection

Ƨ. Periprosthetic fracture of the femur

Ʃ. Failure of the patellofemoral and extensor mechanisms

ƪ. Aseptic loosening of cementing tibial components

ƫ. Asceptic loosening of cemented femoral components

Ƭ. Acceptance of the current position of the ankle

Ƭ. Open reduction and fixation in the epiphysis only

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

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

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

Ʊ. Resection arthroplasty and local radiation

Ʋ. In situ fusion of the hip

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

Ƴ. Excision of heterotopic bone and local radiation

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

Ƶ. Closed reduction of both fractures and immediate spica casting

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

Ƹ. External fixation of both femora

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

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

ƻ. Synovial sarcoma

Ƽ. Soft-tissue abcess

Ƽ. Rhabdomyosarcoma

ƾ. Eosinophilic granuloma

Ƿ. Nodular pigmented villonodular synovitis

ǀ. Changing to a titanium nail

ǁ. Changing to a nonslotted nail

ǂ. Changing the cross-sectional shape of the nail

ǃ. Increasing the diameter of the nail by 3 mm

Ǆ. Increasing the diameter of the interlocking screws

Ǆ. Fracture healing

Ǆ. Chondrosarcoma

Ǉ. Periosteal chondroma

Ǉ. Periosteal osteosarcoma

Ǉ. Dysplasia epiphysealis hemimelica

Ǌ. Demonstrate competence in the subject of the case

Ǌ. Be fellowship trained in the subject of the case

Ǌ. Be paid on a contingency basis

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

Ǎ. Have been involved in the case as a consultant

Ǐ. Diagnostic arthroscopy

Ǐ. Arthroscopy and subacromial decompression

Ǒ. Reduction and fixation of the proximal humeral epiphysis

Ǒ. Temporary cessation of throwing

Ǔ. Physical therapy for rotator cuff strengthening

Ǔ. Oblique popliteal ligament

Ǖ. Lateral capsule

Ǖ. Popliteal tendon

Ǘ. Fibular collateral ligament

Ǘ. Posterior oblique ligament

Ǚ. Radial tear

Ǚ. Parrot-beak tear

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

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

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

Ǟ. 0 degrees of abduction, with neural rotation

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

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

Ǡ. 90 degrees of abduction with neutral rotation

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

Ǣ. Sural

Ǥ. Saphenous and its branches

Ǥ. Posterior tibial and its branches

Ǧ. Deep peroneal and its branches

Ǧ. Superficial peroneal and its branches

Ǩ. Strength

Ǩ. Stiffness

Ǫ. Shelf life

Ǫ. Antigenicity

Ǭ. Risk of HIV transmission

Ǭ. Indemnification

Ǯ. Occurrence

Ǯ. Excess liability

J̌. Claims-made

Ǳ. Nose

Ǳ. Lateral Y

Ǳ. Scapular AP

Ǵ. Neutral rotation AP

Ǵ. Internal rotation AP

Ƕ. External rotation AP

Ƿ. Trauma

Ǹ. Hemophilia

Ǹ. Reiter’s syndrome

Ǻ. Rheumatoid arthritis

Ǻ. Systemic lupus erythematosus

Ǽ. Cast immobilization for 6 weeks

Ǽ. Activity modification and re-evaluation in 2 months

Ǿ. Internal fixation with or without bone grafting

Ǿ. Retrograde drilling of the defect without articular cartilage penetration

Ȁ. Drilling of the defect directly through the articular cartilage

Ȁ. repair or reconstruction of the medial collateral ligament

Ȃ. repair or reconstruction of the medialand lateral collateral ligaments

Ȃ. immobilization for 5 days or less

Ȅ. immobilization for 14 days

Ȅ. immobilization for 25 days

Ȇ. Cystinosis

Ȇ. Hypophosphatemia

Ȉ. Renal osteodystrophy

Ȉ. Primary hyperparathyroidism

Ȋ. Nutritional vitamin D deficiency

Ȋ. Lateral meniscus tear

Ȍ. Popliteus tenosynovitis

Ȍ. Iliotibial band friction syndrome

Ȏ. Peroneal nerve entrapment

Ȏ. Biceps tendinitis

Ȑ. Observation

Ȑ. Removal of the prosthetic components

Ȓ. Operative exploration and decompression of the peroneal nerve

Ȓ. Nerve conduction velocity studies

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

Ȕ. I

Ȗ. II

Ȗ. III

Ș. decreased tissue tension

Ș. decreased abductor lever arm

Ț. decreased joint reaction force

Ț. increased body weight over lever arm

Ȝ. increased polyethylene wear rate

Ȝ. recurrent traumatic anterior dislocation

Ȟ. recurrent traumatic posterior dislocation

Ȟ. traumatic subluxation with no previous dislocation

Ƞ. traumatic anterior subluxation

ȡ. atraumatic involuntary subluxation

Ȣ. radial

Ȣ. axillary

Ȥ. suprascapular

Ȥ. thoracodorsal

Ȧ. long thoracic

Ȧ. Flexion

Ȩ. Extension

Ȩ. Axial rotation

Ȫ. Left lateral bending

Ȫ. Right lateral bending

Ȭ. Skin

Ȭ. Lung

Ȯ. Brain

Ȯ. Heart

Ȱ. Kidney

Ȱ. Thoracoacromial, lateral thoracic, subscapular

Ȳ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȳ. Posterior humeral circumflex, subscapular, thoracacromial

ȴ. Subscapular, thoracacromial, anterior humeral circumflex

ȵ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ȶ. Respondeat superior

ȷ. Indemnity agreement

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

ȹ. Comparative negligence-% of involvement

Ⱥ. Contributory negligence- resident contributed to the negligence

Ȼ. t-type

Ȼ. both column

Ƚ. transverse

Ⱦ. anterior column

Ȿ. anterior column posterior hemitransverse

Ɀ. Posterior interosseous

Ɂ. Anterior interosseous

Ɂ. Radial

Ƀ. Median

Ʉ. Ulnar

Ʌ. Shock from hypovolemia

Ɇ. Associated rupture of the bladder

Ɇ. Arterial bleeding on pelvic angiogram

Ɉ. Presence of a hematoma in the perineum and scrotum

Ɉ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Posterior fusion at T10-L3 with segmental instrumentation

Explanation

Question 4162

Topic: 10. Pathology and Oncology

A patient is in respiratory distress as a result of a high-speed motor vehicle accident. After emergent intubation, the arterial blood is poorly oxygenated, and examination shows left-sided tracheal deviation, absence of breath sounds on the right side and tympany on percussion over the right side of the chest. Management should include

. 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

&. Rabdomyosarcoma

'. Malignant fibrous histiocytoma

(. Extra-abdominal desmoid tumor

). Clubfeet

*. Thrombocytopenia

+. Congenital scoliosis

,. Ventricular septal defect

-. Arnold-Chiari malformation

.. delayed primary closure

/. free flap

0. pedicle groin flap

1. full-thickness skin graft

2. split-thickness skin graft

3. Infection

4. Nonunion

5. Improper screw length

6. Osteonecrosis of the distal fragment

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

8. Infection

9. 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

A. Lower risk of disease transmission

B. Manipulation Under Anesthesia

C. Arthroscopic acromioplasty

D. Arthroscopic debridement of G-H joint

E. Replacement of the humeral head

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

G. Bacteroides

H. E. coli

I. Staph. aureus

J. group A streptococcus

K. Clostridium perforingens

L. observation and exercises

M. bracing with a thoracolumbar orthosis

N. fusion of the posterior spine

O. fusion of the anterior spine

P. fusion of the anterior and posterior spine

Q. Total wrist replacement and bridge grafts

R. palmar shelf arthroplasty and tendon transfers

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

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

U. Total wrist fusion and tendon transfers

V. constrained acetabular component

W. protrusion ring with morselized graft

X. cemented metal backed acetabular component

Y. cemented all-polyethylene acetabular component

Z. 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

A. Absent pulses on vascular examination

B. Pain that originates proximally and spreads distally

C. Pain that is relieved by stopping and standing

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

E. wrist flexors and finger flexors

F. elbow flexors and wrist flexors

G. elbow flexors and finger flexors

H. 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

I. elbow extensors and wrist extensors

J. Syndactyly

K. Macrodactyly

L. Camptodactyly

M. Preaxial polydactyly

N. Postaxial polydactyly

O. Arthrodesis

P. Rotationplasty

Q. Above-knee amputation

R. Osteoarticular allograft

S. Endoprosthesis (custom arthroplasty)

T. Plantar fascia

U. Spring ligament

V. Deltoid ligament

W. Intrinsic tendons

X. Gastorcnemius-solelus complex

Y. Prevention of presynaptic release of acetylcholine

Z. 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

. 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

£. 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

¨. Immediate exchange arthroplasty with antibiotic-impregnated cement

©. Two-stage surgical prosthetic exchange and IV antibiotics

ª. Resection arthroplasty and IV antibiotics

«. SCFE

¬. MED

. Perthes disease

®. Hypothyroidism

¯. Chondrolysis

°. gout.

±. osteoporosis.

². eosinophilic granuloma.

³. tuberculosis of the spine.

´. metastatic disease of the spine.

Μ. water content.

¶. Synthesis of type I collagen.

·. Proteoglycan content.

¸. Activity of chondrocytes.

¹. Synthesis of hyaluronate.

º. Lung

». Breast

¼. Prostate

½. Thyroid

¾. Renal

¿. T1-low, T2-low.

À. T1-low, T2-high.

Á. T1-moderate, T2-low.

Â. T1-high, T2-low.

Ã. T1-high, T2-high.

Ä. hypothesis is incorrect or invalid

Å. interobserver error rate is 4%.

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

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

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

É. I

Ê. II

Ë. IV

Ì. IX

Í. X

Î. Cranial setting

Ï. Cranial subluxation

Ð. Odontoid fracture

Ñ. Lysis of the arch of the atlas

Ò. Atlantoaxial subluxation

Ó. Retrograde collapse of the endoneurial tubes

Ô. Irreversible atrophy of the denervated muscles

Õ. Elongation of the axons across the zone of injury

Ö. Sprouting of the axons at the neuromuscular junction

×. Misdirection of the axons across the zone of injury

Ø. Maximally pronated and elbow extended

Ù. Maximally pronated and the elbow flexed

Ú. Maximally supinated and the elbow flexed

Û. Maximally supinated and the elbow extended

Ü. In neutral rotation, with the elbow extended

Ý. open reduction and internal fixation

Þ. buddy taping to the adjacent index finger

SS. early motion with application of a dynamic banjo splint

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

Á. dorsal extension block splinting

Â. The name of the manufacturer

Ã. The manufacturer’s potential liability

Ä. The physician’s clinical performance

Å. The physician’s materials testing data

Æ. Any royalties the physician receives from the manufacturer

Ç. Femoral

È. Obturator

É. Inferior gluteal

Ê. Superior gluteal

Ë. Lateral femoral cutaneous

Ì. open biopsy and a long leg cast

Í. open biopsy and wide resection of the tumor

Î. a long leg cast and observation

Ï. intramedullary stabilization and observation

Ð. Triggering

Ñ. Lateral instability

Ò. Swan-neck deformity

Ó. Boutonniere deformity

Ô. Loss of distal interphalangeal joint flexion

Õ. Peroneus brevis to peroneus longus

Ö. Peroneus tertius to extensor hallucis longus

÷. Peroneus tertius to superficial peroneal nerve

Ø. Extensor hallucis longus to deep peroneal nerve

Ù. Extensor hallucis longus to extensor digitorum longus

Ú. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ÿ. an onlay iliac crest bone graft.

Ā. limited weightbearing and observation.

Ā. removal of the implant and limited weightbearing.

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

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

Ą. Coronal

Ą. Sagittal

Ć. Anteromedial, midway between the sagittal and the coronal

Ć. Proximal pins sagittal, distal pins coronal

Ĉ. Proximal pins coronal, distal pins sagittal

Ĉ. Rheumatoid arthritis

Ċ. Posttraumatic arthritis

Ċ. Degenerative osteoarthritis

Č. Osteonecrosis of the tibial plateau

Č. Osteonecrosis of the medial femoral condyle

Ď. Trapeziometacarpal arthrodesis

Ď. Osteotomy of the thumb metacarpal

Đ. Arthrotomy and joint debridement

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

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

Ē. Creep

Ĕ. Relaxation

Ĕ. Energy dissipation

Ė. Plastic deformation

Ė. Elastic deformation

Ę. bending

Ę. axial loading

Ě. high-speed rotation

Ě. direct impact from anteromedial

Ĝ. crush from anteromedial to posterolateral

Ĝ. Increase stiffness

Ğ. Increase fracture toughness

Ğ. Increase fatigue strength

Ġ. Decrease mechanical strength

Ġ. Decrease wear rate

Ģ. disuse osteopenia

Ģ. paraendocrine effect of the tumor

Ĥ. abnormally increased density on the right side

Ĥ. side effect of the treatment of the lesion

Ħ. extensive tumor involvement of the left hip

Ħ. Sciatic nerve

Ĩ. Superior gluteal artery

Ĩ. Profunda femoris artery

Ī. Femoral artery and nerve

Ī. External iliac artery and vein

Ĭ. Length

Ĭ. Moment arm

Į. Total volume

Į. Physiologic cross-sectional area

İ. Distribution of slow and fast twitch fibers

I. decreasing initiation of action potentials.

Ĳ. increasing action potential amplitude.

Ĳ. blocking the opening of gated sodium channels.

Ĵ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ļ. hemiarthroplasty

Ļ. open reduction and internal fixation

Ľ. closed reduction and percutaneous pinning

Ľ. a sling and early pedulum exercises

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

Ŀ. open acromioplasty

Ł. open Bankart repair

Ł. open subscapularis tendon repair

Ń. inferior capsular shift

Ń. a supervised physical therapy program

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

Ņ. open reduction and internal fixation through an anterior approach

Ň. open reduction and internal fixation through a posterior approach

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

ʼN. arthroscopically assisted reduction and percutaneous screw fixation

Ŋ. Repair of the rotator cuff

Ŋ. Replacement of the humeral head

Ō. Resection arthroplasty

Ō. Total shoulder arthroplasty

Ŏ. AP and lateral radiographs of the elbow

Ŏ. Diagnositc arthroscopy

Ő. Aspiration of joint fluid

Ő. An erythrocyte sedimentation rate and CBC

Œ. A diagnostic lidocaine injection

Œ. Insulin-like growth factor (IGF-1)

Ŕ. Fibroblast growth factor (FGF-1)

Ŕ. Platelet-derived growth factor (PDGF)

Ŗ. Transforming growth factor beta (TGF-B)

Ŗ. Bone morphogenetic proteins (BMP)

Ř. clinical history and radiographic findings.

Ř. technetium bone scan

Ś. flow cytometry pattern of extracted chondrocytes

Ś. immunohistochemical staining patterns of a biopsy specimen

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

Ŝ. Radial

Ş. Radial recurrent

Ş. Posterior interosseous

Š. Superior ulnar recurrent

Š. Superficial radial circumflex

Ţ. Impaired hydroxylation of proline

Ţ. Failure of cleavage in procollagen

Ť. Defective binding sites for hydroxyproline

Ť. Failure to incorporate glycine into the helix

Ŧ. Diminished production of collagen through the rough endoplasmic reticulum

Ŧ. Asking the legal staff to seek a court injunction

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

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

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

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

Ŭ. Meta-analysis

Ŭ. Confidence interval

Ů. Analysis of variance (ANOVA)

Ů. Statistical significance (p-value)

Ű. Survivorship analysis (Kaplan-Meier)

Ű. Spinal shock

Ų. Neurogenic shock

Ų. Hypovolemic shock

Ŵ. Pulmonary embolism

Ŵ. Fat embolus syndrome

Ŷ. Lumbar spinal stenosis

Ŷ. Metastatic disease of the spine

Ÿ. Rheumatoid lumbar spondylitis

Ź. Isthmic spondyloloisthesis

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

Ż. Patella alta

Ż. A metal-backed patella

Ž. Varus malalignment of the knee

Ž. A posterior cruciate-substituting femoral component

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

Ƀ. The sesamoids are separated

Ɓ. The sesamoid is fractured

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

Ƃ. The dislocation is dorsal and centered

Ƅ. The proximal phalanx is hyperextended

Ƅ. Patella

Ɔ. Tibial stem

Ƈ. Distal femoral interface

Ƈ. Posterior femoral interface

Ɖ. Sites of screw fixation for the tibia

Ɗ. Hallux rigidus

Ƌ. Fracture of the sesamoid

Ƌ. Disruption of the plantar plate

ƍ. Osteonecrosis of the metatarsal head

Ǝ. Rupture of the flexor hallucis longus

Ə. Gout

Ɛ. Sepsis

Ƒ. Old trauma

Ƒ. Rheumatoid arthritis

Ɠ. Charcot arthroplasty

Ɣ. Aspiration and steroid injection

Ƕ. Biopsy, curettage, and allograft bone grafting

Ɩ. Percutaneous Kirschner wire fixation

Ɨ. Percutaneous injection of autogenous bone marrow

Ƙ. Nerve roots

Ƙ. Spinal cord

Ƚ. Sciatic nerve

ƛ. Peroneal nerve

Ɯ. Conus medullaris

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

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

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

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

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

Ƣ. Early and late infection

Ƣ. Periprosthetic fracture of the femur

Ƥ. Failure of the patellofemoral and extensor mechanisms

Ƥ. Aseptic loosening of cementing tibial components

Ʀ. Asceptic loosening of cemented femoral components

Ƨ. Acceptance of the current position of the ankle

Ƨ. Open reduction and fixation in the epiphysis only

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

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

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

Ƭ. Resection arthroplasty and local radiation

Ƭ. In situ fusion of the hip

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

Ư. Excision of heterotopic bone and local radiation

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

Ʊ. Closed reduction of both fractures and immediate spica casting

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

Ƴ. External fixation of both femora

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

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

Ƶ. Synovial sarcoma

Ʒ. Soft-tissue abcess

Ƹ. Rhabdomyosarcoma

Ƹ. Eosinophilic granuloma

ƺ. Nodular pigmented villonodular synovitis

ƻ. Changing to a titanium nail

Ƽ. Changing to a nonslotted nail

Ƽ. Changing the cross-sectional shape of the nail

ƾ. Increasing the diameter of the nail by 3 mm

Ƿ. Increasing the diameter of the interlocking screws

ǀ. Fracture healing

ǁ. Chondrosarcoma

ǂ. Periosteal chondroma

ǃ. Periosteal osteosarcoma

Ǆ. Dysplasia epiphysealis hemimelica

Ǆ. Demonstrate competence in the subject of the case

Ǆ. Be fellowship trained in the subject of the case

Ǉ. Be paid on a contingency basis

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

Ǉ. Have been involved in the case as a consultant

Ǌ. Diagnostic arthroscopy

Ǌ. Arthroscopy and subacromial decompression

Ǌ. Reduction and fixation of the proximal humeral epiphysis

Ǎ. Temporary cessation of throwing

Ǎ. Physical therapy for rotator cuff strengthening

Ǐ. Oblique popliteal ligament

Ǐ. Lateral capsule

Ǒ. Popliteal tendon

Ǒ. Fibular collateral ligament

Ǔ. Posterior oblique ligament

Ǔ. Radial tear

Ǖ. Parrot-beak tear

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

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

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

Ǚ. 0 degrees of abduction, with neural rotation

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

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

Ǜ. 90 degrees of abduction with neutral rotation

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

Ǟ. Sural

Ǟ. Saphenous and its branches

Ǡ. Posterior tibial and its branches

Ǡ. Deep peroneal and its branches

Ǣ. Superficial peroneal and its branches

Ǣ. Strength

Ǥ. Stiffness

Ǥ. Shelf life

Ǧ. Antigenicity

Ǧ. Risk of HIV transmission

Ǩ. Indemnification

Ǩ. Occurrence

Ǫ. Excess liability

Ǫ. Claims-made

Ǭ. Nose

Ǭ. Lateral Y

Ǯ. Scapular AP

Ǯ. Neutral rotation AP

J̌. Internal rotation AP

Ǳ. External rotation AP

Ǳ. Trauma

Ǳ. Hemophilia

Ǵ. Reiter’s syndrome

Ǵ. Rheumatoid arthritis

Ƕ. Systemic lupus erythematosus

Ƿ. Cast immobilization for 6 weeks

Ǹ. Activity modification and re-evaluation in 2 months

Ǹ. Internal fixation with or without bone grafting

Ǻ. Retrograde drilling of the defect without articular cartilage penetration

Ǻ. Drilling of the defect directly through the articular cartilage

Ǽ. repair or reconstruction of the medial collateral ligament

Ǽ. repair or reconstruction of the medialand lateral collateral ligaments

Ǿ. immobilization for 5 days or less

Ǿ. immobilization for 14 days

Ȁ. immobilization for 25 days

Ȁ. Cystinosis

Ȃ. Hypophosphatemia

Ȃ. Renal osteodystrophy

Ȅ. Primary hyperparathyroidism

Ȅ. Nutritional vitamin D deficiency

Ȇ. Lateral meniscus tear

Ȇ. Popliteus tenosynovitis

Ȉ. Iliotibial band friction syndrome

Ȉ. Peroneal nerve entrapment

Ȋ. Biceps tendinitis

Ȋ. Observation

Ȍ. Removal of the prosthetic components

Ȍ. Operative exploration and decompression of the peroneal nerve

Ȏ. Nerve conduction velocity studies

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

Ȑ. I

Ȑ. II

Ȓ. III

Ȓ. decreased tissue tension

Ȕ. decreased abductor lever arm

Ȕ. decreased joint reaction force

Ȗ. increased body weight over lever arm

Ȗ. increased polyethylene wear rate

Ș. recurrent traumatic anterior dislocation

Ș. recurrent traumatic posterior dislocation

Ț. traumatic subluxation with no previous dislocation

Ț. traumatic anterior subluxation

Ȝ. atraumatic involuntary subluxation

Ȝ. radial

Ȟ. axillary

Ȟ. suprascapular

Ƞ. thoracodorsal

ȡ. long thoracic

Ȣ. Flexion

Ȣ. Extension

Ȥ. Axial rotation

Ȥ. Left lateral bending

Ȧ. Right lateral bending

Ȧ. Skin

Ȩ. Lung

Ȩ. Brain

Ȫ. Heart

Ȫ. Kidney

Ȭ. Thoracoacromial, lateral thoracic, subscapular

Ȭ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȯ. Posterior humeral circumflex, subscapular, thoracacromial

Ȯ. Subscapular, thoracacromial, anterior humeral circumflex

Ȱ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȱ. Respondeat superior

Ȳ. Indemnity agreement

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

ȴ. Comparative negligence-% of involvement

ȵ. Contributory negligence- resident contributed to the negligence

ȶ. t-type

ȷ. both column

ȸ. transverse

ȹ. anterior column

Ⱥ. anterior column posterior hemitransverse

Ȼ. Posterior interosseous

Ȼ. Anterior interosseous

Ƚ. Radial

Ⱦ. Median

Ȿ. Ulnar

Ɀ. Shock from hypovolemia

Ɂ. Associated rupture of the bladder

Ɂ. Arterial bleeding on pelvic angiogram

Ƀ. Presence of a hematoma in the perineum and scrotum

Ʉ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Positive-pressure ventilation

Explanation

Question 4163

Topic: 10. Pathology and Oncology

The axial stability of a 4-pin uniplanar external fixator used to treat a patient who has a transverse midthird fracture of the tibia with a 5-mm fracture gap can be most greatly increased by

. 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

!. 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

0. Improper screw length

1. Osteonecrosis of the distal fragment

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

3. Infection

4. Tear of the rotator cuff

5. Loosening of the humeral component

6. Arthritis of the glenoid

7. Arthritis of the A-C joint

8. Reduced morbidity

9. 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

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

B. Bacteroides

C. E. coli

D. Staph. aureus

E. group A streptococcus

F. Clostridium perforingens

G. observation and exercises

H. bracing with a thoracolumbar orthosis

I. fusion of the posterior spine

J. fusion of the anterior spine

K. fusion of the anterior and posterior spine

L. Total wrist replacement and bridge grafts

M. palmar shelf arthroplasty and tendon transfers

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

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

P. Total wrist fusion and tendon transfers

Q. constrained acetabular component

R. protrusion ring with morselized graft

S. cemented metal backed acetabular component

T. cemented all-polyethylene acetabular component

U. cementless hemispherical component with screw fixation

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

W. application of a hip spica under anesthesia

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

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

Z. 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

A. elbow flexors and wrist flexors

B. elbow flexors and finger flexors

C. 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

D. elbow extensors and wrist extensors

E. Syndactyly

F. Macrodactyly

G. Camptodactyly

H. Preaxial polydactyly

I. Postaxial polydactyly

J. Arthrodesis

K. Rotationplasty

L. Above-knee amputation

M. Osteoarticular allograft

N. Endoprosthesis (custom arthroplasty)

O. Plantar fascia

P. Spring ligament

Q. Deltoid ligament

R. Intrinsic tendons

S. Gastorcnemius-solelus complex

T. Prevention of presynaptic release of acetylcholine

U. Prevention of synthesis of presynaptic acetylcholine

V. Activation of acetylcholinesterase at the motor end-plate

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

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

Y. stiffness of the femoral component.

Z. 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

. 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

. 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

£. Immediate exchange arthroplasty with antibiotic-impregnated cement

¤. Two-stage surgical prosthetic exchange and IV antibiotics

¥. Resection arthroplasty and IV antibiotics

¦. SCFE

§. MED

¨. Perthes disease

©. Hypothyroidism

ª. Chondrolysis

«. gout.

¬. osteoporosis.

. eosinophilic granuloma.

®. tuberculosis of the spine.

¯. metastatic disease of the spine.

°. water content.

±. Synthesis of type I collagen.

². Proteoglycan content.

³. Activity of chondrocytes.

´. Synthesis of hyaluronate.

Μ. Lung

¶. Breast

·. Prostate

¸. Thyroid

¹. Renal

º. T1-low, T2-low.

». T1-low, T2-high.

¼. T1-moderate, T2-low.

½. T1-high, T2-low.

¾. T1-high, T2-high.

¿. hypothesis is incorrect or invalid

À. interobserver error rate is 4%.

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

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

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

Ä. I

Å. II

Æ. IV

Ç. IX

È. X

É. Cranial setting

Ê. Cranial subluxation

Ë. Odontoid fracture

Ì. Lysis of the arch of the atlas

Í. Atlantoaxial subluxation

Î. Retrograde collapse of the endoneurial tubes

Ï. Irreversible atrophy of the denervated muscles

Ð. Elongation of the axons across the zone of injury

Ñ. Sprouting of the axons at the neuromuscular junction

Ò. Misdirection of the axons across the zone of injury

Ó. Maximally pronated and elbow extended

Ô. Maximally pronated and the elbow flexed

Õ. Maximally supinated and the elbow flexed

Ö. Maximally supinated and the elbow extended

×. In neutral rotation, with the elbow extended

Ø. open reduction and internal fixation

Ù. buddy taping to the adjacent index finger

Ú. early motion with application of a dynamic banjo splint

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

Ü. dorsal extension block splinting

Ý. The name of the manufacturer

Þ. The manufacturer’s potential liability

SS. The physician’s clinical performance

À. The physician’s materials testing data

Á. Any royalties the physician receives from the manufacturer

Â. Femoral

Ã. Obturator

Ä. Inferior gluteal

Å. Superior gluteal

Æ. Lateral femoral cutaneous

Ç. open biopsy and a long leg cast

È. open biopsy and wide resection of the tumor

É. a long leg cast and observation

Ê. intramedullary stabilization and observation

Ë. Triggering

Ì. Lateral instability

Í. Swan-neck deformity

Î. Boutonniere deformity

Ï. Loss of distal interphalangeal joint flexion

Ð. Peroneus brevis to peroneus longus

Ñ. Peroneus tertius to extensor hallucis longus

Ò. Peroneus tertius to superficial peroneal nerve

Ó. Extensor hallucis longus to deep peroneal nerve

Ô. Extensor hallucis longus to extensor digitorum longus

Õ. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ú. an onlay iliac crest bone graft.

Û. limited weightbearing and observation.

Ü. removal of the implant and limited weightbearing.

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

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

Ÿ. Coronal

Ā. Sagittal

Ā. Anteromedial, midway between the sagittal and the coronal

Ă. Proximal pins sagittal, distal pins coronal

Ă. Proximal pins coronal, distal pins sagittal

Ą. Rheumatoid arthritis

Ą. Posttraumatic arthritis

Ć. Degenerative osteoarthritis

Ć. Osteonecrosis of the tibial plateau

Ĉ. Osteonecrosis of the medial femoral condyle

Ĉ. Trapeziometacarpal arthrodesis

Ċ. Osteotomy of the thumb metacarpal

Ċ. Arthrotomy and joint debridement

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

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

Ď. Creep

Ď. Relaxation

Đ. Energy dissipation

Đ. Plastic deformation

Ē. Elastic deformation

Ē. bending

Ĕ. axial loading

Ĕ. high-speed rotation

Ė. direct impact from anteromedial

Ė. crush from anteromedial to posterolateral

Ę. Increase stiffness

Ę. Increase fracture toughness

Ě. Increase fatigue strength

Ě. Decrease mechanical strength

Ĝ. Decrease wear rate

Ĝ. disuse osteopenia

Ğ. paraendocrine effect of the tumor

Ğ. abnormally increased density on the right side

Ġ. side effect of the treatment of the lesion

Ġ. extensive tumor involvement of the left hip

Ģ. Sciatic nerve

Ģ. Superior gluteal artery

Ĥ. Profunda femoris artery

Ĥ. Femoral artery and nerve

Ħ. External iliac artery and vein

Ħ. Length

Ĩ. Moment arm

Ĩ. Total volume

Ī. Physiologic cross-sectional area

Ī. Distribution of slow and fast twitch fibers

Ĭ. decreasing initiation of action potentials.

Ĭ. increasing action potential amplitude.

Į. blocking the opening of gated sodium channels.

Į. decreasing the number of functional motor units.

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

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

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

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

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

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

Ķ. hemiarthroplasty

Ķ. open reduction and internal fixation

ĸ. closed reduction and percutaneous pinning

Ĺ. a sling and early pedulum exercises

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

Ļ. open acromioplasty

Ļ. open Bankart repair

Ľ. open subscapularis tendon repair

Ľ. inferior capsular shift

Ŀ. a supervised physical therapy program

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

Ł. open reduction and internal fixation through an anterior approach

Ł. open reduction and internal fixation through a posterior approach

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

Ń. arthroscopically assisted reduction and percutaneous screw fixation

Ņ. Repair of the rotator cuff

Ņ. Replacement of the humeral head

Ň. Resection arthroplasty

Ň. Total shoulder arthroplasty

ʼN. AP and lateral radiographs of the elbow

Ŋ. Diagnositc arthroscopy

Ŋ. Aspiration of joint fluid

Ō. An erythrocyte sedimentation rate and CBC

Ō. A diagnostic lidocaine injection

Ŏ. Insulin-like growth factor (IGF-1)

Ŏ. Fibroblast growth factor (FGF-1)

Ő. Platelet-derived growth factor (PDGF)

Ő. Transforming growth factor beta (TGF-B)

Œ. Bone morphogenetic proteins (BMP)

Œ. clinical history and radiographic findings.

Ŕ. technetium bone scan

Ŕ. flow cytometry pattern of extracted chondrocytes

Ŗ. immunohistochemical staining patterns of a biopsy specimen

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

Ř. Radial

Ř. Radial recurrent

Ś. Posterior interosseous

Ś. Superior ulnar recurrent

Ŝ. Superficial radial circumflex

Ŝ. Impaired hydroxylation of proline

Ş. Failure of cleavage in procollagen

Ş. Defective binding sites for hydroxyproline

Š. Failure to incorporate glycine into the helix

Š. Diminished production of collagen through the rough endoplasmic reticulum

Ţ. Asking the legal staff to seek a court injunction

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

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

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

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

Ŧ. Meta-analysis

Ũ. Confidence interval

Ũ. Analysis of variance (ANOVA)

Ū. Statistical significance (p-value)

Ū. Survivorship analysis (Kaplan-Meier)

Ŭ. Spinal shock

Ŭ. Neurogenic shock

Ů. Hypovolemic shock

Ů. Pulmonary embolism

Ű. Fat embolus syndrome

Ű. Lumbar spinal stenosis

Ų. Metastatic disease of the spine

Ų. Rheumatoid lumbar spondylitis

Ŵ. Isthmic spondyloloisthesis

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

Ŷ. Patella alta

Ŷ. A metal-backed patella

Ÿ. Varus malalignment of the knee

Ź. A posterior cruciate-substituting femoral component

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

Ż. The sesamoids are separated

Ż. The sesamoid is fractured

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

Ž. The dislocation is dorsal and centered

S. The proximal phalanx is hyperextended

Ƀ. Patella

Ɓ. Tibial stem

Ƃ. Distal femoral interface

Ƃ. Posterior femoral interface

Ƅ. Sites of screw fixation for the tibia

Ƅ. Hallux rigidus

Ɔ. Fracture of the sesamoid

Ƈ. Disruption of the plantar plate

Ƈ. Osteonecrosis of the metatarsal head

Ɖ. Rupture of the flexor hallucis longus

Ɗ. Gout

Ƌ. Sepsis

Ƌ. Old trauma

ƍ. Rheumatoid arthritis

Ǝ. Charcot arthroplasty

Ə. Aspiration and steroid injection

Ɛ. Biopsy, curettage, and allograft bone grafting

Ƒ. Percutaneous Kirschner wire fixation

Ƒ. Percutaneous injection of autogenous bone marrow

Ɠ. Nerve roots

Ɣ. Spinal cord

Ƕ. Sciatic nerve

Ɩ. Peroneal nerve

Ɨ. Conus medullaris

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

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

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

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

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

Ɲ. Early and late infection

Ƞ. Periprosthetic fracture of the femur

Ɵ. Failure of the patellofemoral and extensor mechanisms

Ơ. Aseptic loosening of cementing tibial components

Ơ. Asceptic loosening of cemented femoral components

Ƣ. Acceptance of the current position of the ankle

Ƣ. Open reduction and fixation in the epiphysis only

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

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

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

Ƨ. Resection arthroplasty and local radiation

Ƨ. In situ fusion of the hip

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

ƪ. Excision of heterotopic bone and local radiation

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

Ƭ. Closed reduction of both fractures and immediate spica casting

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

Ʈ. External fixation of both femora

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

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

Ʊ. Synovial sarcoma

Ʋ. Soft-tissue abcess

Ƴ. Rhabdomyosarcoma

Ƴ. Eosinophilic granuloma

Ƶ. Nodular pigmented villonodular synovitis

Ƶ. Changing to a titanium nail

Ʒ. Changing to a nonslotted nail

Ƹ. Changing the cross-sectional shape of the nail

Ƹ. Increasing the diameter of the nail by 3 mm

ƺ. Increasing the diameter of the interlocking screws

ƻ. Fracture healing

Ƽ. Chondrosarcoma

Ƽ. Periosteal chondroma

ƾ. Periosteal osteosarcoma

Ƿ. Dysplasia epiphysealis hemimelica

ǀ. Demonstrate competence in the subject of the case

ǁ. Be fellowship trained in the subject of the case

ǂ. Be paid on a contingency basis

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

Ǆ. Have been involved in the case as a consultant

Ǆ. Diagnostic arthroscopy

Ǆ. Arthroscopy and subacromial decompression

Ǉ. Reduction and fixation of the proximal humeral epiphysis

Ǉ. Temporary cessation of throwing

Ǉ. Physical therapy for rotator cuff strengthening

Ǌ. Oblique popliteal ligament

Ǌ. Lateral capsule

Ǌ. Popliteal tendon

Ǎ. Fibular collateral ligament

Ǎ. Posterior oblique ligament

Ǐ. Radial tear

Ǐ. Parrot-beak tear

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

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

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

Ǔ. 0 degrees of abduction, with neural rotation

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

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

Ǘ. 90 degrees of abduction with neutral rotation

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

Ǚ. Sural

Ǚ. Saphenous and its branches

Ǜ. Posterior tibial and its branches

Ǜ. Deep peroneal and its branches

Ǝ. Superficial peroneal and its branches

Ǟ. Strength

Ǟ. Stiffness

Ǡ. Shelf life

Ǡ. Antigenicity

Ǣ. Risk of HIV transmission

Ǣ. Indemnification

Ǥ. Occurrence

Ǥ. Excess liability

Ǧ. Claims-made

Ǧ. Nose

Ǩ. Lateral Y

Ǩ. Scapular AP

Ǫ. Neutral rotation AP

Ǫ. Internal rotation AP

Ǭ. External rotation AP

Ǭ. Trauma

Ǯ. Hemophilia

Ǯ. Reiter’s syndrome

J̌. Rheumatoid arthritis

Ǳ. Systemic lupus erythematosus

Ǳ. Cast immobilization for 6 weeks

Ǳ. Activity modification and re-evaluation in 2 months

Ǵ. Internal fixation with or without bone grafting

Ǵ. Retrograde drilling of the defect without articular cartilage penetration

Ƕ. Drilling of the defect directly through the articular cartilage

Ƿ. repair or reconstruction of the medial collateral ligament

Ǹ. repair or reconstruction of the medialand lateral collateral ligaments

Ǹ. immobilization for 5 days or less

Ǻ. immobilization for 14 days

Ǻ. immobilization for 25 days

Ǽ. Cystinosis

Ǽ. Hypophosphatemia

Ǿ. Renal osteodystrophy

Ǿ. Primary hyperparathyroidism

Ȁ. Nutritional vitamin D deficiency

Ȁ. Lateral meniscus tear

Ȃ. Popliteus tenosynovitis

Ȃ. Iliotibial band friction syndrome

Ȅ. Peroneal nerve entrapment

Ȅ. Biceps tendinitis

Ȇ. Observation

Ȇ. Removal of the prosthetic components

Ȉ. Operative exploration and decompression of the peroneal nerve

Ȉ. Nerve conduction velocity studies

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

Ȋ. I

Ȍ. II

Ȍ. III

Ȏ. decreased tissue tension

Ȏ. decreased abductor lever arm

Ȑ. decreased joint reaction force

Ȑ. increased body weight over lever arm

Ȓ. increased polyethylene wear rate

Ȓ. recurrent traumatic anterior dislocation

Ȕ. recurrent traumatic posterior dislocation

Ȕ. traumatic subluxation with no previous dislocation

Ȗ. traumatic anterior subluxation

Ȗ. atraumatic involuntary subluxation

Ș. radial

Ș. axillary

Ț. suprascapular

Ț. thoracodorsal

Ȝ. long thoracic

Ȝ. Flexion

Ȟ. Extension

Ȟ. Axial rotation

Ƞ. Left lateral bending

ȡ. Right lateral bending

Ȣ. Skin

Ȣ. Lung

Ȥ. Brain

Ȥ. Heart

Ȧ. Kidney

Ȧ. Thoracoacromial, lateral thoracic, subscapular

Ȩ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȩ. Posterior humeral circumflex, subscapular, thoracacromial

Ȫ. Subscapular, thoracacromial, anterior humeral circumflex

Ȫ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȭ. Respondeat superior

Ȭ. Indemnity agreement

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

Ȯ. Comparative negligence-% of involvement

Ȱ. Contributory negligence- resident contributed to the negligence

Ȱ. t-type

Ȳ. both column

Ȳ. transverse

ȴ. anterior column

ȵ. anterior column posterior hemitransverse

ȶ. Posterior interosseous

ȷ. Anterior interosseous

ȸ. Radial

ȹ. Median

Ⱥ. Ulnar

Ȼ. Shock from hypovolemia

Ȼ. Associated rupture of the bladder

Ƚ. Arterial bleeding on pelvic angiogram

Ⱦ. Presence of a hematoma in the perineum and scrotum

Ȿ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Allowing the ends of the fracture to touch

Explanation

Question 4164

Topic: 10. Pathology and Oncology

Figure 30 shows the current radiograph of a 32-year-old woman who had a giant cell tumor of the distal radius that was treated with curettage/burring and packed with polymethylmethacrylate 2 years ago. What is the most likely diagnosis?

. 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

. 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

0. Loosening of the humeral component

1. Arthritis of the glenoid

2. Arthritis of the A-C joint

3. Reduced morbidity

4. Improved osteoinduction

5. Improved osteoconduction

6. More rapid revascularization

7. Lower risk of disease transmission

8. Manipulation Under Anesthesia

9. 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

A. Clostridium perforingens

B. observation and exercises

C. bracing with a thoracolumbar orthosis

D. fusion of the posterior spine

E. fusion of the anterior spine

F. fusion of the anterior and posterior spine

G. Total wrist replacement and bridge grafts

H. palmar shelf arthroplasty and tendon transfers

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

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

K. Total wrist fusion and tendon transfers

L. constrained acetabular component

M. protrusion ring with morselized graft

N. cemented metal backed acetabular component

O. cemented all-polyethylene acetabular component

P. cementless hemispherical component with screw fixation

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

R. application of a hip spica under anesthesia

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

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

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

V. Loss of skin hair on the feet

W. Absent pulses on vascular examination

X. Pain that originates proximally and spreads distally

Y. Pain that is relieved by stopping and standing

Z. 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

A. Macrodactyly

B. Camptodactyly

C. Preaxial polydactyly

D. Postaxial polydactyly

E. Arthrodesis

F. Rotationplasty

G. Above-knee amputation

H. Osteoarticular allograft

I. Endoprosthesis (custom arthroplasty)

J. Plantar fascia

K. Spring ligament

L. Deltoid ligament

M. Intrinsic tendons

N. Gastorcnemius-solelus complex

O. Prevention of presynaptic release of acetylcholine

P. Prevention of synthesis of presynaptic acetylcholine

Q. Activation of acetylcholinesterase at the motor end-plate

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

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

T. stiffness of the femoral component.

U. head offset of the femoral component.

V. femoral component material modulus of elasticity.

W. extent of the femoral component porous coating.

X. Presence of a femoral component collar.

Y. plantar fascia and quadratus plantae tendon.

Z. 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

. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

¡. SCFE

¢. MED

£. Perthes disease

¤. Hypothyroidism

¥. Chondrolysis

¦. gout.

§. osteoporosis.

¨. eosinophilic granuloma.

©. tuberculosis of the spine.

ª. metastatic disease of the spine.

«. water content.

¬. Synthesis of type I collagen.

. Proteoglycan content.

®. Activity of chondrocytes.

¯. Synthesis of hyaluronate.

°. Lung

±. Breast

². Prostate

³. Thyroid

´. Renal

Μ. T1-low, T2-low.

¶. T1-low, T2-high.

·. T1-moderate, T2-low.

¸. T1-high, T2-low.

¹. T1-high, T2-high.

º. hypothesis is incorrect or invalid

». interobserver error rate is 4%.

¼. Standard deviation is 4% higher or lower than the mean.

½. Sample size is 4% larger than required to be clinically significant.

¾. Probability that the differences noted between two study groups were due to chance alone is 4%.

¿. I

À. II

Á. IV

Â. IX

Ã. X

Ä. Cranial setting

Å. Cranial subluxation

Æ. Odontoid fracture

Ç. Lysis of the arch of the atlas

È. Atlantoaxial subluxation

É. Retrograde collapse of the endoneurial tubes

Ê. Irreversible atrophy of the denervated muscles

Ë. Elongation of the axons across the zone of injury

Ì. Sprouting of the axons at the neuromuscular junction

Í. Misdirection of the axons across the zone of injury

Î. Maximally pronated and elbow extended

Ï. Maximally pronated and the elbow flexed

Ð. Maximally supinated and the elbow flexed

Ñ. Maximally supinated and the elbow extended

Ò. In neutral rotation, with the elbow extended

Ó. open reduction and internal fixation

Ô. buddy taping to the adjacent index finger

Õ. early motion with application of a dynamic banjo splint

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

×. dorsal extension block splinting

Ø. The name of the manufacturer

Ù. The manufacturer’s potential liability

Ú. The physician’s clinical performance

Û. The physician’s materials testing data

Ü. Any royalties the physician receives from the manufacturer

Ý. Femoral

Þ. Obturator

SS. Inferior gluteal

À. Superior gluteal

Á. Lateral femoral cutaneous

Â. open biopsy and a long leg cast

Ã. open biopsy and wide resection of the tumor

Ä. a long leg cast and observation

Å. intramedullary stabilization and observation

Æ. Triggering

Ç. Lateral instability

È. Swan-neck deformity

É. Boutonniere deformity

Ê. Loss of distal interphalangeal joint flexion

Ë. Peroneus brevis to peroneus longus

Ì. Peroneus tertius to extensor hallucis longus

Í. Peroneus tertius to superficial peroneal nerve

Î. Extensor hallucis longus to deep peroneal nerve

Ï. Extensor hallucis longus to extensor digitorum longus

Ð. reassurance that Medicare will pay for the treatment.

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

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

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

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

Õ. an onlay iliac crest bone graft.

Ö. limited weightbearing and observation.

÷. removal of the implant and limited weightbearing.

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

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

Ú. Coronal

Û. Sagittal

Ü. Anteromedial, midway between the sagittal and the coronal

Ý. Proximal pins sagittal, distal pins coronal

Þ. Proximal pins coronal, distal pins sagittal

Ÿ. Rheumatoid arthritis

Ā. Posttraumatic arthritis

Ā. Degenerative osteoarthritis

Ă. Osteonecrosis of the tibial plateau

Ă. Osteonecrosis of the medial femoral condyle

Ą. Trapeziometacarpal arthrodesis

Ą. Osteotomy of the thumb metacarpal

Ć. Arthrotomy and joint debridement

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

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

Ĉ. Creep

Ċ. Relaxation

Ċ. Energy dissipation

Č. Plastic deformation

Č. Elastic deformation

Ď. bending

Ď. axial loading

Đ. high-speed rotation

Đ. direct impact from anteromedial

Ē. crush from anteromedial to posterolateral

Ē. Increase stiffness

Ĕ. Increase fracture toughness

Ĕ. Increase fatigue strength

Ė. Decrease mechanical strength

Ė. Decrease wear rate

Ę. disuse osteopenia

Ę. paraendocrine effect of the tumor

Ě. abnormally increased density on the right side

Ě. side effect of the treatment of the lesion

Ĝ. extensive tumor involvement of the left hip

Ĝ. Sciatic nerve

Ğ. Superior gluteal artery

Ğ. Profunda femoris artery

Ġ. Femoral artery and nerve

Ġ. External iliac artery and vein

Ģ. Length

Ģ. Moment arm

Ĥ. Total volume

Ĥ. Physiologic cross-sectional area

Ħ. Distribution of slow and fast twitch fibers

Ħ. decreasing initiation of action potentials.

Ĩ. increasing action potential amplitude.

Ĩ. blocking the opening of gated sodium channels.

Ī. decreasing the number of functional motor units.

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

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

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

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

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

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

I. hemiarthroplasty

Ĳ. open reduction and internal fixation

Ĳ. closed reduction and percutaneous pinning

Ĵ. a sling and early pedulum exercises

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

Ķ. open acromioplasty

Ķ. open Bankart repair

ĸ. open subscapularis tendon repair

Ĺ. inferior capsular shift

Ĺ. a supervised physical therapy program

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

Ļ. open reduction and internal fixation through an anterior approach

Ľ. open reduction and internal fixation through a posterior approach

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

Ŀ. arthroscopically assisted reduction and percutaneous screw fixation

Ŀ. Repair of the rotator cuff

Ł. Replacement of the humeral head

Ł. Resection arthroplasty

Ń. Total shoulder arthroplasty

Ń. AP and lateral radiographs of the elbow

Ņ. Diagnositc arthroscopy

Ņ. Aspiration of joint fluid

Ň. An erythrocyte sedimentation rate and CBC

Ň. A diagnostic lidocaine injection

ʼN. Insulin-like growth factor (IGF-1)

Ŋ. Fibroblast growth factor (FGF-1)

Ŋ. Platelet-derived growth factor (PDGF)

Ō. Transforming growth factor beta (TGF-B)

Ō. Bone morphogenetic proteins (BMP)

Ŏ. clinical history and radiographic findings.

Ŏ. technetium bone scan

Ő. flow cytometry pattern of extracted chondrocytes

Ő. immunohistochemical staining patterns of a biopsy specimen

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

Œ. Radial

Ŕ. Radial recurrent

Ŕ. Posterior interosseous

Ŗ. Superior ulnar recurrent

Ŗ. Superficial radial circumflex

Ř. Impaired hydroxylation of proline

Ř. Failure of cleavage in procollagen

Ś. Defective binding sites for hydroxyproline

Ś. Failure to incorporate glycine into the helix

Ŝ. Diminished production of collagen through the rough endoplasmic reticulum

Ŝ. Asking the legal staff to seek a court injunction

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

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

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

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

Ţ. Meta-analysis

Ţ. Confidence interval

Ť. Analysis of variance (ANOVA)

Ť. Statistical significance (p-value)

Ŧ. Survivorship analysis (Kaplan-Meier)

Ŧ. Spinal shock

Ũ. Neurogenic shock

Ũ. Hypovolemic shock

Ū. Pulmonary embolism

Ū. Fat embolus syndrome

Ŭ. Lumbar spinal stenosis

Ŭ. Metastatic disease of the spine

Ů. Rheumatoid lumbar spondylitis

Ů. Isthmic spondyloloisthesis

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

Ű. Patella alta

Ų. A metal-backed patella

Ų. Varus malalignment of the knee

Ŵ. A posterior cruciate-substituting femoral component

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

Ŷ. The sesamoids are separated

Ŷ. The sesamoid is fractured

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

Ź. The dislocation is dorsal and centered

Ź. The proximal phalanx is hyperextended

Ż. Patella

Ż. Tibial stem

Ž. Distal femoral interface

Ž. Posterior femoral interface

S. Sites of screw fixation for the tibia

Ƀ. Hallux rigidus

Ɓ. Fracture of the sesamoid

Ƃ. Disruption of the plantar plate

Ƃ. Osteonecrosis of the metatarsal head

Ƅ. Rupture of the flexor hallucis longus

Ƅ. Gout

Ɔ. Sepsis

Ƈ. Old trauma

Ƈ. Rheumatoid arthritis

Ɖ. Charcot arthroplasty

Ɗ. Aspiration and steroid injection

Ƌ. Biopsy, curettage, and allograft bone grafting

Ƌ. Percutaneous Kirschner wire fixation

ƍ. Percutaneous injection of autogenous bone marrow

Ǝ. Nerve roots

Ə. Spinal cord

Ɛ. Sciatic nerve

Ƒ. Peroneal nerve

Ƒ. Conus medullaris

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

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

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

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

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

Ƙ. Early and late infection

Ƙ. Periprosthetic fracture of the femur

Ƚ. Failure of the patellofemoral and extensor mechanisms

ƛ. Aseptic loosening of cementing tibial components

Ɯ. Asceptic loosening of cemented femoral components

Ɲ. Acceptance of the current position of the ankle

Ƞ. Open reduction and fixation in the epiphysis only

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

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

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

Ƣ. Resection arthroplasty and local radiation

Ƣ. In situ fusion of the hip

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

Ƥ. Excision of heterotopic bone and local radiation

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

Ƨ. Closed reduction of both fractures and immediate spica casting

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

Ʃ. External fixation of both femora

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

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

Ƭ. Synovial sarcoma

Ƭ. Soft-tissue abcess

Ʈ. Rhabdomyosarcoma

Ư. Eosinophilic granuloma

Ư. Nodular pigmented villonodular synovitis

Ʊ. Changing to a titanium nail

Ʋ. Changing to a nonslotted nail

Ƴ. Changing the cross-sectional shape of the nail

Ƴ. Increasing the diameter of the nail by 3 mm

Ƶ. Increasing the diameter of the interlocking screws

Ƶ. Fracture healing

Ʒ. Chondrosarcoma

Ƹ. Periosteal chondroma

Ƹ. Periosteal osteosarcoma

ƺ. Dysplasia epiphysealis hemimelica

ƻ. Demonstrate competence in the subject of the case

Ƽ. Be fellowship trained in the subject of the case

Ƽ. Be paid on a contingency basis

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

Ƿ. Have been involved in the case as a consultant

ǀ. Diagnostic arthroscopy

ǁ. Arthroscopy and subacromial decompression

ǂ. Reduction and fixation of the proximal humeral epiphysis

ǃ. Temporary cessation of throwing

Ǆ. Physical therapy for rotator cuff strengthening

Ǆ. Oblique popliteal ligament

Ǆ. Lateral capsule

Ǉ. Popliteal tendon

Ǉ. Fibular collateral ligament

Ǉ. Posterior oblique ligament

Ǌ. Radial tear

Ǌ. Parrot-beak tear

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

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

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

Ǐ. 0 degrees of abduction, with neural rotation

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

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

Ǒ. 90 degrees of abduction with neutral rotation

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

Ǔ. Sural

Ǖ. Saphenous and its branches

Ǖ. Posterior tibial and its branches

Ǘ. Deep peroneal and its branches

Ǘ. Superficial peroneal and its branches

Ǚ. Strength

Ǚ. Stiffness

Ǜ. Shelf life

Ǜ. Antigenicity

Ǝ. Risk of HIV transmission

Ǟ. Indemnification

Ǟ. Occurrence

Ǡ. Excess liability

Ǡ. Claims-made

Ǣ. Nose

Ǣ. Lateral Y

Ǥ. Scapular AP

Ǥ. Neutral rotation AP

Ǧ. Internal rotation AP

Ǧ. External rotation AP

Ǩ. Trauma

Ǩ. Hemophilia

Ǫ. Reiter’s syndrome

Ǫ. Rheumatoid arthritis

Ǭ. Systemic lupus erythematosus

Ǭ. Cast immobilization for 6 weeks

Ǯ. Activity modification and re-evaluation in 2 months

Ǯ. Internal fixation with or without bone grafting

J̌. Retrograde drilling of the defect without articular cartilage penetration

Ǳ. Drilling of the defect directly through the articular cartilage

Ǳ. repair or reconstruction of the medial collateral ligament

Ǳ. repair or reconstruction of the medialand lateral collateral ligaments

Ǵ. immobilization for 5 days or less

Ǵ. immobilization for 14 days

Ƕ. immobilization for 25 days

Ƿ. Cystinosis

Ǹ. Hypophosphatemia

Ǹ. Renal osteodystrophy

Ǻ. Primary hyperparathyroidism

Ǻ. Nutritional vitamin D deficiency

Ǽ. Lateral meniscus tear

Ǽ. Popliteus tenosynovitis

Ǿ. Iliotibial band friction syndrome

Ǿ. Peroneal nerve entrapment

Ȁ. Biceps tendinitis

Ȁ. Observation

Ȃ. Removal of the prosthetic components

Ȃ. Operative exploration and decompression of the peroneal nerve

Ȅ. Nerve conduction velocity studies

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

Ȇ. I

Ȇ. II

Ȉ. III

Ȉ. decreased tissue tension

Ȋ. decreased abductor lever arm

Ȋ. decreased joint reaction force

Ȍ. increased body weight over lever arm

Ȍ. increased polyethylene wear rate

Ȏ. recurrent traumatic anterior dislocation

Ȏ. recurrent traumatic posterior dislocation

Ȑ. traumatic subluxation with no previous dislocation

Ȑ. traumatic anterior subluxation

Ȓ. atraumatic involuntary subluxation

Ȓ. radial

Ȕ. axillary

Ȕ. suprascapular

Ȗ. thoracodorsal

Ȗ. long thoracic

Ș. Flexion

Ș. Extension

Ț. Axial rotation

Ț. Left lateral bending

Ȝ. Right lateral bending

Ȝ. Skin

Ȟ. Lung

Ȟ. Brain

Ƞ. Heart

ȡ. Kidney

Ȣ. Thoracoacromial, lateral thoracic, subscapular

Ȣ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȥ. Posterior humeral circumflex, subscapular, thoracacromial

Ȥ. Subscapular, thoracacromial, anterior humeral circumflex

Ȧ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȧ. Respondeat superior

Ȩ. Indemnity agreement

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

Ȫ. Comparative negligence-% of involvement

Ȫ. Contributory negligence- resident contributed to the negligence

Ȭ. t-type

Ȭ. both column

Ȯ. transverse

Ȯ. anterior column

Ȱ. anterior column posterior hemitransverse

Ȱ. Posterior interosseous

Ȳ. Anterior interosseous

Ȳ. Radial

ȴ. Median

ȵ. Ulnar

ȶ. Shock from hypovolemia

ȷ. Associated rupture of the bladder

ȸ. Arterial bleeding on pelvic angiogram

ȹ. Presence of a hematoma in the perineum and scrotum

Ⱥ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Osteomyelitis

Explanation

Question 4165

Topic: 10. Pathology and Oncology

A 40-year-old woman has had pain in the metatarsophal joint of the second toe for the past 6 months despite nonsurgical treatment. A dorsalplantar stress test reproduces the pain, and there is 10 mm of dorsal subluxation of the toe. Radiographs show a normal second metatarsophalangeal joint. Surgical treatment should consist of synovectomy and

. 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

. 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

0. Improved osteoconduction

1. More rapid revascularization

2. Lower risk of disease transmission

3. Manipulation Under Anesthesia

4. Arthroscopic acromioplasty

5. Arthroscopic debridement of G-H joint

6. Replacement of the humeral head

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

8. Bacteroides

9. 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

A. fusion of the anterior and posterior spine

B. Total wrist replacement and bridge grafts

C. palmar shelf arthroplasty and tendon transfers

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

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

F. Total wrist fusion and tendon transfers

G. constrained acetabular component

H. protrusion ring with morselized graft

I. cemented metal backed acetabular component

J. cemented all-polyethylene acetabular component

K. cementless hemispherical component with screw fixation

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

M. application of a hip spica under anesthesia

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

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

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

Q. Loss of skin hair on the feet

R. Absent pulses on vascular examination

S. Pain that originates proximally and spreads distally

T. Pain that is relieved by stopping and standing

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

V. wrist flexors and finger flexors

W. elbow flexors and wrist flexors

X. elbow flexors and finger flexors

Y. 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

Z. elbow extensors and wrist extensors

[. Syndactyly

\. Macrodactyly

]. Camptodactyly

^. Preaxial polydactyly

_. Postaxial polydactyly

`. Arthrodesis

A. Rotationplasty

B. Above-knee amputation

C. Osteoarticular allograft

D. Endoprosthesis (custom arthroplasty)

E. Plantar fascia

F. Spring ligament

G. Deltoid ligament

H. Intrinsic tendons

I. Gastorcnemius-solelus complex

J. Prevention of presynaptic release of acetylcholine

K. Prevention of synthesis of presynaptic acetylcholine

L. Activation of acetylcholinesterase at the motor end-plate

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

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

O. stiffness of the femoral component.

P. head offset of the femoral component.

Q. femoral component material modulus of elasticity.

R. extent of the femoral component porous coating.

S. Presence of a femoral component collar.

T. plantar fascia and quadratus plantae tendon.

U. ligamentous structures connecting the tarsal bones.

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

W. activity of the intrinsic muscles of the foot.

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

Y. scapulothoracic fusion

Z. 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

. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

¡. gout.

¢. osteoporosis.

£. eosinophilic granuloma.

¤. tuberculosis of the spine.

¥. metastatic disease of the spine.

¦. water content.

§. Synthesis of type I collagen.

¨. Proteoglycan content.

©. Activity of chondrocytes.

ª. Synthesis of hyaluronate.

«. Lung

¬. Breast

. Prostate

®. Thyroid

¯. Renal

°. T1-low, T2-low.

±. T1-low, T2-high.

². T1-moderate, T2-low.

³. T1-high, T2-low.

´. T1-high, T2-high.

Μ. hypothesis is incorrect or invalid

¶. interobserver error rate is 4%.

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

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

¹. Probability that the differences noted between two study groups were due to chance alone is 4%.

º. I

». II

¼. IV

½. IX

¾. X

¿. Cranial setting

À. Cranial subluxation

Á. Odontoid fracture

Â. Lysis of the arch of the atlas

Ã. Atlantoaxial subluxation

Ä. Retrograde collapse of the endoneurial tubes

Å. Irreversible atrophy of the denervated muscles

Æ. Elongation of the axons across the zone of injury

Ç. Sprouting of the axons at the neuromuscular junction

È. Misdirection of the axons across the zone of injury

É. Maximally pronated and elbow extended

Ê. Maximally pronated and the elbow flexed

Ë. Maximally supinated and the elbow flexed

Ì. Maximally supinated and the elbow extended

Í. In neutral rotation, with the elbow extended

Î. open reduction and internal fixation

Ï. buddy taping to the adjacent index finger

Ð. early motion with application of a dynamic banjo splint

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

Ò. dorsal extension block splinting

Ó. The name of the manufacturer

Ô. The manufacturer’s potential liability

Õ. The physician’s clinical performance

Ö. The physician’s materials testing data

×. Any royalties the physician receives from the manufacturer

Ø. Femoral

Ù. Obturator

Ú. Inferior gluteal

Û. Superior gluteal

Ü. Lateral femoral cutaneous

Ý. open biopsy and a long leg cast

Þ. open biopsy and wide resection of the tumor

SS. a long leg cast and observation

À. intramedullary stabilization and observation

Á. Triggering

Â. Lateral instability

Ã. Swan-neck deformity

Ä. Boutonniere deformity

Å. Loss of distal interphalangeal joint flexion

Æ. Peroneus brevis to peroneus longus

Ç. Peroneus tertius to extensor hallucis longus

È. Peroneus tertius to superficial peroneal nerve

É. Extensor hallucis longus to deep peroneal nerve

Ê. Extensor hallucis longus to extensor digitorum longus

Ë. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ð. an onlay iliac crest bone graft.

Ñ. limited weightbearing and observation.

Ò. removal of the implant and limited weightbearing.

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

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

Õ. Coronal

Ö. Sagittal

÷. Anteromedial, midway between the sagittal and the coronal

Ø. Proximal pins sagittal, distal pins coronal

Ù. Proximal pins coronal, distal pins sagittal

Ú. Rheumatoid arthritis

Û. Posttraumatic arthritis

Ü. Degenerative osteoarthritis

Ý. Osteonecrosis of the tibial plateau

Þ. Osteonecrosis of the medial femoral condyle

Ÿ. Trapeziometacarpal arthrodesis

Ā. Osteotomy of the thumb metacarpal

Ā. Arthrotomy and joint debridement

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

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

Ą. Creep

Ą. Relaxation

Ć. Energy dissipation

Ć. Plastic deformation

Ĉ. Elastic deformation

Ĉ. bending

Ċ. axial loading

Ċ. high-speed rotation

Č. direct impact from anteromedial

Č. crush from anteromedial to posterolateral

Ď. Increase stiffness

Ď. Increase fracture toughness

Đ. Increase fatigue strength

Đ. Decrease mechanical strength

Ē. Decrease wear rate

Ē. disuse osteopenia

Ĕ. paraendocrine effect of the tumor

Ĕ. abnormally increased density on the right side

Ė. side effect of the treatment of the lesion

Ė. extensive tumor involvement of the left hip

Ę. Sciatic nerve

Ę. Superior gluteal artery

Ě. Profunda femoris artery

Ě. Femoral artery and nerve

Ĝ. External iliac artery and vein

Ĝ. Length

Ğ. Moment arm

Ğ. Total volume

Ġ. Physiologic cross-sectional area

Ġ. Distribution of slow and fast twitch fibers

Ģ. decreasing initiation of action potentials.

Ģ. increasing action potential amplitude.

Ĥ. blocking the opening of gated sodium channels.

Ĥ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ĭ. hemiarthroplasty

Ĭ. open reduction and internal fixation

Į. closed reduction and percutaneous pinning

Į. a sling and early pedulum exercises

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

I. open acromioplasty

Ĳ. open Bankart repair

Ĳ. open subscapularis tendon repair

Ĵ. inferior capsular shift

Ĵ. a supervised physical therapy program

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

Ķ. open reduction and internal fixation through an anterior approach

ĸ. open reduction and internal fixation through a posterior approach

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

Ĺ. arthroscopically assisted reduction and percutaneous screw fixation

Ļ. Repair of the rotator cuff

Ļ. Replacement of the humeral head

Ľ. Resection arthroplasty

Ľ. Total shoulder arthroplasty

Ŀ. AP and lateral radiographs of the elbow

Ŀ. Diagnositc arthroscopy

Ł. Aspiration of joint fluid

Ł. An erythrocyte sedimentation rate and CBC

Ń. A diagnostic lidocaine injection

Ń. Insulin-like growth factor (IGF-1)

Ņ. Fibroblast growth factor (FGF-1)

Ņ. Platelet-derived growth factor (PDGF)

Ň. Transforming growth factor beta (TGF-B)

Ň. Bone morphogenetic proteins (BMP)

ʼN. clinical history and radiographic findings.

Ŋ. technetium bone scan

Ŋ. flow cytometry pattern of extracted chondrocytes

Ō. immunohistochemical staining patterns of a biopsy specimen

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

Ŏ. Radial

Ŏ. Radial recurrent

Ő. Posterior interosseous

Ő. Superior ulnar recurrent

Œ. Superficial radial circumflex

Œ. Impaired hydroxylation of proline

Ŕ. Failure of cleavage in procollagen

Ŕ. Defective binding sites for hydroxyproline

Ŗ. Failure to incorporate glycine into the helix

Ŗ. Diminished production of collagen through the rough endoplasmic reticulum

Ř. Asking the legal staff to seek a court injunction

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

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

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

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

Ŝ. Meta-analysis

Ş. Confidence interval

Ş. Analysis of variance (ANOVA)

Š. Statistical significance (p-value)

Š. Survivorship analysis (Kaplan-Meier)

Ţ. Spinal shock

Ţ. Neurogenic shock

Ť. Hypovolemic shock

Ť. Pulmonary embolism

Ŧ. Fat embolus syndrome

Ŧ. Lumbar spinal stenosis

Ũ. Metastatic disease of the spine

Ũ. Rheumatoid lumbar spondylitis

Ū. Isthmic spondyloloisthesis

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

Ŭ. Patella alta

Ŭ. A metal-backed patella

Ů. Varus malalignment of the knee

Ů. A posterior cruciate-substituting femoral component

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

Ű. The sesamoids are separated

Ų. The sesamoid is fractured

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

Ŵ. The dislocation is dorsal and centered

Ŵ. The proximal phalanx is hyperextended

Ŷ. Patella

Ŷ. Tibial stem

Ÿ. Distal femoral interface

Ź. Posterior femoral interface

Ź. Sites of screw fixation for the tibia

Ż. Hallux rigidus

Ż. Fracture of the sesamoid

Ž. Disruption of the plantar plate

Ž. Osteonecrosis of the metatarsal head

S. Rupture of the flexor hallucis longus

Ƀ. Gout

Ɓ. Sepsis

Ƃ. Old trauma

Ƃ. Rheumatoid arthritis

Ƅ. Charcot arthroplasty

Ƅ. Aspiration and steroid injection

Ɔ. Biopsy, curettage, and allograft bone grafting

Ƈ. Percutaneous Kirschner wire fixation

Ƈ. Percutaneous injection of autogenous bone marrow

Ɖ. Nerve roots

Ɗ. Spinal cord

Ƌ. Sciatic nerve

Ƌ. Peroneal nerve

ƍ. Conus medullaris

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

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

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

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

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

Ɠ. Early and late infection

Ɣ. Periprosthetic fracture of the femur

Ƕ. Failure of the patellofemoral and extensor mechanisms

Ɩ. Aseptic loosening of cementing tibial components

Ɨ. Asceptic loosening of cemented femoral components

Ƙ. Acceptance of the current position of the ankle

Ƙ. Open reduction and fixation in the epiphysis only

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

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

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

Ɲ. Resection arthroplasty and local radiation

Ƞ. In situ fusion of the hip

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

Ơ. Excision of heterotopic bone and local radiation

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

Ƣ. Closed reduction of both fractures and immediate spica casting

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

Ƥ. External fixation of both femora

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

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

Ƨ. Synovial sarcoma

Ƨ. Soft-tissue abcess

Ʃ. Rhabdomyosarcoma

ƪ. Eosinophilic granuloma

ƫ. Nodular pigmented villonodular synovitis

Ƭ. Changing to a titanium nail

Ƭ. Changing to a nonslotted nail

Ʈ. Changing the cross-sectional shape of the nail

Ư. Increasing the diameter of the nail by 3 mm

Ư. Increasing the diameter of the interlocking screws

Ʊ. Fracture healing

Ʋ. Chondrosarcoma

Ƴ. Periosteal chondroma

Ƴ. Periosteal osteosarcoma

Ƶ. Dysplasia epiphysealis hemimelica

Ƶ. Demonstrate competence in the subject of the case

Ʒ. Be fellowship trained in the subject of the case

Ƹ. Be paid on a contingency basis

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

ƺ. Have been involved in the case as a consultant

ƻ. Diagnostic arthroscopy

Ƽ. Arthroscopy and subacromial decompression

Ƽ. Reduction and fixation of the proximal humeral epiphysis

ƾ. Temporary cessation of throwing

Ƿ. Physical therapy for rotator cuff strengthening

ǀ. Oblique popliteal ligament

ǁ. Lateral capsule

ǂ. Popliteal tendon

ǃ. Fibular collateral ligament

Ǆ. Posterior oblique ligament

Ǆ. Radial tear

Ǆ. Parrot-beak tear

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

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

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

Ǌ. 0 degrees of abduction, with neural rotation

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

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

Ǎ. 90 degrees of abduction with neutral rotation

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

Ǐ. Sural

Ǐ. Saphenous and its branches

Ǒ. Posterior tibial and its branches

Ǒ. Deep peroneal and its branches

Ǔ. Superficial peroneal and its branches

Ǔ. Strength

Ǖ. Stiffness

Ǖ. Shelf life

Ǘ. Antigenicity

Ǘ. Risk of HIV transmission

Ǚ. Indemnification

Ǚ. Occurrence

Ǜ. Excess liability

Ǜ. Claims-made

Ǝ. Nose

Ǟ. Lateral Y

Ǟ. Scapular AP

Ǡ. Neutral rotation AP

Ǡ. Internal rotation AP

Ǣ. External rotation AP

Ǣ. Trauma

Ǥ. Hemophilia

Ǥ. Reiter’s syndrome

Ǧ. Rheumatoid arthritis

Ǧ. Systemic lupus erythematosus

Ǩ. Cast immobilization for 6 weeks

Ǩ. Activity modification and re-evaluation in 2 months

Ǫ. Internal fixation with or without bone grafting

Ǫ. Retrograde drilling of the defect without articular cartilage penetration

Ǭ. Drilling of the defect directly through the articular cartilage

Ǭ. repair or reconstruction of the medial collateral ligament

Ǯ. repair or reconstruction of the medialand lateral collateral ligaments

Ǯ. immobilization for 5 days or less

J̌. immobilization for 14 days

Ǳ. immobilization for 25 days

Ǳ. Cystinosis

Ǳ. Hypophosphatemia

Ǵ. Renal osteodystrophy

Ǵ. Primary hyperparathyroidism

Ƕ. Nutritional vitamin D deficiency

Ƿ. Lateral meniscus tear

Ǹ. Popliteus tenosynovitis

Ǹ. Iliotibial band friction syndrome

Ǻ. Peroneal nerve entrapment

Ǻ. Biceps tendinitis

Ǽ. Observation

Ǽ. Removal of the prosthetic components

Ǿ. Operative exploration and decompression of the peroneal nerve

Ǿ. Nerve conduction velocity studies

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

Ȁ. I

Ȃ. II

Ȃ. III

Ȅ. decreased tissue tension

Ȅ. decreased abductor lever arm

Ȇ. decreased joint reaction force

Ȇ. increased body weight over lever arm

Ȉ. increased polyethylene wear rate

Ȉ. recurrent traumatic anterior dislocation

Ȋ. recurrent traumatic posterior dislocation

Ȋ. traumatic subluxation with no previous dislocation

Ȍ. traumatic anterior subluxation

Ȍ. atraumatic involuntary subluxation

Ȏ. radial

Ȏ. axillary

Ȑ. suprascapular

Ȑ. thoracodorsal

Ȓ. long thoracic

Ȓ. Flexion

Ȕ. Extension

Ȕ. Axial rotation

Ȗ. Left lateral bending

Ȗ. Right lateral bending

Ș. Skin

Ș. Lung

Ț. Brain

Ț. Heart

Ȝ. Kidney

Ȝ. Thoracoacromial, lateral thoracic, subscapular

Ȟ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȟ. Posterior humeral circumflex, subscapular, thoracacromial

Ƞ. Subscapular, thoracacromial, anterior humeral circumflex

ȡ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȣ. Respondeat superior

Ȣ. Indemnity agreement

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

Ȥ. Comparative negligence-% of involvement

Ȧ. Contributory negligence- resident contributed to the negligence

Ȧ. t-type

Ȩ. both column

Ȩ. transverse

Ȫ. anterior column

Ȫ. anterior column posterior hemitransverse

Ȭ. Posterior interosseous

Ȭ. Anterior interosseous

Ȯ. Radial

Ȯ. Median

Ȱ. Ulnar

Ȱ. Shock from hypovolemia

Ȳ. Associated rupture of the bladder

Ȳ. Arterial bleeding on pelvic angiogram

ȴ. Presence of a hematoma in the perineum and scrotum

ȵ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Advancement of the plantar plate

Explanation

Question 4166

Topic: 10. Pathology and Oncology

A 25-year-old patient who was wearing a seat belt in the back chair of a car involved in a head-on collision undergoes a laparotomy. During surgery, an injury to the sigmoid colon is identified and treated. Two days later the patient has back pain when sitting in a chair. What is the most likely diagnosis?

. 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

.. Manipulation Under Anesthesia

/. Arthroscopic acromioplasty

0. Arthroscopic debridement of G-H joint

1. Replacement of the humeral head

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

3. Bacteroides

4. E. coli

5. Staph. aureus

6. group A streptococcus

7. Clostridium perforingens

8. observation and exercises

9. 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

A. Total wrist fusion and tendon transfers

B. constrained acetabular component

C. protrusion ring with morselized graft

D. cemented metal backed acetabular component

E. cemented all-polyethylene acetabular component

F. cementless hemispherical component with screw fixation

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

H. application of a hip spica under anesthesia

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

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

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

L. Loss of skin hair on the feet

M. Absent pulses on vascular examination

N. Pain that originates proximally and spreads distally

O. Pain that is relieved by stopping and standing

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

Q. wrist flexors and finger flexors

R. elbow flexors and wrist flexors

S. elbow flexors and finger flexors

T. 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

U. elbow extensors and wrist extensors

V. Syndactyly

W. Macrodactyly

X. Camptodactyly

Y. Preaxial polydactyly

Z. Postaxial polydactyly

[. Arthrodesis

\. Rotationplasty

]. Above-knee amputation

^. Osteoarticular allograft

_. Endoprosthesis (custom arthroplasty)

`. Plantar fascia

A. Spring ligament

B. Deltoid ligament

C. Intrinsic tendons

D. Gastorcnemius-solelus complex

E. Prevention of presynaptic release of acetylcholine

F. Prevention of synthesis of presynaptic acetylcholine

G. Activation of acetylcholinesterase at the motor end-plate

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

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

J. stiffness of the femoral component.

K. head offset of the femoral component.

L. femoral component material modulus of elasticity.

M. extent of the femoral component porous coating.

N. Presence of a femoral component collar.

O. plantar fascia and quadratus plantae tendon.

P. ligamentous structures connecting the tarsal bones.

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

R. activity of the intrinsic muscles of the foot.

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

T. scapulothoracic fusion

U. strengthening of the periscapular muscles

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

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

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

Y. tricompartmental knee replacement

Z. 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

. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

¡. water content.

¢. Synthesis of type I collagen.

£. Proteoglycan content.

¤. Activity of chondrocytes.

¥. Synthesis of hyaluronate.

¦. Lung

§. Breast

¨. Prostate

©. Thyroid

ª. Renal

«. T1-low, T2-low.

¬. T1-low, T2-high.

. T1-moderate, T2-low.

®. T1-high, T2-low.

¯. T1-high, T2-high.

°. hypothesis is incorrect or invalid

±. interobserver error rate is 4%.

². Standard deviation is 4% higher or lower than the mean.

³. 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%.

Μ. I

¶. II

·. IV

¸. IX

¹. X

º. Cranial setting

». Cranial subluxation

¼. Odontoid fracture

½. Lysis of the arch of the atlas

¾. Atlantoaxial subluxation

¿. Retrograde collapse of the endoneurial tubes

À. Irreversible atrophy of the denervated muscles

Á. Elongation of the axons across the zone of injury

Â. Sprouting of the axons at the neuromuscular junction

Ã. Misdirection of the axons across the zone of injury

Ä. Maximally pronated and elbow extended

Å. Maximally pronated and the elbow flexed

Æ. Maximally supinated and the elbow flexed

Ç. Maximally supinated and the elbow extended

È. In neutral rotation, with the elbow extended

É. open reduction and internal fixation

Ê. buddy taping to the adjacent index finger

Ë. early motion with application of a dynamic banjo splint

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

Í. dorsal extension block splinting

Î. The name of the manufacturer

Ï. The manufacturer’s potential liability

Ð. The physician’s clinical performance

Ñ. The physician’s materials testing data

Ò. Any royalties the physician receives from the manufacturer

Ó. Femoral

Ô. Obturator

Õ. Inferior gluteal

Ö. Superior gluteal

×. Lateral femoral cutaneous

Ø. open biopsy and a long leg cast

Ù. open biopsy and wide resection of the tumor

Ú. a long leg cast and observation

Û. intramedullary stabilization and observation

Ü. Triggering

Ý. Lateral instability

Þ. Swan-neck deformity

SS. Boutonniere deformity

À. Loss of distal interphalangeal joint flexion

Á. Peroneus brevis to peroneus longus

Â. Peroneus tertius to extensor hallucis longus

Ã. Peroneus tertius to superficial peroneal nerve

Ä. Extensor hallucis longus to deep peroneal nerve

Å. Extensor hallucis longus to extensor digitorum longus

Æ. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ë. an onlay iliac crest bone graft.

Ì. limited weightbearing and observation.

Í. removal of the implant and limited weightbearing.

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

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

Ð. Coronal

Ñ. Sagittal

Ò. Anteromedial, midway between the sagittal and the coronal

Ó. Proximal pins sagittal, distal pins coronal

Ô. Proximal pins coronal, distal pins sagittal

Õ. Rheumatoid arthritis

Ö. Posttraumatic arthritis

÷. Degenerative osteoarthritis

Ø. Osteonecrosis of the tibial plateau

Ù. Osteonecrosis of the medial femoral condyle

Ú. Trapeziometacarpal arthrodesis

Û. Osteotomy of the thumb metacarpal

Ü. Arthrotomy and joint debridement

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

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

Ÿ. Creep

Ā. Relaxation

Ā. Energy dissipation

Ă. Plastic deformation

Ă. Elastic deformation

Ą. bending

Ą. axial loading

Ć. high-speed rotation

Ć. direct impact from anteromedial

Ĉ. crush from anteromedial to posterolateral

Ĉ. Increase stiffness

Ċ. Increase fracture toughness

Ċ. Increase fatigue strength

Č. Decrease mechanical strength

Č. Decrease wear rate

Ď. disuse osteopenia

Ď. paraendocrine effect of the tumor

Đ. abnormally increased density on the right side

Đ. side effect of the treatment of the lesion

Ē. extensive tumor involvement of the left hip

Ē. Sciatic nerve

Ĕ. Superior gluteal artery

Ĕ. Profunda femoris artery

Ė. Femoral artery and nerve

Ė. External iliac artery and vein

Ę. Length

Ę. Moment arm

Ě. Total volume

Ě. Physiologic cross-sectional area

Ĝ. Distribution of slow and fast twitch fibers

Ĝ. decreasing initiation of action potentials.

Ğ. increasing action potential amplitude.

Ğ. blocking the opening of gated sodium channels.

Ġ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ħ. hemiarthroplasty

Ĩ. open reduction and internal fixation

Ĩ. closed reduction and percutaneous pinning

Ī. a sling and early pedulum exercises

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

Ĭ. open acromioplasty

Ĭ. open Bankart repair

Į. open subscapularis tendon repair

Į. inferior capsular shift

İ. a supervised physical therapy program

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

Ĳ. open reduction and internal fixation through an anterior approach

Ĳ. open reduction and internal fixation through a posterior approach

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

Ĵ. arthroscopically assisted reduction and percutaneous screw fixation

Ķ. Repair of the rotator cuff

Ķ. Replacement of the humeral head

ĸ. Resection arthroplasty

Ĺ. Total shoulder arthroplasty

Ĺ. AP and lateral radiographs of the elbow

Ļ. Diagnositc arthroscopy

Ļ. Aspiration of joint fluid

Ľ. An erythrocyte sedimentation rate and CBC

Ľ. A diagnostic lidocaine injection

Ŀ. Insulin-like growth factor (IGF-1)

Ŀ. Fibroblast growth factor (FGF-1)

Ł. Platelet-derived growth factor (PDGF)

Ł. Transforming growth factor beta (TGF-B)

Ń. Bone morphogenetic proteins (BMP)

Ń. clinical history and radiographic findings.

Ņ. technetium bone scan

Ņ. flow cytometry pattern of extracted chondrocytes

Ň. immunohistochemical staining patterns of a biopsy specimen

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

ʼN. Radial

Ŋ. Radial recurrent

Ŋ. Posterior interosseous

Ō. Superior ulnar recurrent

Ō. Superficial radial circumflex

Ŏ. Impaired hydroxylation of proline

Ŏ. Failure of cleavage in procollagen

Ő. Defective binding sites for hydroxyproline

Ő. Failure to incorporate glycine into the helix

Œ. Diminished production of collagen through the rough endoplasmic reticulum

Œ. Asking the legal staff to seek a court injunction

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

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

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

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

Ř. Meta-analysis

Ř. Confidence interval

Ś. Analysis of variance (ANOVA)

Ś. Statistical significance (p-value)

Ŝ. Survivorship analysis (Kaplan-Meier)

Ŝ. Spinal shock

Ş. Neurogenic shock

Ş. Hypovolemic shock

Š. Pulmonary embolism

Š. Fat embolus syndrome

Ţ. Lumbar spinal stenosis

Ţ. Metastatic disease of the spine

Ť. Rheumatoid lumbar spondylitis

Ť. Isthmic spondyloloisthesis

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

Ŧ. Patella alta

Ũ. A metal-backed patella

Ũ. Varus malalignment of the knee

Ū. A posterior cruciate-substituting femoral component

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

Ŭ. The sesamoids are separated

Ŭ. The sesamoid is fractured

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

Ů. The dislocation is dorsal and centered

Ű. The proximal phalanx is hyperextended

Ű. Patella

Ų. Tibial stem

Ų. Distal femoral interface

Ŵ. Posterior femoral interface

Ŵ. Sites of screw fixation for the tibia

Ŷ. Hallux rigidus

Ŷ. Fracture of the sesamoid

Ÿ. Disruption of the plantar plate

Ź. Osteonecrosis of the metatarsal head

Ź. Rupture of the flexor hallucis longus

Ż. Gout

Ż. Sepsis

Ž. Old trauma

Ž. Rheumatoid arthritis

S. Charcot arthroplasty

Ƀ. Aspiration and steroid injection

Ɓ. Biopsy, curettage, and allograft bone grafting

Ƃ. Percutaneous Kirschner wire fixation

Ƃ. Percutaneous injection of autogenous bone marrow

Ƅ. Nerve roots

Ƅ. Spinal cord

Ɔ. Sciatic nerve

Ƈ. Peroneal nerve

Ƈ. Conus medullaris

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

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

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

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

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

Ǝ. Early and late infection

Ə. Periprosthetic fracture of the femur

Ɛ. Failure of the patellofemoral and extensor mechanisms

Ƒ. Aseptic loosening of cementing tibial components

Ƒ. Asceptic loosening of cemented femoral components

Ɠ. Acceptance of the current position of the ankle

Ɣ. Open reduction and fixation in the epiphysis only

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

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

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

Ƙ. Resection arthroplasty and local radiation

Ƙ. In situ fusion of the hip

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

ƛ. Excision of heterotopic bone and local radiation

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

Ɲ. Closed reduction of both fractures and immediate spica casting

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

Ɵ. External fixation of both femora

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

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

Ƣ. Synovial sarcoma

Ƣ. Soft-tissue abcess

Ƥ. Rhabdomyosarcoma

Ƥ. Eosinophilic granuloma

Ʀ. Nodular pigmented villonodular synovitis

Ƨ. Changing to a titanium nail

Ƨ. Changing to a nonslotted nail

Ʃ. Changing the cross-sectional shape of the nail

ƪ. Increasing the diameter of the nail by 3 mm

ƫ. Increasing the diameter of the interlocking screws

Ƭ. Fracture healing

Ƭ. Chondrosarcoma

Ʈ. Periosteal chondroma

Ư. Periosteal osteosarcoma

Ư. Dysplasia epiphysealis hemimelica

Ʊ. Demonstrate competence in the subject of the case

Ʋ. Be fellowship trained in the subject of the case

Ƴ. Be paid on a contingency basis

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

Ƶ. Have been involved in the case as a consultant

Ƶ. Diagnostic arthroscopy

Ʒ. Arthroscopy and subacromial decompression

Ƹ. Reduction and fixation of the proximal humeral epiphysis

Ƹ. Temporary cessation of throwing

ƺ. Physical therapy for rotator cuff strengthening

ƻ. Oblique popliteal ligament

Ƽ. Lateral capsule

Ƽ. Popliteal tendon

ƾ. Fibular collateral ligament

Ƿ. Posterior oblique ligament

ǀ. Radial tear

ǁ. Parrot-beak tear

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

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

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

Ǆ. 0 degrees of abduction, with neural rotation

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

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

Ǉ. 90 degrees of abduction with neutral rotation

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

Ǌ. Sural

Ǌ. Saphenous and its branches

Ǌ. Posterior tibial and its branches

Ǎ. Deep peroneal and its branches

Ǎ. Superficial peroneal and its branches

Ǐ. Strength

Ǐ. Stiffness

Ǒ. Shelf life

Ǒ. Antigenicity

Ǔ. Risk of HIV transmission

Ǔ. Indemnification

Ǖ. Occurrence

Ǖ. Excess liability

Ǘ. Claims-made

Ǘ. Nose

Ǚ. Lateral Y

Ǚ. Scapular AP

Ǜ. Neutral rotation AP

Ǜ. Internal rotation AP

Ǝ. External rotation AP

Ǟ. Trauma

Ǟ. Hemophilia

Ǡ. Reiter’s syndrome

Ǡ. Rheumatoid arthritis

Ǣ. Systemic lupus erythematosus

Ǣ. Cast immobilization for 6 weeks

Ǥ. Activity modification and re-evaluation in 2 months

Ǥ. Internal fixation with or without bone grafting

Ǧ. Retrograde drilling of the defect without articular cartilage penetration

Ǧ. Drilling of the defect directly through the articular cartilage

Ǩ. repair or reconstruction of the medial collateral ligament

Ǩ. repair or reconstruction of the medialand lateral collateral ligaments

Ǫ. immobilization for 5 days or less

Ǫ. immobilization for 14 days

Ǭ. immobilization for 25 days

Ǭ. Cystinosis

Ǯ. Hypophosphatemia

Ǯ. Renal osteodystrophy

J̌. Primary hyperparathyroidism

Ǳ. Nutritional vitamin D deficiency

Ǳ. Lateral meniscus tear

Ǳ. Popliteus tenosynovitis

Ǵ. Iliotibial band friction syndrome

Ǵ. Peroneal nerve entrapment

Ƕ. Biceps tendinitis

Ƿ. Observation

Ǹ. Removal of the prosthetic components

Ǹ. Operative exploration and decompression of the peroneal nerve

Ǻ. Nerve conduction velocity studies

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

Ǽ. I

Ǽ. II

Ǿ. III

Ǿ. decreased tissue tension

Ȁ. decreased abductor lever arm

Ȁ. decreased joint reaction force

Ȃ. increased body weight over lever arm

Ȃ. increased polyethylene wear rate

Ȅ. recurrent traumatic anterior dislocation

Ȅ. recurrent traumatic posterior dislocation

Ȇ. traumatic subluxation with no previous dislocation

Ȇ. traumatic anterior subluxation

Ȉ. atraumatic involuntary subluxation

Ȉ. radial

Ȋ. axillary

Ȋ. suprascapular

Ȍ. thoracodorsal

Ȍ. long thoracic

Ȏ. Flexion

Ȏ. Extension

Ȑ. Axial rotation

Ȑ. Left lateral bending

Ȓ. Right lateral bending

Ȓ. Skin

Ȕ. Lung

Ȕ. Brain

Ȗ. Heart

Ȗ. Kidney

Ș. Thoracoacromial, lateral thoracic, subscapular

Ș. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ț. Posterior humeral circumflex, subscapular, thoracacromial

Ț. Subscapular, thoracacromial, anterior humeral circumflex

Ȝ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȝ. Respondeat superior

Ȟ. Indemnity agreement

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

Ƞ. Comparative negligence-% of involvement

ȡ. Contributory negligence- resident contributed to the negligence

Ȣ. t-type

Ȣ. both column

Ȥ. transverse

Ȥ. anterior column

Ȧ. anterior column posterior hemitransverse

Ȧ. Posterior interosseous

Ȩ. Anterior interosseous

Ȩ. Radial

Ȫ. Median

Ȫ. Ulnar

Ȭ. Shock from hypovolemia

Ȭ. Associated rupture of the bladder

Ȯ. Arterial bleeding on pelvic angiogram

Ȯ. Presence of a hematoma in the perineum and scrotum

Ȱ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Sacral fracture

Explanation

Question 4167

Topic: 10. Pathology and Oncology

A 65-year-old man undergoes total shoulder arthroplasty. Examination in the recovery room reveals the absence of voluntary deltoid and biceps contraction, weakness of wrist extension, and absence of sensation over the lateral arm and radial forearm. Management should now consist of

. 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

.. Bacteroides

/. E. coli

0. Staph. aureus

1. group A streptococcus

2. Clostridium perforingens

3. observation and exercises

4. bracing with a thoracolumbar orthosis

5. fusion of the posterior spine

6. fusion of the anterior spine

7. fusion of the anterior and posterior spine

8. Total wrist replacement and bridge grafts

9. 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

A. cementless hemispherical component with screw fixation

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

C. application of a hip spica under anesthesia

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

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

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

G. Loss of skin hair on the feet

H. Absent pulses on vascular examination

I. Pain that originates proximally and spreads distally

J. Pain that is relieved by stopping and standing

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

L. wrist flexors and finger flexors

M. elbow flexors and wrist flexors

N. elbow flexors and finger flexors

O. 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

P. elbow extensors and wrist extensors

Q. Syndactyly

R. Macrodactyly

S. Camptodactyly

T. Preaxial polydactyly

U. Postaxial polydactyly

V. Arthrodesis

W. Rotationplasty

X. Above-knee amputation

Y. Osteoarticular allograft

Z. Endoprosthesis (custom arthroplasty)

[. Plantar fascia

\. Spring ligament

]. Deltoid ligament

^. Intrinsic tendons

_. Gastorcnemius-solelus complex

`. Prevention of presynaptic release of acetylcholine

A. Prevention of synthesis of presynaptic acetylcholine

B. Activation of acetylcholinesterase at the motor end-plate

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

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

E. stiffness of the femoral component.

F. head offset of the femoral component.

G. femoral component material modulus of elasticity.

H. extent of the femoral component porous coating.

I. Presence of a femoral component collar.

J. plantar fascia and quadratus plantae tendon.

K. ligamentous structures connecting the tarsal bones.

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

M. activity of the intrinsic muscles of the foot.

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

O. scapulothoracic fusion

P. strengthening of the periscapular muscles

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

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

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

T. tricompartmental knee replacement

U. unicompartmental knee replacement

V. medial compartment meniscal allograft

W. valgus-producing distal femoral osteotomy

X. valgus-producing proximal tibial osteotomy

Y. Internal rotation of the femoral component

Z. 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

. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

¡. Lung

¢. Breast

£. Prostate

¤. Thyroid

¥. Renal

¦. T1-low, T2-low.

§. T1-low, T2-high.

¨. T1-moderate, T2-low.

©. T1-high, T2-low.

ª. T1-high, T2-high.

«. hypothesis is incorrect or invalid

¬. interobserver error rate is 4%.

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

®. 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%.

°. I

±. II

². IV

³. IX

´. X

Μ. Cranial setting

¶. Cranial subluxation

·. Odontoid fracture

¸. Lysis of the arch of the atlas

¹. Atlantoaxial subluxation

º. Retrograde collapse of the endoneurial tubes

». Irreversible atrophy of the denervated muscles

¼. Elongation of the axons across the zone of injury

½. Sprouting of the axons at the neuromuscular junction

¾. Misdirection of the axons across the zone of injury

¿. Maximally pronated and elbow extended

À. Maximally pronated and the elbow flexed

Á. Maximally supinated and the elbow flexed

Â. Maximally supinated and the elbow extended

Ã. In neutral rotation, with the elbow extended

Ä. open reduction and internal fixation

Å. buddy taping to the adjacent index finger

Æ. early motion with application of a dynamic banjo splint

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

È. dorsal extension block splinting

É. The name of the manufacturer

Ê. The manufacturer’s potential liability

Ë. The physician’s clinical performance

Ì. The physician’s materials testing data

Í. Any royalties the physician receives from the manufacturer

Î. Femoral

Ï. Obturator

Ð. Inferior gluteal

Ñ. Superior gluteal

Ò. Lateral femoral cutaneous

Ó. open biopsy and a long leg cast

Ô. open biopsy and wide resection of the tumor

Õ. a long leg cast and observation

Ö. intramedullary stabilization and observation

×. Triggering

Ø. Lateral instability

Ù. Swan-neck deformity

Ú. Boutonniere deformity

Û. Loss of distal interphalangeal joint flexion

Ü. Peroneus brevis to peroneus longus

Ý. Peroneus tertius to extensor hallucis longus

Þ. Peroneus tertius to superficial peroneal nerve

SS. Extensor hallucis longus to deep peroneal nerve

À. Extensor hallucis longus to extensor digitorum longus

Á. reassurance that Medicare will pay for the treatment.

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

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

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

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

Æ. an onlay iliac crest bone graft.

Ç. limited weightbearing and observation.

È. removal of the implant and limited weightbearing.

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

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

Ë. Coronal

Ì. Sagittal

Í. Anteromedial, midway between the sagittal and the coronal

Î. Proximal pins sagittal, distal pins coronal

Ï. Proximal pins coronal, distal pins sagittal

Ð. Rheumatoid arthritis

Ñ. Posttraumatic arthritis

Ò. Degenerative osteoarthritis

Ó. Osteonecrosis of the tibial plateau

Ô. Osteonecrosis of the medial femoral condyle

Õ. Trapeziometacarpal arthrodesis

Ö. Osteotomy of the thumb metacarpal

÷. Arthrotomy and joint debridement

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

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

Ú. Creep

Û. Relaxation

Ü. Energy dissipation

Ý. Plastic deformation

Þ. Elastic deformation

Ÿ. bending

Ā. axial loading

Ā. high-speed rotation

Ă. direct impact from anteromedial

Ă. crush from anteromedial to posterolateral

Ą. Increase stiffness

Ą. Increase fracture toughness

Ć. Increase fatigue strength

Ć. Decrease mechanical strength

Ĉ. Decrease wear rate

Ĉ. disuse osteopenia

Ċ. paraendocrine effect of the tumor

Ċ. abnormally increased density on the right side

Č. side effect of the treatment of the lesion

Č. extensive tumor involvement of the left hip

Ď. Sciatic nerve

Ď. Superior gluteal artery

Đ. Profunda femoris artery

Đ. Femoral artery and nerve

Ē. External iliac artery and vein

Ē. Length

Ĕ. Moment arm

Ĕ. Total volume

Ė. Physiologic cross-sectional area

Ė. Distribution of slow and fast twitch fibers

Ę. decreasing initiation of action potentials.

Ę. increasing action potential amplitude.

Ě. blocking the opening of gated sodium channels.

Ě. decreasing the number of functional motor units.

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

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

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

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

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

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

Ģ. hemiarthroplasty

Ģ. open reduction and internal fixation

Ĥ. closed reduction and percutaneous pinning

Ĥ. a sling and early pedulum exercises

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

Ħ. open acromioplasty

Ĩ. open Bankart repair

Ĩ. open subscapularis tendon repair

Ī. inferior capsular shift

Ī. a supervised physical therapy program

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

Ĭ. open reduction and internal fixation through an anterior approach

Į. open reduction and internal fixation through a posterior approach

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

İ. arthroscopically assisted reduction and percutaneous screw fixation

I. Repair of the rotator cuff

Ĳ. Replacement of the humeral head

Ĳ. Resection arthroplasty

Ĵ. Total shoulder arthroplasty

Ĵ. AP and lateral radiographs of the elbow

Ķ. Diagnositc arthroscopy

Ķ. Aspiration of joint fluid

ĸ. An erythrocyte sedimentation rate and CBC

Ĺ. A diagnostic lidocaine injection

Ĺ. Insulin-like growth factor (IGF-1)

Ļ. Fibroblast growth factor (FGF-1)

Ļ. Platelet-derived growth factor (PDGF)

Ľ. Transforming growth factor beta (TGF-B)

Ľ. Bone morphogenetic proteins (BMP)

Ŀ. clinical history and radiographic findings.

Ŀ. technetium bone scan

Ł. flow cytometry pattern of extracted chondrocytes

Ł. immunohistochemical staining patterns of a biopsy specimen

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

Ń. Radial

Ņ. Radial recurrent

Ņ. Posterior interosseous

Ň. Superior ulnar recurrent

Ň. Superficial radial circumflex

ʼN. Impaired hydroxylation of proline

Ŋ. Failure of cleavage in procollagen

Ŋ. Defective binding sites for hydroxyproline

Ō. Failure to incorporate glycine into the helix

Ō. Diminished production of collagen through the rough endoplasmic reticulum

Ŏ. Asking the legal staff to seek a court injunction

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

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

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

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

Œ. Meta-analysis

Ŕ. Confidence interval

Ŕ. Analysis of variance (ANOVA)

Ŗ. Statistical significance (p-value)

Ŗ. Survivorship analysis (Kaplan-Meier)

Ř. Spinal shock

Ř. Neurogenic shock

Ś. Hypovolemic shock

Ś. Pulmonary embolism

Ŝ. Fat embolus syndrome

Ŝ. Lumbar spinal stenosis

Ş. Metastatic disease of the spine

Ş. Rheumatoid lumbar spondylitis

Š. Isthmic spondyloloisthesis

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

Ţ. Patella alta

Ţ. A metal-backed patella

Ť. Varus malalignment of the knee

Ť. A posterior cruciate-substituting femoral component

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

Ŧ. The sesamoids are separated

Ũ. The sesamoid is fractured

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

Ū. The dislocation is dorsal and centered

Ū. The proximal phalanx is hyperextended

Ŭ. Patella

Ŭ. Tibial stem

Ů. Distal femoral interface

Ů. Posterior femoral interface

Ű. Sites of screw fixation for the tibia

Ű. Hallux rigidus

Ų. Fracture of the sesamoid

Ų. Disruption of the plantar plate

Ŵ. Osteonecrosis of the metatarsal head

Ŵ. Rupture of the flexor hallucis longus

Ŷ. Gout

Ŷ. Sepsis

Ÿ. Old trauma

Ź. Rheumatoid arthritis

Ź. Charcot arthroplasty

Ż. Aspiration and steroid injection

Ż. Biopsy, curettage, and allograft bone grafting

Ž. Percutaneous Kirschner wire fixation

Ž. Percutaneous injection of autogenous bone marrow

S. Nerve roots

Ƀ. Spinal cord

Ɓ. Sciatic nerve

Ƃ. Peroneal nerve

Ƃ. Conus medullaris

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

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

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

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

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

Ɖ. Early and late infection

Ɗ. Periprosthetic fracture of the femur

Ƌ. Failure of the patellofemoral and extensor mechanisms

Ƌ. Aseptic loosening of cementing tibial components

ƍ. Asceptic loosening of cemented femoral components

Ǝ. Acceptance of the current position of the ankle

Ə. Open reduction and fixation in the epiphysis only

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

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

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

Ɠ. Resection arthroplasty and local radiation

Ɣ. In situ fusion of the hip

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

Ɩ. Excision of heterotopic bone and local radiation

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

Ƙ. Closed reduction of both fractures and immediate spica casting

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

Ƚ. External fixation of both femora

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

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

Ɲ. Synovial sarcoma

Ƞ. Soft-tissue abcess

Ɵ. Rhabdomyosarcoma

Ơ. Eosinophilic granuloma

Ơ. Nodular pigmented villonodular synovitis

Ƣ. Changing to a titanium nail

Ƣ. Changing to a nonslotted nail

Ƥ. Changing the cross-sectional shape of the nail

Ƥ. Increasing the diameter of the nail by 3 mm

Ʀ. Increasing the diameter of the interlocking screws

Ƨ. Fracture healing

Ƨ. Chondrosarcoma

Ʃ. Periosteal chondroma

ƪ. Periosteal osteosarcoma

ƫ. Dysplasia epiphysealis hemimelica

Ƭ. Demonstrate competence in the subject of the case

Ƭ. Be fellowship trained in the subject of the case

Ʈ. Be paid on a contingency basis

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

Ư. Have been involved in the case as a consultant

Ʊ. Diagnostic arthroscopy

Ʋ. Arthroscopy and subacromial decompression

Ƴ. Reduction and fixation of the proximal humeral epiphysis

Ƴ. Temporary cessation of throwing

Ƶ. Physical therapy for rotator cuff strengthening

Ƶ. Oblique popliteal ligament

Ʒ. Lateral capsule

Ƹ. Popliteal tendon

Ƹ. Fibular collateral ligament

ƺ. Posterior oblique ligament

ƻ. Radial tear

Ƽ. Parrot-beak tear

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

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

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

ǀ. 0 degrees of abduction, with neural rotation

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

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

ǃ. 90 degrees of abduction with neutral rotation

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

Ǆ. Sural

Ǆ. Saphenous and its branches

Ǉ. Posterior tibial and its branches

Ǉ. Deep peroneal and its branches

Ǉ. Superficial peroneal and its branches

Ǌ. Strength

Ǌ. Stiffness

Ǌ. Shelf life

Ǎ. Antigenicity

Ǎ. Risk of HIV transmission

Ǐ. Indemnification

Ǐ. Occurrence

Ǒ. Excess liability

Ǒ. Claims-made

Ǔ. Nose

Ǔ. Lateral Y

Ǖ. Scapular AP

Ǖ. Neutral rotation AP

Ǘ. Internal rotation AP

Ǘ. External rotation AP

Ǚ. Trauma

Ǚ. Hemophilia

Ǜ. Reiter’s syndrome

Ǜ. Rheumatoid arthritis

Ǝ. Systemic lupus erythematosus

Ǟ. Cast immobilization for 6 weeks

Ǟ. Activity modification and re-evaluation in 2 months

Ǡ. Internal fixation with or without bone grafting

Ǡ. Retrograde drilling of the defect without articular cartilage penetration

Ǣ. Drilling of the defect directly through the articular cartilage

Ǣ. repair or reconstruction of the medial collateral ligament

Ǥ. repair or reconstruction of the medialand lateral collateral ligaments

Ǥ. immobilization for 5 days or less

Ǧ. immobilization for 14 days

Ǧ. immobilization for 25 days

Ǩ. Cystinosis

Ǩ. Hypophosphatemia

Ǫ. Renal osteodystrophy

Ǫ. Primary hyperparathyroidism

Ǭ. Nutritional vitamin D deficiency

Ǭ. Lateral meniscus tear

Ǯ. Popliteus tenosynovitis

Ǯ. Iliotibial band friction syndrome

J̌. Peroneal nerve entrapment

Ǳ. Biceps tendinitis

Ǳ. Observation

Ǳ. Removal of the prosthetic components

Ǵ. Operative exploration and decompression of the peroneal nerve

Ǵ. Nerve conduction velocity studies

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

Ƿ. I

Ǹ. II

Ǹ. III

Ǻ. decreased tissue tension

Ǻ. decreased abductor lever arm

Ǽ. decreased joint reaction force

Ǽ. increased body weight over lever arm

Ǿ. increased polyethylene wear rate

Ǿ. recurrent traumatic anterior dislocation

Ȁ. recurrent traumatic posterior dislocation

Ȁ. traumatic subluxation with no previous dislocation

Ȃ. traumatic anterior subluxation

Ȃ. atraumatic involuntary subluxation

Ȅ. radial

Ȅ. axillary

Ȇ. suprascapular

Ȇ. thoracodorsal

Ȉ. long thoracic

Ȉ. Flexion

Ȋ. Extension

Ȋ. Axial rotation

Ȍ. Left lateral bending

Ȍ. Right lateral bending

Ȏ. Skin

Ȏ. Lung

Ȑ. Brain

Ȑ. Heart

Ȓ. Kidney

Ȓ. Thoracoacromial, lateral thoracic, subscapular

Ȕ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȕ. Posterior humeral circumflex, subscapular, thoracacromial

Ȗ. Subscapular, thoracacromial, anterior humeral circumflex

Ȗ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ș. Respondeat superior

Ș. Indemnity agreement

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

Ț. Comparative negligence-% of involvement

Ȝ. Contributory negligence- resident contributed to the negligence

Ȝ. t-type

Ȟ. both column

Ȟ. transverse

Ƞ. anterior column

ȡ. anterior column posterior hemitransverse

Ȣ. Posterior interosseous

Ȣ. Anterior interosseous

Ȥ. Radial

Ȥ. Median

Ȧ. Ulnar

Ȧ. Shock from hypovolemia

Ȩ. Associated rupture of the bladder

Ȩ. Arterial bleeding on pelvic angiogram

Ȫ. Presence of a hematoma in the perineum and scrotum

Ȫ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. An MRI scan of the shoulder

Explanation

Question 4168

Topic: 10. Pathology and Oncology

A 76-year-old woman who underwent primary total knee arthroplasty 9 months ago falls and sustains a transverse fracture of the proximal third of the patella that is displaced 5 mm. Although the knee is painful, she is able to ambulate and has a 5-degree extension lag. The component appears to be well fixed. Treatment should now include

. 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

.. observation and exercises

/. bracing with a thoracolumbar orthosis

0. fusion of the posterior spine

1. fusion of the anterior spine

2. fusion of the anterior and posterior spine

3. Total wrist replacement and bridge grafts

4. palmar shelf arthroplasty and tendon transfers

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

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

7. Total wrist fusion and tendon transfers

8. constrained acetabular component

9. 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

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

B. Loss of skin hair on the feet

C. Absent pulses on vascular examination

D. Pain that originates proximally and spreads distally

E. Pain that is relieved by stopping and standing

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

G. wrist flexors and finger flexors

H. elbow flexors and wrist flexors

I. elbow flexors and finger flexors

J. 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

K. elbow extensors and wrist extensors

L. Syndactyly

M. Macrodactyly

N. Camptodactyly

O. Preaxial polydactyly

P. Postaxial polydactyly

Q. Arthrodesis

R. Rotationplasty

S. Above-knee amputation

T. Osteoarticular allograft

U. Endoprosthesis (custom arthroplasty)

V. Plantar fascia

W. Spring ligament

X. Deltoid ligament

Y. Intrinsic tendons

Z. 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.

A. head offset of the femoral component.

B. femoral component material modulus of elasticity.

C. extent of the femoral component porous coating.

D. Presence of a femoral component collar.

E. plantar fascia and quadratus plantae tendon.

F. ligamentous structures connecting the tarsal bones.

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

H. activity of the intrinsic muscles of the foot.

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

J. scapulothoracic fusion

K. strengthening of the periscapular muscles

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

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

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

O. tricompartmental knee replacement

P. unicompartmental knee replacement

Q. medial compartment meniscal allograft

R. valgus-producing distal femoral osteotomy

S. valgus-producing proximal tibial osteotomy

T. Internal rotation of the femoral component

U. External rotation of the tibial component

V. Lateral placement of the femoral component

W. Medial placement of the patellar component

X. Excessive resection of the patella

Y. Hallux rigidus

Z. 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

. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

¡. T1-low, T2-low.

¢. T1-low, T2-high.

£. T1-moderate, T2-low.

¤. T1-high, T2-low.

¥. T1-high, T2-high.

¦. hypothesis is incorrect or invalid

§. interobserver error rate is 4%.

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

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

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

«. I

¬. II

. IV

®. IX

¯. X

°. Cranial setting

±. Cranial subluxation

². Odontoid fracture

³. Lysis of the arch of the atlas

´. Atlantoaxial subluxation

Μ. Retrograde collapse of the endoneurial tubes

¶. Irreversible atrophy of the denervated muscles

·. Elongation of the axons across the zone of injury

¸. Sprouting of the axons at the neuromuscular junction

¹. Misdirection of the axons across the zone of injury

º. Maximally pronated and elbow extended

». Maximally pronated and the elbow flexed

¼. Maximally supinated and the elbow flexed

½. Maximally supinated and the elbow extended

¾. In neutral rotation, with the elbow extended

¿. open reduction and internal fixation

À. buddy taping to the adjacent index finger

Á. early motion with application of a dynamic banjo splint

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

Ã. dorsal extension block splinting

Ä. The name of the manufacturer

Å. The manufacturer’s potential liability

Æ. The physician’s clinical performance

Ç. The physician’s materials testing data

È. Any royalties the physician receives from the manufacturer

É. Femoral

Ê. Obturator

Ë. Inferior gluteal

Ì. Superior gluteal

Í. Lateral femoral cutaneous

Î. open biopsy and a long leg cast

Ï. open biopsy and wide resection of the tumor

Ð. a long leg cast and observation

Ñ. intramedullary stabilization and observation

Ò. Triggering

Ó. Lateral instability

Ô. Swan-neck deformity

Õ. Boutonniere deformity

Ö. Loss of distal interphalangeal joint flexion

×. Peroneus brevis to peroneus longus

Ø. Peroneus tertius to extensor hallucis longus

Ù. Peroneus tertius to superficial peroneal nerve

Ú. Extensor hallucis longus to deep peroneal nerve

Û. Extensor hallucis longus to extensor digitorum longus

Ü. reassurance that Medicare will pay for the treatment.

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

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

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

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

Á. an onlay iliac crest bone graft.

Â. limited weightbearing and observation.

Ã. removal of the implant and limited weightbearing.

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

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

Æ. Coronal

Ç. Sagittal

È. Anteromedial, midway between the sagittal and the coronal

É. Proximal pins sagittal, distal pins coronal

Ê. Proximal pins coronal, distal pins sagittal

Ë. Rheumatoid arthritis

Ì. Posttraumatic arthritis

Í. Degenerative osteoarthritis

Î. Osteonecrosis of the tibial plateau

Ï. Osteonecrosis of the medial femoral condyle

Ð. Trapeziometacarpal arthrodesis

Ñ. Osteotomy of the thumb metacarpal

Ò. Arthrotomy and joint debridement

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

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

Õ. Creep

Ö. Relaxation

÷. Energy dissipation

Ø. Plastic deformation

Ù. Elastic deformation

Ú. bending

Û. axial loading

Ü. high-speed rotation

Ý. direct impact from anteromedial

Þ. crush from anteromedial to posterolateral

Ÿ. Increase stiffness

Ā. Increase fracture toughness

Ā. Increase fatigue strength

Ă. Decrease mechanical strength

Ă. Decrease wear rate

Ą. disuse osteopenia

Ą. paraendocrine effect of the tumor

Ć. abnormally increased density on the right side

Ć. side effect of the treatment of the lesion

Ĉ. extensive tumor involvement of the left hip

Ĉ. Sciatic nerve

Ċ. Superior gluteal artery

Ċ. Profunda femoris artery

Č. Femoral artery and nerve

Č. External iliac artery and vein

Ď. Length

Ď. Moment arm

Đ. Total volume

Đ. Physiologic cross-sectional area

Ē. Distribution of slow and fast twitch fibers

Ē. decreasing initiation of action potentials.

Ĕ. increasing action potential amplitude.

Ĕ. blocking the opening of gated sodium channels.

Ė. decreasing the number of functional motor units.

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

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

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

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

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

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

Ĝ. hemiarthroplasty

Ğ. open reduction and internal fixation

Ğ. closed reduction and percutaneous pinning

Ġ. a sling and early pedulum exercises

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

Ģ. open acromioplasty

Ģ. open Bankart repair

Ĥ. open subscapularis tendon repair

Ĥ. inferior capsular shift

Ħ. a supervised physical therapy program

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

Ĩ. open reduction and internal fixation through an anterior approach

Ĩ. open reduction and internal fixation through a posterior approach

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

Ī. arthroscopically assisted reduction and percutaneous screw fixation

Ĭ. Repair of the rotator cuff

Ĭ. Replacement of the humeral head

Į. Resection arthroplasty

Į. Total shoulder arthroplasty

İ. AP and lateral radiographs of the elbow

I. Diagnositc arthroscopy

Ĳ. Aspiration of joint fluid

Ĳ. An erythrocyte sedimentation rate and CBC

Ĵ. A diagnostic lidocaine injection

Ĵ. Insulin-like growth factor (IGF-1)

Ķ. Fibroblast growth factor (FGF-1)

Ķ. Platelet-derived growth factor (PDGF)

ĸ. Transforming growth factor beta (TGF-B)

Ĺ. Bone morphogenetic proteins (BMP)

Ĺ. clinical history and radiographic findings.

Ļ. technetium bone scan

Ļ. flow cytometry pattern of extracted chondrocytes

Ľ. immunohistochemical staining patterns of a biopsy specimen

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

Ŀ. Radial

Ŀ. Radial recurrent

Ł. Posterior interosseous

Ł. Superior ulnar recurrent

Ń. Superficial radial circumflex

Ń. Impaired hydroxylation of proline

Ņ. Failure of cleavage in procollagen

Ņ. Defective binding sites for hydroxyproline

Ň. Failure to incorporate glycine into the helix

Ň. Diminished production of collagen through the rough endoplasmic reticulum

ʼN. Asking the legal staff to seek a court injunction

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

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

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

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

Ŏ. Meta-analysis

Ŏ. Confidence interval

Ő. Analysis of variance (ANOVA)

Ő. Statistical significance (p-value)

Œ. Survivorship analysis (Kaplan-Meier)

Œ. Spinal shock

Ŕ. Neurogenic shock

Ŕ. Hypovolemic shock

Ŗ. Pulmonary embolism

Ŗ. Fat embolus syndrome

Ř. Lumbar spinal stenosis

Ř. Metastatic disease of the spine

Ś. Rheumatoid lumbar spondylitis

Ś. Isthmic spondyloloisthesis

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

Ŝ. Patella alta

Ş. A metal-backed patella

Ş. Varus malalignment of the knee

Š. A posterior cruciate-substituting femoral component

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

Ţ. The sesamoids are separated

Ţ. The sesamoid is fractured

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

Ť. The dislocation is dorsal and centered

Ŧ. The proximal phalanx is hyperextended

Ŧ. Patella

Ũ. Tibial stem

Ũ. Distal femoral interface

Ū. Posterior femoral interface

Ū. Sites of screw fixation for the tibia

Ŭ. Hallux rigidus

Ŭ. Fracture of the sesamoid

Ů. Disruption of the plantar plate

Ů. Osteonecrosis of the metatarsal head

Ű. Rupture of the flexor hallucis longus

Ű. Gout

Ų. Sepsis

Ų. Old trauma

Ŵ. Rheumatoid arthritis

Ŵ. Charcot arthroplasty

Ŷ. Aspiration and steroid injection

Ŷ. Biopsy, curettage, and allograft bone grafting

Ÿ. Percutaneous Kirschner wire fixation

Ź. Percutaneous injection of autogenous bone marrow

Ź. Nerve roots

Ż. Spinal cord

Ż. Sciatic nerve

Ž. Peroneal nerve

Ž. Conus medullaris

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

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

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

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

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

Ƅ. Early and late infection

Ƅ. Periprosthetic fracture of the femur

Ɔ. Failure of the patellofemoral and extensor mechanisms

Ƈ. Aseptic loosening of cementing tibial components

Ƈ. Asceptic loosening of cemented femoral components

Ɖ. Acceptance of the current position of the ankle

Ɗ. Open reduction and fixation in the epiphysis only

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

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

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

Ǝ. Resection arthroplasty and local radiation

Ə. In situ fusion of the hip

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

Ƒ. Excision of heterotopic bone and local radiation

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

Ɠ. Closed reduction of both fractures and immediate spica casting

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

Ƕ. External fixation of both femora

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

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

Ƙ. Synovial sarcoma

Ƙ. Soft-tissue abcess

Ƚ. Rhabdomyosarcoma

ƛ. Eosinophilic granuloma

Ɯ. Nodular pigmented villonodular synovitis

Ɲ. Changing to a titanium nail

Ƞ. Changing to a nonslotted nail

Ɵ. Changing the cross-sectional shape of the nail

Ơ. Increasing the diameter of the nail by 3 mm

Ơ. Increasing the diameter of the interlocking screws

Ƣ. Fracture healing

Ƣ. Chondrosarcoma

Ƥ. Periosteal chondroma

Ƥ. Periosteal osteosarcoma

Ʀ. Dysplasia epiphysealis hemimelica

Ƨ. Demonstrate competence in the subject of the case

Ƨ. Be fellowship trained in the subject of the case

Ʃ. Be paid on a contingency basis

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

ƫ. Have been involved in the case as a consultant

Ƭ. Diagnostic arthroscopy

Ƭ. Arthroscopy and subacromial decompression

Ʈ. Reduction and fixation of the proximal humeral epiphysis

Ư. Temporary cessation of throwing

Ư. Physical therapy for rotator cuff strengthening

Ʊ. Oblique popliteal ligament

Ʋ. Lateral capsule

Ƴ. Popliteal tendon

Ƴ. Fibular collateral ligament

Ƶ. Posterior oblique ligament

Ƶ. Radial tear

Ʒ. Parrot-beak tear

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

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

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

ƻ. 0 degrees of abduction, with neural rotation

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

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

ƾ. 90 degrees of abduction with neutral rotation

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

ǀ. Sural

ǁ. Saphenous and its branches

ǂ. Posterior tibial and its branches

ǃ. Deep peroneal and its branches

Ǆ. Superficial peroneal and its branches

Ǆ. Strength

Ǆ. Stiffness

Ǉ. Shelf life

Ǉ. Antigenicity

Ǉ. Risk of HIV transmission

Ǌ. Indemnification

Ǌ. Occurrence

Ǌ. Excess liability

Ǎ. Claims-made

Ǎ. Nose

Ǐ. Lateral Y

Ǐ. Scapular AP

Ǒ. Neutral rotation AP

Ǒ. Internal rotation AP

Ǔ. External rotation AP

Ǔ. Trauma

Ǖ. Hemophilia

Ǖ. Reiter’s syndrome

Ǘ. Rheumatoid arthritis

Ǘ. Systemic lupus erythematosus

Ǚ. Cast immobilization for 6 weeks

Ǚ. Activity modification and re-evaluation in 2 months

Ǜ. Internal fixation with or without bone grafting

Ǜ. Retrograde drilling of the defect without articular cartilage penetration

Ǝ. Drilling of the defect directly through the articular cartilage

Ǟ. repair or reconstruction of the medial collateral ligament

Ǟ. repair or reconstruction of the medialand lateral collateral ligaments

Ǡ. immobilization for 5 days or less

Ǡ. immobilization for 14 days

Ǣ. immobilization for 25 days

Ǣ. Cystinosis

Ǥ. Hypophosphatemia

Ǥ. Renal osteodystrophy

Ǧ. Primary hyperparathyroidism

Ǧ. Nutritional vitamin D deficiency

Ǩ. Lateral meniscus tear

Ǩ. Popliteus tenosynovitis

Ǫ. Iliotibial band friction syndrome

Ǫ. Peroneal nerve entrapment

Ǭ. Biceps tendinitis

Ǭ. Observation

Ǯ. Removal of the prosthetic components

Ǯ. Operative exploration and decompression of the peroneal nerve

J̌. Nerve conduction velocity studies

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

Ǳ. I

Ǳ. II

Ǵ. III

Ǵ. decreased tissue tension

Ƕ. decreased abductor lever arm

Ƿ. decreased joint reaction force

Ǹ. increased body weight over lever arm

Ǹ. increased polyethylene wear rate

Ǻ. recurrent traumatic anterior dislocation

Ǻ. recurrent traumatic posterior dislocation

Ǽ. traumatic subluxation with no previous dislocation

Ǽ. traumatic anterior subluxation

Ǿ. atraumatic involuntary subluxation

Ǿ. radial

Ȁ. axillary

Ȁ. suprascapular

Ȃ. thoracodorsal

Ȃ. long thoracic

Ȅ. Flexion

Ȅ. Extension

Ȇ. Axial rotation

Ȇ. Left lateral bending

Ȉ. Right lateral bending

Ȉ. Skin

Ȋ. Lung

Ȋ. Brain

Ȍ. Heart

Ȍ. Kidney

Ȏ. Thoracoacromial, lateral thoracic, subscapular

Ȏ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȑ. Posterior humeral circumflex, subscapular, thoracacromial

Ȑ. Subscapular, thoracacromial, anterior humeral circumflex

Ȓ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȓ. Respondeat superior

Ȕ. Indemnity agreement

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

Ȗ. Comparative negligence-% of involvement

Ȗ. Contributory negligence- resident contributed to the negligence

Ș. t-type

Ș. both column

Ț. transverse

Ț. anterior column

Ȝ. anterior column posterior hemitransverse

Ȝ. Posterior interosseous

Ȟ. Anterior interosseous

Ȟ. Radial

Ƞ. Median

ȡ. Ulnar

Ȣ. Shock from hypovolemia

Ȣ. Associated rupture of the bladder

Ȥ. Arterial bleeding on pelvic angiogram

Ȥ. Presence of a hematoma in the perineum and scrotum

Ȧ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. cerclage wiring

Explanation

Question 4169

Topic: 10. Pathology and Oncology

Lymphatic metastasis is a common feature of which of the following lesions?

. 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

.. Total wrist replacement and bridge grafts

/. palmar shelf arthroplasty and tendon transfers

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

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

2. Total wrist fusion and tendon transfers

3. constrained acetabular component

4. protrusion ring with morselized graft

5. cemented metal backed acetabular component

6. cemented all-polyethylene acetabular component

7. cementless hemispherical component with screw fixation

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

9. 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

B. wrist flexors and finger flexors

C. elbow flexors and wrist flexors

D. elbow flexors and finger flexors

E. 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

F. elbow extensors and wrist extensors

G. Syndactyly

H. Macrodactyly

I. Camptodactyly

J. Preaxial polydactyly

K. Postaxial polydactyly

L. Arthrodesis

M. Rotationplasty

N. Above-knee amputation

O. Osteoarticular allograft

P. Endoprosthesis (custom arthroplasty)

Q. Plantar fascia

R. Spring ligament

S. Deltoid ligament

T. Intrinsic tendons

U. Gastorcnemius-solelus complex

V. Prevention of presynaptic release of acetylcholine

W. Prevention of synthesis of presynaptic acetylcholine

X. Activation of acetylcholinesterase at the motor end-plate

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

Z. 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.

A. ligamentous structures connecting the tarsal bones.

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

C. activity of the intrinsic muscles of the foot.

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

E. scapulothoracic fusion

F. strengthening of the periscapular muscles

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

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

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

J. tricompartmental knee replacement

K. unicompartmental knee replacement

L. medial compartment meniscal allograft

M. valgus-producing distal femoral osteotomy

N. valgus-producing proximal tibial osteotomy

O. Internal rotation of the femoral component

P. External rotation of the tibial component

Q. Lateral placement of the femoral component

R. Medial placement of the patellar component

S. Excessive resection of the patella

T. Hallux rigidus

U. Hallux valgus

V. Neuroma of the first web space

W. Fracture of the sesamoid

X. Rupture of the flexor hallucis longus

Y. Sickle cell crisis

Z. 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

. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

¡. hypothesis is incorrect or invalid

¢. interobserver error rate is 4%.

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

¤. 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%.

¦. I

§. II

¨. IV

©. IX

ª. X

«. Cranial setting

¬. Cranial subluxation

. Odontoid fracture

®. Lysis of the arch of the atlas

¯. Atlantoaxial subluxation

°. Retrograde collapse of the endoneurial tubes

±. Irreversible atrophy of the denervated muscles

². Elongation of the axons across the zone of injury

³. Sprouting of the axons at the neuromuscular junction

´. Misdirection of the axons across the zone of injury

Μ. Maximally pronated and elbow extended

¶. Maximally pronated and the elbow flexed

·. Maximally supinated and the elbow flexed

¸. Maximally supinated and the elbow extended

¹. In neutral rotation, with the elbow extended

º. open reduction and internal fixation

». buddy taping to the adjacent index finger

¼. early motion with application of a dynamic banjo splint

½. application of a cast with the hand in a “safe position” for 3 weeks.

¾. dorsal extension block splinting

¿. The name of the manufacturer

À. The manufacturer’s potential liability

Á. The physician’s clinical performance

Â. The physician’s materials testing data

Ã. Any royalties the physician receives from the manufacturer

Ä. Femoral

Å. Obturator

Æ. Inferior gluteal

Ç. Superior gluteal

È. Lateral femoral cutaneous

É. open biopsy and a long leg cast

Ê. open biopsy and wide resection of the tumor

Ë. a long leg cast and observation

Ì. intramedullary stabilization and observation

Í. Triggering

Î. Lateral instability

Ï. Swan-neck deformity

Ð. Boutonniere deformity

Ñ. Loss of distal interphalangeal joint flexion

Ò. Peroneus brevis to peroneus longus

Ó. Peroneus tertius to extensor hallucis longus

Ô. Peroneus tertius to superficial peroneal nerve

Õ. Extensor hallucis longus to deep peroneal nerve

Ö. Extensor hallucis longus to extensor digitorum longus

×. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ü. an onlay iliac crest bone graft.

Ý. limited weightbearing and observation.

Þ. removal of the implant and limited weightbearing.

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

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

Á. Coronal

Â. Sagittal

Ã. Anteromedial, midway between the sagittal and the coronal

Ä. Proximal pins sagittal, distal pins coronal

Å. Proximal pins coronal, distal pins sagittal

Æ. Rheumatoid arthritis

Ç. Posttraumatic arthritis

È. Degenerative osteoarthritis

É. Osteonecrosis of the tibial plateau

Ê. Osteonecrosis of the medial femoral condyle

Ë. Trapeziometacarpal arthrodesis

Ì. Osteotomy of the thumb metacarpal

Í. Arthrotomy and joint debridement

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

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

Ð. Creep

Ñ. Relaxation

Ò. Energy dissipation

Ó. Plastic deformation

Ô. Elastic deformation

Õ. bending

Ö. axial loading

÷. high-speed rotation

Ø. direct impact from anteromedial

Ù. crush from anteromedial to posterolateral

Ú. Increase stiffness

Û. Increase fracture toughness

Ü. Increase fatigue strength

Ý. Decrease mechanical strength

Þ. Decrease wear rate

Ÿ. disuse osteopenia

Ā. paraendocrine effect of the tumor

Ā. abnormally increased density on the right side

Ă. side effect of the treatment of the lesion

Ă. extensive tumor involvement of the left hip

Ą. Sciatic nerve

Ą. Superior gluteal artery

Ć. Profunda femoris artery

Ć. Femoral artery and nerve

Ĉ. External iliac artery and vein

Ĉ. Length

Ċ. Moment arm

Ċ. Total volume

Č. Physiologic cross-sectional area

Č. Distribution of slow and fast twitch fibers

Ď. decreasing initiation of action potentials.

Ď. increasing action potential amplitude.

Đ. blocking the opening of gated sodium channels.

Đ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ę. hemiarthroplasty

Ę. open reduction and internal fixation

Ě. closed reduction and percutaneous pinning

Ě. a sling and early pedulum exercises

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

Ĝ. open acromioplasty

Ğ. open Bankart repair

Ğ. open subscapularis tendon repair

Ġ. inferior capsular shift

Ġ. a supervised physical therapy program

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

Ģ. open reduction and internal fixation through an anterior approach

Ĥ. open reduction and internal fixation through a posterior approach

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

Ħ. arthroscopically assisted reduction and percutaneous screw fixation

Ħ. Repair of the rotator cuff

Ĩ. Replacement of the humeral head

Ĩ. Resection arthroplasty

Ī. Total shoulder arthroplasty

Ī. AP and lateral radiographs of the elbow

Ĭ. Diagnositc arthroscopy

Ĭ. Aspiration of joint fluid

Į. An erythrocyte sedimentation rate and CBC

Į. A diagnostic lidocaine injection

İ. Insulin-like growth factor (IGF-1)

I. Fibroblast growth factor (FGF-1)

Ĳ. Platelet-derived growth factor (PDGF)

Ĳ. Transforming growth factor beta (TGF-B)

Ĵ. Bone morphogenetic proteins (BMP)

Ĵ. clinical history and radiographic findings.

Ķ. technetium bone scan

Ķ. flow cytometry pattern of extracted chondrocytes

ĸ. immunohistochemical staining patterns of a biopsy specimen

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

Ĺ. Radial

Ļ. Radial recurrent

Ļ. Posterior interosseous

Ľ. Superior ulnar recurrent

Ľ. Superficial radial circumflex

Ŀ. Impaired hydroxylation of proline

Ŀ. Failure of cleavage in procollagen

Ł. Defective binding sites for hydroxyproline

Ł. Failure to incorporate glycine into the helix

Ń. Diminished production of collagen through the rough endoplasmic reticulum

Ń. Asking the legal staff to seek a court injunction

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

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

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

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

ʼN. Meta-analysis

Ŋ. Confidence interval

Ŋ. Analysis of variance (ANOVA)

Ō. Statistical significance (p-value)

Ō. Survivorship analysis (Kaplan-Meier)

Ŏ. Spinal shock

Ŏ. Neurogenic shock

Ő. Hypovolemic shock

Ő. Pulmonary embolism

Œ. Fat embolus syndrome

Œ. Lumbar spinal stenosis

Ŕ. Metastatic disease of the spine

Ŕ. Rheumatoid lumbar spondylitis

Ŗ. Isthmic spondyloloisthesis

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

Ř. Patella alta

Ř. A metal-backed patella

Ś. Varus malalignment of the knee

Ś. A posterior cruciate-substituting femoral component

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

Ŝ. The sesamoids are separated

Ş. The sesamoid is fractured

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

Š. The dislocation is dorsal and centered

Š. The proximal phalanx is hyperextended

Ţ. Patella

Ţ. Tibial stem

Ť. Distal femoral interface

Ť. Posterior femoral interface

Ŧ. Sites of screw fixation for the tibia

Ŧ. Hallux rigidus

Ũ. Fracture of the sesamoid

Ũ. Disruption of the plantar plate

Ū. Osteonecrosis of the metatarsal head

Ū. Rupture of the flexor hallucis longus

Ŭ. Gout

Ŭ. Sepsis

Ů. Old trauma

Ů. Rheumatoid arthritis

Ű. Charcot arthroplasty

Ű. Aspiration and steroid injection

Ų. Biopsy, curettage, and allograft bone grafting

Ų. Percutaneous Kirschner wire fixation

Ŵ. Percutaneous injection of autogenous bone marrow

Ŵ. Nerve roots

Ŷ. Spinal cord

Ŷ. Sciatic nerve

Ÿ. Peroneal nerve

Ź. Conus medullaris

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

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

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

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

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

S. Early and late infection

Ƀ. Periprosthetic fracture of the femur

Ɓ. Failure of the patellofemoral and extensor mechanisms

Ƃ. Aseptic loosening of cementing tibial components

Ƃ. Asceptic loosening of cemented femoral components

Ƅ. Acceptance of the current position of the ankle

Ƅ. Open reduction and fixation in the epiphysis only

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

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

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

Ɖ. Resection arthroplasty and local radiation

Ɗ. In situ fusion of the hip

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

Ƌ. Excision of heterotopic bone and local radiation

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

Ǝ. Closed reduction of both fractures and immediate spica casting

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

Ɛ. External fixation of both femora

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

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

Ɠ. Synovial sarcoma

Ɣ. Soft-tissue abcess

Ƕ. Rhabdomyosarcoma

Ɩ. Eosinophilic granuloma

Ɨ. Nodular pigmented villonodular synovitis

Ƙ. Changing to a titanium nail

Ƙ. Changing to a nonslotted nail

Ƚ. Changing the cross-sectional shape of the nail

ƛ. Increasing the diameter of the nail by 3 mm

Ɯ. Increasing the diameter of the interlocking screws

Ɲ. Fracture healing

Ƞ. Chondrosarcoma

Ɵ. Periosteal chondroma

Ơ. Periosteal osteosarcoma

Ơ. Dysplasia epiphysealis hemimelica

Ƣ. Demonstrate competence in the subject of the case

Ƣ. Be fellowship trained in the subject of the case

Ƥ. Be paid on a contingency basis

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

Ʀ. Have been involved in the case as a consultant

Ƨ. Diagnostic arthroscopy

Ƨ. Arthroscopy and subacromial decompression

Ʃ. Reduction and fixation of the proximal humeral epiphysis

ƪ. Temporary cessation of throwing

ƫ. Physical therapy for rotator cuff strengthening

Ƭ. Oblique popliteal ligament

Ƭ. Lateral capsule

Ʈ. Popliteal tendon

Ư. Fibular collateral ligament

Ư. Posterior oblique ligament

Ʊ. Radial tear

Ʋ. Parrot-beak tear

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

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

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

Ƶ. 0 degrees of abduction, with neural rotation

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

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

Ƹ. 90 degrees of abduction with neutral rotation

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

ƻ. Sural

Ƽ. Saphenous and its branches

Ƽ. Posterior tibial and its branches

ƾ. Deep peroneal and its branches

Ƿ. Superficial peroneal and its branches

ǀ. Strength

ǁ. Stiffness

ǂ. Shelf life

ǃ. Antigenicity

Ǆ. Risk of HIV transmission

Ǆ. Indemnification

Ǆ. Occurrence

Ǉ. Excess liability

Ǉ. Claims-made

Ǉ. Nose

Ǌ. Lateral Y

Ǌ. Scapular AP

Ǌ. Neutral rotation AP

Ǎ. Internal rotation AP

Ǎ. External rotation AP

Ǐ. Trauma

Ǐ. Hemophilia

Ǒ. Reiter’s syndrome

Ǒ. Rheumatoid arthritis

Ǔ. Systemic lupus erythematosus

Ǔ. Cast immobilization for 6 weeks

Ǖ. Activity modification and re-evaluation in 2 months

Ǖ. Internal fixation with or without bone grafting

Ǘ. Retrograde drilling of the defect without articular cartilage penetration

Ǘ. Drilling of the defect directly through the articular cartilage

Ǚ. repair or reconstruction of the medial collateral ligament

Ǚ. repair or reconstruction of the medialand lateral collateral ligaments

Ǜ. immobilization for 5 days or less

Ǜ. immobilization for 14 days

Ǝ. immobilization for 25 days

Ǟ. Cystinosis

Ǟ. Hypophosphatemia

Ǡ. Renal osteodystrophy

Ǡ. Primary hyperparathyroidism

Ǣ. Nutritional vitamin D deficiency

Ǣ. Lateral meniscus tear

Ǥ. Popliteus tenosynovitis

Ǥ. Iliotibial band friction syndrome

Ǧ. Peroneal nerve entrapment

Ǧ. Biceps tendinitis

Ǩ. Observation

Ǩ. Removal of the prosthetic components

Ǫ. Operative exploration and decompression of the peroneal nerve

Ǫ. Nerve conduction velocity studies

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

Ǭ. I

Ǯ. II

Ǯ. III

J̌. decreased tissue tension

Ǳ. decreased abductor lever arm

Ǳ. decreased joint reaction force

Ǳ. increased body weight over lever arm

Ǵ. increased polyethylene wear rate

Ǵ. recurrent traumatic anterior dislocation

Ƕ. recurrent traumatic posterior dislocation

Ƿ. traumatic subluxation with no previous dislocation

Ǹ. traumatic anterior subluxation

Ǹ. atraumatic involuntary subluxation

Ǻ. radial

Ǻ. axillary

Ǽ. suprascapular

Ǽ. thoracodorsal

Ǿ. long thoracic

Ǿ. Flexion

Ȁ. Extension

Ȁ. Axial rotation

Ȃ. Left lateral bending

Ȃ. Right lateral bending

Ȅ. Skin

Ȅ. Lung

Ȇ. Brain

Ȇ. Heart

Ȉ. Kidney

Ȉ. Thoracoacromial, lateral thoracic, subscapular

Ȋ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȋ. Posterior humeral circumflex, subscapular, thoracacromial

Ȍ. Subscapular, thoracacromial, anterior humeral circumflex

Ȍ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȏ. Respondeat superior

Ȏ. Indemnity agreement

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

Ȑ. Comparative negligence-% of involvement

Ȓ. Contributory negligence- resident contributed to the negligence

Ȓ. t-type

Ȕ. both column

Ȕ. transverse

Ȗ. anterior column

Ȗ. anterior column posterior hemitransverse

Ș. Posterior interosseous

Ș. Anterior interosseous

Ț. Radial

Ț. Median

Ȝ. Ulnar

Ȝ. Shock from hypovolemia

Ȟ. Associated rupture of the bladder

Ȟ. Arterial bleeding on pelvic angiogram

Ƞ. Presence of a hematoma in the perineum and scrotum

ȡ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Liposarcoma

Explanation

Question 4170

Topic: 10. Pathology and Oncology

Which of the following conditions is most commonly associated with the congenital hand problem shown in Figure 33?

. 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

.. constrained acetabular component

/. protrusion ring with morselized graft

0. cemented metal backed acetabular component

1. cemented all-polyethylene acetabular component

2. cementless hemispherical component with screw fixation

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

4. application of a hip spica under anesthesia

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

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

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

8. Loss of skin hair on the feet

9. 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

B. Syndactyly

C. Macrodactyly

D. Camptodactyly

E. Preaxial polydactyly

F. Postaxial polydactyly

G. Arthrodesis

H. Rotationplasty

I. Above-knee amputation

J. Osteoarticular allograft

K. Endoprosthesis (custom arthroplasty)

L. Plantar fascia

M. Spring ligament

N. Deltoid ligament

O. Intrinsic tendons

P. Gastorcnemius-solelus complex

Q. Prevention of presynaptic release of acetylcholine

R. Prevention of synthesis of presynaptic acetylcholine

S. Activation of acetylcholinesterase at the motor end-plate

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

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

V. stiffness of the femoral component.

W. head offset of the femoral component.

X. femoral component material modulus of elasticity.

Y. extent of the femoral component porous coating.

Z. 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

A. strengthening of the periscapular muscles

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

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

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

E. tricompartmental knee replacement

F. unicompartmental knee replacement

G. medial compartment meniscal allograft

H. valgus-producing distal femoral osteotomy

I. valgus-producing proximal tibial osteotomy

J. Internal rotation of the femoral component

K. External rotation of the tibial component

L. Lateral placement of the femoral component

M. Medial placement of the patellar component

N. Excessive resection of the patella

O. Hallux rigidus

P. Hallux valgus

Q. Neuroma of the first web space

R. Fracture of the sesamoid

S. Rupture of the flexor hallucis longus

T. Sickle cell crisis

U. Idiopathic chondrolysis

V. Hemophilic arthropathy

W. Osteoid osteoma of the femoral neck

X. Legg-Calve-Perthes disease

Y. Decreased ankle jerk and positive femoral nerve stretch test

Z. 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

. Immediate exchange arthroplasty with antibiotic-impregnated cement

. Two-stage surgical prosthetic exchange and IV antibiotics

. Resection arthroplasty and IV antibiotics

. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

. 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%.

¡. I

¢. II

£. IV

¤. IX

¥. X

¦. Cranial setting

§. Cranial subluxation

¨. Odontoid fracture

©. Lysis of the arch of the atlas

ª. Atlantoaxial subluxation

«. Retrograde collapse of the endoneurial tubes

¬. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

®. Sprouting of the axons at the neuromuscular junction

¯. Misdirection of the axons across the zone of injury

°. Maximally pronated and elbow extended

±. Maximally pronated and the elbow flexed

². Maximally supinated and the elbow flexed

³. Maximally supinated and the elbow extended

´. In neutral rotation, with the elbow extended

Μ. open reduction and internal fixation

¶. buddy taping to the adjacent index finger

·. early motion with application of a dynamic banjo splint

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

¹. dorsal extension block splinting

º. The name of the manufacturer

». The manufacturer’s potential liability

¼. The physician’s clinical performance

½. The physician’s materials testing data

¾. Any royalties the physician receives from the manufacturer

¿. Femoral

À. Obturator

Á. Inferior gluteal

Â. Superior gluteal

Ã. Lateral femoral cutaneous

Ä. open biopsy and a long leg cast

Å. open biopsy and wide resection of the tumor

Æ. a long leg cast and observation

Ç. intramedullary stabilization and observation

È. Triggering

É. Lateral instability

Ê. Swan-neck deformity

Ë. Boutonniere deformity

Ì. Loss of distal interphalangeal joint flexion

Í. Peroneus brevis to peroneus longus

Î. Peroneus tertius to extensor hallucis longus

Ï. Peroneus tertius to superficial peroneal nerve

Ð. Extensor hallucis longus to deep peroneal nerve

Ñ. Extensor hallucis longus to extensor digitorum longus

Ò. reassurance that Medicare will pay for the treatment.

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

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

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

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

×. an onlay iliac crest bone graft.

Ø. limited weightbearing and observation.

Ù. removal of the implant and limited weightbearing.

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

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

Ü. Coronal

Ý. Sagittal

Þ. Anteromedial, midway between the sagittal and the coronal

SS. Proximal pins sagittal, distal pins coronal

À. Proximal pins coronal, distal pins sagittal

Á. Rheumatoid arthritis

Â. Posttraumatic arthritis

Ã. Degenerative osteoarthritis

Ä. Osteonecrosis of the tibial plateau

Å. Osteonecrosis of the medial femoral condyle

Æ. Trapeziometacarpal arthrodesis

Ç. Osteotomy of the thumb metacarpal

È. Arthrotomy and joint debridement

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

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

Ë. Creep

Ì. Relaxation

Í. Energy dissipation

Î. Plastic deformation

Ï. Elastic deformation

Ð. bending

Ñ. axial loading

Ò. high-speed rotation

Ó. direct impact from anteromedial

Ô. crush from anteromedial to posterolateral

Õ. Increase stiffness

Ö. Increase fracture toughness

÷. Increase fatigue strength

Ø. Decrease mechanical strength

Ù. Decrease wear rate

Ú. disuse osteopenia

Û. paraendocrine effect of the tumor

Ü. abnormally increased density on the right side

Ý. side effect of the treatment of the lesion

Þ. extensive tumor involvement of the left hip

Ÿ. Sciatic nerve

Ā. Superior gluteal artery

Ā. Profunda femoris artery

Ă. Femoral artery and nerve

Ă. External iliac artery and vein

Ą. Length

Ą. Moment arm

Ć. Total volume

Ć. Physiologic cross-sectional area

Ĉ. Distribution of slow and fast twitch fibers

Ĉ. decreasing initiation of action potentials.

Ċ. increasing action potential amplitude.

Ċ. blocking the opening of gated sodium channels.

Č. decreasing the number of functional motor units.

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

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

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

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

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

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

Ē. hemiarthroplasty

Ĕ. open reduction and internal fixation

Ĕ. closed reduction and percutaneous pinning

Ė. a sling and early pedulum exercises

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

Ę. open acromioplasty

Ę. open Bankart repair

Ě. open subscapularis tendon repair

Ě. inferior capsular shift

Ĝ. a supervised physical therapy program

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

Ğ. open reduction and internal fixation through an anterior approach

Ğ. open reduction and internal fixation through a posterior approach

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

Ġ. arthroscopically assisted reduction and percutaneous screw fixation

Ģ. Repair of the rotator cuff

Ģ. Replacement of the humeral head

Ĥ. Resection arthroplasty

Ĥ. Total shoulder arthroplasty

Ħ. AP and lateral radiographs of the elbow

Ħ. Diagnositc arthroscopy

Ĩ. Aspiration of joint fluid

Ĩ. An erythrocyte sedimentation rate and CBC

Ī. A diagnostic lidocaine injection

Ī. Insulin-like growth factor (IGF-1)

Ĭ. Fibroblast growth factor (FGF-1)

Ĭ. Platelet-derived growth factor (PDGF)

Į. Transforming growth factor beta (TGF-B)

Į. Bone morphogenetic proteins (BMP)

İ. clinical history and radiographic findings.

I. technetium bone scan

Ĳ. flow cytometry pattern of extracted chondrocytes

Ĳ. immunohistochemical staining patterns of a biopsy specimen

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

Ĵ. Radial

Ķ. Radial recurrent

Ķ. Posterior interosseous

ĸ. Superior ulnar recurrent

Ĺ. Superficial radial circumflex

Ĺ. Impaired hydroxylation of proline

Ļ. Failure of cleavage in procollagen

Ļ. Defective binding sites for hydroxyproline

Ľ. Failure to incorporate glycine into the helix

Ľ. Diminished production of collagen through the rough endoplasmic reticulum

Ŀ. Asking the legal staff to seek a court injunction

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

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

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

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

Ń. Meta-analysis

Ņ. Confidence interval

Ņ. Analysis of variance (ANOVA)

Ň. Statistical significance (p-value)

Ň. Survivorship analysis (Kaplan-Meier)

ʼN. Spinal shock

Ŋ. Neurogenic shock

Ŋ. Hypovolemic shock

Ō. Pulmonary embolism

Ō. Fat embolus syndrome

Ŏ. Lumbar spinal stenosis

Ŏ. Metastatic disease of the spine

Ő. Rheumatoid lumbar spondylitis

Ő. Isthmic spondyloloisthesis

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

Œ. Patella alta

Ŕ. A metal-backed patella

Ŕ. Varus malalignment of the knee

Ŗ. A posterior cruciate-substituting femoral component

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

Ř. The sesamoids are separated

Ř. The sesamoid is fractured

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

Ś. The dislocation is dorsal and centered

Ŝ. The proximal phalanx is hyperextended

Ŝ. Patella

Ş. Tibial stem

Ş. Distal femoral interface

Š. Posterior femoral interface

Š. Sites of screw fixation for the tibia

Ţ. Hallux rigidus

Ţ. Fracture of the sesamoid

Ť. Disruption of the plantar plate

Ť. Osteonecrosis of the metatarsal head

Ŧ. Rupture of the flexor hallucis longus

Ŧ. Gout

Ũ. Sepsis

Ũ. Old trauma

Ū. Rheumatoid arthritis

Ū. Charcot arthroplasty

Ŭ. Aspiration and steroid injection

Ŭ. Biopsy, curettage, and allograft bone grafting

Ů. Percutaneous Kirschner wire fixation

Ů. Percutaneous injection of autogenous bone marrow

Ű. Nerve roots

Ű. Spinal cord

Ų. Sciatic nerve

Ų. Peroneal nerve

Ŵ. Conus medullaris

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

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

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

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

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

Ź. Early and late infection

Ż. Periprosthetic fracture of the femur

Ż. Failure of the patellofemoral and extensor mechanisms

Ž. Aseptic loosening of cementing tibial components

Ž. Asceptic loosening of cemented femoral components

S. Acceptance of the current position of the ankle

Ƀ. Open reduction and fixation in the epiphysis only

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

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

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

Ƅ. Resection arthroplasty and local radiation

Ƅ. In situ fusion of the hip

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

Ƈ. Excision of heterotopic bone and local radiation

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

Ɖ. Closed reduction of both fractures and immediate spica casting

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

Ƌ. External fixation of both femora

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

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

Ǝ. Synovial sarcoma

Ə. Soft-tissue abcess

Ɛ. Rhabdomyosarcoma

Ƒ. Eosinophilic granuloma

Ƒ. Nodular pigmented villonodular synovitis

Ɠ. Changing to a titanium nail

Ɣ. Changing to a nonslotted nail

Ƕ. Changing the cross-sectional shape of the nail

Ɩ. Increasing the diameter of the nail by 3 mm

Ɨ. Increasing the diameter of the interlocking screws

Ƙ. Fracture healing

Ƙ. Chondrosarcoma

Ƚ. Periosteal chondroma

ƛ. Periosteal osteosarcoma

Ɯ. Dysplasia epiphysealis hemimelica

Ɲ. Demonstrate competence in the subject of the case

Ƞ. Be fellowship trained in the subject of the case

Ɵ. Be paid on a contingency basis

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

Ơ. Have been involved in the case as a consultant

Ƣ. Diagnostic arthroscopy

Ƣ. Arthroscopy and subacromial decompression

Ƥ. Reduction and fixation of the proximal humeral epiphysis

Ƥ. Temporary cessation of throwing

Ʀ. Physical therapy for rotator cuff strengthening

Ƨ. Oblique popliteal ligament

Ƨ. Lateral capsule

Ʃ. Popliteal tendon

ƪ. Fibular collateral ligament

ƫ. Posterior oblique ligament

Ƭ. Radial tear

Ƭ. Parrot-beak tear

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

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

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

Ʊ. 0 degrees of abduction, with neural rotation

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

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

Ƴ. 90 degrees of abduction with neutral rotation

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

Ƶ. Sural

Ʒ. Saphenous and its branches

Ƹ. Posterior tibial and its branches

Ƹ. Deep peroneal and its branches

ƺ. Superficial peroneal and its branches

ƻ. Strength

Ƽ. Stiffness

Ƽ. Shelf life

ƾ. Antigenicity

Ƿ. Risk of HIV transmission

ǀ. Indemnification

ǁ. Occurrence

ǂ. Excess liability

ǃ. Claims-made

Ǆ. Nose

Ǆ. Lateral Y

Ǆ. Scapular AP

Ǉ. Neutral rotation AP

Ǉ. Internal rotation AP

Ǉ. External rotation AP

Ǌ. Trauma

Ǌ. Hemophilia

Ǌ. Reiter’s syndrome

Ǎ. Rheumatoid arthritis

Ǎ. Systemic lupus erythematosus

Ǐ. Cast immobilization for 6 weeks

Ǐ. Activity modification and re-evaluation in 2 months

Ǒ. Internal fixation with or without bone grafting

Ǒ. Retrograde drilling of the defect without articular cartilage penetration

Ǔ. Drilling of the defect directly through the articular cartilage

Ǔ. repair or reconstruction of the medial collateral ligament

Ǖ. repair or reconstruction of the medialand lateral collateral ligaments

Ǖ. immobilization for 5 days or less

Ǘ. immobilization for 14 days

Ǘ. immobilization for 25 days

Ǚ. Cystinosis

Ǚ. Hypophosphatemia

Ǜ. Renal osteodystrophy

Ǜ. Primary hyperparathyroidism

Ǝ. Nutritional vitamin D deficiency

Ǟ. Lateral meniscus tear

Ǟ. Popliteus tenosynovitis

Ǡ. Iliotibial band friction syndrome

Ǡ. Peroneal nerve entrapment

Ǣ. Biceps tendinitis

Ǣ. Observation

Ǥ. Removal of the prosthetic components

Ǥ. Operative exploration and decompression of the peroneal nerve

Ǧ. Nerve conduction velocity studies

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

Ǩ. I

Ǩ. II

Ǫ. III

Ǫ. decreased tissue tension

Ǭ. decreased abductor lever arm

Ǭ. decreased joint reaction force

Ǯ. increased body weight over lever arm

Ǯ. increased polyethylene wear rate

J̌. recurrent traumatic anterior dislocation

Ǳ. recurrent traumatic posterior dislocation

Ǳ. traumatic subluxation with no previous dislocation

Ǳ. traumatic anterior subluxation

Ǵ. atraumatic involuntary subluxation

Ǵ. radial

Ƕ. axillary

Ƿ. suprascapular

Ǹ. thoracodorsal

Ǹ. long thoracic

Ǻ. Flexion

Ǻ. Extension

Ǽ. Axial rotation

Ǽ. Left lateral bending

Ǿ. Right lateral bending

Ǿ. Skin

Ȁ. Lung

Ȁ. Brain

Ȃ. Heart

Ȃ. Kidney

Ȅ. Thoracoacromial, lateral thoracic, subscapular

Ȅ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȇ. Posterior humeral circumflex, subscapular, thoracacromial

Ȇ. Subscapular, thoracacromial, anterior humeral circumflex

Ȉ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȉ. Respondeat superior

Ȋ. Indemnity agreement

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

Ȍ. Comparative negligence-% of involvement

Ȍ. Contributory negligence- resident contributed to the negligence

Ȏ. t-type

Ȏ. both column

Ȑ. transverse

Ȑ. anterior column

Ȓ. anterior column posterior hemitransverse

Ȓ. Posterior interosseous

Ȕ. Anterior interosseous

Ȕ. Radial

Ȗ. Median

Ȗ. Ulnar

Ș. Shock from hypovolemia

Ș. Associated rupture of the bladder

Ț. Arterial bleeding on pelvic angiogram

Ț. Presence of a hematoma in the perineum and scrotum

Ȝ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Clubfeet

Explanation

Question 4171

Topic: 10. Pathology and Oncology

A 35-year-old machinist sustains a crush injury to the forearm in an industrial accident. Figure 34 shows the arm following skeletal stabilization and fasciotomy. Wound closure is best accomplished by

. 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

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

/. application of a hip spica under anesthesia

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

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

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

3. Loss of skin hair on the feet

4. Absent pulses on vascular examination

5. Pain that originates proximally and spreads distally

6. Pain that is relieved by stopping and standing

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

8. wrist flexors and finger flexors

9. 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

B. Arthrodesis

C. Rotationplasty

D. Above-knee amputation

E. Osteoarticular allograft

F. Endoprosthesis (custom arthroplasty)

G. Plantar fascia

H. Spring ligament

I. Deltoid ligament

J. Intrinsic tendons

K. Gastorcnemius-solelus complex

L. Prevention of presynaptic release of acetylcholine

M. Prevention of synthesis of presynaptic acetylcholine

N. Activation of acetylcholinesterase at the motor end-plate

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

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

Q. stiffness of the femoral component.

R. head offset of the femoral component.

S. femoral component material modulus of elasticity.

T. extent of the femoral component porous coating.

U. Presence of a femoral component collar.

V. plantar fascia and quadratus plantae tendon.

W. ligamentous structures connecting the tarsal bones.

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

Y. activity of the intrinsic muscles of the foot.

Z. 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

A. unicompartmental knee replacement

B. medial compartment meniscal allograft

C. valgus-producing distal femoral osteotomy

D. valgus-producing proximal tibial osteotomy

E. Internal rotation of the femoral component

F. External rotation of the tibial component

G. Lateral placement of the femoral component

H. Medial placement of the patellar component

I. Excessive resection of the patella

J. Hallux rigidus

K. Hallux valgus

L. Neuroma of the first web space

M. Fracture of the sesamoid

N. Rupture of the flexor hallucis longus

O. Sickle cell crisis

P. Idiopathic chondrolysis

Q. Hemophilic arthropathy

R. Osteoid osteoma of the femoral neck

S. Legg-Calve-Perthes disease

T. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

Y. Long-term administration of IV and oral antibiotics

Z. 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

}. Resection arthroplasty and IV antibiotics

~. SCFE

. MED

. Perthes disease

. Hypothyroidism

. Chondrolysis

. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

. 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%.

. I

. II

. IV

. IX

. X

¡. Cranial setting

¢. Cranial subluxation

£. Odontoid fracture

¤. Lysis of the arch of the atlas

¥. Atlantoaxial subluxation

¦. Retrograde collapse of the endoneurial tubes

§. Irreversible atrophy of the denervated muscles

¨. Elongation of the axons across the zone of injury

©. Sprouting of the axons at the neuromuscular junction

ª. Misdirection of the axons across the zone of injury

«. Maximally pronated and elbow extended

¬. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

®. Maximally supinated and the elbow extended

¯. In neutral rotation, with the elbow extended

°. open reduction and internal fixation

±. buddy taping to the adjacent index finger

². early motion with application of a dynamic banjo splint

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

´. dorsal extension block splinting

Μ. The name of the manufacturer

¶. The manufacturer’s potential liability

·. The physician’s clinical performance

¸. The physician’s materials testing data

¹. Any royalties the physician receives from the manufacturer

º. Femoral

». Obturator

¼. Inferior gluteal

½. Superior gluteal

¾. Lateral femoral cutaneous

¿. open biopsy and a long leg cast

À. open biopsy and wide resection of the tumor

Á. a long leg cast and observation

Â. intramedullary stabilization and observation

Ã. Triggering

Ä. Lateral instability

Å. Swan-neck deformity

Æ. Boutonniere deformity

Ç. Loss of distal interphalangeal joint flexion

È. Peroneus brevis to peroneus longus

É. Peroneus tertius to extensor hallucis longus

Ê. Peroneus tertius to superficial peroneal nerve

Ë. Extensor hallucis longus to deep peroneal nerve

Ì. Extensor hallucis longus to extensor digitorum longus

Í. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ò. an onlay iliac crest bone graft.

Ó. limited weightbearing and observation.

Ô. removal of the implant and limited weightbearing.

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

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

×. Coronal

Ø. Sagittal

Ù. Anteromedial, midway between the sagittal and the coronal

Ú. Proximal pins sagittal, distal pins coronal

Û. Proximal pins coronal, distal pins sagittal

Ü. Rheumatoid arthritis

Ý. Posttraumatic arthritis

Þ. Degenerative osteoarthritis

SS. Osteonecrosis of the tibial plateau

À. Osteonecrosis of the medial femoral condyle

Á. Trapeziometacarpal arthrodesis

Â. Osteotomy of the thumb metacarpal

Ã. Arthrotomy and joint debridement

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

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

Æ. Creep

Ç. Relaxation

È. Energy dissipation

É. Plastic deformation

Ê. Elastic deformation

Ë. bending

Ì. axial loading

Í. high-speed rotation

Î. direct impact from anteromedial

Ï. crush from anteromedial to posterolateral

Ð. Increase stiffness

Ñ. Increase fracture toughness

Ò. Increase fatigue strength

Ó. Decrease mechanical strength

Ô. Decrease wear rate

Õ. disuse osteopenia

Ö. paraendocrine effect of the tumor

÷. abnormally increased density on the right side

Ø. side effect of the treatment of the lesion

Ù. extensive tumor involvement of the left hip

Ú. Sciatic nerve

Û. Superior gluteal artery

Ü. Profunda femoris artery

Ý. Femoral artery and nerve

Þ. External iliac artery and vein

Ÿ. Length

Ā. Moment arm

Ā. Total volume

Ă. Physiologic cross-sectional area

Ă. Distribution of slow and fast twitch fibers

Ą. decreasing initiation of action potentials.

Ą. increasing action potential amplitude.

Ć. blocking the opening of gated sodium channels.

Ć. decreasing the number of functional motor units.

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

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

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

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

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

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

Ď. hemiarthroplasty

Ď. open reduction and internal fixation

Đ. closed reduction and percutaneous pinning

Đ. a sling and early pedulum exercises

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

Ē. open acromioplasty

Ĕ. open Bankart repair

Ĕ. open subscapularis tendon repair

Ė. inferior capsular shift

Ė. a supervised physical therapy program

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

Ę. open reduction and internal fixation through an anterior approach

Ě. open reduction and internal fixation through a posterior approach

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

Ĝ. arthroscopically assisted reduction and percutaneous screw fixation

Ĝ. Repair of the rotator cuff

Ğ. Replacement of the humeral head

Ğ. Resection arthroplasty

Ġ. Total shoulder arthroplasty

Ġ. AP and lateral radiographs of the elbow

Ģ. Diagnositc arthroscopy

Ģ. Aspiration of joint fluid

Ĥ. An erythrocyte sedimentation rate and CBC

Ĥ. A diagnostic lidocaine injection

Ħ. Insulin-like growth factor (IGF-1)

Ħ. Fibroblast growth factor (FGF-1)

Ĩ. Platelet-derived growth factor (PDGF)

Ĩ. Transforming growth factor beta (TGF-B)

Ī. Bone morphogenetic proteins (BMP)

Ī. clinical history and radiographic findings.

Ĭ. technetium bone scan

Ĭ. flow cytometry pattern of extracted chondrocytes

Į. immunohistochemical staining patterns of a biopsy specimen

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

İ. Radial

I. Radial recurrent

Ĳ. Posterior interosseous

Ĳ. Superior ulnar recurrent

Ĵ. Superficial radial circumflex

Ĵ. Impaired hydroxylation of proline

Ķ. Failure of cleavage in procollagen

Ķ. Defective binding sites for hydroxyproline

ĸ. Failure to incorporate glycine into the helix

Ĺ. Diminished production of collagen through the rough endoplasmic reticulum

Ĺ. Asking the legal staff to seek a court injunction

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

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

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

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

Ŀ. Meta-analysis

Ŀ. Confidence interval

Ł. Analysis of variance (ANOVA)

Ł. Statistical significance (p-value)

Ń. Survivorship analysis (Kaplan-Meier)

Ń. Spinal shock

Ņ. Neurogenic shock

Ņ. Hypovolemic shock

Ň. Pulmonary embolism

Ň. Fat embolus syndrome

ʼN. Lumbar spinal stenosis

Ŋ. Metastatic disease of the spine

Ŋ. Rheumatoid lumbar spondylitis

Ō. Isthmic spondyloloisthesis

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

Ŏ. Patella alta

Ŏ. A metal-backed patella

Ő. Varus malalignment of the knee

Ő. A posterior cruciate-substituting femoral component

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

Œ. The sesamoids are separated

Ŕ. The sesamoid is fractured

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

Ŗ. The dislocation is dorsal and centered

Ŗ. The proximal phalanx is hyperextended

Ř. Patella

Ř. Tibial stem

Ś. Distal femoral interface

Ś. Posterior femoral interface

Ŝ. Sites of screw fixation for the tibia

Ŝ. Hallux rigidus

Ş. Fracture of the sesamoid

Ş. Disruption of the plantar plate

Š. Osteonecrosis of the metatarsal head

Š. Rupture of the flexor hallucis longus

Ţ. Gout

Ţ. Sepsis

Ť. Old trauma

Ť. Rheumatoid arthritis

Ŧ. Charcot arthroplasty

Ŧ. Aspiration and steroid injection

Ũ. Biopsy, curettage, and allograft bone grafting

Ũ. Percutaneous Kirschner wire fixation

Ū. Percutaneous injection of autogenous bone marrow

Ū. Nerve roots

Ŭ. Spinal cord

Ŭ. Sciatic nerve

Ů. Peroneal nerve

Ů. Conus medullaris

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

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

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

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

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

Ŵ. Early and late infection

Ŷ. Periprosthetic fracture of the femur

Ŷ. Failure of the patellofemoral and extensor mechanisms

Ÿ. Aseptic loosening of cementing tibial components

Ź. Asceptic loosening of cemented femoral components

Ź. Acceptance of the current position of the ankle

Ż. Open reduction and fixation in the epiphysis only

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

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

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

S. Resection arthroplasty and local radiation

Ƀ. In situ fusion of the hip

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

Ƃ. Excision of heterotopic bone and local radiation

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

Ƅ. Closed reduction of both fractures and immediate spica casting

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

Ɔ. External fixation of both femora

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

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

Ɖ. Synovial sarcoma

Ɗ. Soft-tissue abcess

Ƌ. Rhabdomyosarcoma

Ƌ. Eosinophilic granuloma

ƍ. Nodular pigmented villonodular synovitis

Ǝ. Changing to a titanium nail

Ə. Changing to a nonslotted nail

Ɛ. Changing the cross-sectional shape of the nail

Ƒ. Increasing the diameter of the nail by 3 mm

Ƒ. Increasing the diameter of the interlocking screws

Ɠ. Fracture healing

Ɣ. Chondrosarcoma

Ƕ. Periosteal chondroma

Ɩ. Periosteal osteosarcoma

Ɨ. Dysplasia epiphysealis hemimelica

Ƙ. Demonstrate competence in the subject of the case

Ƙ. Be fellowship trained in the subject of the case

Ƚ. Be paid on a contingency basis

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

Ɯ. Have been involved in the case as a consultant

Ɲ. Diagnostic arthroscopy

Ƞ. Arthroscopy and subacromial decompression

Ɵ. Reduction and fixation of the proximal humeral epiphysis

Ơ. Temporary cessation of throwing

Ơ. Physical therapy for rotator cuff strengthening

Ƣ. Oblique popliteal ligament

Ƣ. Lateral capsule

Ƥ. Popliteal tendon

Ƥ. Fibular collateral ligament

Ʀ. Posterior oblique ligament

Ƨ. Radial tear

Ƨ. Parrot-beak tear

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

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

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

Ƭ. 0 degrees of abduction, with neural rotation

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

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

Ư. 90 degrees of abduction with neutral rotation

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

Ʊ. Sural

Ʋ. Saphenous and its branches

Ƴ. Posterior tibial and its branches

Ƴ. Deep peroneal and its branches

Ƶ. Superficial peroneal and its branches

Ƶ. Strength

Ʒ. Stiffness

Ƹ. Shelf life

Ƹ. Antigenicity

ƺ. Risk of HIV transmission

ƻ. Indemnification

Ƽ. Occurrence

Ƽ. Excess liability

ƾ. Claims-made

Ƿ. Nose

ǀ. Lateral Y

ǁ. Scapular AP

ǂ. Neutral rotation AP

ǃ. Internal rotation AP

Ǆ. External rotation AP

Ǆ. Trauma

Ǆ. Hemophilia

Ǉ. Reiter’s syndrome

Ǉ. Rheumatoid arthritis

Ǉ. Systemic lupus erythematosus

Ǌ. Cast immobilization for 6 weeks

Ǌ. Activity modification and re-evaluation in 2 months

Ǌ. Internal fixation with or without bone grafting

Ǎ. Retrograde drilling of the defect without articular cartilage penetration

Ǎ. Drilling of the defect directly through the articular cartilage

Ǐ. repair or reconstruction of the medial collateral ligament

Ǐ. repair or reconstruction of the medialand lateral collateral ligaments

Ǒ. immobilization for 5 days or less

Ǒ. immobilization for 14 days

Ǔ. immobilization for 25 days

Ǔ. Cystinosis

Ǖ. Hypophosphatemia

Ǖ. Renal osteodystrophy

Ǘ. Primary hyperparathyroidism

Ǘ. Nutritional vitamin D deficiency

Ǚ. Lateral meniscus tear

Ǚ. Popliteus tenosynovitis

Ǜ. Iliotibial band friction syndrome

Ǜ. Peroneal nerve entrapment

Ǝ. Biceps tendinitis

Ǟ. Observation

Ǟ. Removal of the prosthetic components

Ǡ. Operative exploration and decompression of the peroneal nerve

Ǡ. Nerve conduction velocity studies

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

Ǣ. I

Ǥ. II

Ǥ. III

Ǧ. decreased tissue tension

Ǧ. decreased abductor lever arm

Ǩ. decreased joint reaction force

Ǩ. increased body weight over lever arm

Ǫ. increased polyethylene wear rate

Ǫ. recurrent traumatic anterior dislocation

Ǭ. recurrent traumatic posterior dislocation

Ǭ. traumatic subluxation with no previous dislocation

Ǯ. traumatic anterior subluxation

Ǯ. atraumatic involuntary subluxation

J̌. radial

Ǳ. axillary

Ǳ. suprascapular

Ǳ. thoracodorsal

Ǵ. long thoracic

Ǵ. Flexion

Ƕ. Extension

Ƿ. Axial rotation

Ǹ. Left lateral bending

Ǹ. Right lateral bending

Ǻ. Skin

Ǻ. Lung

Ǽ. Brain

Ǽ. Heart

Ǿ. Kidney

Ǿ. Thoracoacromial, lateral thoracic, subscapular

Ȁ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ȁ. Posterior humeral circumflex, subscapular, thoracacromial

Ȃ. Subscapular, thoracacromial, anterior humeral circumflex

Ȃ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ȅ. Respondeat superior

Ȅ. Indemnity agreement

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

Ȇ. Comparative negligence-% of involvement

Ȉ. Contributory negligence- resident contributed to the negligence

Ȉ. t-type

Ȋ. both column

Ȋ. transverse

Ȍ. anterior column

Ȍ. anterior column posterior hemitransverse

Ȏ. Posterior interosseous

Ȏ. Anterior interosseous

Ȑ. Radial

Ȑ. Median

Ȓ. Ulnar

Ȓ. Shock from hypovolemia

Ȕ. Associated rupture of the bladder

Ȕ. Arterial bleeding on pelvic angiogram

Ȗ. Presence of a hematoma in the perineum and scrotum

Ȗ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. delayed primary closure

Explanation

Question 4172

Topic: 10. Pathology and Oncology

Figure 35 shows a postoperative radiograph of a femur fracture proximal to a total knee prosthesis that was treated by open reduction and blade plate fixation 9 months ago. What is the most likely reason the previously well seated screw has backed out of the central portion of the plate?

. 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

.. Loss of skin hair on the feet

/. Absent pulses on vascular examination

0. Pain that originates proximally and spreads distally

1. Pain that is relieved by stopping and standing

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

3. wrist flexors and finger flexors

4. elbow flexors and wrist flexors

5. elbow flexors and finger flexors

6. 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

7. elbow extensors and wrist extensors

8. Syndactyly

9. Macrodactyly

:. Camptodactyly

;. Preaxial polydactyly

<. Postaxial polydactyly

=. Arthrodesis

>. Rotationplasty

?. Above-knee amputation

@. Osteoarticular allograft

A. Endoprosthesis (custom arthroplasty)

B. Plantar fascia

C. Spring ligament

D. Deltoid ligament

E. Intrinsic tendons

F. Gastorcnemius-solelus complex

G. Prevention of presynaptic release of acetylcholine

H. Prevention of synthesis of presynaptic acetylcholine

I. Activation of acetylcholinesterase at the motor end-plate

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

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

L. stiffness of the femoral component.

M. head offset of the femoral component.

N. femoral component material modulus of elasticity.

O. extent of the femoral component porous coating.

P. Presence of a femoral component collar.

Q. plantar fascia and quadratus plantae tendon.

R. ligamentous structures connecting the tarsal bones.

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

T. activity of the intrinsic muscles of the foot.

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

V. scapulothoracic fusion

W. strengthening of the periscapular muscles

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

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

Z. 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

A. External rotation of the tibial component

B. Lateral placement of the femoral component

C. Medial placement of the patellar component

D. Excessive resection of the patella

E. Hallux rigidus

F. Hallux valgus

G. Neuroma of the first web space

H. Fracture of the sesamoid

I. Rupture of the flexor hallucis longus

J. Sickle cell crisis

K. Idiopathic chondrolysis

L. Hemophilic arthropathy

M. Osteoid osteoma of the femoral neck

N. Legg-Calve-Perthes disease

O. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

T. Long-term administration of IV and oral antibiotics

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

V. Immediate exchange arthroplasty with antibiotic-impregnated cement

W. Two-stage surgical prosthetic exchange and IV antibiotics

X. Resection arthroplasty and IV antibiotics

Y. SCFE

Z. MED

{. Perthes disease

|. Hypothyroidism

}. Chondrolysis

~. gout.

. osteoporosis.

. eosinophilic granuloma.

. tuberculosis of the spine.

. metastatic disease of the spine.

. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

. 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%.

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

¡. Retrograde collapse of the endoneurial tubes

¢. Irreversible atrophy of the denervated muscles

£. Elongation of the axons across the zone of injury

¤. Sprouting of the axons at the neuromuscular junction

¥. Misdirection of the axons across the zone of injury

¦. Maximally pronated and elbow extended

§. Maximally pronated and the elbow flexed

¨. Maximally supinated and the elbow flexed

©. Maximally supinated and the elbow extended

ª. In neutral rotation, with the elbow extended

«. open reduction and internal fixation

¬. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

¯. dorsal extension block splinting

°. The name of the manufacturer

±. The manufacturer’s potential liability

². The physician’s clinical performance

³. The physician’s materials testing data

´. Any royalties the physician receives from the manufacturer

Μ. Femoral

¶. Obturator

·. Inferior gluteal

¸. Superior gluteal

¹. Lateral femoral cutaneous

º. open biopsy and a long leg cast

». open biopsy and wide resection of the tumor

¼. a long leg cast and observation

½. intramedullary stabilization and observation

¾. Triggering

¿. Lateral instability

À. Swan-neck deformity

Á. Boutonniere deformity

Â. Loss of distal interphalangeal joint flexion

Ã. Peroneus brevis to peroneus longus

Ä. Peroneus tertius to extensor hallucis longus

Å. Peroneus tertius to superficial peroneal nerve

Æ. Extensor hallucis longus to deep peroneal nerve

Ç. Extensor hallucis longus to extensor digitorum longus

È. reassurance that Medicare will pay for the treatment.

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

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

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

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

Í. an onlay iliac crest bone graft.

Î. limited weightbearing and observation.

Ï. removal of the implant and limited weightbearing.

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

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

Ò. Coronal

Ó. Sagittal

Ô. Anteromedial, midway between the sagittal and the coronal

Õ. Proximal pins sagittal, distal pins coronal

Ö. Proximal pins coronal, distal pins sagittal

×. Rheumatoid arthritis

Ø. Posttraumatic arthritis

Ù. Degenerative osteoarthritis

Ú. Osteonecrosis of the tibial plateau

Û. Osteonecrosis of the medial femoral condyle

Ü. Trapeziometacarpal arthrodesis

Ý. Osteotomy of the thumb metacarpal

Þ. Arthrotomy and joint debridement

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

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

Á. Creep

Â. Relaxation

Ã. Energy dissipation

Ä. Plastic deformation

Å. Elastic deformation

Æ. bending

Ç. axial loading

È. high-speed rotation

É. direct impact from anteromedial

Ê. crush from anteromedial to posterolateral

Ë. Increase stiffness

Ì. Increase fracture toughness

Í. Increase fatigue strength

Î. Decrease mechanical strength

Ï. Decrease wear rate

Ð. disuse osteopenia

Ñ. paraendocrine effect of the tumor

Ò. abnormally increased density on the right side

Ó. side effect of the treatment of the lesion

Ô. extensive tumor involvement of the left hip

Õ. Sciatic nerve

Ö. Superior gluteal artery

÷. Profunda femoris artery

Ø. Femoral artery and nerve

Ù. External iliac artery and vein

Ú. Length

Û. Moment arm

Ü. Total volume

Ý. Physiologic cross-sectional area

Þ. Distribution of slow and fast twitch fibers

Ÿ. decreasing initiation of action potentials.

Ā. increasing action potential amplitude.

Ā. blocking the opening of gated sodium channels.

Ă. decreasing the number of functional motor units.

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

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

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

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

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

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

Ĉ. hemiarthroplasty

Ċ. open reduction and internal fixation

Ċ. closed reduction and percutaneous pinning

Č. a sling and early pedulum exercises

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

Ď. open acromioplasty

Ď. open Bankart repair

Đ. open subscapularis tendon repair

Đ. inferior capsular shift

Ē. a supervised physical therapy program

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

Ĕ. open reduction and internal fixation through an anterior approach

Ĕ. open reduction and internal fixation through a posterior approach

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

Ė. arthroscopically assisted reduction and percutaneous screw fixation

Ę. Repair of the rotator cuff

Ę. Replacement of the humeral head

Ě. Resection arthroplasty

Ě. Total shoulder arthroplasty

Ĝ. AP and lateral radiographs of the elbow

Ĝ. Diagnositc arthroscopy

Ğ. Aspiration of joint fluid

Ğ. An erythrocyte sedimentation rate and CBC

Ġ. A diagnostic lidocaine injection

Ġ. Insulin-like growth factor (IGF-1)

Ģ. Fibroblast growth factor (FGF-1)

Ģ. Platelet-derived growth factor (PDGF)

Ĥ. Transforming growth factor beta (TGF-B)

Ĥ. Bone morphogenetic proteins (BMP)

Ħ. clinical history and radiographic findings.

Ħ. technetium bone scan

Ĩ. flow cytometry pattern of extracted chondrocytes

Ĩ. immunohistochemical staining patterns of a biopsy specimen

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

Ī. Radial

Ĭ. Radial recurrent

Ĭ. Posterior interosseous

Į. Superior ulnar recurrent

Į. Superficial radial circumflex

İ. Impaired hydroxylation of proline

I. Failure of cleavage in procollagen

Ĳ. Defective binding sites for hydroxyproline

Ĳ. Failure to incorporate glycine into the helix

Ĵ. Diminished production of collagen through the rough endoplasmic reticulum

Ĵ. Asking the legal staff to seek a court injunction

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

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

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

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

Ĺ. Meta-analysis

Ļ. Confidence interval

Ļ. Analysis of variance (ANOVA)

Ľ. Statistical significance (p-value)

Ľ. Survivorship analysis (Kaplan-Meier)

Ŀ. Spinal shock

Ŀ. Neurogenic shock

Ł. Hypovolemic shock

Ł. Pulmonary embolism

Ń. Fat embolus syndrome

Ń. Lumbar spinal stenosis

Ņ. Metastatic disease of the spine

Ņ. Rheumatoid lumbar spondylitis

Ň. Isthmic spondyloloisthesis

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

ʼN. Patella alta

Ŋ. A metal-backed patella

Ŋ. Varus malalignment of the knee

Ō. A posterior cruciate-substituting femoral component

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

Ŏ. The sesamoids are separated

Ŏ. The sesamoid is fractured

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

Ő. The dislocation is dorsal and centered

Œ. The proximal phalanx is hyperextended

Œ. Patella

Ŕ. Tibial stem

Ŕ. Distal femoral interface

Ŗ. Posterior femoral interface

Ŗ. Sites of screw fixation for the tibia

Ř. Hallux rigidus

Ř. Fracture of the sesamoid

Ś. Disruption of the plantar plate

Ś. Osteonecrosis of the metatarsal head

Ŝ. Rupture of the flexor hallucis longus

Ŝ. Gout

Ş. Sepsis

Ş. Old trauma

Š. Rheumatoid arthritis

Š. Charcot arthroplasty

Ţ. Aspiration and steroid injection

Ţ. Biopsy, curettage, and allograft bone grafting

Ť. Percutaneous Kirschner wire fixation

Ť. Percutaneous injection of autogenous bone marrow

Ŧ. Nerve roots

Ŧ. Spinal cord

Ũ. Sciatic nerve

Ũ. Peroneal nerve

Ū. Conus medullaris

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

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

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

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

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

Ű. Early and late infection

Ű. Periprosthetic fracture of the femur

Ų. Failure of the patellofemoral and extensor mechanisms

Ų. Aseptic loosening of cementing tibial components

Ŵ. Asceptic loosening of cemented femoral components

Ŵ. Acceptance of the current position of the ankle

Ŷ. Open reduction and fixation in the epiphysis only

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

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

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

Ź. Resection arthroplasty and local radiation

Ż. In situ fusion of the hip

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

Ž. Excision of heterotopic bone and local radiation

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

S. Closed reduction of both fractures and immediate spica casting

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

Ɓ. External fixation of both femora

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

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

Ƅ. Synovial sarcoma

Ƅ. Soft-tissue abcess

Ɔ. Rhabdomyosarcoma

Ƈ. Eosinophilic granuloma

Ƈ. Nodular pigmented villonodular synovitis

Ɖ. Changing to a titanium nail

Ɗ. Changing to a nonslotted nail

Ƌ. Changing the cross-sectional shape of the nail

Ƌ. Increasing the diameter of the nail by 3 mm

ƍ. Increasing the diameter of the interlocking screws

Ǝ. Fracture healing

Ə. Chondrosarcoma

Ɛ. Periosteal chondroma

Ƒ. Periosteal osteosarcoma

Ƒ. Dysplasia epiphysealis hemimelica

Ɠ. Demonstrate competence in the subject of the case

Ɣ. Be fellowship trained in the subject of the case

Ƕ. Be paid on a contingency basis

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

Ɨ. Have been involved in the case as a consultant

Ƙ. Diagnostic arthroscopy

Ƙ. Arthroscopy and subacromial decompression

Ƚ. Reduction and fixation of the proximal humeral epiphysis

ƛ. Temporary cessation of throwing

Ɯ. Physical therapy for rotator cuff strengthening

Ɲ. Oblique popliteal ligament

Ƞ. Lateral capsule

Ɵ. Popliteal tendon

Ơ. Fibular collateral ligament

Ơ. Posterior oblique ligament

Ƣ. Radial tear

Ƣ. Parrot-beak tear

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

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

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

Ƨ. 0 degrees of abduction, with neural rotation

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

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

ƪ. 90 degrees of abduction with neutral rotation

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

Ƭ. Sural

Ƭ. Saphenous and its branches

Ʈ. Posterior tibial and its branches

Ư. Deep peroneal and its branches

Ư. Superficial peroneal and its branches

Ʊ. Strength

Ʋ. Stiffness

Ƴ. Shelf life

Ƴ. Antigenicity

Ƶ. Risk of HIV transmission

Ƶ. Indemnification

Ʒ. Occurrence

Ƹ. Excess liability

Ƹ. Claims-made

ƺ. Nose

ƻ. Lateral Y

Ƽ. Scapular AP

Ƽ. Neutral rotation AP

ƾ. Internal rotation AP

Ƿ. External rotation AP

ǀ. Trauma

ǁ. Hemophilia

ǂ. Reiter’s syndrome

ǃ. Rheumatoid arthritis

Ǆ. Systemic lupus erythematosus

Ǆ. Cast immobilization for 6 weeks

Ǆ. Activity modification and re-evaluation in 2 months

Ǉ. Internal fixation with or without bone grafting

Ǉ. Retrograde drilling of the defect without articular cartilage penetration

Ǉ. Drilling of the defect directly through the articular cartilage

Ǌ. repair or reconstruction of the medial collateral ligament

Ǌ. repair or reconstruction of the medialand lateral collateral ligaments

Ǌ. immobilization for 5 days or less

Ǎ. immobilization for 14 days

Ǎ. immobilization for 25 days

Ǐ. Cystinosis

Ǐ. Hypophosphatemia

Ǒ. Renal osteodystrophy

Ǒ. Primary hyperparathyroidism

Ǔ. Nutritional vitamin D deficiency

Ǔ. Lateral meniscus tear

Ǖ. Popliteus tenosynovitis

Ǖ. Iliotibial band friction syndrome

Ǘ. Peroneal nerve entrapment

Ǘ. Biceps tendinitis

Ǚ. Observation

Ǚ. Removal of the prosthetic components

Ǜ. Operative exploration and decompression of the peroneal nerve

Ǜ. Nerve conduction velocity studies

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

Ǟ. I

Ǟ. II

Ǡ. III

Ǡ. decreased tissue tension

Ǣ. decreased abductor lever arm

Ǣ. decreased joint reaction force

Ǥ. increased body weight over lever arm

Ǥ. increased polyethylene wear rate

Ǧ. recurrent traumatic anterior dislocation

Ǧ. recurrent traumatic posterior dislocation

Ǩ. traumatic subluxation with no previous dislocation

Ǩ. traumatic anterior subluxation

Ǫ. atraumatic involuntary subluxation

Ǫ. radial

Ǭ. axillary

Ǭ. suprascapular

Ǯ. thoracodorsal

Ǯ. long thoracic

J̌. Flexion

Ǳ. Extension

Ǳ. Axial rotation

Ǳ. Left lateral bending

Ǵ. Right lateral bending

Ǵ. Skin

Ƕ. Lung

Ƿ. Brain

Ǹ. Heart

Ǹ. Kidney

Ǻ. Thoracoacromial, lateral thoracic, subscapular

Ǻ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǽ. Posterior humeral circumflex, subscapular, thoracacromial

Ǽ. Subscapular, thoracacromial, anterior humeral circumflex

Ǿ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǿ. Respondeat superior

Ȁ. Indemnity agreement

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

Ȃ. Comparative negligence-% of involvement

Ȃ. Contributory negligence- resident contributed to the negligence

Ȅ. t-type

Ȅ. both column

Ȇ. transverse

Ȇ. anterior column

Ȉ. anterior column posterior hemitransverse

Ȉ. Posterior interosseous

Ȋ. Anterior interosseous

Ȋ. Radial

Ȍ. Median

Ȍ. Ulnar

Ȏ. Shock from hypovolemia

Ȏ. Associated rupture of the bladder

Ȑ. Arterial bleeding on pelvic angiogram

Ȑ. Presence of a hematoma in the perineum and scrotum

Ȓ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Infection

Explanation

Question 4173

Topic: 10. Pathology and Oncology

Figures 37a & 37b show radiographs of a right handed, 78 year old man who had painful G-H arthritis, moderate limitation of motion, and good strength prior to replacement of the humeral head 2 years ago. At the time of treatment, the rotator cuff was intact. He now has limited motion, weakness, and persistent pain in the shoulder. What is the most likely diagnosis?

. 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

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

.. wrist flexors and finger flexors

/. elbow flexors and wrist flexors

0. elbow flexors and finger flexors

1. 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

2. elbow extensors and wrist extensors

3. Syndactyly

4. Macrodactyly

5. Camptodactyly

6. Preaxial polydactyly

7. Postaxial polydactyly

8. Arthrodesis

9. Rotationplasty

:. Above-knee amputation

;. Osteoarticular allograft

<. Endoprosthesis (custom arthroplasty)

=. Plantar fascia

>. Spring ligament

?. Deltoid ligament

@. Intrinsic tendons

A. Gastorcnemius-solelus complex

B. Prevention of presynaptic release of acetylcholine

C. Prevention of synthesis of presynaptic acetylcholine

D. Activation of acetylcholinesterase at the motor end-plate

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

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

G. stiffness of the femoral component.

H. head offset of the femoral component.

I. femoral component material modulus of elasticity.

J. extent of the femoral component porous coating.

K. Presence of a femoral component collar.

L. plantar fascia and quadratus plantae tendon.

M. ligamentous structures connecting the tarsal bones.

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

O. activity of the intrinsic muscles of the foot.

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

Q. scapulothoracic fusion

R. strengthening of the periscapular muscles

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

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

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

V. tricompartmental knee replacement

W. unicompartmental knee replacement

X. medial compartment meniscal allograft

Y. valgus-producing distal femoral osteotomy

Z. 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

A. Hallux valgus

B. Neuroma of the first web space

C. Fracture of the sesamoid

D. Rupture of the flexor hallucis longus

E. Sickle cell crisis

F. Idiopathic chondrolysis

G. Hemophilic arthropathy

H. Osteoid osteoma of the femoral neck

I. Legg-Calve-Perthes disease

J. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

O. Long-term administration of IV and oral antibiotics

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

Q. Immediate exchange arthroplasty with antibiotic-impregnated cement

R. Two-stage surgical prosthetic exchange and IV antibiotics

S. Resection arthroplasty and IV antibiotics

T. SCFE

U. MED

V. Perthes disease

W. Hypothyroidism

X. Chondrolysis

Y. gout.

Z. osteoporosis.

{. eosinophilic granuloma.

|. tuberculosis of the spine.

}. metastatic disease of the spine.

~. water content.

. Synthesis of type I collagen.

. Proteoglycan content.

. Activity of chondrocytes.

. Synthesis of hyaluronate.

. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

. 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%.

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

¡. Maximally pronated and elbow extended

¢. Maximally pronated and the elbow flexed

£. Maximally supinated and the elbow flexed

¤. Maximally supinated and the elbow extended

¥. In neutral rotation, with the elbow extended

¦. open reduction and internal fixation

§. buddy taping to the adjacent index finger

¨. early motion with application of a dynamic banjo splint

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

ª. dorsal extension block splinting

«. The name of the manufacturer

¬. The manufacturer’s potential liability

. The physician’s clinical performance

®. The physician’s materials testing data

¯. Any royalties the physician receives from the manufacturer

°. Femoral

±. Obturator

². Inferior gluteal

³. Superior gluteal

´. Lateral femoral cutaneous

Μ. open biopsy and a long leg cast

¶. open biopsy and wide resection of the tumor

·. a long leg cast and observation

¸. intramedullary stabilization and observation

¹. Triggering

º. Lateral instability

». Swan-neck deformity

¼. Boutonniere deformity

½. Loss of distal interphalangeal joint flexion

¾. Peroneus brevis to peroneus longus

¿. Peroneus tertius to extensor hallucis longus

À. Peroneus tertius to superficial peroneal nerve

Á. Extensor hallucis longus to deep peroneal nerve

Â. Extensor hallucis longus to extensor digitorum longus

Ã. reassurance that Medicare will pay for the treatment.

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

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

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

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

È. an onlay iliac crest bone graft.

É. limited weightbearing and observation.

Ê. removal of the implant and limited weightbearing.

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

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

Í. Coronal

Î. Sagittal

Ï. Anteromedial, midway between the sagittal and the coronal

Ð. Proximal pins sagittal, distal pins coronal

Ñ. Proximal pins coronal, distal pins sagittal

Ò. Rheumatoid arthritis

Ó. Posttraumatic arthritis

Ô. Degenerative osteoarthritis

Õ. Osteonecrosis of the tibial plateau

Ö. Osteonecrosis of the medial femoral condyle

×. Trapeziometacarpal arthrodesis

Ø. Osteotomy of the thumb metacarpal

Ù. Arthrotomy and joint debridement

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

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

Ü. Creep

Ý. Relaxation

Þ. Energy dissipation

SS. Plastic deformation

À. Elastic deformation

Á. bending

Â. axial loading

Ã. high-speed rotation

Ä. direct impact from anteromedial

Å. crush from anteromedial to posterolateral

Æ. Increase stiffness

Ç. Increase fracture toughness

È. Increase fatigue strength

É. Decrease mechanical strength

Ê. Decrease wear rate

Ë. disuse osteopenia

Ì. paraendocrine effect of the tumor

Í. abnormally increased density on the right side

Î. side effect of the treatment of the lesion

Ï. extensive tumor involvement of the left hip

Ð. Sciatic nerve

Ñ. Superior gluteal artery

Ò. Profunda femoris artery

Ó. Femoral artery and nerve

Ô. External iliac artery and vein

Õ. Length

Ö. Moment arm

÷. Total volume

Ø. Physiologic cross-sectional area

Ù. Distribution of slow and fast twitch fibers

Ú. decreasing initiation of action potentials.

Û. increasing action potential amplitude.

Ü. blocking the opening of gated sodium channels.

Ý. decreasing the number of functional motor units.

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

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

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

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

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

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

Ą. hemiarthroplasty

Ą. open reduction and internal fixation

Ć. closed reduction and percutaneous pinning

Ć. a sling and early pedulum exercises

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

Ĉ. open acromioplasty

Ċ. open Bankart repair

Ċ. open subscapularis tendon repair

Č. inferior capsular shift

Č. a supervised physical therapy program

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

Ď. open reduction and internal fixation through an anterior approach

Đ. open reduction and internal fixation through a posterior approach

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

Ē. arthroscopically assisted reduction and percutaneous screw fixation

Ē. Repair of the rotator cuff

Ĕ. Replacement of the humeral head

Ĕ. Resection arthroplasty

Ė. Total shoulder arthroplasty

Ė. AP and lateral radiographs of the elbow

Ę. Diagnositc arthroscopy

Ę. Aspiration of joint fluid

Ě. An erythrocyte sedimentation rate and CBC

Ě. A diagnostic lidocaine injection

Ĝ. Insulin-like growth factor (IGF-1)

Ĝ. Fibroblast growth factor (FGF-1)

Ğ. Platelet-derived growth factor (PDGF)

Ğ. Transforming growth factor beta (TGF-B)

Ġ. Bone morphogenetic proteins (BMP)

Ġ. clinical history and radiographic findings.

Ģ. technetium bone scan

Ģ. flow cytometry pattern of extracted chondrocytes

Ĥ. immunohistochemical staining patterns of a biopsy specimen

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

Ħ. Radial

Ħ. Radial recurrent

Ĩ. Posterior interosseous

Ĩ. Superior ulnar recurrent

Ī. Superficial radial circumflex

Ī. Impaired hydroxylation of proline

Ĭ. Failure of cleavage in procollagen

Ĭ. Defective binding sites for hydroxyproline

Į. Failure to incorporate glycine into the helix

Į. Diminished production of collagen through the rough endoplasmic reticulum

İ. Asking the legal staff to seek a court injunction

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

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

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

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

Ĵ. Meta-analysis

Ķ. Confidence interval

Ķ. Analysis of variance (ANOVA)

ĸ. Statistical significance (p-value)

Ĺ. Survivorship analysis (Kaplan-Meier)

Ĺ. Spinal shock

Ļ. Neurogenic shock

Ļ. Hypovolemic shock

Ľ. Pulmonary embolism

Ľ. Fat embolus syndrome

Ŀ. Lumbar spinal stenosis

Ŀ. Metastatic disease of the spine

Ł. Rheumatoid lumbar spondylitis

Ł. Isthmic spondyloloisthesis

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

Ń. Patella alta

Ņ. A metal-backed patella

Ņ. Varus malalignment of the knee

Ň. A posterior cruciate-substituting femoral component

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

ʼN. The sesamoids are separated

Ŋ. The sesamoid is fractured

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

Ō. The dislocation is dorsal and centered

Ō. The proximal phalanx is hyperextended

Ŏ. Patella

Ŏ. Tibial stem

Ő. Distal femoral interface

Ő. Posterior femoral interface

Œ. Sites of screw fixation for the tibia

Œ. Hallux rigidus

Ŕ. Fracture of the sesamoid

Ŕ. Disruption of the plantar plate

Ŗ. Osteonecrosis of the metatarsal head

Ŗ. Rupture of the flexor hallucis longus

Ř. Gout

Ř. Sepsis

Ś. Old trauma

Ś. Rheumatoid arthritis

Ŝ. Charcot arthroplasty

Ŝ. Aspiration and steroid injection

Ş. Biopsy, curettage, and allograft bone grafting

Ş. Percutaneous Kirschner wire fixation

Š. Percutaneous injection of autogenous bone marrow

Š. Nerve roots

Ţ. Spinal cord

Ţ. Sciatic nerve

Ť. Peroneal nerve

Ť. Conus medullaris

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

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

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

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

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

Ū. Early and late infection

Ŭ. Periprosthetic fracture of the femur

Ŭ. Failure of the patellofemoral and extensor mechanisms

Ů. Aseptic loosening of cementing tibial components

Ů. Asceptic loosening of cemented femoral components

Ű. Acceptance of the current position of the ankle

Ű. Open reduction and fixation in the epiphysis only

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

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

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

Ŵ. Resection arthroplasty and local radiation

Ŷ. In situ fusion of the hip

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

Ÿ. Excision of heterotopic bone and local radiation

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

Ź. Closed reduction of both fractures and immediate spica casting

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

Ż. External fixation of both femora

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

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

S. Synovial sarcoma

Ƀ. Soft-tissue abcess

Ɓ. Rhabdomyosarcoma

Ƃ. Eosinophilic granuloma

Ƃ. Nodular pigmented villonodular synovitis

Ƅ. Changing to a titanium nail

Ƅ. Changing to a nonslotted nail

Ɔ. Changing the cross-sectional shape of the nail

Ƈ. Increasing the diameter of the nail by 3 mm

Ƈ. Increasing the diameter of the interlocking screws

Ɖ. Fracture healing

Ɗ. Chondrosarcoma

Ƌ. Periosteal chondroma

Ƌ. Periosteal osteosarcoma

ƍ. Dysplasia epiphysealis hemimelica

Ǝ. Demonstrate competence in the subject of the case

Ə. Be fellowship trained in the subject of the case

Ɛ. Be paid on a contingency basis

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

Ƒ. Have been involved in the case as a consultant

Ɠ. Diagnostic arthroscopy

Ɣ. Arthroscopy and subacromial decompression

Ƕ. Reduction and fixation of the proximal humeral epiphysis

Ɩ. Temporary cessation of throwing

Ɨ. Physical therapy for rotator cuff strengthening

Ƙ. Oblique popliteal ligament

Ƙ. Lateral capsule

Ƚ. Popliteal tendon

ƛ. Fibular collateral ligament

Ɯ. Posterior oblique ligament

Ɲ. Radial tear

Ƞ. Parrot-beak tear

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

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

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

Ƣ. 0 degrees of abduction, with neural rotation

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

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

Ƥ. 90 degrees of abduction with neutral rotation

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

Ƨ. Sural

Ƨ. Saphenous and its branches

Ʃ. Posterior tibial and its branches

ƪ. Deep peroneal and its branches

ƫ. Superficial peroneal and its branches

Ƭ. Strength

Ƭ. Stiffness

Ʈ. Shelf life

Ư. Antigenicity

Ư. Risk of HIV transmission

Ʊ. Indemnification

Ʋ. Occurrence

Ƴ. Excess liability

Ƴ. Claims-made

Ƶ. Nose

Ƶ. Lateral Y

Ʒ. Scapular AP

Ƹ. Neutral rotation AP

Ƹ. Internal rotation AP

ƺ. External rotation AP

ƻ. Trauma

Ƽ. Hemophilia

Ƽ. Reiter’s syndrome

ƾ. Rheumatoid arthritis

Ƿ. Systemic lupus erythematosus

ǀ. Cast immobilization for 6 weeks

ǁ. Activity modification and re-evaluation in 2 months

ǂ. Internal fixation with or without bone grafting

ǃ. Retrograde drilling of the defect without articular cartilage penetration

Ǆ. Drilling of the defect directly through the articular cartilage

Ǆ. repair or reconstruction of the medial collateral ligament

Ǆ. repair or reconstruction of the medialand lateral collateral ligaments

Ǉ. immobilization for 5 days or less

Ǉ. immobilization for 14 days

Ǉ. immobilization for 25 days

Ǌ. Cystinosis

Ǌ. Hypophosphatemia

Ǌ. Renal osteodystrophy

Ǎ. Primary hyperparathyroidism

Ǎ. Nutritional vitamin D deficiency

Ǐ. Lateral meniscus tear

Ǐ. Popliteus tenosynovitis

Ǒ. Iliotibial band friction syndrome

Ǒ. Peroneal nerve entrapment

Ǔ. Biceps tendinitis

Ǔ. Observation

Ǖ. Removal of the prosthetic components

Ǖ. Operative exploration and decompression of the peroneal nerve

Ǘ. Nerve conduction velocity studies

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

Ǚ. I

Ǚ. II

Ǜ. III

Ǜ. decreased tissue tension

Ǝ. decreased abductor lever arm

Ǟ. decreased joint reaction force

Ǟ. increased body weight over lever arm

Ǡ. increased polyethylene wear rate

Ǡ. recurrent traumatic anterior dislocation

Ǣ. recurrent traumatic posterior dislocation

Ǣ. traumatic subluxation with no previous dislocation

Ǥ. traumatic anterior subluxation

Ǥ. atraumatic involuntary subluxation

Ǧ. radial

Ǧ. axillary

Ǩ. suprascapular

Ǩ. thoracodorsal

Ǫ. long thoracic

Ǫ. Flexion

Ǭ. Extension

Ǭ. Axial rotation

Ǯ. Left lateral bending

Ǯ. Right lateral bending

J̌. Skin

Ǳ. Lung

Ǳ. Brain

Ǳ. Heart

Ǵ. Kidney

Ǵ. Thoracoacromial, lateral thoracic, subscapular

Ƕ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƿ. Posterior humeral circumflex, subscapular, thoracacromial

Ǹ. Subscapular, thoracacromial, anterior humeral circumflex

Ǹ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǻ. Respondeat superior

Ǻ. Indemnity agreement

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

Ǽ. Comparative negligence-% of involvement

Ǿ. Contributory negligence- resident contributed to the negligence

Ǿ. t-type

Ȁ. both column

Ȁ. transverse

Ȃ. anterior column

Ȃ. anterior column posterior hemitransverse

Ȅ. Posterior interosseous

Ȅ. Anterior interosseous

Ȇ. Radial

Ȇ. Median

Ȉ. Ulnar

Ȉ. Shock from hypovolemia

Ȋ. Associated rupture of the bladder

Ȋ. Arterial bleeding on pelvic angiogram

Ȍ. Presence of a hematoma in the perineum and scrotum

Ȍ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Infection

Explanation

Question 4174

Topic: 10. Pathology and Oncology

What is the primary reason for choosing a bone graft substitute rather than an autologous cancellous graft in the treatment of distal radius fractures with metaphyseal comminution and impaction?

. 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

-. elbow extensors and wrist extensors

.. Syndactyly

/. Macrodactyly

0. Camptodactyly

1. Preaxial polydactyly

2. Postaxial polydactyly

3. Arthrodesis

4. Rotationplasty

5. Above-knee amputation

6. Osteoarticular allograft

7. Endoprosthesis (custom arthroplasty)

8. Plantar fascia

9. 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

B. stiffness of the femoral component.

C. head offset of the femoral component.

D. femoral component material modulus of elasticity.

E. extent of the femoral component porous coating.

F. Presence of a femoral component collar.

G. plantar fascia and quadratus plantae tendon.

H. ligamentous structures connecting the tarsal bones.

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

J. activity of the intrinsic muscles of the foot.

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

L. scapulothoracic fusion

M. strengthening of the periscapular muscles

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

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

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

Q. tricompartmental knee replacement

R. unicompartmental knee replacement

S. medial compartment meniscal allograft

T. valgus-producing distal femoral osteotomy

U. valgus-producing proximal tibial osteotomy

V. Internal rotation of the femoral component

W. External rotation of the tibial component

X. Lateral placement of the femoral component

Y. Medial placement of the patellar component

Z. 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

A. Idiopathic chondrolysis

B. Hemophilic arthropathy

C. Osteoid osteoma of the femoral neck

D. Legg-Calve-Perthes disease

E. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

J. Long-term administration of IV and oral antibiotics

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

L. Immediate exchange arthroplasty with antibiotic-impregnated cement

M. Two-stage surgical prosthetic exchange and IV antibiotics

N. Resection arthroplasty and IV antibiotics

O. SCFE

P. MED

Q. Perthes disease

R. Hypothyroidism

S. Chondrolysis

T. gout.

U. osteoporosis.

V. eosinophilic granuloma.

W. tuberculosis of the spine.

X. metastatic disease of the spine.

Y. water content.

Z. Synthesis of type I collagen.

{. Proteoglycan content.

|. Activity of chondrocytes.

}. Synthesis of hyaluronate.

~. Lung

. Breast

. Prostate

. Thyroid

. Renal

. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

. 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%.

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

¡. open reduction and internal fixation

¢. buddy taping to the adjacent index finger

£. early motion with application of a dynamic banjo splint

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

¥. dorsal extension block splinting

¦. The name of the manufacturer

§. The manufacturer’s potential liability

¨. The physician’s clinical performance

©. The physician’s materials testing data

ª. Any royalties the physician receives from the manufacturer

«. Femoral

¬. Obturator

. Inferior gluteal

®. Superior gluteal

¯. Lateral femoral cutaneous

°. open biopsy and a long leg cast

±. open biopsy and wide resection of the tumor

². a long leg cast and observation

³. intramedullary stabilization and observation

´. Triggering

Μ. Lateral instability

¶. Swan-neck deformity

·. Boutonniere deformity

¸. Loss of distal interphalangeal joint flexion

¹. Peroneus brevis to peroneus longus

º. Peroneus tertius to extensor hallucis longus

». Peroneus tertius to superficial peroneal nerve

¼. Extensor hallucis longus to deep peroneal nerve

½. Extensor hallucis longus to extensor digitorum longus

¾. reassurance that Medicare will pay for the treatment.

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

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

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

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

Ã. an onlay iliac crest bone graft.

Ä. limited weightbearing and observation.

Å. removal of the implant and limited weightbearing.

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

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

È. Coronal

É. Sagittal

Ê. Anteromedial, midway between the sagittal and the coronal

Ë. Proximal pins sagittal, distal pins coronal

Ì. Proximal pins coronal, distal pins sagittal

Í. Rheumatoid arthritis

Î. Posttraumatic arthritis

Ï. Degenerative osteoarthritis

Ð. Osteonecrosis of the tibial plateau

Ñ. Osteonecrosis of the medial femoral condyle

Ò. Trapeziometacarpal arthrodesis

Ó. Osteotomy of the thumb metacarpal

Ô. Arthrotomy and joint debridement

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

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

×. Creep

Ø. Relaxation

Ù. Energy dissipation

Ú. Plastic deformation

Û. Elastic deformation

Ü. bending

Ý. axial loading

Þ. high-speed rotation

SS. direct impact from anteromedial

À. crush from anteromedial to posterolateral

Á. Increase stiffness

Â. Increase fracture toughness

Ã. Increase fatigue strength

Ä. Decrease mechanical strength

Å. Decrease wear rate

Æ. disuse osteopenia

Ç. paraendocrine effect of the tumor

È. abnormally increased density on the right side

É. side effect of the treatment of the lesion

Ê. extensive tumor involvement of the left hip

Ë. Sciatic nerve

Ì. Superior gluteal artery

Í. Profunda femoris artery

Î. Femoral artery and nerve

Ï. External iliac artery and vein

Ð. Length

Ñ. Moment arm

Ò. Total volume

Ó. Physiologic cross-sectional area

Ô. Distribution of slow and fast twitch fibers

Õ. decreasing initiation of action potentials.

Ö. increasing action potential amplitude.

÷. blocking the opening of gated sodium channels.

Ø. decreasing the number of functional motor units.

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

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

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

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

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

Þ. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ÿ. hemiarthroplasty

Ā. open reduction and internal fixation

Ā. closed reduction and percutaneous pinning

Ă. a sling and early pedulum exercises

Ă. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ą. open acromioplasty

Ą. open Bankart repair

Ć. open subscapularis tendon repair

Ć. inferior capsular shift

Ĉ. a supervised physical therapy program

Ĉ. a sling and swathe, with pendulum exercises in 10 days

Ċ. open reduction and internal fixation through an anterior approach

Ċ. open reduction and internal fixation through a posterior approach

Č. immobilization with a splint in 45 degrees of abduction for 6 weeks

Č. arthroscopically assisted reduction and percutaneous screw fixation

Ď. Repair of the rotator cuff

Ď. Replacement of the humeral head

Đ. Resection arthroplasty

Đ. Total shoulder arthroplasty

Ē. AP and lateral radiographs of the elbow

Ē. Diagnositc arthroscopy

Ĕ. Aspiration of joint fluid

Ĕ. An erythrocyte sedimentation rate and CBC

Ė. A diagnostic lidocaine injection

Ė. Insulin-like growth factor (IGF-1)

Ę. Fibroblast growth factor (FGF-1)

Ę. Platelet-derived growth factor (PDGF)

Ě. Transforming growth factor beta (TGF-B)

Ě. Bone morphogenetic proteins (BMP)

Ĝ. clinical history and radiographic findings.

Ĝ. technetium bone scan

Ğ. flow cytometry pattern of extracted chondrocytes

Ğ. immunohistochemical staining patterns of a biopsy specimen

Ġ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ġ. Radial

Ģ. Radial recurrent

Ģ. Posterior interosseous

Ĥ. Superior ulnar recurrent

Ĥ. Superficial radial circumflex

Ħ. Impaired hydroxylation of proline

Ħ. Failure of cleavage in procollagen

Ĩ. Defective binding sites for hydroxyproline

Ĩ. Failure to incorporate glycine into the helix

Ī. Diminished production of collagen through the rough endoplasmic reticulum

Ī. Asking the legal staff to seek a court injunction

Ĭ. Copying the patient’s chart and giving it to him as he leaves

Ĭ. Having the patient sign a written legal contract that specifies acceptable behavior

Į. Continuing care of the patient until an appropriate referral can be arranged

Į. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

İ. Meta-analysis

I. Confidence interval

Ĳ. Analysis of variance (ANOVA)

Ĳ. Statistical significance (p-value)

Ĵ. Survivorship analysis (Kaplan-Meier)

Ĵ. Spinal shock

Ķ. Neurogenic shock

Ķ. Hypovolemic shock

ĸ. Pulmonary embolism

Ĺ. Fat embolus syndrome

Ĺ. Lumbar spinal stenosis

Ļ. Metastatic disease of the spine

Ļ. Rheumatoid lumbar spondylitis

Ľ. Isthmic spondyloloisthesis

Ľ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ŀ. Patella alta

Ŀ. A metal-backed patella

Ł. Varus malalignment of the knee

Ł. A posterior cruciate-substituting femoral component

Ń. Lateral subluxation of the patella on a Merchant’s view

Ń. The sesamoids are separated

Ņ. The sesamoid is fractured

Ņ. The proximal phx is on the neck of the metatarsal

Ň. The dislocation is dorsal and centered

Ň. The proximal phalanx is hyperextended

ʼN. Patella

Ŋ. Tibial stem

Ŋ. Distal femoral interface

Ō. Posterior femoral interface

Ō. Sites of screw fixation for the tibia

Ŏ. Hallux rigidus

Ŏ. Fracture of the sesamoid

Ő. Disruption of the plantar plate

Ő. Osteonecrosis of the metatarsal head

Œ. Rupture of the flexor hallucis longus

Œ. Gout

Ŕ. Sepsis

Ŕ. Old trauma

Ŗ. Rheumatoid arthritis

Ŗ. Charcot arthroplasty

Ř. Aspiration and steroid injection

Ř. Biopsy, curettage, and allograft bone grafting

Ś. Percutaneous Kirschner wire fixation

Ś. Percutaneous injection of autogenous bone marrow

Ŝ. Nerve roots

Ŝ. Spinal cord

Ş. Sciatic nerve

Ş. Peroneal nerve

Š. Conus medullaris

Š. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ţ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ţ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ť. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ť. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ŧ. Early and late infection

Ŧ. Periprosthetic fracture of the femur

Ũ. Failure of the patellofemoral and extensor mechanisms

Ũ. Aseptic loosening of cementing tibial components

Ū. Asceptic loosening of cemented femoral components

Ū. Acceptance of the current position of the ankle

Ŭ. Open reduction and fixation in the epiphysis only

Ŭ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ů. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ů. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ű. Resection arthroplasty and local radiation

Ű. In situ fusion of the hip

Ų. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ų. Excision of heterotopic bone and local radiation

Ŵ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ŵ. Closed reduction of both fractures and immediate spica casting

Ŷ. Bilateral skin traction for 3 weeks, followed by spica casting

Ŷ. External fixation of both femora

Ÿ. External fixation of the left femur and a long leg cast brace for the right femur

Ź. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ź. Synovial sarcoma

Ż. Soft-tissue abcess

Ż. Rhabdomyosarcoma

Ž. Eosinophilic granuloma

Ž. Nodular pigmented villonodular synovitis

S. Changing to a titanium nail

Ƀ. Changing to a nonslotted nail

Ɓ. Changing the cross-sectional shape of the nail

Ƃ. Increasing the diameter of the nail by 3 mm

Ƃ. Increasing the diameter of the interlocking screws

Ƅ. Fracture healing

Ƅ. Chondrosarcoma

Ɔ. Periosteal chondroma

Ƈ. Periosteal osteosarcoma

Ƈ. Dysplasia epiphysealis hemimelica

Ɖ. Demonstrate competence in the subject of the case

Ɗ. Be fellowship trained in the subject of the case

Ƌ. Be paid on a contingency basis

Ƌ. Be board certified by the American Board of Orthopaedic Surgery

ƍ. Have been involved in the case as a consultant

Ǝ. Diagnostic arthroscopy

Ə. Arthroscopy and subacromial decompression

Ɛ. Reduction and fixation of the proximal humeral epiphysis

Ƒ. Temporary cessation of throwing

Ƒ. Physical therapy for rotator cuff strengthening

Ɠ. Oblique popliteal ligament

Ɣ. Lateral capsule

Ƕ. Popliteal tendon

Ɩ. Fibular collateral ligament

Ɨ. Posterior oblique ligament

Ƙ. Radial tear

Ƙ. Parrot-beak tear

Ƚ. Vertical tear in the “red-red” zone

ƛ. Vertical tear in the “red-white” zone

Ɯ. Vertical tear in the “white-white” zone

Ɲ. 0 degrees of abduction, with neural rotation

Ƞ. 40 degrees of flexion and 60 degrees of internal rotation

Ɵ. 45 degrees of flexion and 45 degrees of external rotation

Ơ. 90 degrees of abduction with neutral rotation

Ơ. 90 degrees of abduction and 90 degrees of external rotation

Ƣ. Sural

Ƣ. Saphenous and its branches

Ƥ. Posterior tibial and its branches

Ƥ. Deep peroneal and its branches

Ʀ. Superficial peroneal and its branches

Ƨ. Strength

Ƨ. Stiffness

Ʃ. Shelf life

ƪ. Antigenicity

ƫ. Risk of HIV transmission

Ƭ. Indemnification

Ƭ. Occurrence

Ʈ. Excess liability

Ư. Claims-made

Ư. Nose

Ʊ. Lateral Y

Ʋ. Scapular AP

Ƴ. Neutral rotation AP

Ƴ. Internal rotation AP

Ƶ. External rotation AP

Ƶ. Trauma

Ʒ. Hemophilia

Ƹ. Reiter’s syndrome

Ƹ. Rheumatoid arthritis

ƺ. Systemic lupus erythematosus

ƻ. Cast immobilization for 6 weeks

Ƽ. Activity modification and re-evaluation in 2 months

Ƽ. Internal fixation with or without bone grafting

ƾ. Retrograde drilling of the defect without articular cartilage penetration

Ƿ. Drilling of the defect directly through the articular cartilage

ǀ. repair or reconstruction of the medial collateral ligament

ǁ. repair or reconstruction of the medialand lateral collateral ligaments

ǂ. immobilization for 5 days or less

ǃ. immobilization for 14 days

Ǆ. immobilization for 25 days

Ǆ. Cystinosis

Ǆ. Hypophosphatemia

Ǉ. Renal osteodystrophy

Ǉ. Primary hyperparathyroidism

Ǉ. Nutritional vitamin D deficiency

Ǌ. Lateral meniscus tear

Ǌ. Popliteus tenosynovitis

Ǌ. Iliotibial band friction syndrome

Ǎ. Peroneal nerve entrapment

Ǎ. Biceps tendinitis

Ǐ. Observation

Ǐ. Removal of the prosthetic components

Ǒ. Operative exploration and decompression of the peroneal nerve

Ǒ. Nerve conduction velocity studies

Ǔ. Loosening of the primary dressings and knee flexion to 30 degrees

Ǔ. I

Ǖ. II

Ǖ. III

Ǘ. decreased tissue tension

Ǘ. decreased abductor lever arm

Ǚ. decreased joint reaction force

Ǚ. increased body weight over lever arm

Ǜ. increased polyethylene wear rate

Ǜ. recurrent traumatic anterior dislocation

Ǝ. recurrent traumatic posterior dislocation

Ǟ. traumatic subluxation with no previous dislocation

Ǟ. traumatic anterior subluxation

Ǡ. atraumatic involuntary subluxation

Ǡ. radial

Ǣ. axillary

Ǣ. suprascapular

Ǥ. thoracodorsal

Ǥ. long thoracic

Ǧ. Flexion

Ǧ. Extension

Ǩ. Axial rotation

Ǩ. Left lateral bending

Ǫ. Right lateral bending

Ǫ. Skin

Ǭ. Lung

Ǭ. Brain

Ǯ. Heart

Ǯ. Kidney

J̌. Thoracoacromial, lateral thoracic, subscapular

Ǳ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǳ. Posterior humeral circumflex, subscapular, thoracacromial

Ǳ. Subscapular, thoracacromial, anterior humeral circumflex

Ǵ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǵ. Respondeat superior

Ƕ. Indemnity agreement

Ƿ. Hold harmless agreement- attempt to shift liability from company to physician

Ǹ. Comparative negligence-% of involvement

Ǹ. Contributory negligence- resident contributed to the negligence

Ǻ. t-type

Ǻ. both column

Ǽ. transverse

Ǽ. anterior column

Ǿ. anterior column posterior hemitransverse

Ǿ. Posterior interosseous

Ȁ. Anterior interosseous

Ȁ. Radial

Ȃ. Median

Ȃ. Ulnar

Ȅ. Shock from hypovolemia

Ȅ. Associated rupture of the bladder

Ȇ. Arterial bleeding on pelvic angiogram

Ȇ. Presence of a hematoma in the perineum and scrotum

Ȉ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Reduced morbidity

Explanation

Question 4175

Topic: 10. Pathology and Oncology

-
Figures 38a & 38b show radiographs of a 40 year old man who underwent a Putti-Platt repair for recurrent dislocations at age 22. He reports increasing pain in the shoulder and limited motion for five years. Examination reveals 130 degrees of elevation and 15 degrees of external rotation. Non-surgical treatment has failed. Treatment should now consist of what?

. 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

-. Postaxial polydactyly

.. Arthrodesis

/. Rotationplasty

0. Above-knee amputation

1. Osteoarticular allograft

2. Endoprosthesis (custom arthroplasty)

3. Plantar fascia

4. Spring ligament

5. Deltoid ligament

6. Intrinsic tendons

7. Gastorcnemius-solelus complex

8. Prevention of presynaptic release of acetylcholine

9. 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.

B. plantar fascia and quadratus plantae tendon.

C. ligamentous structures connecting the tarsal bones.

D. shape of the tarsal bones and the intervening joints.

E. activity of the intrinsic muscles of the foot.

F. activity of the posterior tibialis and the peroneus longus muscles.

G. scapulothoracic fusion

H. strengthening of the periscapular muscles

I. pectoralis minor-fascia lata graft transfer to the scapula

J. pectoralis major-fascia lata graft transfer to the scapula

K. exploration of the long thoracic nerve, with sural nerve graft

L. tricompartmental knee replacement

M. unicompartmental knee replacement

N. medial compartment meniscal allograft

O. valgus-producing distal femoral osteotomy

P. valgus-producing proximal tibial osteotomy

Q. Internal rotation of the femoral component

R. External rotation of the tibial component

S. Lateral placement of the femoral component

T. Medial placement of the patellar component

U. Excessive resection of the patella

V. Hallux rigidus

W. Hallux valgus

X. Neuroma of the first web space

Y. Fracture of the sesamoid

Z. 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

A. Decreased knee jerk and positive straight-leg raising sign

B. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

C. Weakness of the extensor hallucis longus and positive straight-leg raising sign

D. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

E. Long-term administration of IV and oral antibiotics

F. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

G. Immediate exchange arthroplasty with antibiotic-impregnated cement

H. Two-stage surgical prosthetic exchange and IV antibiotics

I. Resection arthroplasty and IV antibiotics

J. SCFE

K. MED

L. Perthes disease

M. Hypothyroidism

N. Chondrolysis

O. gout.

P. osteoporosis.

Q. eosinophilic granuloma.

R. tuberculosis of the spine.

S. metastatic disease of the spine.

T. water content.

U. Synthesis of type I collagen.

V. Proteoglycan content.

W. Activity of chondrocytes.

X. Synthesis of hyaluronate.

Y. Lung

Z. Breast

{. Prostate

|. Thyroid

}. Renal

~. T1-low, T2-low.

. T1-low, T2-high.

. T1-moderate, T2-low.

. T1-high, T2-low.

. T1-high, T2-high.

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

. Standard deviation is 4% higher or lower than the mean.

. 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%.

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

¡. The name of the manufacturer

¢. The manufacturer’s potential liability

£. The physician’s clinical performance

¤. The physician’s materials testing data

¥. Any royalties the physician receives from the manufacturer

¦. Femoral

§. Obturator

¨. Inferior gluteal

ª. Lateral femoral cutaneous

«. open biopsy and a long leg cast

¬. open biopsy and wide resection of the tumor

. a long leg cast and observation

®. intramedullary stabilization and observation

¯. Triggering

°. Lateral instability

±. Swan-neck deformity

². Boutonniere deformity

³. Loss of distal interphalangeal joint flexion

´. Peroneus brevis to peroneus longus

Μ. Peroneus tertius to extensor hallucis longus

¶. Peroneus tertius to superficial peroneal nerve

·. Extensor hallucis longus to deep peroneal nerve

¸. Extensor hallucis longus to extensor digitorum longus

¹. reassurance that Medicare will pay for the treatment.

º. consent forms that patients or their guardians are able to understand.

». a detailed description of the device, omitting the fact that it is part of a study.

¼. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

½. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

¾. an onlay iliac crest bone graft.

¿. limited weightbearing and observation.

À. removal of the implant and limited weightbearing.

Á. removal of the implant and insertion of a reamed femoral nail.

Â. removal of the implant and insertion of an unreamed femoral nail.

Ã. Coronal

Ä. Sagittal

Å. Anteromedial, midway between the sagittal and the coronal

Æ. Proximal pins sagittal, distal pins coronal

Ç. Proximal pins coronal, distal pins sagittal

È. Rheumatoid arthritis

É. Posttraumatic arthritis

Ê. Degenerative osteoarthritis

Ë. Osteonecrosis of the tibial plateau

Ì. Osteonecrosis of the medial femoral condyle

Í. Trapeziometacarpal arthrodesis

Î. Osteotomy of the thumb metacarpal

Ï. Arthrotomy and joint debridement

Ð. Ligament reconstruction using one half of the flexor carpi radialis

Ñ. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ò. Creep

Ó. Relaxation

Ô. Energy dissipation

Õ. Plastic deformation

Ö. Elastic deformation

×. bending

Ø. axial loading

Ù. high-speed rotation

Ú. direct impact from anteromedial

Û. crush from anteromedial to posterolateral

Ü. Increase stiffness

Ý. Increase fracture toughness

Þ. Increase fatigue strength

SS. Decrease mechanical strength

À. Decrease wear rate

Á. disuse osteopenia

Â. paraendocrine effect of the tumor

Ã. abnormally increased density on the right side

Ä. side effect of the treatment of the lesion

Å. extensive tumor involvement of the left hip

Æ. Sciatic nerve

Ç. Superior gluteal artery

È. Profunda femoris artery

É. Femoral artery and nerve

Ê. External iliac artery and vein

Ë. Length

Ì. Moment arm

Í. Total volume

Î. Physiologic cross-sectional area

Ï. Distribution of slow and fast twitch fibers

Ð. decreasing initiation of action potentials.

Ñ. increasing action potential amplitude.

Ò. blocking the opening of gated sodium channels.

Ó. decreasing the number of functional motor units.

Ô. slowing or stopping action potential propagation through the axon.

Õ. resection of the metatarsal heads of the first through fifth toes.

Ö. Silastic MP joint arthroplasties of the first through fifth toes.

÷. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ø. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ù. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ú. hemiarthroplasty

Û. open reduction and internal fixation

Ü. closed reduction and percutaneous pinning

Ý. a sling and early pedulum exercises

Þ. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ÿ. open acromioplasty

Ā. open Bankart repair

Ā. open subscapularis tendon repair

Ă. inferior capsular shift

Ă. a supervised physical therapy program

Ą. a sling and swathe, with pendulum exercises in 10 days

Ą. open reduction and internal fixation through an anterior approach

Ć. open reduction and internal fixation through a posterior approach

Ć. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ĉ. arthroscopically assisted reduction and percutaneous screw fixation

Ĉ. Repair of the rotator cuff

Ċ. Replacement of the humeral head

Ċ. Resection arthroplasty

Č. Total shoulder arthroplasty

Č. AP and lateral radiographs of the elbow

Ď. Diagnositc arthroscopy

Ď. Aspiration of joint fluid

Đ. An erythrocyte sedimentation rate and CBC

Đ. A diagnostic lidocaine injection

Ē. Insulin-like growth factor (IGF-1)

Ē. Fibroblast growth factor (FGF-1)

Ĕ. Platelet-derived growth factor (PDGF)

Ĕ. Transforming growth factor beta (TGF-B)

Ė. Bone morphogenetic proteins (BMP)

Ė. clinical history and radiographic findings.

Ę. technetium bone scan

Ę. flow cytometry pattern of extracted chondrocytes

Ě. immunohistochemical staining patterns of a biopsy specimen

Ě. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ĝ. Radial

Ĝ. Radial recurrent

Ğ. Posterior interosseous

Ğ. Superior ulnar recurrent

Ġ. Superficial radial circumflex

Ġ. Impaired hydroxylation of proline

Ģ. Failure of cleavage in procollagen

Ģ. Defective binding sites for hydroxyproline

Ĥ. Failure to incorporate glycine into the helix

Ĥ. Diminished production of collagen through the rough endoplasmic reticulum

Ħ. Asking the legal staff to seek a court injunction

Ħ. Copying the patient’s chart and giving it to him as he leaves

Ĩ. Having the patient sign a written legal contract that specifies acceptable behavior

Ĩ. Continuing care of the patient until an appropriate referral can be arranged

Ī. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ī. Meta-analysis

Ĭ. Confidence interval

Ĭ. Analysis of variance (ANOVA)

Į. Statistical significance (p-value)

Į. Survivorship analysis (Kaplan-Meier)

İ. Spinal shock

I. Neurogenic shock

Ĳ. Hypovolemic shock

Ĳ. Pulmonary embolism

Ĵ. Fat embolus syndrome

Ĵ. Lumbar spinal stenosis

Ķ. Metastatic disease of the spine

Ķ. Rheumatoid lumbar spondylitis

ĸ. Isthmic spondyloloisthesis

Ĺ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ĺ. Patella alta

Ļ. A metal-backed patella

Ļ. Varus malalignment of the knee

Ľ. A posterior cruciate-substituting femoral component

Ľ. Lateral subluxation of the patella on a Merchant’s view

Ŀ. The sesamoids are separated

Ŀ. The sesamoid is fractured

Ł. The proximal phx is on the neck of the metatarsal

Ł. The dislocation is dorsal and centered

Ń. The proximal phalanx is hyperextended

Ń. Patella

Ņ. Tibial stem

Ņ. Distal femoral interface

Ň. Posterior femoral interface

Ň. Sites of screw fixation for the tibia

ʼN. Hallux rigidus

Ŋ. Fracture of the sesamoid

Ŋ. Disruption of the plantar plate

Ō. Osteonecrosis of the metatarsal head

Ō. Rupture of the flexor hallucis longus

Ŏ. Gout

Ŏ. Sepsis

Ő. Old trauma

Ő. Rheumatoid arthritis

Œ. Charcot arthroplasty

Œ. Aspiration and steroid injection

Ŕ. Biopsy, curettage, and allograft bone grafting

Ŕ. Percutaneous Kirschner wire fixation

Ŗ. Percutaneous injection of autogenous bone marrow

Ŗ. Nerve roots

Ř. Spinal cord

Ř. Sciatic nerve

Ś. Peroneal nerve

Ś. Conus medullaris

Ŝ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ŝ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ş. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ş. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Š. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Š. Early and late infection

Ţ. Periprosthetic fracture of the femur

Ţ. Failure of the patellofemoral and extensor mechanisms

Ť. Aseptic loosening of cementing tibial components

Ť. Asceptic loosening of cemented femoral components

Ŧ. Acceptance of the current position of the ankle

Ŧ. Open reduction and fixation in the epiphysis only

Ũ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ũ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ū. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ū. Resection arthroplasty and local radiation

Ŭ. In situ fusion of the hip

Ŭ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ů. Excision of heterotopic bone and local radiation

Ů. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ű. Closed reduction of both fractures and immediate spica casting

Ű. Bilateral skin traction for 3 weeks, followed by spica casting

Ų. External fixation of both femora

Ų. External fixation of the left femur and a long leg cast brace for the right femur

Ŵ. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ŵ. Synovial sarcoma

Ŷ. Soft-tissue abcess

Ŷ. Rhabdomyosarcoma

Ÿ. Eosinophilic granuloma

Ź. Nodular pigmented villonodular synovitis

Ź. Changing to a titanium nail

Ż. Changing to a nonslotted nail

Ż. Changing the cross-sectional shape of the nail

Ž. Increasing the diameter of the nail by 3 mm

Ž. Increasing the diameter of the interlocking screws

S. Fracture healing

Ƀ. Chondrosarcoma

Ɓ. Periosteal chondroma

Ƃ. Periosteal osteosarcoma

Ƃ. Dysplasia epiphysealis hemimelica

Ƅ. Demonstrate competence in the subject of the case

Ƅ. Be fellowship trained in the subject of the case

Ɔ. Be paid on a contingency basis

Ƈ. Be board certified by the American Board of Orthopaedic Surgery

Ƈ. Have been involved in the case as a consultant

Ɖ. Diagnostic arthroscopy

Ɗ. Arthroscopy and subacromial decompression

Ƌ. Reduction and fixation of the proximal humeral epiphysis

Ƌ. Temporary cessation of throwing

ƍ. Physical therapy for rotator cuff strengthening

Ǝ. Oblique popliteal ligament

Ə. Lateral capsule

Ɛ. Popliteal tendon

Ƒ. Fibular collateral ligament

Ƒ. Posterior oblique ligament

Ɠ. Radial tear

Ɣ. Parrot-beak tear

Ƕ. Vertical tear in the “red-red” zone

Ɩ. Vertical tear in the “red-white” zone

Ɨ. Vertical tear in the “white-white” zone

Ƙ. 0 degrees of abduction, with neural rotation

Ƙ. 40 degrees of flexion and 60 degrees of internal rotation

Ƚ. 45 degrees of flexion and 45 degrees of external rotation

ƛ. 90 degrees of abduction with neutral rotation

Ɯ. 90 degrees of abduction and 90 degrees of external rotation

Ɲ. Sural

Ƞ. Saphenous and its branches

Ɵ. Posterior tibial and its branches

Ơ. Deep peroneal and its branches

Ơ. Superficial peroneal and its branches

Ƣ. Strength

Ƣ. Stiffness

Ƥ. Shelf life

Ƥ. Antigenicity

Ʀ. Risk of HIV transmission

Ƨ. Indemnification

Ƨ. Occurrence

Ʃ. Excess liability

ƪ. Claims-made

ƫ. Nose

Ƭ. Lateral Y

Ƭ. Scapular AP

Ʈ. Neutral rotation AP

Ư. Internal rotation AP

Ư. External rotation AP

Ʊ. Trauma

Ʋ. Hemophilia

Ƴ. Reiter’s syndrome

Ƴ. Rheumatoid arthritis

Ƶ. Systemic lupus erythematosus

Ƶ. Cast immobilization for 6 weeks

Ʒ. Activity modification and re-evaluation in 2 months

Ƹ. Internal fixation with or without bone grafting

Ƹ. Retrograde drilling of the defect without articular cartilage penetration

ƺ. Drilling of the defect directly through the articular cartilage

ƻ. repair or reconstruction of the medial collateral ligament

Ƽ. repair or reconstruction of the medialand lateral collateral ligaments

Ƽ. immobilization for 5 days or less

ƾ. immobilization for 14 days

Ƿ. immobilization for 25 days

ǀ. Cystinosis

ǁ. Hypophosphatemia

ǂ. Renal osteodystrophy

ǃ. Primary hyperparathyroidism

Ǆ. Nutritional vitamin D deficiency

Ǆ. Lateral meniscus tear

Ǆ. Popliteus tenosynovitis

Ǉ. Iliotibial band friction syndrome

Ǉ. Peroneal nerve entrapment

Ǉ. Biceps tendinitis

Ǌ. Observation

Ǌ. Removal of the prosthetic components

Ǌ. Operative exploration and decompression of the peroneal nerve

Ǎ. Nerve conduction velocity studies

Ǎ. Loosening of the primary dressings and knee flexion to 30 degrees

Ǐ. I

Ǐ. II

Ǒ. III

Ǒ. decreased tissue tension

Ǔ. decreased abductor lever arm

Ǔ. decreased joint reaction force

Ǖ. increased body weight over lever arm

Ǖ. increased polyethylene wear rate

Ǘ. recurrent traumatic anterior dislocation

Ǘ. recurrent traumatic posterior dislocation

Ǚ. traumatic subluxation with no previous dislocation

Ǚ. traumatic anterior subluxation

Ǜ. atraumatic involuntary subluxation

Ǜ. radial

Ǝ. axillary

Ǟ. suprascapular

Ǟ. thoracodorsal

Ǡ. long thoracic

Ǡ. Flexion

Ǣ. Extension

Ǣ. Axial rotation

Ǥ. Left lateral bending

Ǥ. Right lateral bending

Ǧ. Skin

Ǧ. Lung

Ǩ. Brain

Ǩ. Heart

Ǫ. Kidney

Ǫ. Thoracoacromial, lateral thoracic, subscapular

Ǭ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǭ. Posterior humeral circumflex, subscapular, thoracacromial

Ǯ. Subscapular, thoracacromial, anterior humeral circumflex

Ǯ. Lateral thoracic, anterior humeral circumflex, thoracacromial

J̌. Respondeat superior

Ǳ. Indemnity agreement

Ǳ. Hold harmless agreement- attempt to shift liability from company to physician

Ǳ. Comparative negligence-% of involvement

Ǵ. Contributory negligence- resident contributed to the negligence

Ǵ. t-type

Ƕ. both column

Ƿ. transverse

Ǹ. anterior column

Ǹ. anterior column posterior hemitransverse

Ǻ. Posterior interosseous

Ǻ. Anterior interosseous

Ǽ. Radial

Ǽ. Median

Ǿ. Ulnar

Ǿ. Shock from hypovolemia

Ȁ. Associated rupture of the bladder

Ȁ. Arterial bleeding on pelvic angiogram

Ȃ. Presence of a hematoma in the perineum and scrotum

Ȃ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Manipulation Under Anesthesia

Explanation

Question 4176

Topic: 10. Pathology and Oncology

A 50-year-old alcoholic man has erythema and swelling in his entire dominant upper extremity. He has a WBC of 15,000/mm3, a temp of 101 oF (38.3 oC), and a blood pressure of 90/60 mm Hg. After hemodynamic stabilization, the cellulitic forearm is longitudinally incised dorsally and volarly. The forearm muscles are normal in appearance; however, the subcutaneous fat is necrotic. A culture will most likely reveal

. 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

-. Endoprosthesis (custom arthroplasty)

.. Plantar fascia

/. Spring ligament

0. Deltoid ligament

1. Intrinsic tendons

2. Gastorcnemius-solelus complex

3. Prevention of presynaptic release of acetylcholine

4. Prevention of synthesis of presynaptic acetylcholine

5. Activation of acetylcholinesterase at the motor end-plate

6. Blockage of postsynaptic action of acetylcholine until reserves are depleted

7. Stimulation of release of presynaptic acetylcholine until reserves are depleted

8. stiffness of the femoral component.

9. 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.

A. activity of the posterior tibialis and the peroneus longus muscles.

B. scapulothoracic fusion

C. strengthening of the periscapular muscles

D. pectoralis minor-fascia lata graft transfer to the scapula

E. pectoralis major-fascia lata graft transfer to the scapula

F. exploration of the long thoracic nerve, with sural nerve graft

G. tricompartmental knee replacement

H. unicompartmental knee replacement

I. medial compartment meniscal allograft

J. valgus-producing distal femoral osteotomy

K. valgus-producing proximal tibial osteotomy

L. Internal rotation of the femoral component

M. External rotation of the tibial component

N. Lateral placement of the femoral component

O. Medial placement of the patellar component

P. Excessive resection of the patella

Q. Hallux rigidus

R. Hallux valgus

S. Neuroma of the first web space

T. Fracture of the sesamoid

U. Rupture of the flexor hallucis longus

V. Sickle cell crisis

W. Idiopathic chondrolysis

X. Hemophilic arthropathy

Y. Osteoid osteoma of the femoral neck

Z. 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

A. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

B. Immediate exchange arthroplasty with antibiotic-impregnated cement

C. Two-stage surgical prosthetic exchange and IV antibiotics

D. Resection arthroplasty and IV antibiotics

E. SCFE

F. MED

G. Perthes disease

H. Hypothyroidism

I. Chondrolysis

J. gout.

K. osteoporosis.

L. eosinophilic granuloma.

M. tuberculosis of the spine.

N. metastatic disease of the spine.

O. water content.

P. Synthesis of type I collagen.

Q. Proteoglycan content.

R. Activity of chondrocytes.

S. Synthesis of hyaluronate.

T. Lung

U. Breast

V. Prostate

W. Thyroid

X. Renal

Y. T1-low, T2-low.

Z. T1-low, T2-high.

{. T1-moderate, T2-low.

|. T1-high, T2-low.

}. T1-high, T2-high.

~. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

. Standard deviation is 4% higher or lower than the mean.

. 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%.

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

¡. Femoral

¢. Obturator

£. Inferior gluteal

¤. Superior gluteal

¥. Lateral femoral cutaneous

¦. open biopsy and a long leg cast

§. open biopsy and wide resection of the tumor

¨. a long leg cast and observation

ª. Triggering

«. Lateral instability

¬. Swan-neck deformity

. Boutonniere deformity

®. Loss of distal interphalangeal joint flexion

¯. Peroneus brevis to peroneus longus

°. Peroneus tertius to extensor hallucis longus

±. Peroneus tertius to superficial peroneal nerve

². Extensor hallucis longus to deep peroneal nerve

³. Extensor hallucis longus to extensor digitorum longus

´. reassurance that Medicare will pay for the treatment.

Μ. consent forms that patients or their guardians are able to understand.

¶. a detailed description of the device, omitting the fact that it is part of a study.

·. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

¸. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

¹. an onlay iliac crest bone graft.

º. limited weightbearing and observation.

». removal of the implant and limited weightbearing.

¼. removal of the implant and insertion of a reamed femoral nail.

½. removal of the implant and insertion of an unreamed femoral nail.

¾. Coronal

¿. Sagittal

À. Anteromedial, midway between the sagittal and the coronal

Á. Proximal pins sagittal, distal pins coronal

Â. Proximal pins coronal, distal pins sagittal

Ã. Rheumatoid arthritis

Ä. Posttraumatic arthritis

Å. Degenerative osteoarthritis

Æ. Osteonecrosis of the tibial plateau

Ç. Osteonecrosis of the medial femoral condyle

È. Trapeziometacarpal arthrodesis

É. Osteotomy of the thumb metacarpal

Ê. Arthrotomy and joint debridement

Ë. Ligament reconstruction using one half of the flexor carpi radialis

Ì. Trapezium resection, tendon interposition, and reconstruction of the ligament

Í. Creep

Î. Relaxation

Ï. Energy dissipation

Ð. Plastic deformation

Ñ. Elastic deformation

Ò. bending

Ó. axial loading

Ô. high-speed rotation

Õ. direct impact from anteromedial

Ö. crush from anteromedial to posterolateral

×. Increase stiffness

Ø. Increase fracture toughness

Ù. Increase fatigue strength

Ú. Decrease mechanical strength

Û. Decrease wear rate

Ü. disuse osteopenia

Ý. paraendocrine effect of the tumor

Þ. abnormally increased density on the right side

SS. side effect of the treatment of the lesion

À. extensive tumor involvement of the left hip

Á. Sciatic nerve

Â. Superior gluteal artery

Ã. Profunda femoris artery

Ä. Femoral artery and nerve

Å. External iliac artery and vein

Æ. Length

Ç. Moment arm

È. Total volume

É. Physiologic cross-sectional area

Ê. Distribution of slow and fast twitch fibers

Ë. decreasing initiation of action potentials.

Ì. increasing action potential amplitude.

Í. blocking the opening of gated sodium channels.

Î. decreasing the number of functional motor units.

Ï. slowing or stopping action potential propagation through the axon.

Ð. resection of the metatarsal heads of the first through fifth toes.

Ñ. Silastic MP joint arthroplasties of the first through fifth toes.

Ò. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ó. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ô. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Õ. hemiarthroplasty

Ö. open reduction and internal fixation

÷. closed reduction and percutaneous pinning

Ø. a sling and early pedulum exercises

Ù. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ú. open acromioplasty

Û. open Bankart repair

Ü. open subscapularis tendon repair

Ý. inferior capsular shift

Þ. a supervised physical therapy program

Ÿ. a sling and swathe, with pendulum exercises in 10 days

Ā. open reduction and internal fixation through an anterior approach

Ā. open reduction and internal fixation through a posterior approach

Ă. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ă. arthroscopically assisted reduction and percutaneous screw fixation

Ą. Repair of the rotator cuff

Ą. Replacement of the humeral head

Ć. Resection arthroplasty

Ć. Total shoulder arthroplasty

Ĉ. AP and lateral radiographs of the elbow

Ĉ. Diagnositc arthroscopy

Ċ. Aspiration of joint fluid

Ċ. An erythrocyte sedimentation rate and CBC

Č. A diagnostic lidocaine injection

Č. Insulin-like growth factor (IGF-1)

Ď. Fibroblast growth factor (FGF-1)

Ď. Platelet-derived growth factor (PDGF)

Đ. Transforming growth factor beta (TGF-B)

Đ. Bone morphogenetic proteins (BMP)

Ē. clinical history and radiographic findings.

Ē. technetium bone scan

Ĕ. flow cytometry pattern of extracted chondrocytes

Ĕ. immunohistochemical staining patterns of a biopsy specimen

Ė. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ė. Radial

Ę. Radial recurrent

Ę. Posterior interosseous

Ě. Superior ulnar recurrent

Ě. Superficial radial circumflex

Ĝ. Impaired hydroxylation of proline

Ĝ. Failure of cleavage in procollagen

Ğ. Defective binding sites for hydroxyproline

Ğ. Failure to incorporate glycine into the helix

Ġ. Diminished production of collagen through the rough endoplasmic reticulum

Ġ. Asking the legal staff to seek a court injunction

Ģ. Copying the patient’s chart and giving it to him as he leaves

Ģ. Having the patient sign a written legal contract that specifies acceptable behavior

Ĥ. Continuing care of the patient until an appropriate referral can be arranged

Ĥ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ħ. Meta-analysis

Ħ. Confidence interval

Ĩ. Analysis of variance (ANOVA)

Ĩ. Statistical significance (p-value)

Ī. Survivorship analysis (Kaplan-Meier)

Ī. Spinal shock

Ĭ. Neurogenic shock

Ĭ. Hypovolemic shock

Į. Pulmonary embolism

Į. Fat embolus syndrome

İ. Lumbar spinal stenosis

I. Metastatic disease of the spine

Ĳ. Rheumatoid lumbar spondylitis

Ĳ. Isthmic spondyloloisthesis

Ĵ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ĵ. Patella alta

Ķ. A metal-backed patella

Ķ. Varus malalignment of the knee

ĸ. A posterior cruciate-substituting femoral component

Ĺ. Lateral subluxation of the patella on a Merchant’s view

Ĺ. The sesamoids are separated

Ļ. The sesamoid is fractured

Ļ. The proximal phx is on the neck of the metatarsal

Ľ. The dislocation is dorsal and centered

Ľ. The proximal phalanx is hyperextended

Ŀ. Patella

Ŀ. Tibial stem

Ł. Distal femoral interface

Ł. Posterior femoral interface

Ń. Sites of screw fixation for the tibia

Ń. Hallux rigidus

Ņ. Fracture of the sesamoid

Ņ. Disruption of the plantar plate

Ň. Osteonecrosis of the metatarsal head

Ň. Rupture of the flexor hallucis longus

ʼN. Gout

Ŋ. Sepsis

Ŋ. Old trauma

Ō. Rheumatoid arthritis

Ō. Charcot arthroplasty

Ŏ. Aspiration and steroid injection

Ŏ. Biopsy, curettage, and allograft bone grafting

Ő. Percutaneous Kirschner wire fixation

Ő. Percutaneous injection of autogenous bone marrow

Œ. Nerve roots

Œ. Spinal cord

Ŕ. Sciatic nerve

Ŕ. Peroneal nerve

Ŗ. Conus medullaris

Ŗ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ř. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ř. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ś. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ś. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ŝ. Early and late infection

Ŝ. Periprosthetic fracture of the femur

Ş. Failure of the patellofemoral and extensor mechanisms

Ş. Aseptic loosening of cementing tibial components

Š. Asceptic loosening of cemented femoral components

Š. Acceptance of the current position of the ankle

Ţ. Open reduction and fixation in the epiphysis only

Ţ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ť. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ť. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ŧ. Resection arthroplasty and local radiation

Ŧ. In situ fusion of the hip

Ũ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ũ. Excision of heterotopic bone and local radiation

Ū. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ū. Closed reduction of both fractures and immediate spica casting

Ŭ. Bilateral skin traction for 3 weeks, followed by spica casting

Ŭ. External fixation of both femora

Ů. External fixation of the left femur and a long leg cast brace for the right femur

Ů. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ű. Synovial sarcoma

Ű. Soft-tissue abcess

Ų. Rhabdomyosarcoma

Ų. Eosinophilic granuloma

Ŵ. Nodular pigmented villonodular synovitis

Ŵ. Changing to a titanium nail

Ŷ. Changing to a nonslotted nail

Ŷ. Changing the cross-sectional shape of the nail

Ÿ. Increasing the diameter of the nail by 3 mm

Ź. Increasing the diameter of the interlocking screws

Ź. Fracture healing

Ż. Chondrosarcoma

Ż. Periosteal chondroma

Ž. Periosteal osteosarcoma

Ž. Dysplasia epiphysealis hemimelica

S. Demonstrate competence in the subject of the case

Ƀ. Be fellowship trained in the subject of the case

Ɓ. Be paid on a contingency basis

Ƃ. Be board certified by the American Board of Orthopaedic Surgery

Ƃ. Have been involved in the case as a consultant

Ƅ. Diagnostic arthroscopy

Ƅ. Arthroscopy and subacromial decompression

Ɔ. Reduction and fixation of the proximal humeral epiphysis

Ƈ. Temporary cessation of throwing

Ƈ. Physical therapy for rotator cuff strengthening

Ɖ. Oblique popliteal ligament

Ɗ. Lateral capsule

Ƌ. Popliteal tendon

Ƌ. Fibular collateral ligament

ƍ. Posterior oblique ligament

Ǝ. Radial tear

Ə. Parrot-beak tear

Ɛ. Vertical tear in the “red-red” zone

Ƒ. Vertical tear in the “red-white” zone

Ƒ. Vertical tear in the “white-white” zone

Ɠ. 0 degrees of abduction, with neural rotation

Ɣ. 40 degrees of flexion and 60 degrees of internal rotation

Ƕ. 45 degrees of flexion and 45 degrees of external rotation

Ɩ. 90 degrees of abduction with neutral rotation

Ɨ. 90 degrees of abduction and 90 degrees of external rotation

Ƙ. Sural

Ƙ. Saphenous and its branches

Ƚ. Posterior tibial and its branches

ƛ. Deep peroneal and its branches

Ɯ. Superficial peroneal and its branches

Ɲ. Strength

Ƞ. Stiffness

Ɵ. Shelf life

Ơ. Antigenicity

Ơ. Risk of HIV transmission

Ƣ. Indemnification

Ƣ. Occurrence

Ƥ. Excess liability

Ƥ. Claims-made

Ʀ. Nose

Ƨ. Lateral Y

Ƨ. Scapular AP

Ʃ. Neutral rotation AP

ƪ. Internal rotation AP

ƫ. External rotation AP

Ƭ. Trauma

Ƭ. Hemophilia

Ʈ. Reiter’s syndrome

Ư. Rheumatoid arthritis

Ư. Systemic lupus erythematosus

Ʊ. Cast immobilization for 6 weeks

Ʋ. Activity modification and re-evaluation in 2 months

Ƴ. Internal fixation with or without bone grafting

Ƴ. Retrograde drilling of the defect without articular cartilage penetration

Ƶ. Drilling of the defect directly through the articular cartilage

Ƶ. repair or reconstruction of the medial collateral ligament

Ʒ. repair or reconstruction of the medialand lateral collateral ligaments

Ƹ. immobilization for 5 days or less

Ƹ. immobilization for 14 days

ƺ. immobilization for 25 days

ƻ. Cystinosis

Ƽ. Hypophosphatemia

Ƽ. Renal osteodystrophy

ƾ. Primary hyperparathyroidism

Ƿ. Nutritional vitamin D deficiency

ǀ. Lateral meniscus tear

ǁ. Popliteus tenosynovitis

ǂ. Iliotibial band friction syndrome

ǃ. Peroneal nerve entrapment

Ǆ. Biceps tendinitis

Ǆ. Observation

Ǆ. Removal of the prosthetic components

Ǉ. Operative exploration and decompression of the peroneal nerve

Ǉ. Nerve conduction velocity studies

Ǉ. Loosening of the primary dressings and knee flexion to 30 degrees

Ǌ. I

Ǌ. II

Ǌ. III

Ǎ. decreased tissue tension

Ǎ. decreased abductor lever arm

Ǐ. decreased joint reaction force

Ǐ. increased body weight over lever arm

Ǒ. increased polyethylene wear rate

Ǒ. recurrent traumatic anterior dislocation

Ǔ. recurrent traumatic posterior dislocation

Ǔ. traumatic subluxation with no previous dislocation

Ǖ. traumatic anterior subluxation

Ǖ. atraumatic involuntary subluxation

Ǘ. radial

Ǘ. axillary

Ǚ. suprascapular

Ǚ. thoracodorsal

Ǜ. long thoracic

Ǜ. Flexion

Ǝ. Extension

Ǟ. Axial rotation

Ǟ. Left lateral bending

Ǡ. Right lateral bending

Ǡ. Skin

Ǣ. Lung

Ǣ. Brain

Ǥ. Heart

Ǥ. Kidney

Ǧ. Thoracoacromial, lateral thoracic, subscapular

Ǧ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǩ. Posterior humeral circumflex, subscapular, thoracacromial

Ǩ. Subscapular, thoracacromial, anterior humeral circumflex

Ǫ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǫ. Respondeat superior

Ǭ. Indemnity agreement

Ǭ. Hold harmless agreement- attempt to shift liability from company to physician

Ǯ. Comparative negligence-% of involvement

Ǯ. Contributory negligence- resident contributed to the negligence

J̌. t-type

Ǳ. both column

Ǳ. transverse

Ǳ. anterior column

Ǵ. anterior column posterior hemitransverse

Ǵ. Posterior interosseous

Ƕ. Anterior interosseous

Ƿ. Radial

Ǹ. Median

Ǹ. Ulnar

Ǻ. Shock from hypovolemia

Ǻ. Associated rupture of the bladder

Ǽ. Arterial bleeding on pelvic angiogram

Ǽ. Presence of a hematoma in the perineum and scrotum

Ǿ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Bacteroides

Explanation

Question 4177

Topic: 10. Pathology and Oncology

A 15-year-old girl has a thoracic kyphosis that causes mild pain. Examination reveals a sagittal curve measuring 55 degrees and wedging of the eighth through tenth vertebrae. The iliac apophyses are Risser 4. Management should include

. 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

-. Gastorcnemius-solelus complex

.. Prevention of presynaptic release of acetylcholine

/. Prevention of synthesis of presynaptic acetylcholine

0. Activation of acetylcholinesterase at the motor end-plate

1. Blockage of postsynaptic action of acetylcholine until reserves are depleted

2. Stimulation of release of presynaptic acetylcholine until reserves are depleted

3. stiffness of the femoral component.

4. head offset of the femoral component.

5. femoral component material modulus of elasticity.

6. extent of the femoral component porous coating.

7. Presence of a femoral component collar.

8. plantar fascia and quadratus plantae tendon.

9. 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

A. exploration of the long thoracic nerve, with sural nerve graft

B. tricompartmental knee replacement

C. unicompartmental knee replacement

D. medial compartment meniscal allograft

E. valgus-producing distal femoral osteotomy

F. valgus-producing proximal tibial osteotomy

G. Internal rotation of the femoral component

H. External rotation of the tibial component

I. Lateral placement of the femoral component

J. Medial placement of the patellar component

K. Excessive resection of the patella

L. Hallux rigidus

M. Hallux valgus

N. Neuroma of the first web space

O. Fracture of the sesamoid

P. Rupture of the flexor hallucis longus

Q. Sickle cell crisis

R. Idiopathic chondrolysis

S. Hemophilic arthropathy

T. Osteoid osteoma of the femoral neck

U. Legg-Calve-Perthes disease

V. Decreased ankle jerk and positive femoral nerve stretch test

W. Decreased knee jerk and positive straight-leg raising sign

X. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

Y. Weakness of the extensor hallucis longus and positive straight-leg raising sign

Z. 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

]. Immediate exchange arthroplasty with antibiotic-impregnated cement

^. Two-stage surgical prosthetic exchange and IV antibiotics

_. Resection arthroplasty and IV antibiotics

`. SCFE

A. MED

B. Perthes disease

C. Hypothyroidism

D. Chondrolysis

E. gout.

F. osteoporosis.

G. eosinophilic granuloma.

H. tuberculosis of the spine.

I. metastatic disease of the spine.

J. water content.

K. Synthesis of type I collagen.

L. Proteoglycan content.

M. Activity of chondrocytes.

N. Synthesis of hyaluronate.

O. Lung

P. Breast

Q. Prostate

R. Thyroid

S. Renal

T. T1-low, T2-low.

U. T1-low, T2-high.

V. T1-moderate, T2-low.

W. T1-high, T2-low.

X. T1-high, T2-high.

Y. hypothesis is incorrect or invalid

Z. interobserver error rate is 4%.

{. Standard deviation is 4% higher or lower than the mean.

|. 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%.

~. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

¡. open biopsy and a long leg cast

¢. open biopsy and wide resection of the tumor

£. a long leg cast and observation

¤. intramedullary stabilization and observation

¥. Triggering

¦. Lateral instability

§. Swan-neck deformity

¨. Boutonniere deformity

ª. Peroneus brevis to peroneus longus

«. Peroneus tertius to extensor hallucis longus

¬. Peroneus tertius to superficial peroneal nerve

. Extensor hallucis longus to deep peroneal nerve

®. Extensor hallucis longus to extensor digitorum longus

¯. reassurance that Medicare will pay for the treatment.

°. consent forms that patients or their guardians are able to understand.

±. a detailed description of the device, omitting the fact that it is part of a study.

². a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

³. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

´. an onlay iliac crest bone graft.

Μ. limited weightbearing and observation.

¶. removal of the implant and limited weightbearing.

·. removal of the implant and insertion of a reamed femoral nail.

¸. removal of the implant and insertion of an unreamed femoral nail.

¹. Coronal

º. Sagittal

». Anteromedial, midway between the sagittal and the coronal

¼. Proximal pins sagittal, distal pins coronal

½. Proximal pins coronal, distal pins sagittal

¾. Rheumatoid arthritis

¿. Posttraumatic arthritis

À. Degenerative osteoarthritis

Á. Osteonecrosis of the tibial plateau

Â. Osteonecrosis of the medial femoral condyle

Ã. Trapeziometacarpal arthrodesis

Ä. Osteotomy of the thumb metacarpal

Å. Arthrotomy and joint debridement

Æ. Ligament reconstruction using one half of the flexor carpi radialis

Ç. Trapezium resection, tendon interposition, and reconstruction of the ligament

È. Creep

É. Relaxation

Ê. Energy dissipation

Ë. Plastic deformation

Ì. Elastic deformation

Í. bending

Î. axial loading

Ï. high-speed rotation

Ð. direct impact from anteromedial

Ñ. crush from anteromedial to posterolateral

Ò. Increase stiffness

Ó. Increase fracture toughness

Ô. Increase fatigue strength

Õ. Decrease mechanical strength

Ö. Decrease wear rate

×. disuse osteopenia

Ø. paraendocrine effect of the tumor

Ù. abnormally increased density on the right side

Ú. side effect of the treatment of the lesion

Û. extensive tumor involvement of the left hip

Ü. Sciatic nerve

Ý. Superior gluteal artery

Þ. Profunda femoris artery

SS. Femoral artery and nerve

À. External iliac artery and vein

Á. Length

Â. Moment arm

Ã. Total volume

Ä. Physiologic cross-sectional area

Å. Distribution of slow and fast twitch fibers

Æ. decreasing initiation of action potentials.

Ç. increasing action potential amplitude.

È. blocking the opening of gated sodium channels.

É. decreasing the number of functional motor units.

Ê. slowing or stopping action potential propagation through the axon.

Ë. resection of the metatarsal heads of the first through fifth toes.

Ì. Silastic MP joint arthroplasties of the first through fifth toes.

Í. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Î. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ï. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ð. hemiarthroplasty

Ñ. open reduction and internal fixation

Ò. closed reduction and percutaneous pinning

Ó. a sling and early pedulum exercises

Ô. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Õ. open acromioplasty

Ö. open Bankart repair

÷. open subscapularis tendon repair

Ø. inferior capsular shift

Ù. a supervised physical therapy program

Ú. a sling and swathe, with pendulum exercises in 10 days

Û. open reduction and internal fixation through an anterior approach

Ü. open reduction and internal fixation through a posterior approach

Ý. immobilization with a splint in 45 degrees of abduction for 6 weeks

Þ. arthroscopically assisted reduction and percutaneous screw fixation

Ÿ. Repair of the rotator cuff

Ā. Replacement of the humeral head

Ā. Resection arthroplasty

Ă. Total shoulder arthroplasty

Ă. AP and lateral radiographs of the elbow

Ą. Diagnositc arthroscopy

Ą. Aspiration of joint fluid

Ć. An erythrocyte sedimentation rate and CBC

Ć. A diagnostic lidocaine injection

Ĉ. Insulin-like growth factor (IGF-1)

Ĉ. Fibroblast growth factor (FGF-1)

Ċ. Platelet-derived growth factor (PDGF)

Ċ. Transforming growth factor beta (TGF-B)

Č. Bone morphogenetic proteins (BMP)

Č. clinical history and radiographic findings.

Ď. technetium bone scan

Ď. flow cytometry pattern of extracted chondrocytes

Đ. immunohistochemical staining patterns of a biopsy specimen

Đ. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ē. Radial

Ē. Radial recurrent

Ĕ. Posterior interosseous

Ĕ. Superior ulnar recurrent

Ė. Superficial radial circumflex

Ė. Impaired hydroxylation of proline

Ę. Failure of cleavage in procollagen

Ę. Defective binding sites for hydroxyproline

Ě. Failure to incorporate glycine into the helix

Ě. Diminished production of collagen through the rough endoplasmic reticulum

Ĝ. Asking the legal staff to seek a court injunction

Ĝ. Copying the patient’s chart and giving it to him as he leaves

Ğ. Having the patient sign a written legal contract that specifies acceptable behavior

Ğ. Continuing care of the patient until an appropriate referral can be arranged

Ġ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ġ. Meta-analysis

Ģ. Confidence interval

Ģ. Analysis of variance (ANOVA)

Ĥ. Statistical significance (p-value)

Ĥ. Survivorship analysis (Kaplan-Meier)

Ħ. Spinal shock

Ħ. Neurogenic shock

Ĩ. Hypovolemic shock

Ĩ. Pulmonary embolism

Ī. Fat embolus syndrome

Ī. Lumbar spinal stenosis

Ĭ. Metastatic disease of the spine

Ĭ. Rheumatoid lumbar spondylitis

Į. Isthmic spondyloloisthesis

Į. Degenerative spondylolisthesis at L4-5 and L5-S1

İ. Patella alta

I. A metal-backed patella

Ĳ. Varus malalignment of the knee

Ĳ. A posterior cruciate-substituting femoral component

Ĵ. Lateral subluxation of the patella on a Merchant’s view

Ĵ. The sesamoids are separated

Ķ. The sesamoid is fractured

Ķ. The proximal phx is on the neck of the metatarsal

ĸ. The dislocation is dorsal and centered

Ĺ. The proximal phalanx is hyperextended

Ĺ. Patella

Ļ. Tibial stem

Ļ. Distal femoral interface

Ľ. Posterior femoral interface

Ľ. Sites of screw fixation for the tibia

Ŀ. Hallux rigidus

Ŀ. Fracture of the sesamoid

Ł. Disruption of the plantar plate

Ł. Osteonecrosis of the metatarsal head

Ń. Rupture of the flexor hallucis longus

Ń. Gout

Ņ. Sepsis

Ņ. Old trauma

Ň. Rheumatoid arthritis

Ň. Charcot arthroplasty

ʼN. Aspiration and steroid injection

Ŋ. Biopsy, curettage, and allograft bone grafting

Ŋ. Percutaneous Kirschner wire fixation

Ō. Percutaneous injection of autogenous bone marrow

Ō. Nerve roots

Ŏ. Spinal cord

Ŏ. Sciatic nerve

Ő. Peroneal nerve

Ő. Conus medullaris

Œ. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Œ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ŕ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ŕ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ŗ. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ŗ. Early and late infection

Ř. Periprosthetic fracture of the femur

Ř. Failure of the patellofemoral and extensor mechanisms

Ś. Aseptic loosening of cementing tibial components

Ś. Asceptic loosening of cemented femoral components

Ŝ. Acceptance of the current position of the ankle

Ŝ. Open reduction and fixation in the epiphysis only

Ş. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ş. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Š. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Š. Resection arthroplasty and local radiation

Ţ. In situ fusion of the hip

Ţ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ť. Excision of heterotopic bone and local radiation

Ť. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ŧ. Closed reduction of both fractures and immediate spica casting

Ŧ. Bilateral skin traction for 3 weeks, followed by spica casting

Ũ. External fixation of both femora

Ũ. External fixation of the left femur and a long leg cast brace for the right femur

Ū. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ū. Synovial sarcoma

Ŭ. Soft-tissue abcess

Ŭ. Rhabdomyosarcoma

Ů. Eosinophilic granuloma

Ů. Nodular pigmented villonodular synovitis

Ű. Changing to a titanium nail

Ű. Changing to a nonslotted nail

Ų. Changing the cross-sectional shape of the nail

Ų. Increasing the diameter of the nail by 3 mm

Ŵ. Increasing the diameter of the interlocking screws

Ŵ. Fracture healing

Ŷ. Chondrosarcoma

Ŷ. Periosteal chondroma

Ÿ. Periosteal osteosarcoma

Ź. Dysplasia epiphysealis hemimelica

Ź. Demonstrate competence in the subject of the case

Ż. Be fellowship trained in the subject of the case

Ż. Be paid on a contingency basis

Ž. Be board certified by the American Board of Orthopaedic Surgery

Ž. Have been involved in the case as a consultant

S. Diagnostic arthroscopy

Ƀ. Arthroscopy and subacromial decompression

Ɓ. Reduction and fixation of the proximal humeral epiphysis

Ƃ. Temporary cessation of throwing

Ƃ. Physical therapy for rotator cuff strengthening

Ƅ. Oblique popliteal ligament

Ƅ. Lateral capsule

Ɔ. Popliteal tendon

Ƈ. Fibular collateral ligament

Ƈ. Posterior oblique ligament

Ɖ. Radial tear

Ɗ. Parrot-beak tear

Ƌ. Vertical tear in the “red-red” zone

Ƌ. Vertical tear in the “red-white” zone

ƍ. Vertical tear in the “white-white” zone

Ǝ. 0 degrees of abduction, with neural rotation

Ə. 40 degrees of flexion and 60 degrees of internal rotation

Ɛ. 45 degrees of flexion and 45 degrees of external rotation

Ƒ. 90 degrees of abduction with neutral rotation

Ƒ. 90 degrees of abduction and 90 degrees of external rotation

Ɠ. Sural

Ɣ. Saphenous and its branches

Ƕ. Posterior tibial and its branches

Ɩ. Deep peroneal and its branches

Ɨ. Superficial peroneal and its branches

Ƙ. Strength

Ƙ. Stiffness

Ƚ. Shelf life

ƛ. Antigenicity

Ɯ. Risk of HIV transmission

Ɲ. Indemnification

Ƞ. Occurrence

Ɵ. Excess liability

Ơ. Claims-made

Ơ. Nose

Ƣ. Lateral Y

Ƣ. Scapular AP

Ƥ. Neutral rotation AP

Ƥ. Internal rotation AP

Ʀ. External rotation AP

Ƨ. Trauma

Ƨ. Hemophilia

Ʃ. Reiter’s syndrome

ƪ. Rheumatoid arthritis

ƫ. Systemic lupus erythematosus

Ƭ. Cast immobilization for 6 weeks

Ƭ. Activity modification and re-evaluation in 2 months

Ʈ. Internal fixation with or without bone grafting

Ư. Retrograde drilling of the defect without articular cartilage penetration

Ư. Drilling of the defect directly through the articular cartilage

Ʊ. repair or reconstruction of the medial collateral ligament

Ʋ. repair or reconstruction of the medialand lateral collateral ligaments

Ƴ. immobilization for 5 days or less

Ƴ. immobilization for 14 days

Ƶ. immobilization for 25 days

Ƶ. Cystinosis

Ʒ. Hypophosphatemia

Ƹ. Renal osteodystrophy

Ƹ. Primary hyperparathyroidism

ƺ. Nutritional vitamin D deficiency

ƻ. Lateral meniscus tear

Ƽ. Popliteus tenosynovitis

Ƽ. Iliotibial band friction syndrome

ƾ. Peroneal nerve entrapment

Ƿ. Biceps tendinitis

ǀ. Observation

ǁ. Removal of the prosthetic components

ǂ. Operative exploration and decompression of the peroneal nerve

ǃ. Nerve conduction velocity studies

Ǆ. Loosening of the primary dressings and knee flexion to 30 degrees

Ǆ. I

Ǆ. II

Ǉ. III

Ǉ. decreased tissue tension

Ǉ. decreased abductor lever arm

Ǌ. decreased joint reaction force

Ǌ. increased body weight over lever arm

Ǌ. increased polyethylene wear rate

Ǎ. recurrent traumatic anterior dislocation

Ǎ. recurrent traumatic posterior dislocation

Ǐ. traumatic subluxation with no previous dislocation

Ǐ. traumatic anterior subluxation

Ǒ. atraumatic involuntary subluxation

Ǒ. radial

Ǔ. axillary

Ǔ. suprascapular

Ǖ. thoracodorsal

Ǖ. long thoracic

Ǘ. Flexion

Ǘ. Extension

Ǚ. Axial rotation

Ǚ. Left lateral bending

Ǜ. Right lateral bending

Ǜ. Skin

Ǝ. Lung

Ǟ. Brain

Ǟ. Heart

Ǡ. Kidney

Ǡ. Thoracoacromial, lateral thoracic, subscapular

Ǣ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǣ. Posterior humeral circumflex, subscapular, thoracacromial

Ǥ. Subscapular, thoracacromial, anterior humeral circumflex

Ǥ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǧ. Respondeat superior

Ǧ. Indemnity agreement

Ǩ. Hold harmless agreement- attempt to shift liability from company to physician

Ǩ. Comparative negligence-% of involvement

Ǫ. Contributory negligence- resident contributed to the negligence

Ǫ. t-type

Ǭ. both column

Ǭ. transverse

Ǯ. anterior column

Ǯ. anterior column posterior hemitransverse

J̌. Posterior interosseous

Ǳ. Anterior interosseous

Ǳ. Radial

Ǳ. Median

Ǵ. Ulnar

Ǵ. Shock from hypovolemia

Ƕ. Associated rupture of the bladder

Ƿ. Arterial bleeding on pelvic angiogram

Ǹ. Presence of a hematoma in the perineum and scrotum

Ǹ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. observation and exercises

Explanation

Question 4178

Topic: 10. Pathology and Oncology

Figures 39a through 39c show a clinical photograph and the radiographs of a 32-year-old woman who has been unable to actively extend her dominant ring and small finger for the past two weeks. She has no history of trauma and has minimal pain. Examination reveals full passive range of motion (ROM) of the fingers. Active ROM of the wrist is extension of 40 degrees and flexion of 35 degrees. Active forearm pronation is 45 degrees, and supination is 50 degrees. Treatment should consist of

. 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

-. Stimulation of release of presynaptic acetylcholine until reserves are depleted

.. stiffness of the femoral component.

/. head offset of the femoral component.

0. femoral component material modulus of elasticity.

1. extent of the femoral component porous coating.

2. Presence of a femoral component collar.

3. plantar fascia and quadratus plantae tendon.

4. ligamentous structures connecting the tarsal bones.

5. shape of the tarsal bones and the intervening joints.

6. activity of the intrinsic muscles of the foot.

7. activity of the posterior tibialis and the peroneus longus muscles.

8. scapulothoracic fusion

9. 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

A. valgus-producing proximal tibial osteotomy

B. Internal rotation of the femoral component

C. External rotation of the tibial component

D. Lateral placement of the femoral component

E. Medial placement of the patellar component

F. Excessive resection of the patella

G. Hallux rigidus

H. Hallux valgus

I. Neuroma of the first web space

J. Fracture of the sesamoid

K. Rupture of the flexor hallucis longus

L. Sickle cell crisis

M. Idiopathic chondrolysis

N. Hemophilic arthropathy

O. Osteoid osteoma of the femoral neck

P. Legg-Calve-Perthes disease

Q. Decreased ankle jerk and positive femoral nerve stretch test

R. Decreased knee jerk and positive straight-leg raising sign

S. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

T. Weakness of the extensor hallucis longus and positive straight-leg raising sign

U. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

V. Long-term administration of IV and oral antibiotics

W. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

X. Immediate exchange arthroplasty with antibiotic-impregnated cement

Y. Two-stage surgical prosthetic exchange and IV antibiotics

Z. Resection arthroplasty and IV antibiotics

[. SCFE

\. MED

]. Perthes disease

^. Hypothyroidism

_. Chondrolysis

`. gout.

A. osteoporosis.

B. eosinophilic granuloma.

C. tuberculosis of the spine.

D. metastatic disease of the spine.

E. water content.

F. Synthesis of type I collagen.

G. Proteoglycan content.

H. Activity of chondrocytes.

I. Synthesis of hyaluronate.

J. Lung

K. Breast

L. Prostate

M. Thyroid

N. Renal

O. T1-low, T2-low.

P. T1-low, T2-high.

Q. T1-moderate, T2-low.

R. T1-high, T2-low.

S. T1-high, T2-high.

T. hypothesis is incorrect or invalid

U. interobserver error rate is 4%.

V. Standard deviation is 4% higher or lower than the mean.

W. Sample size is 4% larger than required to be clinically significant.

X. Probability that the differences noted between two study groups were due to chance alone is 4%.

Y. I

Z. II

{. IV

|. IX

}. X

~. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

. a long leg cast and observation

. intramedullary stabilization and observation

. Triggering

¡. Lateral instability

¢. Swan-neck deformity

£. Boutonniere deformity

¤. Loss of distal interphalangeal joint flexion

¥. Peroneus brevis to peroneus longus

¦. Peroneus tertius to extensor hallucis longus

§. Peroneus tertius to superficial peroneal nerve

¨. Extensor hallucis longus to deep peroneal nerve

ª. reassurance that Medicare will pay for the treatment.

«. consent forms that patients or their guardians are able to understand.

¬. a detailed description of the device, omitting the fact that it is part of a study.

. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

®. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

¯. an onlay iliac crest bone graft.

°. limited weightbearing and observation.

±. removal of the implant and limited weightbearing.

². removal of the implant and insertion of a reamed femoral nail.

³. removal of the implant and insertion of an unreamed femoral nail.

´. Coronal

Μ. Sagittal

¶. Anteromedial, midway between the sagittal and the coronal

·. Proximal pins sagittal, distal pins coronal

¸. Proximal pins coronal, distal pins sagittal

¹. Rheumatoid arthritis

º. Posttraumatic arthritis

». Degenerative osteoarthritis

¼. Osteonecrosis of the tibial plateau

½. Osteonecrosis of the medial femoral condyle

¾. Trapeziometacarpal arthrodesis

¿. Osteotomy of the thumb metacarpal

À. Arthrotomy and joint debridement

Á. Ligament reconstruction using one half of the flexor carpi radialis

Â. Trapezium resection, tendon interposition, and reconstruction of the ligament

Ã. Creep

Ä. Relaxation

Å. Energy dissipation

Æ. Plastic deformation

Ç. Elastic deformation

È. bending

É. axial loading

Ê. high-speed rotation

Ë. direct impact from anteromedial

Ì. crush from anteromedial to posterolateral

Í. Increase stiffness

Î. Increase fracture toughness

Ï. Increase fatigue strength

Ð. Decrease mechanical strength

Ñ. Decrease wear rate

Ò. disuse osteopenia

Ó. paraendocrine effect of the tumor

Ô. abnormally increased density on the right side

Õ. side effect of the treatment of the lesion

Ö. extensive tumor involvement of the left hip

×. Sciatic nerve

Ø. Superior gluteal artery

Ù. Profunda femoris artery

Ú. Femoral artery and nerve

Û. External iliac artery and vein

Ü. Length

Ý. Moment arm

Þ. Total volume

SS. Physiologic cross-sectional area

À. Distribution of slow and fast twitch fibers

Á. decreasing initiation of action potentials.

Â. increasing action potential amplitude.

Ã. blocking the opening of gated sodium channels.

Ä. decreasing the number of functional motor units.

Å. slowing or stopping action potential propagation through the axon.

Æ. resection of the metatarsal heads of the first through fifth toes.

Ç. Silastic MP joint arthroplasties of the first through fifth toes.

È. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

É. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Ê. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Ë. hemiarthroplasty

Ì. open reduction and internal fixation

Í. closed reduction and percutaneous pinning

Î. a sling and early pedulum exercises

Ï. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ð. open acromioplasty

Ñ. open Bankart repair

Ò. open subscapularis tendon repair

Ó. inferior capsular shift

Ô. a supervised physical therapy program

Õ. a sling and swathe, with pendulum exercises in 10 days

Ö. open reduction and internal fixation through an anterior approach

÷. open reduction and internal fixation through a posterior approach

Ø. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ù. arthroscopically assisted reduction and percutaneous screw fixation

Ú. Repair of the rotator cuff

Û. Replacement of the humeral head

Ü. Resection arthroplasty

Ý. Total shoulder arthroplasty

Þ. AP and lateral radiographs of the elbow

Ÿ. Diagnositc arthroscopy

Ā. Aspiration of joint fluid

Ā. An erythrocyte sedimentation rate and CBC

Ă. A diagnostic lidocaine injection

Ă. Insulin-like growth factor (IGF-1)

Ą. Fibroblast growth factor (FGF-1)

Ą. Platelet-derived growth factor (PDGF)

Ć. Transforming growth factor beta (TGF-B)

Ć. Bone morphogenetic proteins (BMP)

Ĉ. clinical history and radiographic findings.

Ĉ. technetium bone scan

Ċ. flow cytometry pattern of extracted chondrocytes

Ċ. immunohistochemical staining patterns of a biopsy specimen

Č. histologic features of a biopsy specimen stained with hematoxylin-cosin

Č. Radial

Ď. Radial recurrent

Ď. Posterior interosseous

Đ. Superior ulnar recurrent

Đ. Superficial radial circumflex

Ē. Impaired hydroxylation of proline

Ē. Failure of cleavage in procollagen

Ĕ. Defective binding sites for hydroxyproline

Ĕ. Failure to incorporate glycine into the helix

Ė. Diminished production of collagen through the rough endoplasmic reticulum

Ė. Asking the legal staff to seek a court injunction

Ę. Copying the patient’s chart and giving it to him as he leaves

Ę. Having the patient sign a written legal contract that specifies acceptable behavior

Ě. Continuing care of the patient until an appropriate referral can be arranged

Ě. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ĝ. Meta-analysis

Ĝ. Confidence interval

Ğ. Analysis of variance (ANOVA)

Ğ. Statistical significance (p-value)

Ġ. Survivorship analysis (Kaplan-Meier)

Ġ. Spinal shock

Ģ. Neurogenic shock

Ģ. Hypovolemic shock

Ĥ. Pulmonary embolism

Ĥ. Fat embolus syndrome

Ħ. Lumbar spinal stenosis

Ħ. Metastatic disease of the spine

Ĩ. Rheumatoid lumbar spondylitis

Ĩ. Isthmic spondyloloisthesis

Ī. Degenerative spondylolisthesis at L4-5 and L5-S1

Ī. Patella alta

Ĭ. A metal-backed patella

Ĭ. Varus malalignment of the knee

Į. A posterior cruciate-substituting femoral component

Į. Lateral subluxation of the patella on a Merchant’s view

İ. The sesamoids are separated

I. The sesamoid is fractured

Ĳ. The proximal phx is on the neck of the metatarsal

Ĳ. The dislocation is dorsal and centered

Ĵ. The proximal phalanx is hyperextended

Ĵ. Patella

Ķ. Tibial stem

Ķ. Distal femoral interface

ĸ. Posterior femoral interface

Ĺ. Sites of screw fixation for the tibia

Ĺ. Hallux rigidus

Ļ. Fracture of the sesamoid

Ļ. Disruption of the plantar plate

Ľ. Osteonecrosis of the metatarsal head

Ľ. Rupture of the flexor hallucis longus

Ŀ. Gout

Ŀ. Sepsis

Ł. Old trauma

Ł. Rheumatoid arthritis

Ń. Charcot arthroplasty

Ń. Aspiration and steroid injection

Ņ. Biopsy, curettage, and allograft bone grafting

Ņ. Percutaneous Kirschner wire fixation

Ň. Percutaneous injection of autogenous bone marrow

Ň. Nerve roots

ʼN. Spinal cord

Ŋ. Sciatic nerve

Ŋ. Peroneal nerve

Ō. Conus medullaris

Ō. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ŏ. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ŏ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ő. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ő. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Œ. Early and late infection

Œ. Periprosthetic fracture of the femur

Ŕ. Failure of the patellofemoral and extensor mechanisms

Ŕ. Aseptic loosening of cementing tibial components

Ŗ. Asceptic loosening of cemented femoral components

Ŗ. Acceptance of the current position of the ankle

Ř. Open reduction and fixation in the epiphysis only

Ř. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ś. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ś. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ŝ. Resection arthroplasty and local radiation

Ŝ. In situ fusion of the hip

Ş. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ş. Excision of heterotopic bone and local radiation

Š. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Š. Closed reduction of both fractures and immediate spica casting

Ţ. Bilateral skin traction for 3 weeks, followed by spica casting

Ţ. External fixation of both femora

Ť. External fixation of the left femur and a long leg cast brace for the right femur

Ť. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ŧ. Synovial sarcoma

Ŧ. Soft-tissue abcess

Ũ. Rhabdomyosarcoma

Ũ. Eosinophilic granuloma

Ū. Nodular pigmented villonodular synovitis

Ū. Changing to a titanium nail

Ŭ. Changing to a nonslotted nail

Ŭ. Changing the cross-sectional shape of the nail

Ů. Increasing the diameter of the nail by 3 mm

Ů. Increasing the diameter of the interlocking screws

Ű. Fracture healing

Ű. Chondrosarcoma

Ų. Periosteal chondroma

Ų. Periosteal osteosarcoma

Ŵ. Dysplasia epiphysealis hemimelica

Ŵ. Demonstrate competence in the subject of the case

Ŷ. Be fellowship trained in the subject of the case

Ŷ. Be paid on a contingency basis

Ÿ. Be board certified by the American Board of Orthopaedic Surgery

Ź. Have been involved in the case as a consultant

Ź. Diagnostic arthroscopy

Ż. Arthroscopy and subacromial decompression

Ż. Reduction and fixation of the proximal humeral epiphysis

Ž. Temporary cessation of throwing

Ž. Physical therapy for rotator cuff strengthening

S. Oblique popliteal ligament

Ƀ. Lateral capsule

Ɓ. Popliteal tendon

Ƃ. Fibular collateral ligament

Ƃ. Posterior oblique ligament

Ƅ. Radial tear

Ƅ. Parrot-beak tear

Ɔ. Vertical tear in the “red-red” zone

Ƈ. Vertical tear in the “red-white” zone

Ƈ. Vertical tear in the “white-white” zone

Ɖ. 0 degrees of abduction, with neural rotation

Ɗ. 40 degrees of flexion and 60 degrees of internal rotation

Ƌ. 45 degrees of flexion and 45 degrees of external rotation

Ƌ. 90 degrees of abduction with neutral rotation

ƍ. 90 degrees of abduction and 90 degrees of external rotation

Ǝ. Sural

Ə. Saphenous and its branches

Ɛ. Posterior tibial and its branches

Ƒ. Deep peroneal and its branches

Ƒ. Superficial peroneal and its branches

Ɠ. Strength

Ɣ. Stiffness

Ƕ. Shelf life

Ɩ. Antigenicity

Ɨ. Risk of HIV transmission

Ƙ. Indemnification

Ƙ. Occurrence

Ƚ. Excess liability

ƛ. Claims-made

Ɯ. Nose

Ɲ. Lateral Y

Ƞ. Scapular AP

Ɵ. Neutral rotation AP

Ơ. Internal rotation AP

Ơ. External rotation AP

Ƣ. Trauma

Ƣ. Hemophilia

Ƥ. Reiter’s syndrome

Ƥ. Rheumatoid arthritis

Ʀ. Systemic lupus erythematosus

Ƨ. Cast immobilization for 6 weeks

Ƨ. Activity modification and re-evaluation in 2 months

Ʃ. Internal fixation with or without bone grafting

ƪ. Retrograde drilling of the defect without articular cartilage penetration

ƫ. Drilling of the defect directly through the articular cartilage

Ƭ. repair or reconstruction of the medial collateral ligament

Ƭ. repair or reconstruction of the medialand lateral collateral ligaments

Ʈ. immobilization for 5 days or less

Ư. immobilization for 14 days

Ư. immobilization for 25 days

Ʊ. Cystinosis

Ʋ. Hypophosphatemia

Ƴ. Renal osteodystrophy

Ƴ. Primary hyperparathyroidism

Ƶ. Nutritional vitamin D deficiency

Ƶ. Lateral meniscus tear

Ʒ. Popliteus tenosynovitis

Ƹ. Iliotibial band friction syndrome

Ƹ. Peroneal nerve entrapment

ƺ. Biceps tendinitis

ƻ. Observation

Ƽ. Removal of the prosthetic components

Ƽ. Operative exploration and decompression of the peroneal nerve

ƾ. Nerve conduction velocity studies

Ƿ. Loosening of the primary dressings and knee flexion to 30 degrees

ǀ. I

ǁ. II

ǂ. III

ǃ. decreased tissue tension

Ǆ. decreased abductor lever arm

Ǆ. decreased joint reaction force

Ǆ. increased body weight over lever arm

Ǉ. increased polyethylene wear rate

Ǉ. recurrent traumatic anterior dislocation

Ǉ. recurrent traumatic posterior dislocation

Ǌ. traumatic subluxation with no previous dislocation

Ǌ. traumatic anterior subluxation

Ǌ. atraumatic involuntary subluxation

Ǎ. radial

Ǎ. axillary

Ǐ. suprascapular

Ǐ. thoracodorsal

Ǒ. long thoracic

Ǒ. Flexion

Ǔ. Extension

Ǔ. Axial rotation

Ǖ. Left lateral bending

Ǖ. Right lateral bending

Ǘ. Skin

Ǘ. Lung

Ǚ. Brain

Ǚ. Heart

Ǜ. Kidney

Ǜ. Thoracoacromial, lateral thoracic, subscapular

Ǝ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǟ. Posterior humeral circumflex, subscapular, thoracacromial

Ǟ. Subscapular, thoracacromial, anterior humeral circumflex

Ǡ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǡ. Respondeat superior

Ǣ. Indemnity agreement

Ǣ. Hold harmless agreement- attempt to shift liability from company to physician

Ǥ. Comparative negligence-% of involvement

Ǥ. Contributory negligence- resident contributed to the negligence

Ǧ. t-type

Ǧ. both column

Ǩ. transverse

Ǩ. anterior column

Ǫ. anterior column posterior hemitransverse

Ǫ. Posterior interosseous

Ǭ. Anterior interosseous

Ǭ. Radial

Ǯ. Median

Ǯ. Ulnar

J̌. Shock from hypovolemia

Ǳ. Associated rupture of the bladder

Ǳ. Arterial bleeding on pelvic angiogram

Ǳ. Presence of a hematoma in the perineum and scrotum

Ǵ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Total wrist replacement and bridge grafts

Explanation

Question 4179

Topic: 10. Pathology and Oncology

A 75-year-old woman who has groin pain states that she had total hip arthroplasty 15 years ago. The radiograph shown in Figure 40 reveals that the left acetabular component is grossly loose. Revision of the acetabular component should include use of 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

. 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.

0. shape of the tarsal bones and the intervening joints.

1. activity of the intrinsic muscles of the foot.

2. activity of the posterior tibialis and the peroneus longus muscles.

3. scapulothoracic fusion

4. strengthening of the periscapular muscles

5. pectoralis minor-fascia lata graft transfer to the scapula

6. pectoralis major-fascia lata graft transfer to the scapula

7. exploration of the long thoracic nerve, with sural nerve graft

8. tricompartmental knee replacement

9. 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

A. Excessive resection of the patella

B. Hallux rigidus

C. Hallux valgus

D. Neuroma of the first web space

E. Fracture of the sesamoid

F. Rupture of the flexor hallucis longus

G. Sickle cell crisis

H. Idiopathic chondrolysis

I. Hemophilic arthropathy

J. Osteoid osteoma of the femoral neck

K. Legg-Calve-Perthes disease

L. Decreased ankle jerk and positive femoral nerve stretch test

M. Decreased knee jerk and positive straight-leg raising sign

N. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

O. Weakness of the extensor hallucis longus and positive straight-leg raising sign

P. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

Q. Long-term administration of IV and oral antibiotics

R. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

S. Immediate exchange arthroplasty with antibiotic-impregnated cement

T. Two-stage surgical prosthetic exchange and IV antibiotics

U. Resection arthroplasty and IV antibiotics

V. SCFE

W. MED

X. Perthes disease

Y. Hypothyroidism

Z. Chondrolysis

[. gout.

\. osteoporosis.

]. eosinophilic granuloma.

^. tuberculosis of the spine.

_. metastatic disease of the spine.

`. water content.

A. Synthesis of type I collagen.

B. Proteoglycan content.

C. Activity of chondrocytes.

D. Synthesis of hyaluronate.

E. Lung

F. Breast

G. Prostate

H. Thyroid

I. Renal

J. T1-low, T2-low.

K. T1-low, T2-high.

L. T1-moderate, T2-low.

M. T1-high, T2-low.

N. T1-high, T2-high.

O. hypothesis is incorrect or invalid

P. interobserver error rate is 4%.

Q. Standard deviation is 4% higher or lower than the mean.

R. Sample size is 4% larger than required to be clinically significant.

S. Probability that the differences noted between two study groups were due to chance alone is 4%.

T. I

U. II

V. IV

W. IX

X. X

Y. Cranial setting

Z. Cranial subluxation

{. Odontoid fracture

|. Lysis of the arch of the atlas

}. Atlantoaxial subluxation

~. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

. a long leg cast and observation

. intramedullary stabilization and observation

. Triggering

. Lateral instability

. Swan-neck deformity

. Boutonniere deformity

. Loss of distal interphalangeal joint flexion

. Peroneus brevis to peroneus longus

¡. Peroneus tertius to extensor hallucis longus

¢. Peroneus tertius to superficial peroneal nerve

£. Extensor hallucis longus to deep peroneal nerve

¤. Extensor hallucis longus to extensor digitorum longus

¥. reassurance that Medicare will pay for the treatment.

¦. consent forms that patients or their guardians are able to understand.

§. a detailed description of the device, omitting the fact that it is part of a study.

¨. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

©. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

ª. an onlay iliac crest bone graft.

«. limited weightbearing and observation.

¬. removal of the implant and limited weightbearing.

. removal of the implant and insertion of a reamed femoral nail.

®. removal of the implant and insertion of an unreamed femoral nail.

¯. Coronal

°. Sagittal

±. Anteromedial, midway between the sagittal and the coronal

². Proximal pins sagittal, distal pins coronal

³. Proximal pins coronal, distal pins sagittal

´. Rheumatoid arthritis

Μ. Posttraumatic arthritis

¶. Degenerative osteoarthritis

·. Osteonecrosis of the tibial plateau

¸. Osteonecrosis of the medial femoral condyle

¹. Trapeziometacarpal arthrodesis

º. Osteotomy of the thumb metacarpal

». Arthrotomy and joint debridement

¼. Ligament reconstruction using one half of the flexor carpi radialis

½. Trapezium resection, tendon interposition, and reconstruction of the ligament

¾. Creep

¿. Relaxation

À. Energy dissipation

Á. Plastic deformation

Â. Elastic deformation

Ã. bending

Ä. axial loading

Å. high-speed rotation

Æ. direct impact from anteromedial

Ç. crush from anteromedial to posterolateral

È. Increase stiffness

É. Increase fracture toughness

Ê. Increase fatigue strength

Ë. Decrease mechanical strength

Ì. Decrease wear rate

Í. disuse osteopenia

Î. paraendocrine effect of the tumor

Ï. abnormally increased density on the right side

Ð. side effect of the treatment of the lesion

Ñ. extensive tumor involvement of the left hip

Ò. Sciatic nerve

Ó. Superior gluteal artery

Ô. Profunda femoris artery

Õ. Femoral artery and nerve

Ö. External iliac artery and vein

×. Length

Ø. Moment arm

Ù. Total volume

Ú. Physiologic cross-sectional area

Û. Distribution of slow and fast twitch fibers

Ü. decreasing initiation of action potentials.

Ý. increasing action potential amplitude.

Þ. blocking the opening of gated sodium channels.

SS. decreasing the number of functional motor units.

À. slowing or stopping action potential propagation through the axon.

Á. resection of the metatarsal heads of the first through fifth toes.

Â. Silastic MP joint arthroplasties of the first through fifth toes.

Ã. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

Ä. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

Å. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Æ. hemiarthroplasty

Ç. open reduction and internal fixation

È. closed reduction and percutaneous pinning

É. a sling and early pedulum exercises

Ê. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Ë. open acromioplasty

Ì. open Bankart repair

Í. open subscapularis tendon repair

Î. inferior capsular shift

Ï. a supervised physical therapy program

Ð. a sling and swathe, with pendulum exercises in 10 days

Ñ. open reduction and internal fixation through an anterior approach

Ò. open reduction and internal fixation through a posterior approach

Ó. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ô. arthroscopically assisted reduction and percutaneous screw fixation

Õ. Repair of the rotator cuff

Ö. Replacement of the humeral head

÷. Resection arthroplasty

Ø. Total shoulder arthroplasty

Ù. AP and lateral radiographs of the elbow

Ú. Diagnositc arthroscopy

Û. Aspiration of joint fluid

Ü. An erythrocyte sedimentation rate and CBC

Ý. A diagnostic lidocaine injection

Þ. Insulin-like growth factor (IGF-1)

Ÿ. Fibroblast growth factor (FGF-1)

Ā. Platelet-derived growth factor (PDGF)

Ā. Transforming growth factor beta (TGF-B)

Ă. Bone morphogenetic proteins (BMP)

Ă. clinical history and radiographic findings.

Ą. technetium bone scan

Ą. flow cytometry pattern of extracted chondrocytes

Ć. immunohistochemical staining patterns of a biopsy specimen

Ć. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ĉ. Radial

Ĉ. Radial recurrent

Ċ. Posterior interosseous

Ċ. Superior ulnar recurrent

Č. Superficial radial circumflex

Č. Impaired hydroxylation of proline

Ď. Failure of cleavage in procollagen

Ď. Defective binding sites for hydroxyproline

Đ. Failure to incorporate glycine into the helix

Đ. Diminished production of collagen through the rough endoplasmic reticulum

Ē. Asking the legal staff to seek a court injunction

Ē. Copying the patient’s chart and giving it to him as he leaves

Ĕ. Having the patient sign a written legal contract that specifies acceptable behavior

Ĕ. Continuing care of the patient until an appropriate referral can be arranged

Ė. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ė. Meta-analysis

Ę. Confidence interval

Ę. Analysis of variance (ANOVA)

Ě. Statistical significance (p-value)

Ě. Survivorship analysis (Kaplan-Meier)

Ĝ. Spinal shock

Ĝ. Neurogenic shock

Ğ. Hypovolemic shock

Ğ. Pulmonary embolism

Ġ. Fat embolus syndrome

Ġ. Lumbar spinal stenosis

Ģ. Metastatic disease of the spine

Ģ. Rheumatoid lumbar spondylitis

Ĥ. Isthmic spondyloloisthesis

Ĥ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ħ. Patella alta

Ħ. A metal-backed patella

Ĩ. Varus malalignment of the knee

Ĩ. A posterior cruciate-substituting femoral component

Ī. Lateral subluxation of the patella on a Merchant’s view

Ī. The sesamoids are separated

Ĭ. The sesamoid is fractured

Ĭ. The proximal phx is on the neck of the metatarsal

Į. The dislocation is dorsal and centered

Į. The proximal phalanx is hyperextended

İ. Patella

I. Tibial stem

Ĳ. Distal femoral interface

Ĳ. Posterior femoral interface

Ĵ. Sites of screw fixation for the tibia

Ĵ. Hallux rigidus

Ķ. Fracture of the sesamoid

Ķ. Disruption of the plantar plate

ĸ. Osteonecrosis of the metatarsal head

Ĺ. Rupture of the flexor hallucis longus

Ĺ. Gout

Ļ. Sepsis

Ļ. Old trauma

Ľ. Rheumatoid arthritis

Ľ. Charcot arthroplasty

Ŀ. Aspiration and steroid injection

Ŀ. Biopsy, curettage, and allograft bone grafting

Ł. Percutaneous Kirschner wire fixation

Ł. Percutaneous injection of autogenous bone marrow

Ń. Nerve roots

Ń. Spinal cord

Ņ. Sciatic nerve

Ņ. Peroneal nerve

Ň. Conus medullaris

Ň. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

ʼN. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ŋ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ŋ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ō. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ō. Early and late infection

Ŏ. Periprosthetic fracture of the femur

Ŏ. Failure of the patellofemoral and extensor mechanisms

Ő. Aseptic loosening of cementing tibial components

Ő. Asceptic loosening of cemented femoral components

Œ. Acceptance of the current position of the ankle

Œ. Open reduction and fixation in the epiphysis only

Ŕ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ŕ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ŗ. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ŗ. Resection arthroplasty and local radiation

Ř. In situ fusion of the hip

Ř. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ś. Excision of heterotopic bone and local radiation

Ś. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ŝ. Closed reduction of both fractures and immediate spica casting

Ŝ. Bilateral skin traction for 3 weeks, followed by spica casting

Ş. External fixation of both femora

Ş. External fixation of the left femur and a long leg cast brace for the right femur

Š. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Š. Synovial sarcoma

Ţ. Soft-tissue abcess

Ţ. Rhabdomyosarcoma

Ť. Eosinophilic granuloma

Ť. Nodular pigmented villonodular synovitis

Ŧ. Changing to a titanium nail

Ŧ. Changing to a nonslotted nail

Ũ. Changing the cross-sectional shape of the nail

Ũ. Increasing the diameter of the nail by 3 mm

Ū. Increasing the diameter of the interlocking screws

Ū. Fracture healing

Ŭ. Chondrosarcoma

Ŭ. Periosteal chondroma

Ů. Periosteal osteosarcoma

Ů. Dysplasia epiphysealis hemimelica

Ű. Demonstrate competence in the subject of the case

Ű. Be fellowship trained in the subject of the case

Ų. Be paid on a contingency basis

Ų. Be board certified by the American Board of Orthopaedic Surgery

Ŵ. Have been involved in the case as a consultant

Ŵ. Diagnostic arthroscopy

Ŷ. Arthroscopy and subacromial decompression

Ŷ. Reduction and fixation of the proximal humeral epiphysis

Ÿ. Temporary cessation of throwing

Ź. Physical therapy for rotator cuff strengthening

Ź. Oblique popliteal ligament

Ż. Lateral capsule

Ż. Popliteal tendon

Ž. Fibular collateral ligament

Ž. Posterior oblique ligament

S. Radial tear

Ƀ. Parrot-beak tear

Ɓ. Vertical tear in the “red-red” zone

Ƃ. Vertical tear in the “red-white” zone

Ƃ. Vertical tear in the “white-white” zone

Ƅ. 0 degrees of abduction, with neural rotation

Ƅ. 40 degrees of flexion and 60 degrees of internal rotation

Ɔ. 45 degrees of flexion and 45 degrees of external rotation

Ƈ. 90 degrees of abduction with neutral rotation

Ƈ. 90 degrees of abduction and 90 degrees of external rotation

Ɖ. Sural

Ɗ. Saphenous and its branches

Ƌ. Posterior tibial and its branches

Ƌ. Deep peroneal and its branches

ƍ. Superficial peroneal and its branches

Ǝ. Strength

Ə. Stiffness

Ɛ. Shelf life

Ƒ. Antigenicity

Ƒ. Risk of HIV transmission

Ɠ. Indemnification

Ɣ. Occurrence

Ƕ. Excess liability

Ɩ. Claims-made

Ɨ. Nose

Ƙ. Lateral Y

Ƙ. Scapular AP

Ƚ. Neutral rotation AP

ƛ. Internal rotation AP

Ɯ. External rotation AP

Ɲ. Trauma

Ƞ. Hemophilia

Ɵ. Reiter’s syndrome

Ơ. Rheumatoid arthritis

Ơ. Systemic lupus erythematosus

Ƣ. Cast immobilization for 6 weeks

Ƣ. Activity modification and re-evaluation in 2 months

Ƥ. Internal fixation with or without bone grafting

Ƥ. Retrograde drilling of the defect without articular cartilage penetration

Ʀ. Drilling of the defect directly through the articular cartilage

Ƨ. repair or reconstruction of the medial collateral ligament

Ƨ. repair or reconstruction of the medialand lateral collateral ligaments

Ʃ. immobilization for 5 days or less

ƪ. immobilization for 14 days

ƫ. immobilization for 25 days

Ƭ. Cystinosis

Ƭ. Hypophosphatemia

Ʈ. Renal osteodystrophy

Ư. Primary hyperparathyroidism

Ư. Nutritional vitamin D deficiency

Ʊ. Lateral meniscus tear

Ʋ. Popliteus tenosynovitis

Ƴ. Iliotibial band friction syndrome

Ƴ. Peroneal nerve entrapment

Ƶ. Biceps tendinitis

Ƶ. Observation

Ʒ. Removal of the prosthetic components

Ƹ. Operative exploration and decompression of the peroneal nerve

Ƹ. Nerve conduction velocity studies

ƺ. Loosening of the primary dressings and knee flexion to 30 degrees

ƻ. I

Ƽ. II

Ƽ. III

ƾ. decreased tissue tension

Ƿ. decreased abductor lever arm

ǀ. decreased joint reaction force

ǁ. increased body weight over lever arm

ǂ. increased polyethylene wear rate

ǃ. recurrent traumatic anterior dislocation

Ǆ. recurrent traumatic posterior dislocation

Ǆ. traumatic subluxation with no previous dislocation

Ǆ. traumatic anterior subluxation

Ǉ. atraumatic involuntary subluxation

Ǉ. radial

Ǉ. axillary

Ǌ. suprascapular

Ǌ. thoracodorsal

Ǌ. long thoracic

Ǎ. Flexion

Ǎ. Extension

Ǐ. Axial rotation

Ǐ. Left lateral bending

Ǒ. Right lateral bending

Ǒ. Skin

Ǔ. Lung

Ǔ. Brain

Ǖ. Heart

Ǖ. Kidney

Ǘ. Thoracoacromial, lateral thoracic, subscapular

Ǘ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǚ. Posterior humeral circumflex, subscapular, thoracacromial

Ǚ. Subscapular, thoracacromial, anterior humeral circumflex

Ǜ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǜ. Respondeat superior

Ǝ. Indemnity agreement

Ǟ. Hold harmless agreement- attempt to shift liability from company to physician

Ǟ. Comparative negligence-% of involvement

Ǡ. Contributory negligence- resident contributed to the negligence

Ǡ. t-type

Ǣ. both column

Ǣ. transverse

Ǥ. anterior column

Ǥ. anterior column posterior hemitransverse

Ǧ. Posterior interosseous

Ǧ. Anterior interosseous

Ǩ. Radial

Ǩ. Median

Ǫ. Ulnar

Ǫ. Shock from hypovolemia

Ǭ. Associated rupture of the bladder

Ǭ. Arterial bleeding on pelvic angiogram

Ǯ. Presence of a hematoma in the perineum and scrotum

Ǯ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. constrained acetabular component

Explanation

Question 4180

Topic: 10. Pathology and Oncology

An 8-1/2-month-old male infant who has developmental dysplasia of the hip was treated in a Pavlick harness for 3 months. At follow-up, examination of the hip reveals full flexion and extension and abduction to 80 degrees. Figure 41a shows an AP arthrogram and Figure 41b an arthrographic view in flexion and abduction. Management should now consist of

. 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.

,. 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

0. pectoralis minor-fascia lata graft transfer to the scapula

1. pectoralis major-fascia lata graft transfer to the scapula

2. exploration of the long thoracic nerve, with sural nerve graft

3. tricompartmental knee replacement

4. unicompartmental knee replacement

5. medial compartment meniscal allograft

6. valgus-producing distal femoral osteotomy

7. valgus-producing proximal tibial osteotomy

8. Internal rotation of the femoral component

9. 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

A. Rupture of the flexor hallucis longus

B. Sickle cell crisis

C. Idiopathic chondrolysis

D. Hemophilic arthropathy

E. Osteoid osteoma of the femoral neck

F. Legg-Calve-Perthes disease

G. Decreased ankle jerk and positive femoral nerve stretch test

H. Decreased knee jerk and positive straight-leg raising sign

I. Gastrocnemius-soleus complex weakness and positive straight-leg raising sign

J. Weakness of the extensor hallucis longus and positive straight-leg raising sign

K. Weakness of the extensor hallucis longus and positive femoral nerve stretch test

L. Long-term administration of IV and oral antibiotics

M. Open soft-tissue debridement, retention of prosthetic components, and IV antibiotics

N. Immediate exchange arthroplasty with antibiotic-impregnated cement

O. Two-stage surgical prosthetic exchange and IV antibiotics

P. Resection arthroplasty and IV antibiotics

Q. SCFE

R. MED

S. Perthes disease

T. Hypothyroidism

U. Chondrolysis

V. gout.

W. osteoporosis.

X. eosinophilic granuloma.

Y. tuberculosis of the spine.

Z. metastatic disease of the spine.

[. water content.

\. Synthesis of type I collagen.

]. Proteoglycan content.

^. Activity of chondrocytes.

_. Synthesis of hyaluronate.

`. Lung

A. Breast

B. Prostate

C. Thyroid

D. Renal

E. T1-low, T2-low.

F. T1-low, T2-high.

G. T1-moderate, T2-low.

H. T1-high, T2-low.

I. T1-high, T2-high.

J. hypothesis is incorrect or invalid

K. interobserver error rate is 4%.

L. Standard deviation is 4% higher or lower than the mean.

M. Sample size is 4% larger than required to be clinically significant.

N. Probability that the differences noted between two study groups were due to chance alone is 4%.

O. I

P. II

Q. IV

R. IX

S. X

T. Cranial setting

U. Cranial subluxation

V. Odontoid fracture

W. Lysis of the arch of the atlas

X. Atlantoaxial subluxation

Y. Retrograde collapse of the endoneurial tubes

Z. Irreversible atrophy of the denervated muscles

{. Elongation of the axons across the zone of injury

|. Sprouting of the axons at the neuromuscular junction

}. Misdirection of the axons across the zone of injury

~. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

. application of a cast with the hand in a “safe position” for 3 weeks.

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

. a long leg cast and observation

. intramedullary stabilization and observation

. Triggering

. Lateral instability

. Swan-neck deformity

. Boutonniere deformity

. Loss of distal interphalangeal joint flexion

. Peroneus brevis to peroneus longus

. Peroneus tertius to extensor hallucis longus

. Peroneus tertius to superficial peroneal nerve

. Extensor hallucis longus to deep peroneal nerve

. Extensor hallucis longus to extensor digitorum longus

. reassurance that Medicare will pay for the treatment.

¡. consent forms that patients or their guardians are able to understand.

¢. a detailed description of the device, omitting the fact that it is part of a study.

£. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

¤. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

¥. an onlay iliac crest bone graft.

¦. limited weightbearing and observation.

§. removal of the implant and limited weightbearing.

¨. removal of the implant and insertion of a reamed femoral nail.

ª. Coronal

«. Sagittal

¬. Anteromedial, midway between the sagittal and the coronal

. Proximal pins sagittal, distal pins coronal

®. Proximal pins coronal, distal pins sagittal

¯. Rheumatoid arthritis

°. Posttraumatic arthritis

±. Degenerative osteoarthritis

². Osteonecrosis of the tibial plateau

³. Osteonecrosis of the medial femoral condyle

´. Trapeziometacarpal arthrodesis

Μ. Osteotomy of the thumb metacarpal

¶. Arthrotomy and joint debridement

·. Ligament reconstruction using one half of the flexor carpi radialis

¸. Trapezium resection, tendon interposition, and reconstruction of the ligament

¹. Creep

º. Relaxation

». Energy dissipation

¼. Plastic deformation

½. Elastic deformation

¾. bending

¿. axial loading

À. high-speed rotation

Á. direct impact from anteromedial

Â. crush from anteromedial to posterolateral

Ã. Increase stiffness

Ä. Increase fracture toughness

Å. Increase fatigue strength

Æ. Decrease mechanical strength

Ç. Decrease wear rate

È. disuse osteopenia

É. paraendocrine effect of the tumor

Ê. abnormally increased density on the right side

Ë. side effect of the treatment of the lesion

Ì. extensive tumor involvement of the left hip

Í. Sciatic nerve

Î. Superior gluteal artery

Ï. Profunda femoris artery

Ð. Femoral artery and nerve

Ñ. External iliac artery and vein

Ò. Length

Ó. Moment arm

Ô. Total volume

Õ. Physiologic cross-sectional area

Ö. Distribution of slow and fast twitch fibers

×. decreasing initiation of action potentials.

Ø. increasing action potential amplitude.

Ù. blocking the opening of gated sodium channels.

Ú. decreasing the number of functional motor units.

Û. slowing or stopping action potential propagation through the axon.

Ü. resection of the metatarsal heads of the first through fifth toes.

Ý. Silastic MP joint arthroplasties of the first through fifth toes.

Þ. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

SS. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

À. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

Á. hemiarthroplasty

Â. open reduction and internal fixation

Ã. closed reduction and percutaneous pinning

Ä. a sling and early pedulum exercises

Å. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

Æ. open acromioplasty

Ç. open Bankart repair

È. open subscapularis tendon repair

É. inferior capsular shift

Ê. a supervised physical therapy program

Ë. a sling and swathe, with pendulum exercises in 10 days

Ì. open reduction and internal fixation through an anterior approach

Í. open reduction and internal fixation through a posterior approach

Î. immobilization with a splint in 45 degrees of abduction for 6 weeks

Ï. arthroscopically assisted reduction and percutaneous screw fixation

Ð. Repair of the rotator cuff

Ñ. Replacement of the humeral head

Ò. Resection arthroplasty

Ó. Total shoulder arthroplasty

Ô. AP and lateral radiographs of the elbow

Õ. Diagnositc arthroscopy

Ö. Aspiration of joint fluid

÷. An erythrocyte sedimentation rate and CBC

Ø. A diagnostic lidocaine injection

Ù. Insulin-like growth factor (IGF-1)

Ú. Fibroblast growth factor (FGF-1)

Û. Platelet-derived growth factor (PDGF)

Ü. Transforming growth factor beta (TGF-B)

Ý. Bone morphogenetic proteins (BMP)

Þ. clinical history and radiographic findings.

Ÿ. technetium bone scan

Ā. flow cytometry pattern of extracted chondrocytes

Ā. immunohistochemical staining patterns of a biopsy specimen

Ă. histologic features of a biopsy specimen stained with hematoxylin-cosin

Ă. Radial

Ą. Radial recurrent

Ą. Posterior interosseous

Ć. Superior ulnar recurrent

Ć. Superficial radial circumflex

Ĉ. Impaired hydroxylation of proline

Ĉ. Failure of cleavage in procollagen

Ċ. Defective binding sites for hydroxyproline

Ċ. Failure to incorporate glycine into the helix

Č. Diminished production of collagen through the rough endoplasmic reticulum

Č. Asking the legal staff to seek a court injunction

Ď. Copying the patient’s chart and giving it to him as he leaves

Ď. Having the patient sign a written legal contract that specifies acceptable behavior

Đ. Continuing care of the patient until an appropriate referral can be arranged

Đ. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

Ē. Meta-analysis

Ē. Confidence interval

Ĕ. Analysis of variance (ANOVA)

Ĕ. Statistical significance (p-value)

Ė. Survivorship analysis (Kaplan-Meier)

Ė. Spinal shock

Ę. Neurogenic shock

Ę. Hypovolemic shock

Ě. Pulmonary embolism

Ě. Fat embolus syndrome

Ĝ. Lumbar spinal stenosis

Ĝ. Metastatic disease of the spine

Ğ. Rheumatoid lumbar spondylitis

Ğ. Isthmic spondyloloisthesis

Ġ. Degenerative spondylolisthesis at L4-5 and L5-S1

Ġ. Patella alta

Ģ. A metal-backed patella

Ģ. Varus malalignment of the knee

Ĥ. A posterior cruciate-substituting femoral component

Ĥ. Lateral subluxation of the patella on a Merchant’s view

Ħ. The sesamoids are separated

Ħ. The sesamoid is fractured

Ĩ. The proximal phx is on the neck of the metatarsal

Ĩ. The dislocation is dorsal and centered

Ī. The proximal phalanx is hyperextended

Ī. Patella

Ĭ. Tibial stem

Ĭ. Distal femoral interface

Į. Posterior femoral interface

Į. Sites of screw fixation for the tibia

İ. Hallux rigidus

I. Fracture of the sesamoid

Ĳ. Disruption of the plantar plate

Ĳ. Osteonecrosis of the metatarsal head

Ĵ. Rupture of the flexor hallucis longus

Ĵ. Gout

Ķ. Sepsis

Ķ. Old trauma

ĸ. Rheumatoid arthritis

Ĺ. Charcot arthroplasty

Ĺ. Aspiration and steroid injection

Ļ. Biopsy, curettage, and allograft bone grafting

Ļ. Percutaneous Kirschner wire fixation

Ľ. Percutaneous injection of autogenous bone marrow

Ľ. Nerve roots

Ŀ. Spinal cord

Ŀ. Sciatic nerve

Ł. Peroneal nerve

Ł. Conus medullaris

Ń. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Ń. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Ņ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ņ. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ň. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ň. Early and late infection

ʼN. Periprosthetic fracture of the femur

Ŋ. Failure of the patellofemoral and extensor mechanisms

Ŋ. Aseptic loosening of cementing tibial components

Ō. Asceptic loosening of cemented femoral components

Ō. Acceptance of the current position of the ankle

Ŏ. Open reduction and fixation in the epiphysis only

Ŏ. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ő. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ő. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Œ. Resection arthroplasty and local radiation

Œ. In situ fusion of the hip

Ŕ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ŕ. Excision of heterotopic bone and local radiation

Ŗ. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ŗ. Closed reduction of both fractures and immediate spica casting

Ř. Bilateral skin traction for 3 weeks, followed by spica casting

Ř. External fixation of both femora

Ś. External fixation of the left femur and a long leg cast brace for the right femur

Ś. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ŝ. Synovial sarcoma

Ŝ. Soft-tissue abcess

Ş. Rhabdomyosarcoma

Ş. Eosinophilic granuloma

Š. Nodular pigmented villonodular synovitis

Š. Changing to a titanium nail

Ţ. Changing to a nonslotted nail

Ţ. Changing the cross-sectional shape of the nail

Ť. Increasing the diameter of the nail by 3 mm

Ť. Increasing the diameter of the interlocking screws

Ŧ. Fracture healing

Ŧ. Chondrosarcoma

Ũ. Periosteal chondroma

Ũ. Periosteal osteosarcoma

Ū. Dysplasia epiphysealis hemimelica

Ū. Demonstrate competence in the subject of the case

Ŭ. Be fellowship trained in the subject of the case

Ŭ. Be paid on a contingency basis

Ů. Be board certified by the American Board of Orthopaedic Surgery

Ů. Have been involved in the case as a consultant

Ű. Diagnostic arthroscopy

Ű. Arthroscopy and subacromial decompression

Ų. Reduction and fixation of the proximal humeral epiphysis

Ų. Temporary cessation of throwing

Ŵ. Physical therapy for rotator cuff strengthening

Ŵ. Oblique popliteal ligament

Ŷ. Lateral capsule

Ŷ. Popliteal tendon

Ÿ. Fibular collateral ligament

Ź. Posterior oblique ligament

Ź. Radial tear

Ż. Parrot-beak tear

Ż. Vertical tear in the “red-red” zone

Ž. Vertical tear in the “red-white” zone

Ž. Vertical tear in the “white-white” zone

S. 0 degrees of abduction, with neural rotation

Ƀ. 40 degrees of flexion and 60 degrees of internal rotation

Ɓ. 45 degrees of flexion and 45 degrees of external rotation

Ƃ. 90 degrees of abduction with neutral rotation

Ƃ. 90 degrees of abduction and 90 degrees of external rotation

Ƅ. Sural

Ƅ. Saphenous and its branches

Ɔ. Posterior tibial and its branches

Ƈ. Deep peroneal and its branches

Ƈ. Superficial peroneal and its branches

Ɖ. Strength

Ɗ. Stiffness

Ƌ. Shelf life

Ƌ. Antigenicity

ƍ. Risk of HIV transmission

Ǝ. Indemnification

Ə. Occurrence

Ɛ. Excess liability

Ƒ. Claims-made

Ƒ. Nose

Ɠ. Lateral Y

Ɣ. Scapular AP

Ƕ. Neutral rotation AP

Ɩ. Internal rotation AP

Ɨ. External rotation AP

Ƙ. Trauma

Ƙ. Hemophilia

Ƚ. Reiter’s syndrome

ƛ. Rheumatoid arthritis

Ɯ. Systemic lupus erythematosus

Ɲ. Cast immobilization for 6 weeks

Ƞ. Activity modification and re-evaluation in 2 months

Ɵ. Internal fixation with or without bone grafting

Ơ. Retrograde drilling of the defect without articular cartilage penetration

Ơ. Drilling of the defect directly through the articular cartilage

Ƣ. repair or reconstruction of the medial collateral ligament

Ƣ. repair or reconstruction of the medialand lateral collateral ligaments

Ƥ. immobilization for 5 days or less

Ƥ. immobilization for 14 days

Ʀ. immobilization for 25 days

Ƨ. Cystinosis

Ƨ. Hypophosphatemia

Ʃ. Renal osteodystrophy

ƪ. Primary hyperparathyroidism

ƫ. Nutritional vitamin D deficiency

Ƭ. Lateral meniscus tear

Ƭ. Popliteus tenosynovitis

Ʈ. Iliotibial band friction syndrome

Ư. Peroneal nerve entrapment

Ư. Biceps tendinitis

Ʊ. Observation

Ʋ. Removal of the prosthetic components

Ƴ. Operative exploration and decompression of the peroneal nerve

Ƴ. Nerve conduction velocity studies

Ƶ. Loosening of the primary dressings and knee flexion to 30 degrees

Ƶ. I

Ʒ. II

Ƹ. III

Ƹ. decreased tissue tension

ƺ. decreased abductor lever arm

ƻ. decreased joint reaction force

Ƽ. increased body weight over lever arm

Ƽ. increased polyethylene wear rate

ƾ. recurrent traumatic anterior dislocation

Ƿ. recurrent traumatic posterior dislocation

ǀ. traumatic subluxation with no previous dislocation

ǁ. traumatic anterior subluxation

ǂ. atraumatic involuntary subluxation

ǃ. radial

Ǆ. axillary

Ǆ. suprascapular

Ǆ. thoracodorsal

Ǉ. long thoracic

Ǉ. Flexion

Ǉ. Extension

Ǌ. Axial rotation

Ǌ. Left lateral bending

Ǌ. Right lateral bending

Ǎ. Skin

Ǎ. Lung

Ǐ. Brain

Ǐ. Heart

Ǒ. Kidney

Ǒ. Thoracoacromial, lateral thoracic, subscapular

Ǔ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǔ. Posterior humeral circumflex, subscapular, thoracacromial

Ǖ. Subscapular, thoracacromial, anterior humeral circumflex

Ǖ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǘ. Respondeat superior

Ǘ. Indemnity agreement

Ǚ. Hold harmless agreement- attempt to shift liability from company to physician

Ǚ. Comparative negligence-% of involvement

Ǜ. Contributory negligence- resident contributed to the negligence

Ǜ. t-type

Ǝ. both column

Ǟ. transverse

Ǟ. anterior column

Ǡ. anterior column posterior hemitransverse

Ǡ. Posterior interosseous

Ǣ. Anterior interosseous

Ǣ. Radial

Ǥ. Median

Ǥ. Ulnar

Ǧ. Shock from hypovolemia

Ǧ. Associated rupture of the bladder

Ǩ. Arterial bleeding on pelvic angiogram

Ǩ. Presence of a hematoma in the perineum and scrotum

Ǫ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. application of a hip abduction brace for 22 hours per day

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