Injury to the C7 nerve root results in weakness primarily of the

Correct Answer: wrist flexors and finger flexors. Explanation:

Which of the following conditions is most likely inherited as an autosomal dominant trait?

Correct Answer: Syndactyly. Explanation:

Chronic flatfoot deformity is most commonly associated with a contracture of the

Correct Answer: Plantar fascia. Explanation:

The stability of the longitudinal arch of the foot during standing with equal weight on both feet is due primarily to

Correct Answer: plantar fascia and quadratus plantae tendon.. Explanation:

A 32-year-old has diffuse pain, weakness, and limited overhead motion in the shoulder as a result of falling on his outstretched arm 2 months ago. Examination reveals medial scapular winging, and an

Correct Answer: scapulothoracic fusion. Explanation:

A 45-year-old man who has medial compartment disease and chronic medial knee pain with varus alignment of 5 degrees is best treated with a

Correct Answer: tricompartmental knee replacement. Explanation:

Which of the following factors is most likely to predispose a patient to dislocation of the patellar component following total knee arthoplasty?

Correct Answer: Internal rotation of the femoral component. Explanation:

What is the most common sequela of turf toe (hyperextension of the first metatarsophalangeal joint)?

Correct Answer: Hallux rigidus. Explanation:

Figures 43a and 43b show the radiographs of an 8-year-old boy who was referred by his gym teacher because of an awkward running pattern. The patient denies any pain in his hips. Examination reveals a

Correct Answer: SCFE. Explanation:

A 31-year-old man who is a recent immigrant from Guatemala has had pain in his back and thighs for the past 12 months. History notes a recent diagnosis of gout, and the patient reports falling a dist

Correct Answer: gout.. Explanation:

Which of the following metastatic carcinomas has the worst long-term prognosis?

Correct Answer: Lung. Explanation:

The Magnetic resonance imaging signal characteristics of a high-grade soft-tissue sarcoma are best described as

Correct Answer: T1-low, T2-low.. Explanation:

Clinic OS

Q: Which of the following findings is more suggestive of neurogenic rather than vascular claudication in the differential diagnosis of leg pain?

Correct Answer: Loss of skin hair on the feet. Explanation:

Q: Which of the following surgical options after resection of a sarcoma about the knee would require a patient to expend the greatest amount of energy while walking?

Correct Answer: Arthrodesis. Explanation:

Q: The pharmacologic action of botulinum-A toxin can be best described as

Correct Answer: Prevention of presynaptic release of acetylcholine. Explanation:

Q: With respect to femoral component design, stress relief osteopenia in the proximal femur following noncemented total hip arthroplasty appears to be most strongly influenced by the

Correct Answer: stiffness of the femoral component.. Explanation:

Question 4181

Topic: 10. Pathology and Oncology

Which of the following findings is more suggestive of neurogenic rather than vascular claudication in the differential diagnosis of leg pain?

. Loss of skin hair on the feet

. Absent pulses on vascular examination

. Pain that originates proximally and spreads distally

. Pain that is relieved by stopping and standing

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

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

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

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

!. femoral component material modulus of elasticity.

". extent of the femoral component porous coating.

#. Presence of a femoral component collar.

$. plantar fascia and quadratus plantae tendon.

%. ligamentous structures connecting the tarsal bones.

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

'. activity of the intrinsic muscles of the foot.

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

). scapulothoracic fusion

*. strengthening of the periscapular muscles

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

,. 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

0. medial compartment meniscal allograft

1. valgus-producing distal femoral osteotomy

2. valgus-producing proximal tibial osteotomy

3. Internal rotation of the femoral component

4. External rotation of the tibial component

5. Lateral placement of the femoral component

6. Medial placement of the patellar component

7. Excessive resection of the patella

8. Hallux rigidus

9. 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

A. Legg-Calve-Perthes disease

B. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

G. Long-term administration of IV and oral antibiotics

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

I. Immediate exchange arthroplasty with antibiotic-impregnated cement

J. Two-stage surgical prosthetic exchange and IV antibiotics

K. Resection arthroplasty and IV antibiotics

L. SCFE

M. MED

N. Perthes disease

O. Hypothyroidism

P. Chondrolysis

Q. gout.

R. osteoporosis.

S. eosinophilic granuloma.

T. tuberculosis of the spine.

U. metastatic disease of the spine.

V. water content.

W. Synthesis of type I collagen.

X. Proteoglycan content.

Y. Activity of chondrocytes.

Z. Synthesis of hyaluronate.

[. Lung

\. Breast

]. Prostate

^. Thyroid

_. Renal

`. T1-low, T2-low.

A. T1-low, T2-high.

B. T1-moderate, T2-low.

C. T1-high, T2-low.

D. T1-high, T2-high.

E. hypothesis is incorrect or invalid

F. interobserver error rate is 4%.

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

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

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

J. I

K. II

L. IV

M. IX

N. X

O. Cranial setting

P. Cranial subluxation

Q. Odontoid fracture

R. Lysis of the arch of the atlas

S. Atlantoaxial subluxation

T. Retrograde collapse of the endoneurial tubes

U. Irreversible atrophy of the denervated muscles

V. Elongation of the axons across the zone of injury

W. Sprouting of the axons at the neuromuscular junction

X. Misdirection of the axons across the zone of injury

Y. Maximally pronated and elbow extended

Z. 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.

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

¥. Coronal

¦. Sagittal

§. Anteromedial, midway between the sagittal and the coronal

¨. Proximal pins sagittal, distal pins coronal

©. Proximal pins coronal, distal pins sagittal

ª. Rheumatoid arthritis

«. Posttraumatic arthritis

¬. Degenerative osteoarthritis

. Osteonecrosis of the tibial plateau

®. Osteonecrosis of the medial femoral condyle

¯. Trapeziometacarpal arthrodesis

°. Osteotomy of the thumb metacarpal

±. Arthrotomy and joint debridement

². Ligament reconstruction using one half of the flexor carpi radialis

³. Trapezium resection, tendon interposition, and reconstruction of the ligament

´. Creep

Μ. Relaxation

¶. Energy dissipation

·. Plastic deformation

¸. Elastic deformation

¹. bending

º. axial loading

». high-speed rotation

¼. direct impact from anteromedial

½. crush from anteromedial to posterolateral

¾. Increase stiffness

¿. Increase fracture toughness

À. Increase fatigue strength

Á. Decrease mechanical strength

Â. Decrease wear rate

Ã. disuse osteopenia

Ä. paraendocrine effect of the tumor

Å. abnormally increased density on the right side

Æ. side effect of the treatment of the lesion

Ç. extensive tumor involvement of the left hip

È. Sciatic nerve

É. Superior gluteal artery

Ê. Profunda femoris artery

Ë. Femoral artery and nerve

Ì. External iliac artery and vein

Í. Length

Î. Moment arm

Ï. Total volume

Ð. Physiologic cross-sectional area

Ñ. Distribution of slow and fast twitch fibers

Ò. decreasing initiation of action potentials.

Ó. increasing action potential amplitude.

Ô. blocking the opening of gated sodium channels.

Õ. decreasing the number of functional motor units.

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

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

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

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

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

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

Ü. hemiarthroplasty

Ý. open reduction and internal fixation

Þ. closed reduction and percutaneous pinning

SS. a sling and early pedulum exercises

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

Á. open acromioplasty

Â. open Bankart repair

Ã. open subscapularis tendon repair

Ä. inferior capsular shift

Å. a supervised physical therapy program

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

Ç. open reduction and internal fixation through an anterior approach

È. open reduction and internal fixation through a posterior approach

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

Ê. arthroscopically assisted reduction and percutaneous screw fixation

Ë. Repair of the rotator cuff

Ì. Replacement of the humeral head

Í. Resection arthroplasty

Î. Total shoulder arthroplasty

Ï. AP and lateral radiographs of the elbow

Ð. Diagnositc arthroscopy

Ñ. Aspiration of joint fluid

Ò. An erythrocyte sedimentation rate and CBC

Ó. A diagnostic lidocaine injection

Ô. Insulin-like growth factor (IGF-1)

Õ. Fibroblast growth factor (FGF-1)

Ö. Platelet-derived growth factor (PDGF)

÷. Transforming growth factor beta (TGF-B)

Ø. Bone morphogenetic proteins (BMP)

Ù. clinical history and radiographic findings.

Ú. technetium bone scan

Û. flow cytometry pattern of extracted chondrocytes

Ü. immunohistochemical staining patterns of a biopsy specimen

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

Þ. Radial

Ÿ. Radial recurrent

Ā. Posterior interosseous

Ā. Superior ulnar recurrent

Ă. Superficial radial circumflex

Ă. Impaired hydroxylation of proline

Ą. Failure of cleavage in procollagen

Ą. Defective binding sites for hydroxyproline

Ć. Failure to incorporate glycine into the helix

Ć. Diminished production of collagen through the rough endoplasmic reticulum

Ĉ. Asking the legal staff to seek a court injunction

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

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

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

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

Č. Meta-analysis

Ď. Confidence interval

Ď. Analysis of variance (ANOVA)

Đ. Statistical significance (p-value)

Đ. Survivorship analysis (Kaplan-Meier)

Ē. Spinal shock

Ē. Neurogenic shock

Ĕ. Hypovolemic shock

Ĕ. Pulmonary embolism

Ė. Fat embolus syndrome

Ė. Lumbar spinal stenosis

Ę. Metastatic disease of the spine

Ę. Rheumatoid lumbar spondylitis

Ě. Isthmic spondyloloisthesis

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

Ĝ. Patella alta

Ĝ. A metal-backed patella

Ğ. Varus malalignment of the knee

Ğ. A posterior cruciate-substituting femoral component

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

Ġ. The sesamoids are separated

Ģ. The sesamoid is fractured

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

Ĥ. The dislocation is dorsal and centered

Ĥ. The proximal phalanx is hyperextended

Ħ. Patella

Ħ. Tibial stem

Ĩ. Distal femoral interface

Ĩ. Posterior femoral interface

Ī. Sites of screw fixation for the tibia

Ī. Hallux rigidus

Ĭ. Fracture of the sesamoid

Ĭ. Disruption of the plantar plate

Į. Osteonecrosis of the metatarsal head

Į. Rupture of the flexor hallucis longus

İ. Gout

I. Sepsis

Ĳ. Old trauma

Ĳ. Rheumatoid arthritis

Ĵ. Charcot arthroplasty

Ĵ. Aspiration and steroid injection

Ķ. Biopsy, curettage, and allograft bone grafting

Ķ. Percutaneous Kirschner wire fixation

ĸ. Percutaneous injection of autogenous bone marrow

Ĺ. Nerve roots

Ĺ. Spinal cord

Ļ. Sciatic nerve

Ļ. Peroneal nerve

Ľ. Conus medullaris

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

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

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

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

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

Ń. Early and late infection

Ń. Periprosthetic fracture of the femur

Ņ. Failure of the patellofemoral and extensor mechanisms

Ņ. Aseptic loosening of cementing tibial components

Ň. Asceptic loosening of cemented femoral components

Ň. Acceptance of the current position of the ankle

ʼN. Open reduction and fixation in the epiphysis only

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

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

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

Ō. Resection arthroplasty and local radiation

Ŏ. In situ fusion of the hip

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

Ő. Excision of heterotopic bone and local radiation

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

Œ. Closed reduction of both fractures and immediate spica casting

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

Ŕ. External fixation of both femora

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

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

Ŗ. Synovial sarcoma

Ř. Soft-tissue abcess

Ř. Rhabdomyosarcoma

Ś. Eosinophilic granuloma

Ś. Nodular pigmented villonodular synovitis

Ŝ. Changing to a titanium nail

Ŝ. Changing to a nonslotted nail

Ş. Changing the cross-sectional shape of the nail

Ş. Increasing the diameter of the nail by 3 mm

Š. Increasing the diameter of the interlocking screws

Š. Fracture healing

Ţ. Chondrosarcoma

Ţ. Periosteal chondroma

Ť. Periosteal osteosarcoma

Ť. Dysplasia epiphysealis hemimelica

Ŧ. Demonstrate competence in the subject of the case

Ŧ. Be fellowship trained in the subject of the case

Ũ. Be paid on a contingency basis

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

Ū. Have been involved in the case as a consultant

Ū. Diagnostic arthroscopy

Ŭ. Arthroscopy and subacromial decompression

Ŭ. Reduction and fixation of the proximal humeral epiphysis

Ů. Temporary cessation of throwing

Ů. Physical therapy for rotator cuff strengthening

Ű. Oblique popliteal ligament

Ű. Lateral capsule

Ų. Popliteal tendon

Ų. Fibular collateral ligament

Ŵ. Posterior oblique ligament

Ŵ. Radial tear

Ŷ. Parrot-beak tear

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

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

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

Ź. 0 degrees of abduction, with neural rotation

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

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

Ž. 90 degrees of abduction with neutral rotation

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

S. Sural

Ƀ. Saphenous and its branches

Ɓ. Posterior tibial and its branches

Ƃ. Deep peroneal and its branches

Ƃ. Superficial peroneal and its branches

Ƅ. Strength

Ƅ. Stiffness

Ɔ. Shelf life

Ƈ. Antigenicity

Ƈ. Risk of HIV transmission

Ɖ. Indemnification

Ɗ. Occurrence

Ƌ. Excess liability

Ƌ. Claims-made

ƍ. Nose

Ǝ. Lateral Y

Ə. Scapular AP

Ɛ. Neutral rotation AP

Ƒ. Internal rotation AP

Ƒ. External rotation AP

Ɠ. Trauma

Ɣ. Hemophilia

Ƕ. Reiter’s syndrome

Ɩ. Rheumatoid arthritis

Ɨ. Systemic lupus erythematosus

Ƙ. Cast immobilization for 6 weeks

Ƙ. Activity modification and re-evaluation in 2 months

Ƚ. Internal fixation with or without bone grafting

ƛ. Retrograde drilling of the defect without articular cartilage penetration

Ɯ. Drilling of the defect directly through the articular cartilage

Ɲ. repair or reconstruction of the medial collateral ligament

Ƞ. repair or reconstruction of the medialand lateral collateral ligaments

Ɵ. immobilization for 5 days or less

Ơ. immobilization for 14 days

Ơ. immobilization for 25 days

Ƣ. Cystinosis

Ƣ. Hypophosphatemia

Ƥ. Renal osteodystrophy

Ƥ. Primary hyperparathyroidism

Ʀ. Nutritional vitamin D deficiency

Ƨ. Lateral meniscus tear

Ƨ. Popliteus tenosynovitis

Ʃ. Iliotibial band friction syndrome

ƪ. Peroneal nerve entrapment

ƫ. Biceps tendinitis

Ƭ. Observation

Ƭ. Removal of the prosthetic components

Ʈ. Operative exploration and decompression of the peroneal nerve

Ư. Nerve conduction velocity studies

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

Ʊ. I

Ʋ. II

Ƴ. III

Ƴ. decreased tissue tension

Ƶ. decreased abductor lever arm

Ƶ. decreased joint reaction force

Ʒ. increased body weight over lever arm

Ƹ. increased polyethylene wear rate

Ƹ. recurrent traumatic anterior dislocation

ƺ. recurrent traumatic posterior dislocation

ƻ. traumatic subluxation with no previous dislocation

Ƽ. traumatic anterior subluxation

Ƽ. atraumatic involuntary subluxation

ƾ. radial

Ƿ. axillary

ǀ. suprascapular

ǁ. thoracodorsal

ǂ. long thoracic

ǃ. Flexion

Ǆ. Extension

Ǆ. Axial rotation

Ǆ. Left lateral bending

Ǉ. Right lateral bending

Ǉ. Skin

Ǉ. Lung

Ǌ. Brain

Ǌ. Heart

Ǌ. Kidney

Ǎ. Thoracoacromial, lateral thoracic, subscapular

Ǎ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǐ. Posterior humeral circumflex, subscapular, thoracacromial

Ǐ. Subscapular, thoracacromial, anterior humeral circumflex

Ǒ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǒ. Respondeat superior

Ǔ. Indemnity agreement

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

Ǖ. Comparative negligence-% of involvement

Ǖ. Contributory negligence- resident contributed to the negligence

Ǘ. t-type

Ǘ. both column

Ǚ. transverse

Ǚ. anterior column

Ǜ. anterior column posterior hemitransverse

Ǜ. Posterior interosseous

Ǝ. Anterior interosseous

Ǟ. Radial

Ǟ. Median

Ǡ. Ulnar

Ǡ. Shock from hypovolemia

Ǣ. Associated rupture of the bladder

Ǣ. Arterial bleeding on pelvic angiogram

Ǥ. Presence of a hematoma in the perineum and scrotum

Ǥ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Loss of skin hair on the feet

Explanation

Question 4182

Topic: 10. Pathology and Oncology

Injury to the C7 nerve root results in weakness primarily of the

. wrist flexors and finger flexors

. elbow flexors and wrist flexors

. elbow flexors and finger flexors

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

. elbow extensors and wrist extensors

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

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

". activity of the intrinsic muscles of the foot.

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

$. scapulothoracic fusion

%. strengthening of the periscapular muscles

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

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

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

). tricompartmental knee replacement

*. unicompartmental knee replacement

+. medial compartment meniscal allograft

,. valgus-producing distal femoral osteotomy

-. valgus-producing proximal tibial osteotomy

.. Internal rotation of the femoral component

/. External rotation of the tibial component

0. Lateral placement of the femoral component

1. Medial placement of the patellar component

2. Excessive resection of the patella

3. Hallux rigidus

4. Hallux valgus

5. Neuroma of the first web space

6. Fracture of the sesamoid

7. Rupture of the flexor hallucis longus

8. Sickle cell crisis

9. 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

B. Long-term administration of IV and oral antibiotics

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

D. Immediate exchange arthroplasty with antibiotic-impregnated cement

E. Two-stage surgical prosthetic exchange and IV antibiotics

F. Resection arthroplasty and IV antibiotics

G. SCFE

H. MED

I. Perthes disease

J. Hypothyroidism

K. Chondrolysis

L. gout.

M. osteoporosis.

N. eosinophilic granuloma.

O. tuberculosis of the spine.

P. metastatic disease of the spine.

Q. water content.

R. Synthesis of type I collagen.

S. Proteoglycan content.

T. Activity of chondrocytes.

U. Synthesis of hyaluronate.

V. Lung

W. Breast

X. Prostate

Y. Thyroid

Z. 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

A. interobserver error rate is 4%.

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

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

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

E. I

F. II

G. IV

H. IX

I. X

J. Cranial setting

K. Cranial subluxation

L. Odontoid fracture

M. Lysis of the arch of the atlas

N. Atlantoaxial subluxation

O. Retrograde collapse of the endoneurial tubes

P. Irreversible atrophy of the denervated muscles

Q. Elongation of the axons across the zone of injury

R. Sprouting of the axons at the neuromuscular junction

S. Misdirection of the axons across the zone of injury

T. Maximally pronated and elbow extended

U. Maximally pronated and the elbow flexed

V. Maximally supinated and the elbow flexed

W. Maximally supinated and the elbow extended

X. In neutral rotation, with the elbow extended

Y. open reduction and internal fixation

Z. 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.

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

. 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

¨. Osteonecrosis of the tibial plateau

©. Osteonecrosis of the medial femoral condyle

ª. Trapeziometacarpal arthrodesis

«. 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

¯. Creep

°. Relaxation

±. Energy dissipation

². Plastic deformation

³. Elastic deformation

´. bending

Μ. axial loading

¶. high-speed rotation

·. direct impact from anteromedial

¸. crush from anteromedial to posterolateral

¹. Increase stiffness

º. Increase fracture toughness

». Increase fatigue strength

¼. Decrease mechanical strength

½. Decrease wear rate

¾. disuse osteopenia

¿. paraendocrine effect of the tumor

À. abnormally increased density on the right side

Á. side effect of the treatment of the lesion

Â. extensive tumor involvement of the left hip

Ã. Sciatic nerve

Ä. Superior gluteal artery

Å. Profunda femoris artery

Æ. Femoral artery and nerve

Ç. External iliac artery and vein

È. Length

É. Moment arm

Ê. Total volume

Ë. Physiologic cross-sectional area

Ì. Distribution of slow and fast twitch fibers

Í. decreasing initiation of action potentials.

Î. increasing action potential amplitude.

Ï. blocking the opening of gated sodium channels.

Ð. decreasing the number of functional motor units.

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

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

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

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

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

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

×. hemiarthroplasty

Ø. open reduction and internal fixation

Ù. closed reduction and percutaneous pinning

Ú. a sling and early pedulum exercises

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

Ü. open acromioplasty

Ý. open Bankart repair

Þ. open subscapularis tendon repair

SS. inferior capsular shift

À. a supervised physical therapy program

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

Â. open reduction and internal fixation through an anterior approach

Ã. open reduction and internal fixation through a posterior approach

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

Å. arthroscopically assisted reduction and percutaneous screw fixation

Æ. Repair of the rotator cuff

Ç. Replacement of the humeral head

È. Resection arthroplasty

É. Total shoulder arthroplasty

Ê. AP and lateral radiographs of the elbow

Ë. Diagnositc arthroscopy

Ì. Aspiration of joint fluid

Í. An erythrocyte sedimentation rate and CBC

Î. A diagnostic lidocaine injection

Ï. Insulin-like growth factor (IGF-1)

Ð. Fibroblast growth factor (FGF-1)

Ñ. Platelet-derived growth factor (PDGF)

Ò. Transforming growth factor beta (TGF-B)

Ó. Bone morphogenetic proteins (BMP)

Ô. clinical history and radiographic findings.

Õ. technetium bone scan

Ö. flow cytometry pattern of extracted chondrocytes

÷. immunohistochemical staining patterns of a biopsy specimen

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

Ù. Radial

Ú. Radial recurrent

Û. Posterior interosseous

Ü. Superior ulnar recurrent

Ý. Superficial radial circumflex

Þ. Impaired hydroxylation of proline

Ÿ. Failure of cleavage in procollagen

Ā. Defective binding sites for hydroxyproline

Ā. Failure to incorporate glycine into the helix

Ă. Diminished production of collagen through the rough endoplasmic reticulum

Ă. Asking the legal staff to seek a court injunction

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

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

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

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

Ĉ. Meta-analysis

Ĉ. Confidence interval

Ċ. Analysis of variance (ANOVA)

Ċ. Statistical significance (p-value)

Č. Survivorship analysis (Kaplan-Meier)

Č. Spinal shock

Ď. Neurogenic shock

Ď. Hypovolemic shock

Đ. Pulmonary embolism

Đ. Fat embolus syndrome

Ē. Lumbar spinal stenosis

Ē. Metastatic disease of the spine

Ĕ. Rheumatoid lumbar spondylitis

Ĕ. Isthmic spondyloloisthesis

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

Ė. Patella alta

Ę. A metal-backed patella

Ę. Varus malalignment of the knee

Ě. A posterior cruciate-substituting femoral component

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

Ĝ. The sesamoids are separated

Ĝ. The sesamoid is fractured

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

Ğ. The dislocation is dorsal and centered

Ġ. The proximal phalanx is hyperextended

Ġ. Patella

Ģ. Tibial stem

Ģ. Distal femoral interface

Ĥ. Posterior femoral interface

Ĥ. Sites of screw fixation for the tibia

Ħ. Hallux rigidus

Ħ. Fracture of the sesamoid

Ĩ. Disruption of the plantar plate

Ĩ. Osteonecrosis of the metatarsal head

Ī. Rupture of the flexor hallucis longus

Ī. Gout

Ĭ. Sepsis

Ĭ. Old trauma

Į. Rheumatoid arthritis

Į. Charcot arthroplasty

İ. Aspiration and steroid injection

I. Biopsy, curettage, and allograft bone grafting

Ĳ. Percutaneous Kirschner wire fixation

Ĳ. Percutaneous injection of autogenous bone marrow

Ĵ. Nerve roots

Ĵ. Spinal cord

Ķ. Sciatic nerve

Ķ. Peroneal nerve

ĸ. Conus medullaris

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

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

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

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

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

Ľ. Early and late infection

Ŀ. Periprosthetic fracture of the femur

Ŀ. Failure of the patellofemoral and extensor mechanisms

Ł. Aseptic loosening of cementing tibial components

Ł. Asceptic loosening of cemented femoral components

Ń. Acceptance of the current position of the ankle

Ń. Open reduction and fixation in the epiphysis only

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

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

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

Ň. Resection arthroplasty and local radiation

ʼN. In situ fusion of the hip

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

Ŋ. Excision of heterotopic bone and local radiation

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

Ō. Closed reduction of both fractures and immediate spica casting

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

Ŏ. External fixation of both femora

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

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

Œ. Synovial sarcoma

Œ. Soft-tissue abcess

Ŕ. Rhabdomyosarcoma

Ŕ. Eosinophilic granuloma

Ŗ. Nodular pigmented villonodular synovitis

Ŗ. Changing to a titanium nail

Ř. Changing to a nonslotted nail

Ř. Changing the cross-sectional shape of the nail

Ś. Increasing the diameter of the nail by 3 mm

Ś. Increasing the diameter of the interlocking screws

Ŝ. Fracture healing

Ŝ. Chondrosarcoma

Ş. Periosteal chondroma

Ş. Periosteal osteosarcoma

Š. Dysplasia epiphysealis hemimelica

Š. Demonstrate competence in the subject of the case

Ţ. Be fellowship trained in the subject of the case

Ţ. Be paid on a contingency basis

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

Ť. Have been involved in the case as a consultant

Ŧ. Diagnostic arthroscopy

Ŧ. Arthroscopy and subacromial decompression

Ũ. Reduction and fixation of the proximal humeral epiphysis

Ũ. Temporary cessation of throwing

Ū. Physical therapy for rotator cuff strengthening

Ū. Oblique popliteal ligament

Ŭ. Lateral capsule

Ŭ. Popliteal tendon

Ů. Fibular collateral ligament

Ů. Posterior oblique ligament

Ű. Radial tear

Ű. Parrot-beak tear

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

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

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

Ŵ. 0 degrees of abduction, with neural rotation

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

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

Ÿ. 90 degrees of abduction with neutral rotation

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

Ź. Sural

Ż. Saphenous and its branches

Ż. Posterior tibial and its branches

Ž. Deep peroneal and its branches

Ž. Superficial peroneal and its branches

S. Strength

Ƀ. Stiffness

Ɓ. Shelf life

Ƃ. Antigenicity

Ƃ. Risk of HIV transmission

Ƅ. Indemnification

Ƅ. Occurrence

Ɔ. Excess liability

Ƈ. Claims-made

Ƈ. Nose

Ɖ. Lateral Y

Ɗ. Scapular AP

Ƌ. Neutral rotation AP

Ƌ. Internal rotation AP

ƍ. External rotation AP

Ǝ. Trauma

Ə. Hemophilia

Ɛ. Reiter’s syndrome

Ƒ. Rheumatoid arthritis

Ƒ. Systemic lupus erythematosus

Ɠ. Cast immobilization for 6 weeks

Ɣ. Activity modification and re-evaluation in 2 months

Ƕ. Internal fixation with or without bone grafting

Ɩ. Retrograde drilling of the defect without articular cartilage penetration

Ɨ. Drilling of the defect directly through the articular cartilage

Ƙ. repair or reconstruction of the medial collateral ligament

Ƙ. repair or reconstruction of the medialand lateral collateral ligaments

Ƚ. immobilization for 5 days or less

ƛ. immobilization for 14 days

Ɯ. immobilization for 25 days

Ɲ. Cystinosis

Ƞ. Hypophosphatemia

Ɵ. Renal osteodystrophy

Ơ. Primary hyperparathyroidism

Ơ. Nutritional vitamin D deficiency

Ƣ. Lateral meniscus tear

Ƣ. Popliteus tenosynovitis

Ƥ. Iliotibial band friction syndrome

Ƥ. Peroneal nerve entrapment

Ʀ. Biceps tendinitis

Ƨ. Observation

Ƨ. Removal of the prosthetic components

Ʃ. Operative exploration and decompression of the peroneal nerve

ƪ. Nerve conduction velocity studies

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

Ƭ. I

Ƭ. II

Ʈ. III

Ư. decreased tissue tension

Ư. decreased abductor lever arm

Ʊ. decreased joint reaction force

Ʋ. increased body weight over lever arm

Ƴ. increased polyethylene wear rate

Ƴ. recurrent traumatic anterior dislocation

Ƶ. recurrent traumatic posterior dislocation

Ƶ. traumatic subluxation with no previous dislocation

Ʒ. traumatic anterior subluxation

Ƹ. atraumatic involuntary subluxation

Ƹ. radial

ƺ. axillary

ƻ. suprascapular

Ƽ. thoracodorsal

Ƽ. long thoracic

ƾ. Flexion

Ƿ. Extension

ǀ. Axial rotation

ǁ. Left lateral bending

ǂ. Right lateral bending

ǃ. Skin

Ǆ. Lung

Ǆ. Brain

Ǆ. Heart

Ǉ. Kidney

Ǉ. Thoracoacromial, lateral thoracic, subscapular

Ǉ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǌ. Posterior humeral circumflex, subscapular, thoracacromial

Ǌ. Subscapular, thoracacromial, anterior humeral circumflex

Ǌ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǎ. Respondeat superior

Ǎ. Indemnity agreement

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

Ǐ. Comparative negligence-% of involvement

Ǒ. Contributory negligence- resident contributed to the negligence

Ǒ. t-type

Ǔ. both column

Ǔ. transverse

Ǖ. anterior column

Ǖ. anterior column posterior hemitransverse

Ǘ. Posterior interosseous

Ǘ. Anterior interosseous

Ǚ. Radial

Ǚ. Median

Ǜ. Ulnar

Ǜ. Shock from hypovolemia

Ǝ. Associated rupture of the bladder

Ǟ. Arterial bleeding on pelvic angiogram

Ǟ. Presence of a hematoma in the perineum and scrotum

Ǡ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. wrist flexors and finger flexors

Explanation

Question 4183

Topic: 10. Pathology and Oncology

Which of the following conditions is most likely inherited as an autosomal dominant trait?

. Syndactyly

. Macrodactyly

. Camptodactyly

. Preaxial polydactyly

. Postaxial polydactyly

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

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

. scapulothoracic fusion

. strengthening of the periscapular muscles

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

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

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

$. tricompartmental knee replacement

%. unicompartmental knee replacement

&. medial compartment meniscal allograft

'. valgus-producing distal femoral osteotomy

(. valgus-producing proximal tibial osteotomy

). Internal rotation of the femoral component

*. External rotation of the tibial component

+. Lateral placement of the femoral component

,. Medial placement of the patellar component

-. Excessive resection of the patella

.. Hallux rigidus

/. Hallux valgus

0. Neuroma of the first web space

1. Fracture of the sesamoid

2. Rupture of the flexor hallucis longus

3. Sickle cell crisis

4. Idiopathic chondrolysis

5. Hemophilic arthropathy

6. Osteoid osteoma of the femoral neck

7. Legg-Calve-Perthes disease

8. Decreased ankle jerk and positive femoral nerve stretch test

9. 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

B. SCFE

C. MED

D. Perthes disease

E. Hypothyroidism

F. Chondrolysis

G. gout.

H. osteoporosis.

I. eosinophilic granuloma.

J. tuberculosis of the spine.

K. metastatic disease of the spine.

L. water content.

M. Synthesis of type I collagen.

N. Proteoglycan content.

O. Activity of chondrocytes.

P. Synthesis of hyaluronate.

Q. Lung

R. Breast

S. Prostate

T. Thyroid

U. Renal

V. T1-low, T2-low.

W. T1-low, T2-high.

X. T1-moderate, T2-low.

Y. T1-high, T2-low.

Z. 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

A. II

B. IV

C. IX

D. X

E. Cranial setting

F. Cranial subluxation

G. Odontoid fracture

H. Lysis of the arch of the atlas

I. Atlantoaxial subluxation

J. Retrograde collapse of the endoneurial tubes

K. Irreversible atrophy of the denervated muscles

L. Elongation of the axons across the zone of injury

M. Sprouting of the axons at the neuromuscular junction

N. Misdirection of the axons across the zone of injury

O. Maximally pronated and elbow extended

P. Maximally pronated and the elbow flexed

Q. Maximally supinated and the elbow flexed

R. Maximally supinated and the elbow extended

S. In neutral rotation, with the elbow extended

T. open reduction and internal fixation

U. buddy taping to the adjacent index finger

V. early motion with application of a dynamic banjo splint

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

X. dorsal extension block splinting

Y. The name of the manufacturer

Z. 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.

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

. 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

£. Osteonecrosis of the tibial plateau

¤. Osteonecrosis of the medial femoral condyle

¥. Trapeziometacarpal arthrodesis

¦. 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

ª. Creep

«. Relaxation

¬. Energy dissipation

. Plastic deformation

®. Elastic deformation

¯. bending

°. axial loading

±. high-speed rotation

². direct impact from anteromedial

³. crush from anteromedial to posterolateral

´. Increase stiffness

Μ. Increase fracture toughness

¶. Increase fatigue strength

·. Decrease mechanical strength

¸. Decrease wear rate

¹. disuse osteopenia

º. paraendocrine effect of the tumor

». abnormally increased density on the right side

¼. side effect of the treatment of the lesion

½. extensive tumor involvement of the left hip

¾. Sciatic nerve

¿. Superior gluteal artery

À. Profunda femoris artery

Á. Femoral artery and nerve

Â. External iliac artery and vein

Ã. Length

Ä. Moment arm

Å. Total volume

Æ. Physiologic cross-sectional area

Ç. Distribution of slow and fast twitch fibers

È. decreasing initiation of action potentials.

É. increasing action potential amplitude.

Ê. blocking the opening of gated sodium channels.

Ë. decreasing the number of functional motor units.

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

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

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

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

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

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

Ò. hemiarthroplasty

Ó. open reduction and internal fixation

Ô. closed reduction and percutaneous pinning

Õ. a sling and early pedulum exercises

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

×. open acromioplasty

Ø. open Bankart repair

Ù. open subscapularis tendon repair

Ú. inferior capsular shift

Û. a supervised physical therapy program

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

Ý. open reduction and internal fixation through an anterior approach

Þ. open reduction and internal fixation through a posterior approach

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

À. arthroscopically assisted reduction and percutaneous screw fixation

Á. Repair of the rotator cuff

Â. Replacement of the humeral head

Ã. Resection arthroplasty

Ä. Total shoulder arthroplasty

Å. AP and lateral radiographs of the elbow

Æ. Diagnositc arthroscopy

Ç. Aspiration of joint fluid

È. An erythrocyte sedimentation rate and CBC

É. A diagnostic lidocaine injection

Ê. Insulin-like growth factor (IGF-1)

Ë. Fibroblast growth factor (FGF-1)

Ì. Platelet-derived growth factor (PDGF)

Í. Transforming growth factor beta (TGF-B)

Î. Bone morphogenetic proteins (BMP)

Ï. clinical history and radiographic findings.

Ð. technetium bone scan

Ñ. flow cytometry pattern of extracted chondrocytes

Ò. immunohistochemical staining patterns of a biopsy specimen

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

Ô. Radial

Õ. Radial recurrent

Ö. Posterior interosseous

÷. Superior ulnar recurrent

Ø. Superficial radial circumflex

Ù. Impaired hydroxylation of proline

Ú. Failure of cleavage in procollagen

Û. Defective binding sites for hydroxyproline

Ü. Failure to incorporate glycine into the helix

Ý. Diminished production of collagen through the rough endoplasmic reticulum

Þ. Asking the legal staff to seek a court injunction

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

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

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

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

Ă. Meta-analysis

Ą. Confidence interval

Ą. Analysis of variance (ANOVA)

Ć. Statistical significance (p-value)

Ć. Survivorship analysis (Kaplan-Meier)

Ĉ. Spinal shock

Ĉ. Neurogenic shock

Ċ. Hypovolemic shock

Ċ. Pulmonary embolism

Č. Fat embolus syndrome

Č. Lumbar spinal stenosis

Ď. Metastatic disease of the spine

Ď. Rheumatoid lumbar spondylitis

Đ. Isthmic spondyloloisthesis

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

Ē. Patella alta

Ē. A metal-backed patella

Ĕ. Varus malalignment of the knee

Ĕ. A posterior cruciate-substituting femoral component

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

Ė. The sesamoids are separated

Ę. The sesamoid is fractured

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

Ě. The dislocation is dorsal and centered

Ě. The proximal phalanx is hyperextended

Ĝ. Patella

Ĝ. Tibial stem

Ğ. Distal femoral interface

Ğ. Posterior femoral interface

Ġ. Sites of screw fixation for the tibia

Ġ. Hallux rigidus

Ģ. Fracture of the sesamoid

Ģ. Disruption of the plantar plate

Ĥ. Osteonecrosis of the metatarsal head

Ĥ. Rupture of the flexor hallucis longus

Ħ. Gout

Ħ. Sepsis

Ĩ. Old trauma

Ĩ. Rheumatoid arthritis

Ī. Charcot arthroplasty

Ī. Aspiration and steroid injection

Ĭ. Biopsy, curettage, and allograft bone grafting

Ĭ. Percutaneous Kirschner wire fixation

Į. Percutaneous injection of autogenous bone marrow

Į. Nerve roots

İ. Spinal cord

I. Sciatic nerve

Ĳ. Peroneal nerve

Ĳ. Conus medullaris

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

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

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

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

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

Ĺ. Early and late infection

Ĺ. Periprosthetic fracture of the femur

Ļ. Failure of the patellofemoral and extensor mechanisms

Ļ. Aseptic loosening of cementing tibial components

Ľ. Asceptic loosening of cemented femoral components

Ľ. Acceptance of the current position of the ankle

Ŀ. Open reduction and fixation in the epiphysis only

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

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

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

Ń. Resection arthroplasty and local radiation

Ń. In situ fusion of the hip

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

Ņ. Excision of heterotopic bone and local radiation

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

Ň. Closed reduction of both fractures and immediate spica casting

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

Ŋ. External fixation of both femora

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

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

Ō. Synovial sarcoma

Ŏ. Soft-tissue abcess

Ŏ. Rhabdomyosarcoma

Ő. Eosinophilic granuloma

Ő. Nodular pigmented villonodular synovitis

Œ. Changing to a titanium nail

Œ. Changing to a nonslotted nail

Ŕ. Changing the cross-sectional shape of the nail

Ŕ. Increasing the diameter of the nail by 3 mm

Ŗ. Increasing the diameter of the interlocking screws

Ŗ. Fracture healing

Ř. Chondrosarcoma

Ř. Periosteal chondroma

Ś. Periosteal osteosarcoma

Ś. Dysplasia epiphysealis hemimelica

Ŝ. Demonstrate competence in the subject of the case

Ŝ. Be fellowship trained in the subject of the case

Ş. Be paid on a contingency basis

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

Š. Have been involved in the case as a consultant

Š. Diagnostic arthroscopy

Ţ. Arthroscopy and subacromial decompression

Ţ. Reduction and fixation of the proximal humeral epiphysis

Ť. Temporary cessation of throwing

Ť. Physical therapy for rotator cuff strengthening

Ŧ. Oblique popliteal ligament

Ŧ. Lateral capsule

Ũ. Popliteal tendon

Ũ. Fibular collateral ligament

Ū. Posterior oblique ligament

Ū. Radial tear

Ŭ. Parrot-beak tear

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

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

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

Ű. 0 degrees of abduction, with neural rotation

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

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

Ų. 90 degrees of abduction with neutral rotation

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

Ŵ. Sural

Ŷ. Saphenous and its branches

Ŷ. Posterior tibial and its branches

Ÿ. Deep peroneal and its branches

Ź. Superficial peroneal and its branches

Ź. Strength

Ż. Stiffness

Ż. Shelf life

Ž. Antigenicity

Ž. Risk of HIV transmission

S. Indemnification

Ƀ. Occurrence

Ɓ. Excess liability

Ƃ. Claims-made

Ƃ. Nose

Ƅ. Lateral Y

Ƅ. Scapular AP

Ɔ. Neutral rotation AP

Ƈ. Internal rotation AP

Ƈ. External rotation AP

Ɖ. Trauma

Ɗ. Hemophilia

Ƌ. Reiter’s syndrome

Ƌ. Rheumatoid arthritis

ƍ. Systemic lupus erythematosus

Ǝ. Cast immobilization for 6 weeks

Ə. Activity modification and re-evaluation in 2 months

Ɛ. Internal fixation with or without bone grafting

Ƒ. Retrograde drilling of the defect without articular cartilage penetration

Ƒ. Drilling of the defect directly through the articular cartilage

Ɠ. repair or reconstruction of the medial collateral ligament

Ɣ. repair or reconstruction of the medialand lateral collateral ligaments

Ƕ. immobilization for 5 days or less

Ɩ. immobilization for 14 days

Ɨ. immobilization for 25 days

Ƙ. Cystinosis

Ƙ. Hypophosphatemia

Ƚ. Renal osteodystrophy

ƛ. Primary hyperparathyroidism

Ɯ. Nutritional vitamin D deficiency

Ɲ. Lateral meniscus tear

Ƞ. Popliteus tenosynovitis

Ɵ. Iliotibial band friction syndrome

Ơ. Peroneal nerve entrapment

Ơ. Biceps tendinitis

Ƣ. Observation

Ƣ. Removal of the prosthetic components

Ƥ. Operative exploration and decompression of the peroneal nerve

Ƥ. Nerve conduction velocity studies

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

Ƨ. I

Ƨ. II

Ʃ. III

ƪ. decreased tissue tension

ƫ. decreased abductor lever arm

Ƭ. decreased joint reaction force

Ƭ. increased body weight over lever arm

Ʈ. increased polyethylene wear rate

Ư. recurrent traumatic anterior dislocation

Ư. recurrent traumatic posterior dislocation

Ʊ. traumatic subluxation with no previous dislocation

Ʋ. traumatic anterior subluxation

Ƴ. atraumatic involuntary subluxation

Ƴ. radial

Ƶ. axillary

Ƶ. suprascapular

Ʒ. thoracodorsal

Ƹ. long thoracic

Ƹ. Flexion

ƺ. Extension

ƻ. Axial rotation

Ƽ. Left lateral bending

Ƽ. Right lateral bending

ƾ. Skin

Ƿ. Lung

ǀ. Brain

ǁ. Heart

ǂ. Kidney

ǃ. Thoracoacromial, lateral thoracic, subscapular

Ǆ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǆ. Posterior humeral circumflex, subscapular, thoracacromial

Ǆ. Subscapular, thoracacromial, anterior humeral circumflex

Ǉ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ǉ. Respondeat superior

Ǉ. Indemnity agreement

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

Ǌ. Comparative negligence-% of involvement

Ǌ. Contributory negligence- resident contributed to the negligence

Ǎ. t-type

Ǎ. both column

Ǐ. transverse

Ǐ. anterior column

Ǒ. anterior column posterior hemitransverse

Ǒ. Posterior interosseous

Ǔ. Anterior interosseous

Ǔ. Radial

Ǖ. Median

Ǖ. Ulnar

Ǘ. Shock from hypovolemia

Ǘ. Associated rupture of the bladder

Ǚ. Arterial bleeding on pelvic angiogram

Ǚ. Presence of a hematoma in the perineum and scrotum

Ǜ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Syndactyly

Explanation

Question 4184

Topic: 10. Pathology and Oncology

Which of the following surgical options after resection of a sarcoma about the knee would require a patient to expend the greatest amount of energy while walking?

. Arthrodesis

. Rotationplasty

. Above-knee amputation

. Osteoarticular allograft

. Endoprosthesis (custom arthroplasty)

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

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

. scapulothoracic fusion

. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

. pectoralis major-fascia lata graft transfer to the scapula

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

. tricompartmental knee replacement

. unicompartmental knee replacement

!. medial compartment meniscal allograft

". valgus-producing distal femoral osteotomy

#. valgus-producing proximal tibial osteotomy

$. Internal rotation of the femoral component

%. External rotation of the tibial component

&. Lateral placement of the femoral component

'. Medial placement of the patellar component

(. Excessive resection of the patella

). Hallux rigidus

*. Hallux valgus

+. Neuroma of the first web space

,. Fracture of the sesamoid

-. Rupture of the flexor hallucis longus

.. Sickle cell crisis

/. Idiopathic chondrolysis

0. Hemophilic arthropathy

1. Osteoid osteoma of the femoral neck

2. Legg-Calve-Perthes disease

3. Decreased ankle jerk and positive femoral nerve stretch test

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

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

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

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

8. Long-term administration of IV and oral antibiotics

9. 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

B. gout.

C. osteoporosis.

D. eosinophilic granuloma.

E. tuberculosis of the spine.

F. metastatic disease of the spine.

G. water content.

H. Synthesis of type I collagen.

I. Proteoglycan content.

J. Activity of chondrocytes.

K. Synthesis of hyaluronate.

L. Lung

M. Breast

N. Prostate

O. Thyroid

P. Renal

Q. T1-low, T2-low.

R. T1-low, T2-high.

S. T1-moderate, T2-low.

T. T1-high, T2-low.

U. T1-high, T2-high.

V. hypothesis is incorrect or invalid

W. interobserver error rate is 4%.

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

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

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

[. I

\. II

]. IV

^. IX

_. X

`. Cranial setting

A. Cranial subluxation

B. Odontoid fracture

C. Lysis of the arch of the atlas

D. Atlantoaxial subluxation

E. Retrograde collapse of the endoneurial tubes

F. Irreversible atrophy of the denervated muscles

G. Elongation of the axons across the zone of injury

H. Sprouting of the axons at the neuromuscular junction

I. Misdirection of the axons across the zone of injury

J. Maximally pronated and elbow extended

K. Maximally pronated and the elbow flexed

L. Maximally supinated and the elbow flexed

M. Maximally supinated and the elbow extended

N. In neutral rotation, with the elbow extended

O. open reduction and internal fixation

P. buddy taping to the adjacent index finger

Q. early motion with application of a dynamic banjo splint

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

S. dorsal extension block splinting

T. The name of the manufacturer

U. The manufacturer’s potential liability

V. The physician’s clinical performance

W. The physician’s materials testing data

X. Any royalties the physician receives from the manufacturer

Y. Femoral

Z. 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.

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

. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

¡. 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

¥. Creep

¦. Relaxation

§. Energy dissipation

¨. Plastic deformation

©. Elastic deformation

ª. bending

«. axial loading

¬. high-speed rotation

. direct impact from anteromedial

®. crush from anteromedial to posterolateral

¯. Increase stiffness

°. Increase fracture toughness

±. Increase fatigue strength

². Decrease mechanical strength

³. Decrease wear rate

´. disuse osteopenia

Μ. paraendocrine effect of the tumor

¶. abnormally increased density on the right side

·. side effect of the treatment of the lesion

¸. extensive tumor involvement of the left hip

¹. Sciatic nerve

º. Superior gluteal artery

». Profunda femoris artery

¼. Femoral artery and nerve

½. External iliac artery and vein

¾. Length

¿. Moment arm

À. Total volume

Á. Physiologic cross-sectional area

Â. Distribution of slow and fast twitch fibers

Ã. decreasing initiation of action potentials.

Ä. increasing action potential amplitude.

Å. blocking the opening of gated sodium channels.

Æ. decreasing the number of functional motor units.

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

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

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

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

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

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

Í. hemiarthroplasty

Î. open reduction and internal fixation

Ï. closed reduction and percutaneous pinning

Ð. a sling and early pedulum exercises

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

Ò. open acromioplasty

Ó. open Bankart repair

Ô. open subscapularis tendon repair

Õ. inferior capsular shift

Ö. a supervised physical therapy program

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

Ø. open reduction and internal fixation through an anterior approach

Ù. open reduction and internal fixation through a posterior approach

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

Û. arthroscopically assisted reduction and percutaneous screw fixation

Ü. Repair of the rotator cuff

Ý. Replacement of the humeral head

Þ. Resection arthroplasty

SS. Total shoulder arthroplasty

À. AP and lateral radiographs of the elbow

Á. Diagnositc arthroscopy

Â. Aspiration of joint fluid

Ã. An erythrocyte sedimentation rate and CBC

Ä. A diagnostic lidocaine injection

Å. Insulin-like growth factor (IGF-1)

Æ. Fibroblast growth factor (FGF-1)

Ç. Platelet-derived growth factor (PDGF)

È. Transforming growth factor beta (TGF-B)

É. Bone morphogenetic proteins (BMP)

Ê. clinical history and radiographic findings.

Ë. technetium bone scan

Ì. flow cytometry pattern of extracted chondrocytes

Í. immunohistochemical staining patterns of a biopsy specimen

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

Ï. Radial

Ð. Radial recurrent

Ñ. Posterior interosseous

Ò. Superior ulnar recurrent

Ó. Superficial radial circumflex

Ô. Impaired hydroxylation of proline

Õ. Failure of cleavage in procollagen

Ö. Defective binding sites for hydroxyproline

÷. Failure to incorporate glycine into the helix

Ø. Diminished production of collagen through the rough endoplasmic reticulum

Ù. Asking the legal staff to seek a court injunction

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

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

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

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

Þ. Meta-analysis

Ÿ. Confidence interval

Ā. Analysis of variance (ANOVA)

Ā. Statistical significance (p-value)

Ă. Survivorship analysis (Kaplan-Meier)

Ă. Spinal shock

Ą. Neurogenic shock

Ą. Hypovolemic shock

Ć. Pulmonary embolism

Ć. Fat embolus syndrome

Ĉ. Lumbar spinal stenosis

Ĉ. Metastatic disease of the spine

Ċ. Rheumatoid lumbar spondylitis

Ċ. Isthmic spondyloloisthesis

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

Č. Patella alta

Ď. A metal-backed patella

Ď. Varus malalignment of the knee

Đ. A posterior cruciate-substituting femoral component

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

Ē. The sesamoids are separated

Ē. The sesamoid is fractured

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

Ĕ. The dislocation is dorsal and centered

Ė. The proximal phalanx is hyperextended

Ė. Patella

Ę. Tibial stem

Ę. Distal femoral interface

Ě. Posterior femoral interface

Ě. Sites of screw fixation for the tibia

Ĝ. Hallux rigidus

Ĝ. Fracture of the sesamoid

Ğ. Disruption of the plantar plate

Ğ. Osteonecrosis of the metatarsal head

Ġ. Rupture of the flexor hallucis longus

Ġ. Gout

Ģ. Sepsis

Ģ. Old trauma

Ĥ. Rheumatoid arthritis

Ĥ. Charcot arthroplasty

Ħ. Aspiration and steroid injection

Ħ. Biopsy, curettage, and allograft bone grafting

Ĩ. Percutaneous Kirschner wire fixation

Ĩ. Percutaneous injection of autogenous bone marrow

Ī. Nerve roots

Ī. Spinal cord

Ĭ. Sciatic nerve

Ĭ. Peroneal nerve

Į. Conus medullaris

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

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

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

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

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

Ĵ. Early and late infection

Ĵ. Periprosthetic fracture of the femur

Ķ. Failure of the patellofemoral and extensor mechanisms

Ķ. Aseptic loosening of cementing tibial components

ĸ. Asceptic loosening of cemented femoral components

Ĺ. Acceptance of the current position of the ankle

Ĺ. Open reduction and fixation in the epiphysis only

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

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

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

Ľ. Resection arthroplasty and local radiation

Ŀ. In situ fusion of the hip

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

Ł. Excision of heterotopic bone and local radiation

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

Ń. Closed reduction of both fractures and immediate spica casting

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

Ņ. External fixation of both femora

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

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

Ň. Synovial sarcoma

ʼN. Soft-tissue abcess

Ŋ. Rhabdomyosarcoma

Ŋ. Eosinophilic granuloma

Ō. Nodular pigmented villonodular synovitis

Ō. Changing to a titanium nail

Ŏ. Changing to a nonslotted nail

Ŏ. Changing the cross-sectional shape of the nail

Ő. Increasing the diameter of the nail by 3 mm

Ő. Increasing the diameter of the interlocking screws

Œ. Fracture healing

Œ. Chondrosarcoma

Ŕ. Periosteal chondroma

Ŕ. Periosteal osteosarcoma

Ŗ. Dysplasia epiphysealis hemimelica

Ŗ. Demonstrate competence in the subject of the case

Ř. Be fellowship trained in the subject of the case

Ř. Be paid on a contingency basis

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

Ś. Have been involved in the case as a consultant

Ŝ. Diagnostic arthroscopy

Ŝ. Arthroscopy and subacromial decompression

Ş. Reduction and fixation of the proximal humeral epiphysis

Ş. Temporary cessation of throwing

Š. Physical therapy for rotator cuff strengthening

Š. Oblique popliteal ligament

Ţ. Lateral capsule

Ţ. Popliteal tendon

Ť. Fibular collateral ligament

Ť. Posterior oblique ligament

Ŧ. Radial tear

Ŧ. Parrot-beak tear

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

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

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

Ū. 0 degrees of abduction, with neural rotation

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

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

Ů. 90 degrees of abduction with neutral rotation

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

Ű. Sural

Ű. Saphenous and its branches

Ų. Posterior tibial and its branches

Ų. Deep peroneal and its branches

Ŵ. Superficial peroneal and its branches

Ŵ. Strength

Ŷ. Stiffness

Ŷ. Shelf life

Ÿ. Antigenicity

Ź. Risk of HIV transmission

Ź. Indemnification

Ż. Occurrence

Ż. Excess liability

Ž. Claims-made

Ž. Nose

S. Lateral Y

Ƀ. Scapular AP

Ɓ. Neutral rotation AP

Ƃ. Internal rotation AP

Ƃ. External rotation AP

Ƅ. Trauma

Ƅ. Hemophilia

Ɔ. Reiter’s syndrome

Ƈ. Rheumatoid arthritis

Ƈ. Systemic lupus erythematosus

Ɖ. Cast immobilization for 6 weeks

Ɗ. Activity modification and re-evaluation in 2 months

Ƌ. Internal fixation with or without bone grafting

Ƌ. Retrograde drilling of the defect without articular cartilage penetration

ƍ. Drilling of the defect directly through the articular cartilage

Ǝ. repair or reconstruction of the medial collateral ligament

Ə. repair or reconstruction of the medialand lateral collateral ligaments

Ɛ. immobilization for 5 days or less

Ƒ. immobilization for 14 days

Ƒ. immobilization for 25 days

Ɠ. Cystinosis

Ɣ. Hypophosphatemia

Ƕ. Renal osteodystrophy

Ɩ. Primary hyperparathyroidism

Ɨ. Nutritional vitamin D deficiency

Ƙ. Lateral meniscus tear

Ƙ. Popliteus tenosynovitis

Ƚ. Iliotibial band friction syndrome

ƛ. Peroneal nerve entrapment

Ɯ. Biceps tendinitis

Ɲ. Observation

Ƞ. Removal of the prosthetic components

Ɵ. Operative exploration and decompression of the peroneal nerve

Ơ. Nerve conduction velocity studies

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

Ƣ. I

Ƣ. II

Ƥ. III

Ƥ. decreased tissue tension

Ʀ. decreased abductor lever arm

Ƨ. decreased joint reaction force

Ƨ. increased body weight over lever arm

Ʃ. increased polyethylene wear rate

ƪ. recurrent traumatic anterior dislocation

ƫ. recurrent traumatic posterior dislocation

Ƭ. traumatic subluxation with no previous dislocation

Ƭ. traumatic anterior subluxation

Ʈ. atraumatic involuntary subluxation

Ư. radial

Ư. axillary

Ʊ. suprascapular

Ʋ. thoracodorsal

Ƴ. long thoracic

Ƴ. Flexion

Ƶ. Extension

Ƶ. Axial rotation

Ʒ. Left lateral bending

Ƹ. Right lateral bending

Ƹ. Skin

ƺ. Lung

ƻ. Brain

Ƽ. Heart

Ƽ. Kidney

ƾ. Thoracoacromial, lateral thoracic, subscapular

Ƿ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ǀ. Posterior humeral circumflex, subscapular, thoracacromial

ǁ. Subscapular, thoracacromial, anterior humeral circumflex

ǂ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ǃ. Respondeat superior

Ǆ. Indemnity agreement

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

Ǆ. Comparative negligence-% of involvement

Ǉ. Contributory negligence- resident contributed to the negligence

Ǉ. t-type

Ǉ. both column

Ǌ. transverse

Ǌ. anterior column

Ǌ. anterior column posterior hemitransverse

Ǎ. Posterior interosseous

Ǎ. Anterior interosseous

Ǐ. Radial

Ǐ. Median

Ǒ. Ulnar

Ǒ. Shock from hypovolemia

Ǔ. Associated rupture of the bladder

Ǔ. Arterial bleeding on pelvic angiogram

Ǖ. Presence of a hematoma in the perineum and scrotum

Ǖ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Arthrodesis

Explanation

Question 4185

Topic: 10. Pathology and Oncology

Chronic flatfoot deformity is most commonly associated with a contracture

of the

. Plantar fascia

. Spring ligament

. Deltoid ligament

. Intrinsic tendons

. Gastorcnemius-solelus complex

. Prevention of presynaptic release of acetylcholine

. Prevention of synthesis of presynaptic acetylcholine

. Activation of acetylcholinesterase at the motor end-plate

. Blockage of postsynaptic action of acetylcholine until reserves are depleted

. Stimulation of release of presynaptic acetylcholine until reserves are depleted

. stiffness of the femoral component.

. head offset of the femoral component.

. femoral component material modulus of elasticity.

. extent of the femoral component porous coating.

. Presence of a femoral component collar.

. plantar fascia and quadratus plantae tendon.

. ligamentous structures connecting the tarsal bones.

. shape of the tarsal bones and the intervening joints.

. activity of the intrinsic muscles of the foot.

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

. scapulothoracic fusion

. strengthening of the periscapular muscles

. pectoralis minor-fascia lata graft transfer to the scapula

. pectoralis major-fascia lata graft transfer to the scapula

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

. tricompartmental knee replacement

. unicompartmental knee replacement

. medial compartment meniscal allograft

. valgus-producing distal femoral osteotomy

. valgus-producing proximal tibial osteotomy

. Internal rotation of the femoral component

. External rotation of the tibial component

!. Lateral placement of the femoral component

". Medial placement of the patellar component

#. Excessive resection of the patella

$. Hallux rigidus

%. Hallux valgus

&. Neuroma of the first web space

'. Fracture of the sesamoid

(. Rupture of the flexor hallucis longus

). Sickle cell crisis

*. Idiopathic chondrolysis

+. Hemophilic arthropathy

,. 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

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

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

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

3. Long-term administration of IV and oral antibiotics

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

5. Immediate exchange arthroplasty with antibiotic-impregnated cement

6. Two-stage surgical prosthetic exchange and IV antibiotics

7. Resection arthroplasty and IV antibiotics

8. SCFE

9. MED

:. Perthes disease

;. Hypothyroidism

<. Chondrolysis

=. gout.

>. osteoporosis.

?. eosinophilic granuloma.

@. tuberculosis of the spine.

A. metastatic disease of the spine.

B. water content.

C. Synthesis of type I collagen.

D. Proteoglycan content.

E. Activity of chondrocytes.

F. Synthesis of hyaluronate.

G. Lung

H. Breast

I. Prostate

J. Thyroid

K. Renal

L. T1-low, T2-low.

M. T1-low, T2-high.

N. T1-moderate, T2-low.

O. T1-high, T2-low.

P. T1-high, T2-high.

Q. hypothesis is incorrect or invalid

R. interobserver error rate is 4%.

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

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

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

V. I

W. II

X. IV

Y. IX

Z. X

[. Cranial setting

\. Cranial subluxation

]. Odontoid fracture

^. Lysis of the arch of the atlas

_. Atlantoaxial subluxation

`. Retrograde collapse of the endoneurial tubes

A. Irreversible atrophy of the denervated muscles

B. Elongation of the axons across the zone of injury

C. Sprouting of the axons at the neuromuscular junction

D. Misdirection of the axons across the zone of injury

E. Maximally pronated and elbow extended

F. Maximally pronated and the elbow flexed

G. Maximally supinated and the elbow flexed

H. Maximally supinated and the elbow extended

I. In neutral rotation, with the elbow extended

J. open reduction and internal fixation

K. buddy taping to the adjacent index finger

L. early motion with application of a dynamic banjo splint

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

N. dorsal extension block splinting

O. The name of the manufacturer

P. The manufacturer’s potential liability

Q. The physician’s clinical performance

R. The physician’s materials testing data

S. Any royalties the physician receives from the manufacturer

T. Femoral

U. Obturator

V. Inferior gluteal

W. Superior gluteal

X. Lateral femoral cutaneous

Y. open biopsy and a long leg cast

Z. 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.

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

. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

¡. Relaxation

¢. Energy dissipation

£. Plastic deformation

¤. Elastic deformation

¥. bending

¦. axial loading

§. high-speed rotation

¨. direct impact from anteromedial

©. crush from anteromedial to posterolateral

ª. Increase stiffness

«. Increase fracture toughness

¬. Increase fatigue strength

. Decrease mechanical strength

®. Decrease wear rate

¯. disuse osteopenia

°. paraendocrine effect of the tumor

±. abnormally increased density on the right side

². side effect of the treatment of the lesion

³. extensive tumor involvement of the left hip

´. Sciatic nerve

Μ. Superior gluteal artery

¶. Profunda femoris artery

·. Femoral artery and nerve

¸. External iliac artery and vein

¹. Length

º. Moment arm

». Total volume

¼. Physiologic cross-sectional area

½. Distribution of slow and fast twitch fibers

¾. decreasing initiation of action potentials.

¿. increasing action potential amplitude.

À. blocking the opening of gated sodium channels.

Á. decreasing the number of functional motor units.

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

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

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

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

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

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

È. hemiarthroplasty

É. open reduction and internal fixation

Ê. closed reduction and percutaneous pinning

Ë. a sling and early pedulum exercises

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

Í. open acromioplasty

Î. open Bankart repair

Ï. open subscapularis tendon repair

Ð. inferior capsular shift

Ñ. a supervised physical therapy program

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

Ó. open reduction and internal fixation through an anterior approach

Ô. open reduction and internal fixation through a posterior approach

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

Ö. arthroscopically assisted reduction and percutaneous screw fixation

×. Repair of the rotator cuff

Ø. Replacement of the humeral head

Ù. Resection arthroplasty

Ú. Total shoulder arthroplasty

Û. AP and lateral radiographs of the elbow

Ü. Diagnositc arthroscopy

Ý. Aspiration of joint fluid

Þ. An erythrocyte sedimentation rate and CBC

SS. A diagnostic lidocaine injection

À. Insulin-like growth factor (IGF-1)

Á. Fibroblast growth factor (FGF-1)

Â. Platelet-derived growth factor (PDGF)

Ã. Transforming growth factor beta (TGF-B)

Ä. Bone morphogenetic proteins (BMP)

Å. clinical history and radiographic findings.

Æ. technetium bone scan

Ç. flow cytometry pattern of extracted chondrocytes

È. immunohistochemical staining patterns of a biopsy specimen

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

Ê. Radial

Ë. Radial recurrent

Ì. Posterior interosseous

Í. Superior ulnar recurrent

Î. Superficial radial circumflex

Ï. Impaired hydroxylation of proline

Ð. Failure of cleavage in procollagen

Ñ. Defective binding sites for hydroxyproline

Ò. Failure to incorporate glycine into the helix

Ó. Diminished production of collagen through the rough endoplasmic reticulum

Ô. Asking the legal staff to seek a court injunction

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

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

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

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

Ù. Meta-analysis

Ú. Confidence interval

Û. Analysis of variance (ANOVA)

Ü. Statistical significance (p-value)

Ý. Survivorship analysis (Kaplan-Meier)

Þ. Spinal shock

Ÿ. Neurogenic shock

Ā. Hypovolemic shock

Ā. Pulmonary embolism

Ă. Fat embolus syndrome

Ă. Lumbar spinal stenosis

Ą. Metastatic disease of the spine

Ą. Rheumatoid lumbar spondylitis

Ć. Isthmic spondyloloisthesis

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

Ĉ. Patella alta

Ĉ. A metal-backed patella

Ċ. Varus malalignment of the knee

Ċ. A posterior cruciate-substituting femoral component

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

Č. The sesamoids are separated

Ď. The sesamoid is fractured

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

Đ. The dislocation is dorsal and centered

Đ. The proximal phalanx is hyperextended

Ē. Patella

Ē. Tibial stem

Ĕ. Distal femoral interface

Ĕ. Posterior femoral interface

Ė. Sites of screw fixation for the tibia

Ė. Hallux rigidus

Ę. Fracture of the sesamoid

Ę. Disruption of the plantar plate

Ě. Osteonecrosis of the metatarsal head

Ě. Rupture of the flexor hallucis longus

Ĝ. Gout

Ĝ. Sepsis

Ğ. Old trauma

Ğ. Rheumatoid arthritis

Ġ. Charcot arthroplasty

Ġ. Aspiration and steroid injection

Ģ. Biopsy, curettage, and allograft bone grafting

Ģ. Percutaneous Kirschner wire fixation

Ĥ. Percutaneous injection of autogenous bone marrow

Ĥ. Nerve roots

Ħ. Spinal cord

Ħ. Sciatic nerve

Ĩ. Peroneal nerve

Ĩ. Conus medullaris

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

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

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

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

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

Į. Early and late infection

İ. Periprosthetic fracture of the femur

I. Failure of the patellofemoral and extensor mechanisms

Ĳ. Aseptic loosening of cementing tibial components

Ĳ. Asceptic loosening of cemented femoral components

Ĵ. Acceptance of the current position of the ankle

Ĵ. Open reduction and fixation in the epiphysis only

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

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

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

Ĺ. Resection arthroplasty and local radiation

Ĺ. In situ fusion of the hip

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

Ļ. Excision of heterotopic bone and local radiation

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

Ľ. Closed reduction of both fractures and immediate spica casting

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

Ŀ. External fixation of both femora

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

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

Ń. Synovial sarcoma

Ń. Soft-tissue abcess

Ņ. Rhabdomyosarcoma

Ņ. Eosinophilic granuloma

Ň. Nodular pigmented villonodular synovitis

Ň. Changing to a titanium nail

ʼN. Changing to a nonslotted nail

Ŋ. Changing the cross-sectional shape of the nail

Ŋ. Increasing the diameter of the nail by 3 mm

Ō. Increasing the diameter of the interlocking screws

Ō. Fracture healing

Ŏ. Chondrosarcoma

Ŏ. Periosteal chondroma

Ő. Periosteal osteosarcoma

Ő. Dysplasia epiphysealis hemimelica

Œ. Demonstrate competence in the subject of the case

Œ. Be fellowship trained in the subject of the case

Ŕ. Be paid on a contingency basis

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

Ŗ. Have been involved in the case as a consultant

Ŗ. Diagnostic arthroscopy

Ř. Arthroscopy and subacromial decompression

Ř. Reduction and fixation of the proximal humeral epiphysis

Ś. Temporary cessation of throwing

Ś. Physical therapy for rotator cuff strengthening

Ŝ. Oblique popliteal ligament

Ŝ. Lateral capsule

Ş. Popliteal tendon

Ş. Fibular collateral ligament

Š. Posterior oblique ligament

Š. Radial tear

Ţ. Parrot-beak tear

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

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

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

Ŧ. 0 degrees of abduction, with neural rotation

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

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

Ũ. 90 degrees of abduction with neutral rotation

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

Ū. Sural

Ŭ. Saphenous and its branches

Ŭ. Posterior tibial and its branches

Ů. Deep peroneal and its branches

Ů. Superficial peroneal and its branches

Ű. Strength

Ű. Stiffness

Ų. Shelf life

Ų. Antigenicity

Ŵ. Risk of HIV transmission

Ŵ. Indemnification

Ŷ. Occurrence

Ŷ. Excess liability

Ÿ. Claims-made

Ź. Nose

Ź. Lateral Y

Ż. Scapular AP

Ż. Neutral rotation AP

Ž. Internal rotation AP

Ž. External rotation AP

S. Trauma

Ƀ. Hemophilia

Ɓ. Reiter’s syndrome

Ƃ. Rheumatoid arthritis

Ƃ. Systemic lupus erythematosus

Ƅ. Cast immobilization for 6 weeks

Ƅ. Activity modification and re-evaluation in 2 months

Ɔ. Internal fixation with or without bone grafting

Ƈ. Retrograde drilling of the defect without articular cartilage penetration

Ƈ. Drilling of the defect directly through the articular cartilage

Ɖ. repair or reconstruction of the medial collateral ligament

Ɗ. repair or reconstruction of the medialand lateral collateral ligaments

Ƌ. immobilization for 5 days or less

Ƌ. immobilization for 14 days

ƍ. immobilization for 25 days

Ǝ. Cystinosis

Ə. Hypophosphatemia

Ɛ. Renal osteodystrophy

Ƒ. Primary hyperparathyroidism

Ƒ. Nutritional vitamin D deficiency

Ɠ. Lateral meniscus tear

Ɣ. Popliteus tenosynovitis

Ƕ. Iliotibial band friction syndrome

Ɩ. Peroneal nerve entrapment

Ɨ. Biceps tendinitis

Ƙ. Observation

Ƙ. Removal of the prosthetic components

Ƚ. Operative exploration and decompression of the peroneal nerve

ƛ. Nerve conduction velocity studies

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

Ɲ. I

Ƞ. II

Ɵ. III

Ơ. decreased tissue tension

Ơ. decreased abductor lever arm

Ƣ. decreased joint reaction force

Ƣ. increased body weight over lever arm

Ƥ. increased polyethylene wear rate

Ƥ. recurrent traumatic anterior dislocation

Ʀ. recurrent traumatic posterior dislocation

Ƨ. traumatic subluxation with no previous dislocation

Ƨ. traumatic anterior subluxation

Ʃ. atraumatic involuntary subluxation

ƪ. radial

ƫ. axillary

Ƭ. suprascapular

Ƭ. thoracodorsal

Ʈ. long thoracic

Ư. Flexion

Ư. Extension

Ʊ. Axial rotation

Ʋ. Left lateral bending

Ƴ. Right lateral bending

Ƴ. Skin

Ƶ. Lung

Ƶ. Brain

Ʒ. Heart

Ƹ. Kidney

Ƹ. Thoracoacromial, lateral thoracic, subscapular

ƺ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

ƻ. Posterior humeral circumflex, subscapular, thoracacromial

Ƽ. Subscapular, thoracacromial, anterior humeral circumflex

Ƽ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ƾ. Respondeat superior

Ƿ. Indemnity agreement

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

ǁ. Comparative negligence-% of involvement

ǂ. Contributory negligence- resident contributed to the negligence

ǃ. t-type

Ǆ. both column

Ǆ. transverse

Ǆ. anterior column

Ǉ. anterior column posterior hemitransverse

Ǉ. Posterior interosseous

Ǉ. Anterior interosseous

Ǌ. Radial

Ǌ. Median

Ǌ. Ulnar

Ǎ. Shock from hypovolemia

Ǎ. Associated rupture of the bladder

Ǐ. Arterial bleeding on pelvic angiogram

Ǐ. Presence of a hematoma in the perineum and scrotum

Ǒ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Plantar fascia

Explanation

Question 4186

Topic: 10. Pathology and Oncology

The pharmacologic action of botulinum-A toxin can be best described as

. 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

-. 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

0. Immediate exchange arthroplasty with antibiotic-impregnated cement

1. Two-stage surgical prosthetic exchange and IV antibiotics

2. Resection arthroplasty and IV antibiotics

3. SCFE

4. MED

5. Perthes disease

6. Hypothyroidism

7. Chondrolysis

8. gout.

9. 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.

B. Lung

C. Breast

D. Prostate

E. Thyroid

F. Renal

G. T1-low, T2-low.

H. T1-low, T2-high.

I. T1-moderate, T2-low.

J. T1-high, T2-low.

K. T1-high, T2-high.

L. hypothesis is incorrect or invalid

M. interobserver error rate is 4%.

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

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

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

Q. I

R. II

S. IV

T. IX

U. X

V. Cranial setting

W. Cranial subluxation

X. Odontoid fracture

Y. Lysis of the arch of the atlas

Z. 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

A. Maximally pronated and the elbow flexed

B. Maximally supinated and the elbow flexed

C. Maximally supinated and the elbow extended

D. In neutral rotation, with the elbow extended

E. open reduction and internal fixation

F. buddy taping to the adjacent index finger

G. early motion with application of a dynamic banjo splint

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

I. dorsal extension block splinting

J. The name of the manufacturer

K. The manufacturer’s potential liability

L. The physician’s clinical performance

M. The physician’s materials testing data

N. Any royalties the physician receives from the manufacturer

O. Femoral

P. Obturator

Q. Inferior gluteal

R. Superior gluteal

S. Lateral femoral cutaneous

T. open biopsy and a long leg cast

U. open biopsy and wide resection of the tumor

V. a long leg cast and observation

W. intramedullary stabilization and observation

X. Triggering

Y. Lateral instability

Z. 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.

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

. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

¡. axial loading

¢. high-speed rotation

£. direct impact from anteromedial

¤. crush from anteromedial to posterolateral

¥. Increase stiffness

¦. Increase fracture toughness

§. Increase fatigue strength

¨. Decrease mechanical strength

©. Decrease wear rate

ª. disuse osteopenia

«. paraendocrine effect of the tumor

¬. abnormally increased density on the right side

. side effect of the treatment of the lesion

®. extensive tumor involvement of the left hip

¯. Sciatic nerve

°. Superior gluteal artery

±. Profunda femoris artery

². Femoral artery and nerve

³. External iliac artery and vein

´. Length

Μ. Moment arm

¶. Total volume

·. Physiologic cross-sectional area

¸. Distribution of slow and fast twitch fibers

¹. decreasing initiation of action potentials.

º. increasing action potential amplitude.

». blocking the opening of gated sodium channels.

¼. decreasing the number of functional motor units.

½. slowing or stopping action potential propagation through the axon.

¾. resection of the metatarsal heads of the first through fifth toes.

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

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

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

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

Ã. hemiarthroplasty

Ä. open reduction and internal fixation

Å. closed reduction and percutaneous pinning

Æ. a sling and early pedulum exercises

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

È. open acromioplasty

É. open Bankart repair

Ê. open subscapularis tendon repair

Ë. inferior capsular shift

Ì. a supervised physical therapy program

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

Î. open reduction and internal fixation through an anterior approach

Ï. open reduction and internal fixation through a posterior approach

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

Ñ. arthroscopically assisted reduction and percutaneous screw fixation

Ò. Repair of the rotator cuff

Ó. Replacement of the humeral head

Ô. Resection arthroplasty

Õ. Total shoulder arthroplasty

Ö. AP and lateral radiographs of the elbow

×. Diagnositc arthroscopy

Ø. Aspiration of joint fluid

Ù. An erythrocyte sedimentation rate and CBC

Ú. A diagnostic lidocaine injection

Û. Insulin-like growth factor (IGF-1)

Ü. Fibroblast growth factor (FGF-1)

Ý. Platelet-derived growth factor (PDGF)

Þ. Transforming growth factor beta (TGF-B)

SS. Bone morphogenetic proteins (BMP)

À. clinical history and radiographic findings.

Á. technetium bone scan

Â. flow cytometry pattern of extracted chondrocytes

Ã. immunohistochemical staining patterns of a biopsy specimen

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

Å. Radial

Æ. Radial recurrent

Ç. Posterior interosseous

È. Superior ulnar recurrent

É. Superficial radial circumflex

Ê. Impaired hydroxylation of proline

Ë. Failure of cleavage in procollagen

Ì. Defective binding sites for hydroxyproline

Í. Failure to incorporate glycine into the helix

Î. Diminished production of collagen through the rough endoplasmic reticulum

Ï. Asking the legal staff to seek a court injunction

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

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

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

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

Ô. Meta-analysis

Õ. Confidence interval

Ö. Analysis of variance (ANOVA)

÷. Statistical significance (p-value)

Ø. Survivorship analysis (Kaplan-Meier)

Ù. Spinal shock

Ú. Neurogenic shock

Û. Hypovolemic shock

Ü. Pulmonary embolism

Ý. Fat embolus syndrome

Þ. Lumbar spinal stenosis

Ÿ. Metastatic disease of the spine

Ā. Rheumatoid lumbar spondylitis

Ā. Isthmic spondyloloisthesis

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

Ă. Patella alta

Ą. A metal-backed patella

Ą. Varus malalignment of the knee

Ć. A posterior cruciate-substituting femoral component

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

Ĉ. The sesamoids are separated

Ĉ. The sesamoid is fractured

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

Ċ. The dislocation is dorsal and centered

Č. The proximal phalanx is hyperextended

Č. Patella

Ď. Tibial stem

Ď. Distal femoral interface

Đ. Posterior femoral interface

Đ. Sites of screw fixation for the tibia

Ē. Hallux rigidus

Ē. Fracture of the sesamoid

Ĕ. Disruption of the plantar plate

Ĕ. Osteonecrosis of the metatarsal head

Ė. Rupture of the flexor hallucis longus

Ė. Gout

Ę. Sepsis

Ę. Old trauma

Ě. Rheumatoid arthritis

Ě. Charcot arthroplasty

Ĝ. Aspiration and steroid injection

Ĝ. Biopsy, curettage, and allograft bone grafting

Ğ. Percutaneous Kirschner wire fixation

Ğ. Percutaneous injection of autogenous bone marrow

Ġ. Nerve roots

Ġ. Spinal cord

Ģ. Sciatic nerve

Ģ. Peroneal nerve

Ĥ. Conus medullaris

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

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

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

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

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

Ī. Early and late infection

Ī. Periprosthetic fracture of the femur

Ĭ. Failure of the patellofemoral and extensor mechanisms

Ĭ. Aseptic loosening of cementing tibial components

Į. Asceptic loosening of cemented femoral components

Į. Acceptance of the current position of the ankle

İ. Open reduction and fixation in the epiphysis only

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

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

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

Ĵ. Resection arthroplasty and local radiation

Ĵ. In situ fusion of the hip

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

Ķ. Excision of heterotopic bone and local radiation

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

Ĺ. Closed reduction of both fractures and immediate spica casting

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

Ļ. External fixation of both femora

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

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

Ľ. Synovial sarcoma

Ŀ. Soft-tissue abcess

Ŀ. Rhabdomyosarcoma

Ł. Eosinophilic granuloma

Ł. Nodular pigmented villonodular synovitis

Ń. Changing to a titanium nail

Ń. Changing to a nonslotted nail

Ņ. Changing the cross-sectional shape of the nail

Ņ. Increasing the diameter of the nail by 3 mm

Ň. Increasing the diameter of the interlocking screws

Ň. Fracture healing

ʼN. Chondrosarcoma

Ŋ. Periosteal chondroma

Ŋ. Periosteal osteosarcoma

Ō. Dysplasia epiphysealis hemimelica

Ō. Demonstrate competence in the subject of the case

Ŏ. Be fellowship trained in the subject of the case

Ŏ. Be paid on a contingency basis

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

Ő. Have been involved in the case as a consultant

Œ. Diagnostic arthroscopy

Œ. Arthroscopy and subacromial decompression

Ŕ. Reduction and fixation of the proximal humeral epiphysis

Ŕ. Temporary cessation of throwing

Ŗ. Physical therapy for rotator cuff strengthening

Ŗ. Oblique popliteal ligament

Ř. Lateral capsule

Ř. Popliteal tendon

Ś. Fibular collateral ligament

Ś. Posterior oblique ligament

Ŝ. Radial tear

Ŝ. Parrot-beak tear

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

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

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

Š. 0 degrees of abduction, with neural rotation

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

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

Ť. 90 degrees of abduction with neutral rotation

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

Ŧ. Sural

Ŧ. Saphenous and its branches

Ũ. Posterior tibial and its branches

Ũ. Deep peroneal and its branches

Ū. Superficial peroneal and its branches

Ū. Strength

Ŭ. Stiffness

Ŭ. Shelf life

Ů. Antigenicity

Ů. Risk of HIV transmission

Ű. Indemnification

Ű. Occurrence

Ų. Excess liability

Ų. Claims-made

Ŵ. Nose

Ŵ. Lateral Y

Ŷ. Scapular AP

Ŷ. Neutral rotation AP

Ÿ. Internal rotation AP

Ź. External rotation AP

Ź. Trauma

Ż. Hemophilia

Ż. Reiter’s syndrome

Ž. Rheumatoid arthritis

Ž. Systemic lupus erythematosus

S. Cast immobilization for 6 weeks

Ƀ. Activity modification and re-evaluation in 2 months

Ɓ. Internal fixation with or without bone grafting

Ƃ. Retrograde drilling of the defect without articular cartilage penetration

Ƃ. Drilling of the defect directly through the articular cartilage

Ƅ. repair or reconstruction of the medial collateral ligament

Ƅ. repair or reconstruction of the medialand lateral collateral ligaments

Ɔ. immobilization for 5 days or less

Ƈ. immobilization for 14 days

Ƈ. immobilization for 25 days

Ɖ. Cystinosis

Ɗ. Hypophosphatemia

Ƌ. Renal osteodystrophy

Ƌ. Primary hyperparathyroidism

ƍ. Nutritional vitamin D deficiency

Ǝ. Lateral meniscus tear

Ə. Popliteus tenosynovitis

Ɛ. Iliotibial band friction syndrome

Ƒ. Peroneal nerve entrapment

Ƒ. Biceps tendinitis

Ɠ. Observation

Ɣ. Removal of the prosthetic components

Ƕ. Operative exploration and decompression of the peroneal nerve

Ɩ. Nerve conduction velocity studies

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

Ƙ. I

Ƙ. II

Ƚ. III

ƛ. decreased tissue tension

Ɯ. decreased abductor lever arm

Ɲ. decreased joint reaction force

Ƞ. increased body weight over lever arm

Ɵ. increased polyethylene wear rate

Ơ. recurrent traumatic anterior dislocation

Ơ. recurrent traumatic posterior dislocation

Ƣ. traumatic subluxation with no previous dislocation

Ƣ. traumatic anterior subluxation

Ƥ. atraumatic involuntary subluxation

Ƥ. radial

Ʀ. axillary

Ƨ. suprascapular

Ƨ. thoracodorsal

Ʃ. long thoracic

ƪ. Flexion

ƫ. Extension

Ƭ. Axial rotation

Ƭ. Left lateral bending

Ʈ. Right lateral bending

Ư. Skin

Ư. Lung

Ʊ. Brain

Ʋ. Heart

Ƴ. Kidney

Ƴ. Thoracoacromial, lateral thoracic, subscapular

Ƶ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƶ. Posterior humeral circumflex, subscapular, thoracacromial

Ʒ. Subscapular, thoracacromial, anterior humeral circumflex

Ƹ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƹ. Respondeat superior

ƺ. Indemnity agreement

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

Ƽ. Comparative negligence-% of involvement

Ƽ. Contributory negligence- resident contributed to the negligence

ƾ. t-type

Ƿ. both column

ǀ. transverse

ǁ. anterior column

ǂ. anterior column posterior hemitransverse

ǃ. Posterior interosseous

Ǆ. Anterior interosseous

Ǆ. Radial

Ǆ. Median

Ǉ. Ulnar

Ǉ. Shock from hypovolemia

Ǉ. Associated rupture of the bladder

Ǌ. Arterial bleeding on pelvic angiogram

Ǌ. Presence of a hematoma in the perineum and scrotum

Ǌ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Prevention of presynaptic release of acetylcholine

Explanation

Question 4187

Topic: 10. Pathology and Oncology

With respect to femoral component design, stress relief osteopenia in the proximal femur following noncemented total hip arthroplasty appears to be most strongly influenced by the

. 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

-. Resection arthroplasty and IV antibiotics

.. SCFE

/. MED

0. Perthes disease

1. Hypothyroidism

2. Chondrolysis

3. gout.

4. osteoporosis.

5. eosinophilic granuloma.

6. tuberculosis of the spine.

7. metastatic disease of the spine.

8. water content.

9. Synthesis of type I collagen.

:. Proteoglycan content.

;. Activity of chondrocytes.

<. Synthesis of hyaluronate.

=. Lung

>. Breast

?. Prostate

@. Thyroid

A. Renal

B. T1-low, T2-low.

C. T1-low, T2-high.

D. T1-moderate, T2-low.

E. T1-high, T2-low.

F. T1-high, T2-high.

G. hypothesis is incorrect or invalid

H. interobserver error rate is 4%.

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

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

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

L. I

M. II

N. IV

O. IX

P. X

Q. Cranial setting

R. Cranial subluxation

S. Odontoid fracture

T. Lysis of the arch of the atlas

U. Atlantoaxial subluxation

V. Retrograde collapse of the endoneurial tubes

W. Irreversible atrophy of the denervated muscles

X. Elongation of the axons across the zone of injury

Y. Sprouting of the axons at the neuromuscular junction

Z. 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

A. buddy taping to the adjacent index finger

B. early motion with application of a dynamic banjo splint

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

D. dorsal extension block splinting

E. The name of the manufacturer

F. The manufacturer’s potential liability

G. The physician’s clinical performance

H. The physician’s materials testing data

I. Any royalties the physician receives from the manufacturer

J. Femoral

K. Obturator

L. Inferior gluteal

M. Superior gluteal

N. Lateral femoral cutaneous

O. open biopsy and a long leg cast

P. open biopsy and wide resection of the tumor

Q. a long leg cast and observation

R. intramedullary stabilization and observation

S. Triggering

T. Lateral instability

U. Swan-neck deformity

V. Boutonniere deformity

W. Loss of distal interphalangeal joint flexion

X. Peroneus brevis to peroneus longus

Y. Peroneus tertius to extensor hallucis longus

Z. 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.

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

. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

¡. Increase fracture toughness

¢. Increase fatigue strength

£. Decrease mechanical strength

¤. Decrease wear rate

¥. disuse osteopenia

¦. paraendocrine effect of the tumor

§. abnormally increased density on the right side

¨. side effect of the treatment of the lesion

©. extensive tumor involvement of the left hip

ª. Sciatic nerve

«. Superior gluteal artery

¬. Profunda femoris artery

. Femoral artery and nerve

®. External iliac artery and vein

¯. Length

°. Moment arm

±. Total volume

². Physiologic cross-sectional area

³. Distribution of slow and fast twitch fibers

´. decreasing initiation of action potentials.

Μ. increasing action potential amplitude.

¶. blocking the opening of gated sodium channels.

·. decreasing the number of functional motor units.

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

¹. resection of the metatarsal heads of the first through fifth toes.

º. 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.

¼. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

½. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

¾. hemiarthroplasty

¿. open reduction and internal fixation

À. closed reduction and percutaneous pinning

Á. a sling and early pedulum exercises

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

Ã. open acromioplasty

Ä. open Bankart repair

Å. open subscapularis tendon repair

Æ. inferior capsular shift

Ç. a supervised physical therapy program

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

É. open reduction and internal fixation through an anterior approach

Ê. open reduction and internal fixation through a posterior approach

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

Ì. arthroscopically assisted reduction and percutaneous screw fixation

Í. Repair of the rotator cuff

Î. Replacement of the humeral head

Ï. Resection arthroplasty

Ð. Total shoulder arthroplasty

Ñ. AP and lateral radiographs of the elbow

Ò. Diagnositc arthroscopy

Ó. Aspiration of joint fluid

Ô. An erythrocyte sedimentation rate and CBC

Õ. A diagnostic lidocaine injection

Ö. Insulin-like growth factor (IGF-1)

×. Fibroblast growth factor (FGF-1)

Ø. Platelet-derived growth factor (PDGF)

Ù. Transforming growth factor beta (TGF-B)

Ú. Bone morphogenetic proteins (BMP)

Û. clinical history and radiographic findings.

Ü. technetium bone scan

Ý. flow cytometry pattern of extracted chondrocytes

Þ. immunohistochemical staining patterns of a biopsy specimen

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

À. Radial

Á. Radial recurrent

Â. Posterior interosseous

Ã. Superior ulnar recurrent

Ä. Superficial radial circumflex

Å. Impaired hydroxylation of proline

Æ. Failure of cleavage in procollagen

Ç. Defective binding sites for hydroxyproline

È. Failure to incorporate glycine into the helix

É. Diminished production of collagen through the rough endoplasmic reticulum

Ê. Asking the legal staff to seek a court injunction

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

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

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

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

Ï. Meta-analysis

Ð. Confidence interval

Ñ. Analysis of variance (ANOVA)

Ò. Statistical significance (p-value)

Ó. Survivorship analysis (Kaplan-Meier)

Ô. Spinal shock

Õ. Neurogenic shock

Ö. Hypovolemic shock

÷. Pulmonary embolism

Ø. Fat embolus syndrome

Ù. Lumbar spinal stenosis

Ú. Metastatic disease of the spine

Û. Rheumatoid lumbar spondylitis

Ü. Isthmic spondyloloisthesis

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

Þ. Patella alta

Ÿ. A metal-backed patella

Ā. Varus malalignment of the knee

Ā. A posterior cruciate-substituting femoral component

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

Ă. The sesamoids are separated

Ą. The sesamoid is fractured

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

Ć. The dislocation is dorsal and centered

Ć. The proximal phalanx is hyperextended

Ĉ. Patella

Ĉ. Tibial stem

Ċ. Distal femoral interface

Ċ. Posterior femoral interface

Č. Sites of screw fixation for the tibia

Č. Hallux rigidus

Ď. Fracture of the sesamoid

Ď. Disruption of the plantar plate

Đ. Osteonecrosis of the metatarsal head

Đ. Rupture of the flexor hallucis longus

Ē. Gout

Ē. Sepsis

Ĕ. Old trauma

Ĕ. Rheumatoid arthritis

Ė. Charcot arthroplasty

Ė. Aspiration and steroid injection

Ę. Biopsy, curettage, and allograft bone grafting

Ę. Percutaneous Kirschner wire fixation

Ě. Percutaneous injection of autogenous bone marrow

Ě. Nerve roots

Ĝ. Spinal cord

Ĝ. Sciatic nerve

Ğ. Peroneal nerve

Ğ. Conus medullaris

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

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

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

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

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

Ĥ. Early and late infection

Ħ. Periprosthetic fracture of the femur

Ħ. Failure of the patellofemoral and extensor mechanisms

Ĩ. Aseptic loosening of cementing tibial components

Ĩ. Asceptic loosening of cemented femoral components

Ī. Acceptance of the current position of the ankle

Ī. Open reduction and fixation in the epiphysis only

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

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

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

Į. Resection arthroplasty and local radiation

İ. In situ fusion of the hip

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

Ĳ. Excision of heterotopic bone and local radiation

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

Ĵ. Closed reduction of both fractures and immediate spica casting

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

Ķ. External fixation of both femora

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

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

Ĺ. Synovial sarcoma

Ĺ. Soft-tissue abcess

Ļ. Rhabdomyosarcoma

Ļ. Eosinophilic granuloma

Ľ. Nodular pigmented villonodular synovitis

Ľ. Changing to a titanium nail

Ŀ. Changing to a nonslotted nail

Ŀ. Changing the cross-sectional shape of the nail

Ł. Increasing the diameter of the nail by 3 mm

Ł. Increasing the diameter of the interlocking screws

Ń. Fracture healing

Ń. Chondrosarcoma

Ņ. Periosteal chondroma

Ņ. Periosteal osteosarcoma

Ň. Dysplasia epiphysealis hemimelica

Ň. Demonstrate competence in the subject of the case

ʼN. Be fellowship trained in the subject of the case

Ŋ. Be paid on a contingency basis

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

Ō. Have been involved in the case as a consultant

Ō. Diagnostic arthroscopy

Ŏ. Arthroscopy and subacromial decompression

Ŏ. Reduction and fixation of the proximal humeral epiphysis

Ő. Temporary cessation of throwing

Ő. Physical therapy for rotator cuff strengthening

Œ. Oblique popliteal ligament

Œ. Lateral capsule

Ŕ. Popliteal tendon

Ŕ. Fibular collateral ligament

Ŗ. Posterior oblique ligament

Ŗ. Radial tear

Ř. Parrot-beak tear

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

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

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

Ŝ. 0 degrees of abduction, with neural rotation

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

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

Ş. 90 degrees of abduction with neutral rotation

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

Š. Sural

Ţ. Saphenous and its branches

Ţ. Posterior tibial and its branches

Ť. Deep peroneal and its branches

Ť. Superficial peroneal and its branches

Ŧ. Strength

Ŧ. Stiffness

Ũ. Shelf life

Ũ. Antigenicity

Ū. Risk of HIV transmission

Ū. Indemnification

Ŭ. Occurrence

Ŭ. Excess liability

Ů. Claims-made

Ů. Nose

Ű. Lateral Y

Ű. Scapular AP

Ų. Neutral rotation AP

Ų. Internal rotation AP

Ŵ. External rotation AP

Ŵ. Trauma

Ŷ. Hemophilia

Ŷ. Reiter’s syndrome

Ÿ. Rheumatoid arthritis

Ź. Systemic lupus erythematosus

Ź. Cast immobilization for 6 weeks

Ż. Activity modification and re-evaluation in 2 months

Ż. Internal fixation with or without bone grafting

Ž. Retrograde drilling of the defect without articular cartilage penetration

Ž. Drilling of the defect directly through the articular cartilage

S. repair or reconstruction of the medial collateral ligament

Ƀ. repair or reconstruction of the medialand lateral collateral ligaments

Ɓ. immobilization for 5 days or less

Ƃ. immobilization for 14 days

Ƃ. immobilization for 25 days

Ƅ. Cystinosis

Ƅ. Hypophosphatemia

Ɔ. Renal osteodystrophy

Ƈ. Primary hyperparathyroidism

Ƈ. Nutritional vitamin D deficiency

Ɖ. Lateral meniscus tear

Ɗ. Popliteus tenosynovitis

Ƌ. Iliotibial band friction syndrome

Ƌ. Peroneal nerve entrapment

ƍ. Biceps tendinitis

Ǝ. Observation

Ə. Removal of the prosthetic components

Ɛ. Operative exploration and decompression of the peroneal nerve

Ƒ. Nerve conduction velocity studies

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

Ɠ. I

Ɣ. II

Ƕ. III

Ɩ. decreased tissue tension

Ɨ. decreased abductor lever arm

Ƙ. decreased joint reaction force

Ƙ. increased body weight over lever arm

Ƚ. increased polyethylene wear rate

ƛ. recurrent traumatic anterior dislocation

Ɯ. recurrent traumatic posterior dislocation

Ɲ. traumatic subluxation with no previous dislocation

Ƞ. traumatic anterior subluxation

Ɵ. atraumatic involuntary subluxation

Ơ. radial

Ơ. axillary

Ƣ. suprascapular

Ƣ. thoracodorsal

Ƥ. long thoracic

Ƥ. Flexion

Ʀ. Extension

Ƨ. Axial rotation

Ƨ. Left lateral bending

Ʃ. Right lateral bending

ƪ. Skin

ƫ. Lung

Ƭ. Brain

Ƭ. Heart

Ʈ. Kidney

Ư. Thoracoacromial, lateral thoracic, subscapular

Ư. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ʊ. Posterior humeral circumflex, subscapular, thoracacromial

Ʋ. Subscapular, thoracacromial, anterior humeral circumflex

Ƴ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƴ. Respondeat superior

Ƶ. Indemnity agreement

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

Ʒ. Comparative negligence-% of involvement

Ƹ. Contributory negligence- resident contributed to the negligence

Ƹ. t-type

ƺ. both column

ƻ. transverse

Ƽ. anterior column

Ƽ. anterior column posterior hemitransverse

ƾ. Posterior interosseous

Ƿ. Anterior interosseous

ǀ. Radial

ǁ. Median

ǂ. Ulnar

ǃ. Shock from hypovolemia

Ǆ. Associated rupture of the bladder

Ǆ. Arterial bleeding on pelvic angiogram

Ǆ. Presence of a hematoma in the perineum and scrotum

Ǉ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. stiffness of the femoral component.

Explanation

Question 4188

Topic: 10. Pathology and Oncology

The stability of the longitudinal arch of the foot during standing with equal weight on both feet is due primarily to

. 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

-. Chondrolysis

.. gout.

/. osteoporosis.

0. eosinophilic granuloma.

1. tuberculosis of the spine.

2. metastatic disease of the spine.

3. water content.

4. Synthesis of type I collagen.

5. Proteoglycan content.

6. Activity of chondrocytes.

7. Synthesis of hyaluronate.

8. Lung

9. 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.

B. hypothesis is incorrect or invalid

C. interobserver error rate is 4%.

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

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

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

G. I

H. II

I. IV

J. IX

K. X

L. Cranial setting

M. Cranial subluxation

N. Odontoid fracture

O. Lysis of the arch of the atlas

P. Atlantoaxial subluxation

Q. Retrograde collapse of the endoneurial tubes

R. Irreversible atrophy of the denervated muscles

S. Elongation of the axons across the zone of injury

T. Sprouting of the axons at the neuromuscular junction

U. Misdirection of the axons across the zone of injury

V. Maximally pronated and elbow extended

W. Maximally pronated and the elbow flexed

X. Maximally supinated and the elbow flexed

Y. Maximally supinated and the elbow extended

Z. 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

A. The manufacturer’s potential liability

B. The physician’s clinical performance

C. The physician’s materials testing data

D. Any royalties the physician receives from the manufacturer

E. Femoral

F. Obturator

G. Inferior gluteal

H. Superior gluteal

I. Lateral femoral cutaneous

J. open biopsy and a long leg cast

K. open biopsy and wide resection of the tumor

L. a long leg cast and observation

M. intramedullary stabilization and observation

N. Triggering

O. Lateral instability

P. Swan-neck deformity

Q. Boutonniere deformity

R. Loss of distal interphalangeal joint flexion

S. Peroneus brevis to peroneus longus

T. Peroneus tertius to extensor hallucis longus

U. Peroneus tertius to superficial peroneal nerve

V. Extensor hallucis longus to deep peroneal nerve

W. Extensor hallucis longus to extensor digitorum longus

X. reassurance that Medicare will pay for the treatment.

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

Z. 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.

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

. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

¡. paraendocrine effect of the tumor

¢. abnormally increased density on the right side

£. side effect of the treatment of the lesion

¤. extensive tumor involvement of the left hip

¥. Sciatic nerve

¦. Superior gluteal artery

§. Profunda femoris artery

¨. Femoral artery and nerve

©. External iliac artery and vein

ª. Length

«. Moment arm

¬. Total volume

. Physiologic cross-sectional area

®. Distribution of slow and fast twitch fibers

¯. decreasing initiation of action potentials.

°. increasing action potential amplitude.

±. blocking the opening of gated sodium channels.

². decreasing the number of functional motor units.

³. slowing or stopping action potential propagation through the axon.

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

Μ. 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.

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

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

¹. hemiarthroplasty

º. open reduction and internal fixation

». closed reduction and percutaneous pinning

¼. a sling and early pedulum exercises

½. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

¾. open acromioplasty

¿. open Bankart repair

À. open subscapularis tendon repair

Á. inferior capsular shift

Â. a supervised physical therapy program

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

Ä. open reduction and internal fixation through an anterior approach

Å. open reduction and internal fixation through a posterior approach

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

Ç. arthroscopically assisted reduction and percutaneous screw fixation

È. Repair of the rotator cuff

É. Replacement of the humeral head

Ê. Resection arthroplasty

Ë. Total shoulder arthroplasty

Ì. AP and lateral radiographs of the elbow

Í. Diagnositc arthroscopy

Î. Aspiration of joint fluid

Ï. An erythrocyte sedimentation rate and CBC

Ð. A diagnostic lidocaine injection

Ñ. Insulin-like growth factor (IGF-1)

Ò. Fibroblast growth factor (FGF-1)

Ó. Platelet-derived growth factor (PDGF)

Ô. Transforming growth factor beta (TGF-B)

Õ. Bone morphogenetic proteins (BMP)

Ö. clinical history and radiographic findings.

×. technetium bone scan

Ø. flow cytometry pattern of extracted chondrocytes

Ù. immunohistochemical staining patterns of a biopsy specimen

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

Û. Radial

Ü. Radial recurrent

Ý. Posterior interosseous

Þ. Superior ulnar recurrent

SS. Superficial radial circumflex

À. Impaired hydroxylation of proline

Á. Failure of cleavage in procollagen

Â. Defective binding sites for hydroxyproline

Ã. Failure to incorporate glycine into the helix

Ä. Diminished production of collagen through the rough endoplasmic reticulum

Å. Asking the legal staff to seek a court injunction

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

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

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

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

Ê. Meta-analysis

Ë. Confidence interval

Ì. Analysis of variance (ANOVA)

Í. Statistical significance (p-value)

Î. Survivorship analysis (Kaplan-Meier)

Ï. Spinal shock

Ð. Neurogenic shock

Ñ. Hypovolemic shock

Ò. Pulmonary embolism

Ó. Fat embolus syndrome

Ô. Lumbar spinal stenosis

Õ. Metastatic disease of the spine

Ö. Rheumatoid lumbar spondylitis

÷. Isthmic spondyloloisthesis

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

Ù. Patella alta

Ú. A metal-backed patella

Û. Varus malalignment of the knee

Ü. A posterior cruciate-substituting femoral component

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

Þ. The sesamoids are separated

Ÿ. The sesamoid is fractured

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

Ā. The dislocation is dorsal and centered

Ă. The proximal phalanx is hyperextended

Ă. Patella

Ą. Tibial stem

Ą. Distal femoral interface

Ć. Posterior femoral interface

Ć. Sites of screw fixation for the tibia

Ĉ. Hallux rigidus

Ĉ. Fracture of the sesamoid

Ċ. Disruption of the plantar plate

Ċ. Osteonecrosis of the metatarsal head

Č. Rupture of the flexor hallucis longus

Č. Gout

Ď. Sepsis

Ď. Old trauma

Đ. Rheumatoid arthritis

Đ. Charcot arthroplasty

Ē. Aspiration and steroid injection

Ē. Biopsy, curettage, and allograft bone grafting

Ĕ. Percutaneous Kirschner wire fixation

Ĕ. Percutaneous injection of autogenous bone marrow

Ė. Nerve roots

Ė. Spinal cord

Ę. Sciatic nerve

Ę. Peroneal nerve

Ě. Conus medullaris

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

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

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

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

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

Ġ. Early and late infection

Ġ. Periprosthetic fracture of the femur

Ģ. Failure of the patellofemoral and extensor mechanisms

Ģ. Aseptic loosening of cementing tibial components

Ĥ. Asceptic loosening of cemented femoral components

Ĥ. Acceptance of the current position of the ankle

Ħ. Open reduction and fixation in the epiphysis only

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

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

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

Ī. Resection arthroplasty and local radiation

Ī. In situ fusion of the hip

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

Ĭ. Excision of heterotopic bone and local radiation

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

Į. Closed reduction of both fractures and immediate spica casting

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

I. External fixation of both femora

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

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

Ĵ. Synovial sarcoma

Ĵ. Soft-tissue abcess

Ķ. Rhabdomyosarcoma

Ķ. Eosinophilic granuloma

ĸ. Nodular pigmented villonodular synovitis

Ĺ. Changing to a titanium nail

Ĺ. Changing to a nonslotted nail

Ļ. Changing the cross-sectional shape of the nail

Ļ. Increasing the diameter of the nail by 3 mm

Ľ. Increasing the diameter of the interlocking screws

Ľ. Fracture healing

Ŀ. Chondrosarcoma

Ŀ. Periosteal chondroma

Ł. Periosteal osteosarcoma

Ł. Dysplasia epiphysealis hemimelica

Ń. Demonstrate competence in the subject of the case

Ń. Be fellowship trained in the subject of the case

Ņ. Be paid on a contingency basis

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

Ň. Have been involved in the case as a consultant

Ň. Diagnostic arthroscopy

ʼN. Arthroscopy and subacromial decompression

Ŋ. Reduction and fixation of the proximal humeral epiphysis

Ŋ. Temporary cessation of throwing

Ō. Physical therapy for rotator cuff strengthening

Ō. Oblique popliteal ligament

Ŏ. Lateral capsule

Ŏ. Popliteal tendon

Ő. Fibular collateral ligament

Ő. Posterior oblique ligament

Œ. Radial tear

Œ. Parrot-beak tear

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

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

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

Ŗ. 0 degrees of abduction, with neural rotation

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

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

Ś. 90 degrees of abduction with neutral rotation

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

Ŝ. Sural

Ŝ. Saphenous and its branches

Ş. Posterior tibial and its branches

Ş. Deep peroneal and its branches

Š. Superficial peroneal and its branches

Š. Strength

Ţ. Stiffness

Ţ. Shelf life

Ť. Antigenicity

Ť. Risk of HIV transmission

Ŧ. Indemnification

Ŧ. Occurrence

Ũ. Excess liability

Ũ. Claims-made

Ū. Nose

Ū. Lateral Y

Ŭ. Scapular AP

Ŭ. Neutral rotation AP

Ů. Internal rotation AP

Ů. External rotation AP

Ű. Trauma

Ű. Hemophilia

Ų. Reiter’s syndrome

Ų. Rheumatoid arthritis

Ŵ. Systemic lupus erythematosus

Ŵ. Cast immobilization for 6 weeks

Ŷ. Activity modification and re-evaluation in 2 months

Ŷ. Internal fixation with or without bone grafting

Ÿ. Retrograde drilling of the defect without articular cartilage penetration

Ź. Drilling of the defect directly through the articular cartilage

Ź. repair or reconstruction of the medial collateral ligament

Ż. repair or reconstruction of the medialand lateral collateral ligaments

Ż. immobilization for 5 days or less

Ž. immobilization for 14 days

Ž. immobilization for 25 days

S. Cystinosis

Ƀ. Hypophosphatemia

Ɓ. Renal osteodystrophy

Ƃ. Primary hyperparathyroidism

Ƃ. Nutritional vitamin D deficiency

Ƅ. Lateral meniscus tear

Ƅ. Popliteus tenosynovitis

Ɔ. Iliotibial band friction syndrome

Ƈ. Peroneal nerve entrapment

Ƈ. Biceps tendinitis

Ɖ. Observation

Ɗ. Removal of the prosthetic components

Ƌ. Operative exploration and decompression of the peroneal nerve

Ƌ. Nerve conduction velocity studies

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

Ǝ. I

Ə. II

Ɛ. III

Ƒ. decreased tissue tension

Ƒ. decreased abductor lever arm

Ɠ. decreased joint reaction force

Ɣ. increased body weight over lever arm

Ƕ. increased polyethylene wear rate

Ɩ. recurrent traumatic anterior dislocation

Ɨ. recurrent traumatic posterior dislocation

Ƙ. traumatic subluxation with no previous dislocation

Ƙ. traumatic anterior subluxation

Ƚ. atraumatic involuntary subluxation

ƛ. radial

Ɯ. axillary

Ɲ. suprascapular

Ƞ. thoracodorsal

Ɵ. long thoracic

Ơ. Flexion

Ơ. Extension

Ƣ. Axial rotation

Ƣ. Left lateral bending

Ƥ. Right lateral bending

Ƥ. Skin

Ʀ. Lung

Ƨ. Brain

Ƨ. Heart

Ʃ. Kidney

ƪ. Thoracoacromial, lateral thoracic, subscapular

ƫ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƭ. Posterior humeral circumflex, subscapular, thoracacromial

Ƭ. Subscapular, thoracacromial, anterior humeral circumflex

Ʈ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ư. Respondeat superior

Ư. Indemnity agreement

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

Ʋ. Comparative negligence-% of involvement

Ƴ. Contributory negligence- resident contributed to the negligence

Ƴ. t-type

Ƶ. both column

Ƶ. transverse

Ʒ. anterior column

Ƹ. anterior column posterior hemitransverse

Ƹ. Posterior interosseous

ƺ. Anterior interosseous

ƻ. Radial

Ƽ. Median

Ƽ. Ulnar

ƾ. Shock from hypovolemia

Ƿ. Associated rupture of the bladder

ǀ. Arterial bleeding on pelvic angiogram

ǁ. Presence of a hematoma in the perineum and scrotum

ǂ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. plantar fascia and quadratus plantae tendon.

Explanation

Question 4189

Topic: 10. Pathology and Oncology

A 32-year-old has diffuse pain, weakness, and limited overhead motion in the shoulder as a result of falling on his outstretched arm 2 months ago. Examination reveals medial scapular winging, and an electromyogram shows denervation of the long thoracic nerve. Management should consist of

. 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.

-. metastatic disease of the spine.

.. water content.

/. Synthesis of type I collagen.

0. Proteoglycan content.

1. Activity of chondrocytes.

2. Synthesis of hyaluronate.

3. Lung

4. Breast

5. Prostate

6. Thyroid

7. Renal

8. T1-low, T2-low.

9. 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%.

B. I

C. II

D. IV

E. IX

F. X

G. Cranial setting

H. Cranial subluxation

I. Odontoid fracture

J. Lysis of the arch of the atlas

K. Atlantoaxial subluxation

L. Retrograde collapse of the endoneurial tubes

M. Irreversible atrophy of the denervated muscles

N. Elongation of the axons across the zone of injury

O. Sprouting of the axons at the neuromuscular junction

P. Misdirection of the axons across the zone of injury

Q. Maximally pronated and elbow extended

R. Maximally pronated and the elbow flexed

S. Maximally supinated and the elbow flexed

T. Maximally supinated and the elbow extended

U. In neutral rotation, with the elbow extended

V. open reduction and internal fixation

W. buddy taping to the adjacent index finger

X. early motion with application of a dynamic banjo splint

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

Z. 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

A. Obturator

B. Inferior gluteal

C. Superior gluteal

D. Lateral femoral cutaneous

E. open biopsy and a long leg cast

F. open biopsy and wide resection of the tumor

G. a long leg cast and observation

H. intramedullary stabilization and observation

I. Triggering

J. Lateral instability

K. Swan-neck deformity

L. Boutonniere deformity

M. Loss of distal interphalangeal joint flexion

N. Peroneus brevis to peroneus longus

O. Peroneus tertius to extensor hallucis longus

P. Peroneus tertius to superficial peroneal nerve

Q. Extensor hallucis longus to deep peroneal nerve

R. Extensor hallucis longus to extensor digitorum longus

S. reassurance that Medicare will pay for the treatment.

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

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

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

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

X. an onlay iliac crest bone graft.

Y. limited weightbearing and observation.

Z. 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

. Proximal pins sagittal, distal pins coronal

. Proximal pins coronal, distal pins sagittal

. Rheumatoid arthritis

. Posttraumatic arthritis

. Degenerative osteoarthritis

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

¡. Superior gluteal artery

¢. Profunda femoris artery

£. Femoral artery and nerve

¤. External iliac artery and vein

¥. Length

¦. Moment arm

§. Total volume

¨. Physiologic cross-sectional area

©. Distribution of slow and fast twitch fibers

ª. decreasing initiation of action potentials.

«. increasing action potential amplitude.

¬. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

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

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

°. 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.

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

³. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

´. hemiarthroplasty

Μ. open reduction and internal fixation

¶. closed reduction and percutaneous pinning

·. a sling and early pedulum exercises

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

¹. open acromioplasty

º. open Bankart repair

». open subscapularis tendon repair

¼. inferior capsular shift

½. a supervised physical therapy program

¾. a sling and swathe, with pendulum exercises in 10 days

¿. open reduction and internal fixation through an anterior approach

À. open reduction and internal fixation through a posterior approach

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

Â. arthroscopically assisted reduction and percutaneous screw fixation

Ã. Repair of the rotator cuff

Ä. Replacement of the humeral head

Å. Resection arthroplasty

Æ. Total shoulder arthroplasty

Ç. AP and lateral radiographs of the elbow

È. Diagnositc arthroscopy

É. Aspiration of joint fluid

Ê. An erythrocyte sedimentation rate and CBC

Ë. A diagnostic lidocaine injection

Ì. Insulin-like growth factor (IGF-1)

Í. Fibroblast growth factor (FGF-1)

Î. Platelet-derived growth factor (PDGF)

Ï. Transforming growth factor beta (TGF-B)

Ð. Bone morphogenetic proteins (BMP)

Ñ. clinical history and radiographic findings.

Ò. technetium bone scan

Ó. flow cytometry pattern of extracted chondrocytes

Ô. immunohistochemical staining patterns of a biopsy specimen

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

Ö. Radial

×. Radial recurrent

Ø. Posterior interosseous

Ù. Superior ulnar recurrent

Ú. Superficial radial circumflex

Û. Impaired hydroxylation of proline

Ü. Failure of cleavage in procollagen

Ý. Defective binding sites for hydroxyproline

Þ. Failure to incorporate glycine into the helix

SS. Diminished production of collagen through the rough endoplasmic reticulum

À. Asking the legal staff to seek a court injunction

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

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

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

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

Å. Meta-analysis

Æ. Confidence interval

Ç. Analysis of variance (ANOVA)

È. Statistical significance (p-value)

É. Survivorship analysis (Kaplan-Meier)

Ê. Spinal shock

Ë. Neurogenic shock

Ì. Hypovolemic shock

Í. Pulmonary embolism

Î. Fat embolus syndrome

Ï. Lumbar spinal stenosis

Ð. Metastatic disease of the spine

Ñ. Rheumatoid lumbar spondylitis

Ò. Isthmic spondyloloisthesis

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

Ô. Patella alta

Õ. A metal-backed patella

Ö. Varus malalignment of the knee

÷. A posterior cruciate-substituting femoral component

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

Ù. The sesamoids are separated

Ú. The sesamoid is fractured

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

Ü. The dislocation is dorsal and centered

Ý. The proximal phalanx is hyperextended

Þ. Patella

Ÿ. Tibial stem

Ā. Distal femoral interface

Ā. Posterior femoral interface

Ă. Sites of screw fixation for the tibia

Ă. Hallux rigidus

Ą. Fracture of the sesamoid

Ą. Disruption of the plantar plate

Ć. Osteonecrosis of the metatarsal head

Ć. Rupture of the flexor hallucis longus

Ĉ. Gout

Ĉ. Sepsis

Ċ. Old trauma

Ċ. Rheumatoid arthritis

Č. Charcot arthroplasty

Č. Aspiration and steroid injection

Ď. Biopsy, curettage, and allograft bone grafting

Ď. Percutaneous Kirschner wire fixation

Đ. Percutaneous injection of autogenous bone marrow

Đ. Nerve roots

Ē. Spinal cord

Ē. Sciatic nerve

Ĕ. Peroneal nerve

Ĕ. Conus medullaris

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

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

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

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

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

Ě. Early and late infection

Ĝ. Periprosthetic fracture of the femur

Ĝ. Failure of the patellofemoral and extensor mechanisms

Ğ. Aseptic loosening of cementing tibial components

Ğ. Asceptic loosening of cemented femoral components

Ġ. Acceptance of the current position of the ankle

Ġ. Open reduction and fixation in the epiphysis only

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

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

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

Ĥ. Resection arthroplasty and local radiation

Ħ. In situ fusion of the hip

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

Ĩ. Excision of heterotopic bone and local radiation

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

Ī. Closed reduction of both fractures and immediate spica casting

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

Ĭ. External fixation of both femora

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

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

Į. Synovial sarcoma

İ. Soft-tissue abcess

I. Rhabdomyosarcoma

Ĳ. Eosinophilic granuloma

Ĳ. Nodular pigmented villonodular synovitis

Ĵ. Changing to a titanium nail

Ĵ. Changing to a nonslotted nail

Ķ. Changing the cross-sectional shape of the nail

Ķ. Increasing the diameter of the nail by 3 mm

ĸ. Increasing the diameter of the interlocking screws

Ĺ. Fracture healing

Ĺ. Chondrosarcoma

Ļ. Periosteal chondroma

Ļ. Periosteal osteosarcoma

Ľ. Dysplasia epiphysealis hemimelica

Ľ. Demonstrate competence in the subject of the case

Ŀ. Be fellowship trained in the subject of the case

Ŀ. Be paid on a contingency basis

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

Ł. Have been involved in the case as a consultant

Ń. Diagnostic arthroscopy

Ń. Arthroscopy and subacromial decompression

Ņ. Reduction and fixation of the proximal humeral epiphysis

Ņ. Temporary cessation of throwing

Ň. Physical therapy for rotator cuff strengthening

Ň. Oblique popliteal ligament

ʼN. Lateral capsule

Ŋ. Popliteal tendon

Ŋ. Fibular collateral ligament

Ō. Posterior oblique ligament

Ō. Radial tear

Ŏ. Parrot-beak tear

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

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

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

Œ. 0 degrees of abduction, with neural rotation

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

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

Ŕ. 90 degrees of abduction with neutral rotation

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

Ŗ. Sural

Ř. Saphenous and its branches

Ř. Posterior tibial and its branches

Ś. Deep peroneal and its branches

Ś. Superficial peroneal and its branches

Ŝ. Strength

Ŝ. Stiffness

Ş. Shelf life

Ş. Antigenicity

Š. Risk of HIV transmission

Š. Indemnification

Ţ. Occurrence

Ţ. Excess liability

Ť. Claims-made

Ť. Nose

Ŧ. Lateral Y

Ŧ. Scapular AP

Ũ. Neutral rotation AP

Ũ. Internal rotation AP

Ū. External rotation AP

Ū. Trauma

Ŭ. Hemophilia

Ŭ. Reiter’s syndrome

Ů. Rheumatoid arthritis

Ů. Systemic lupus erythematosus

Ű. Cast immobilization for 6 weeks

Ű. Activity modification and re-evaluation in 2 months

Ų. Internal fixation with or without bone grafting

Ų. Retrograde drilling of the defect without articular cartilage penetration

Ŵ. Drilling of the defect directly through the articular cartilage

Ŵ. repair or reconstruction of the medial collateral ligament

Ŷ. repair or reconstruction of the medialand lateral collateral ligaments

Ŷ. immobilization for 5 days or less

Ÿ. immobilization for 14 days

Ź. immobilization for 25 days

Ź. Cystinosis

Ż. Hypophosphatemia

Ż. Renal osteodystrophy

Ž. Primary hyperparathyroidism

Ž. Nutritional vitamin D deficiency

S. Lateral meniscus tear

Ƀ. Popliteus tenosynovitis

Ɓ. Iliotibial band friction syndrome

Ƃ. Peroneal nerve entrapment

Ƃ. Biceps tendinitis

Ƅ. Observation

Ƅ. Removal of the prosthetic components

Ɔ. Operative exploration and decompression of the peroneal nerve

Ƈ. Nerve conduction velocity studies

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

Ɖ. I

Ɗ. II

Ƌ. III

Ƌ. decreased tissue tension

ƍ. decreased abductor lever arm

Ǝ. decreased joint reaction force

Ə. increased body weight over lever arm

Ɛ. increased polyethylene wear rate

Ƒ. recurrent traumatic anterior dislocation

Ƒ. recurrent traumatic posterior dislocation

Ɠ. traumatic subluxation with no previous dislocation

Ɣ. traumatic anterior subluxation

Ƕ. atraumatic involuntary subluxation

Ɩ. radial

Ɨ. axillary

Ƙ. suprascapular

Ƙ. thoracodorsal

Ƚ. long thoracic

ƛ. Flexion

Ɯ. Extension

Ɲ. Axial rotation

Ƞ. Left lateral bending

Ɵ. Right lateral bending

Ơ. Skin

Ơ. Lung

Ƣ. Brain

Ƣ. Heart

Ƥ. Kidney

Ƥ. Thoracoacromial, lateral thoracic, subscapular

Ʀ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƨ. Posterior humeral circumflex, subscapular, thoracacromial

Ƨ. Subscapular, thoracacromial, anterior humeral circumflex

Ʃ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ƪ. Respondeat superior

ƫ. Indemnity agreement

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

Ƭ. Comparative negligence-% of involvement

Ʈ. Contributory negligence- resident contributed to the negligence

Ư. t-type

Ư. both column

Ʊ. transverse

Ʋ. anterior column

Ƴ. anterior column posterior hemitransverse

Ƴ. Posterior interosseous

Ƶ. Anterior interosseous

Ƶ. Radial

Ʒ. Median

Ƹ. Ulnar

Ƹ. Shock from hypovolemia

ƺ. Associated rupture of the bladder

ƻ. Arterial bleeding on pelvic angiogram

Ƽ. Presence of a hematoma in the perineum and scrotum

Ƽ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. scapulothoracic fusion

Explanation

Question 4190

Topic: 10. Pathology and Oncology

A 45-year-old man who has medial compartment disease and chronic medial knee pain with varus alignment of 5 degrees is best treated with a

. 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.

-. Synthesis of hyaluronate.

.. Lung

/. Breast

0. Prostate

1. Thyroid

2. Renal

3. T1-low, T2-low.

4. T1-low, T2-high.

5. T1-moderate, T2-low.

6. T1-high, T2-low.

7. T1-high, T2-high.

8. hypothesis is incorrect or invalid

9. 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

B. Cranial setting

C. Cranial subluxation

D. Odontoid fracture

E. Lysis of the arch of the atlas

F. Atlantoaxial subluxation

G. Retrograde collapse of the endoneurial tubes

H. Irreversible atrophy of the denervated muscles

I. Elongation of the axons across the zone of injury

J. Sprouting of the axons at the neuromuscular junction

K. Misdirection of the axons across the zone of injury

L. Maximally pronated and elbow extended

M. Maximally pronated and the elbow flexed

N. Maximally supinated and the elbow flexed

O. Maximally supinated and the elbow extended

P. In neutral rotation, with the elbow extended

Q. open reduction and internal fixation

R. buddy taping to the adjacent index finger

S. early motion with application of a dynamic banjo splint

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

U. dorsal extension block splinting

V. The name of the manufacturer

W. The manufacturer’s potential liability

X. The physician’s clinical performance

Y. The physician’s materials testing data

Z. Any royalties the physician receives from the manufacturer

[. Femoral

\. Obturator

]. Inferior gluteal

^. Superior gluteal

_. Lateral femoral cutaneous

`. open biopsy and a long leg cast

A. open biopsy and wide resection of the tumor

B. a long leg cast and observation

C. intramedullary stabilization and observation

D. Triggering

E. Lateral instability

F. Swan-neck deformity

G. Boutonniere deformity

H. Loss of distal interphalangeal joint flexion

I. Peroneus brevis to peroneus longus

J. Peroneus tertius to extensor hallucis longus

K. Peroneus tertius to superficial peroneal nerve

L. Extensor hallucis longus to deep peroneal nerve

M. Extensor hallucis longus to extensor digitorum longus

N. reassurance that Medicare will pay for the treatment.

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

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

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

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

S. an onlay iliac crest bone graft.

T. limited weightbearing and observation.

U. removal of the implant and limited weightbearing.

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

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

X. Coronal

Y. Sagittal

Z. 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

. Osteonecrosis of the tibial plateau

. Osteonecrosis of the medial femoral condyle

. Trapeziometacarpal arthrodesis

. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

¡. Moment arm

¢. Total volume

£. Physiologic cross-sectional area

¤. Distribution of slow and fast twitch fibers

¥. decreasing initiation of action potentials.

¦. increasing action potential amplitude.

§. blocking the opening of gated sodium channels.

¨. decreasing the number of functional motor units.

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

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

«. 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.

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

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

¯. hemiarthroplasty

°. open reduction and internal fixation

±. closed reduction and percutaneous pinning

². a sling and early pedulum exercises

³. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

´. open acromioplasty

Μ. open Bankart repair

¶. open subscapularis tendon repair

·. inferior capsular shift

¸. a supervised physical therapy program

¹. a sling and swathe, with pendulum exercises in 10 days

º. open reduction and internal fixation through an anterior approach

». open reduction and internal fixation through a posterior approach

¼. immobilization with a splint in 45 degrees of abduction for 6 weeks

½. arthroscopically assisted reduction and percutaneous screw fixation

¾. Repair of the rotator cuff

¿. Replacement of the humeral head

À. Resection arthroplasty

Á. Total shoulder arthroplasty

Â. AP and lateral radiographs of the elbow

Ã. Diagnositc arthroscopy

Ä. Aspiration of joint fluid

Å. An erythrocyte sedimentation rate and CBC

Æ. A diagnostic lidocaine injection

Ç. Insulin-like growth factor (IGF-1)

È. Fibroblast growth factor (FGF-1)

É. Platelet-derived growth factor (PDGF)

Ê. Transforming growth factor beta (TGF-B)

Ë. Bone morphogenetic proteins (BMP)

Ì. clinical history and radiographic findings.

Í. technetium bone scan

Î. flow cytometry pattern of extracted chondrocytes

Ï. immunohistochemical staining patterns of a biopsy specimen

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

Ñ. Radial

Ò. Radial recurrent

Ó. Posterior interosseous

Ô. Superior ulnar recurrent

Õ. Superficial radial circumflex

Ö. Impaired hydroxylation of proline

×. Failure of cleavage in procollagen

Ø. Defective binding sites for hydroxyproline

Ù. Failure to incorporate glycine into the helix

Ú. Diminished production of collagen through the rough endoplasmic reticulum

Û. Asking the legal staff to seek a court injunction

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

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

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

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

À. Meta-analysis

Á. Confidence interval

Â. Analysis of variance (ANOVA)

Ã. Statistical significance (p-value)

Ä. Survivorship analysis (Kaplan-Meier)

Å. Spinal shock

Æ. Neurogenic shock

Ç. Hypovolemic shock

È. Pulmonary embolism

É. Fat embolus syndrome

Ê. Lumbar spinal stenosis

Ë. Metastatic disease of the spine

Ì. Rheumatoid lumbar spondylitis

Í. Isthmic spondyloloisthesis

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

Ï. Patella alta

Ð. A metal-backed patella

Ñ. Varus malalignment of the knee

Ò. A posterior cruciate-substituting femoral component

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

Ô. The sesamoids are separated

Õ. The sesamoid is fractured

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

÷. The dislocation is dorsal and centered

Ø. The proximal phalanx is hyperextended

Ù. Patella

Ú. Tibial stem

Û. Distal femoral interface

Ü. Posterior femoral interface

Ý. Sites of screw fixation for the tibia

Þ. Hallux rigidus

Ÿ. Fracture of the sesamoid

Ā. Disruption of the plantar plate

Ā. Osteonecrosis of the metatarsal head

Ă. Rupture of the flexor hallucis longus

Ă. Gout

Ą. Sepsis

Ą. Old trauma

Ć. Rheumatoid arthritis

Ć. Charcot arthroplasty

Ĉ. Aspiration and steroid injection

Ĉ. Biopsy, curettage, and allograft bone grafting

Ċ. Percutaneous Kirschner wire fixation

Ċ. Percutaneous injection of autogenous bone marrow

Č. Nerve roots

Č. Spinal cord

Ď. Sciatic nerve

Ď. Peroneal nerve

Đ. Conus medullaris

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

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

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

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

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

Ė. Early and late infection

Ė. Periprosthetic fracture of the femur

Ę. Failure of the patellofemoral and extensor mechanisms

Ę. Aseptic loosening of cementing tibial components

Ě. Asceptic loosening of cemented femoral components

Ě. Acceptance of the current position of the ankle

Ĝ. Open reduction and fixation in the epiphysis only

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

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

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

Ġ. Resection arthroplasty and local radiation

Ġ. In situ fusion of the hip

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

Ģ. Excision of heterotopic bone and local radiation

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

Ĥ. Closed reduction of both fractures and immediate spica casting

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

Ħ. External fixation of both femora

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

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

Ī. Synovial sarcoma

Ī. Soft-tissue abcess

Ĭ. Rhabdomyosarcoma

Ĭ. Eosinophilic granuloma

Į. Nodular pigmented villonodular synovitis

Į. Changing to a titanium nail

İ. Changing to a nonslotted nail

I. Changing the cross-sectional shape of the nail

Ĳ. Increasing the diameter of the nail by 3 mm

Ĳ. Increasing the diameter of the interlocking screws

Ĵ. Fracture healing

Ĵ. Chondrosarcoma

Ķ. Periosteal chondroma

Ķ. Periosteal osteosarcoma

ĸ. Dysplasia epiphysealis hemimelica

Ĺ. Demonstrate competence in the subject of the case

Ĺ. Be fellowship trained in the subject of the case

Ļ. Be paid on a contingency basis

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

Ľ. Have been involved in the case as a consultant

Ľ. Diagnostic arthroscopy

Ŀ. Arthroscopy and subacromial decompression

Ŀ. Reduction and fixation of the proximal humeral epiphysis

Ł. Temporary cessation of throwing

Ł. Physical therapy for rotator cuff strengthening

Ń. Oblique popliteal ligament

Ń. Lateral capsule

Ņ. Popliteal tendon

Ņ. Fibular collateral ligament

Ň. Posterior oblique ligament

Ň. Radial tear

ʼN. Parrot-beak tear

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

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

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

Ō. 0 degrees of abduction, with neural rotation

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

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

Ő. 90 degrees of abduction with neutral rotation

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

Œ. Sural

Œ. Saphenous and its branches

Ŕ. Posterior tibial and its branches

Ŕ. Deep peroneal and its branches

Ŗ. Superficial peroneal and its branches

Ŗ. Strength

Ř. Stiffness

Ř. Shelf life

Ś. Antigenicity

Ś. Risk of HIV transmission

Ŝ. Indemnification

Ŝ. Occurrence

Ş. Excess liability

Ş. Claims-made

Š. Nose

Š. Lateral Y

Ţ. Scapular AP

Ţ. Neutral rotation AP

Ť. Internal rotation AP

Ť. External rotation AP

Ŧ. Trauma

Ŧ. Hemophilia

Ũ. Reiter’s syndrome

Ũ. Rheumatoid arthritis

Ū. Systemic lupus erythematosus

Ū. Cast immobilization for 6 weeks

Ŭ. Activity modification and re-evaluation in 2 months

Ŭ. Internal fixation with or without bone grafting

Ů. Retrograde drilling of the defect without articular cartilage penetration

Ů. Drilling of the defect directly through the articular cartilage

Ű. repair or reconstruction of the medial collateral ligament

Ű. repair or reconstruction of the medialand lateral collateral ligaments

Ų. immobilization for 5 days or less

Ų. immobilization for 14 days

Ŵ. immobilization for 25 days

Ŵ. Cystinosis

Ŷ. Hypophosphatemia

Ŷ. Renal osteodystrophy

Ÿ. Primary hyperparathyroidism

Ź. Nutritional vitamin D deficiency

Ź. Lateral meniscus tear

Ż. Popliteus tenosynovitis

Ż. Iliotibial band friction syndrome

Ž. Peroneal nerve entrapment

Ž. Biceps tendinitis

S. Observation

Ƀ. Removal of the prosthetic components

Ɓ. Operative exploration and decompression of the peroneal nerve

Ƃ. Nerve conduction velocity studies

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

Ƅ. I

Ƅ. II

Ɔ. III

Ƈ. decreased tissue tension

Ƈ. decreased abductor lever arm

Ɖ. decreased joint reaction force

Ɗ. increased body weight over lever arm

Ƌ. increased polyethylene wear rate

Ƌ. recurrent traumatic anterior dislocation

ƍ. recurrent traumatic posterior dislocation

Ǝ. traumatic subluxation with no previous dislocation

Ə. traumatic anterior subluxation

Ɛ. atraumatic involuntary subluxation

Ƒ. radial

Ƒ. axillary

Ɠ. suprascapular

Ɣ. thoracodorsal

Ƕ. long thoracic

Ɩ. Flexion

Ɨ. Extension

Ƙ. Axial rotation

Ƙ. Left lateral bending

Ƚ. Right lateral bending

ƛ. Skin

Ɯ. Lung

Ɲ. Brain

Ƞ. Heart

Ɵ. Kidney

Ơ. Thoracoacromial, lateral thoracic, subscapular

Ơ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƣ. Posterior humeral circumflex, subscapular, thoracacromial

Ƣ. Subscapular, thoracacromial, anterior humeral circumflex

Ƥ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƥ. Respondeat superior

Ʀ. Indemnity agreement

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

Ƨ. Comparative negligence-% of involvement

Ʃ. Contributory negligence- resident contributed to the negligence

ƪ. t-type

ƫ. both column

Ƭ. transverse

Ƭ. anterior column

Ʈ. anterior column posterior hemitransverse

Ư. Posterior interosseous

Ư. Anterior interosseous

Ʊ. Radial

Ʋ. Median

Ƴ. Ulnar

Ƴ. Shock from hypovolemia

Ƶ. Associated rupture of the bladder

Ƶ. Arterial bleeding on pelvic angiogram

Ʒ. Presence of a hematoma in the perineum and scrotum

Ƹ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. tricompartmental knee replacement

Explanation

Question 4191

Topic: 10. Pathology and Oncology

Which of the following factors is most likely to predispose a patient to dislocation of the patellar component following total knee arthoplasty?

. 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

-. Renal

.. T1-low, T2-low.

/. T1-low, T2-high.

0. T1-moderate, T2-low.

1. T1-high, T2-low.

2. T1-high, T2-high.

3. hypothesis is incorrect or invalid

4. interobserver error rate is 4%.

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

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

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

8. I

9. II

:. IV

;. IX

<. X

=. Cranial setting

>. Cranial subluxation

?. Odontoid fracture

@. Lysis of the arch of the atlas

A. Atlantoaxial subluxation

B. Retrograde collapse of the endoneurial tubes

C. Irreversible atrophy of the denervated muscles

D. Elongation of the axons across the zone of injury

E. Sprouting of the axons at the neuromuscular junction

F. Misdirection of the axons across the zone of injury

G. Maximally pronated and elbow extended

H. Maximally pronated and the elbow flexed

I. Maximally supinated and the elbow flexed

J. Maximally supinated and the elbow extended

K. In neutral rotation, with the elbow extended

L. open reduction and internal fixation

M. buddy taping to the adjacent index finger

N. early motion with application of a dynamic banjo splint

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

P. dorsal extension block splinting

Q. The name of the manufacturer

R. The manufacturer’s potential liability

S. The physician’s clinical performance

T. The physician’s materials testing data

U. Any royalties the physician receives from the manufacturer

V. Femoral

W. Obturator

X. Inferior gluteal

Y. Superior gluteal

Z. 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

A. Swan-neck deformity

B. Boutonniere deformity

C. Loss of distal interphalangeal joint flexion

D. Peroneus brevis to peroneus longus

E. Peroneus tertius to extensor hallucis longus

F. Peroneus tertius to superficial peroneal nerve

G. Extensor hallucis longus to deep peroneal nerve

H. Extensor hallucis longus to extensor digitorum longus

I. reassurance that Medicare will pay for the treatment.

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

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

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

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

N. an onlay iliac crest bone graft.

O. limited weightbearing and observation.

P. removal of the implant and limited weightbearing.

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

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

S. Coronal

T. Sagittal

U. Anteromedial, midway between the sagittal and the coronal

V. Proximal pins sagittal, distal pins coronal

W. Proximal pins coronal, distal pins sagittal

X. Rheumatoid arthritis

Y. Posttraumatic arthritis

Z. Degenerative osteoarthritis

{. Osteonecrosis of the tibial plateau

|. Osteonecrosis of the medial femoral condyle

}. Trapeziometacarpal arthrodesis

~. 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

. Creep

. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

¡. increasing action potential amplitude.

¢. blocking the opening of gated sodium channels.

£. decreasing the number of functional motor units.

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

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

¦. 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.

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

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

ª. hemiarthroplasty

«. open reduction and internal fixation

¬. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

¯. open acromioplasty

°. open Bankart repair

±. open subscapularis tendon repair

². inferior capsular shift

³. a supervised physical therapy program

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

Μ. open reduction and internal fixation through an anterior approach

¶. open reduction and internal fixation through a posterior approach

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

¸. arthroscopically assisted reduction and percutaneous screw fixation

¹. Repair of the rotator cuff

º. Replacement of the humeral head

». Resection arthroplasty

¼. Total shoulder arthroplasty

½. AP and lateral radiographs of the elbow

¾. Diagnositc arthroscopy

¿. Aspiration of joint fluid

À. An erythrocyte sedimentation rate and CBC

Á. A diagnostic lidocaine injection

Â. Insulin-like growth factor (IGF-1)

Ã. Fibroblast growth factor (FGF-1)

Ä. Platelet-derived growth factor (PDGF)

Å. Transforming growth factor beta (TGF-B)

Æ. Bone morphogenetic proteins (BMP)

Ç. clinical history and radiographic findings.

È. technetium bone scan

É. flow cytometry pattern of extracted chondrocytes

Ê. immunohistochemical staining patterns of a biopsy specimen

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

Ì. Radial

Í. Radial recurrent

Î. Posterior interosseous

Ï. Superior ulnar recurrent

Ð. Superficial radial circumflex

Ñ. Impaired hydroxylation of proline

Ò. Failure of cleavage in procollagen

Ó. Defective binding sites for hydroxyproline

Ô. Failure to incorporate glycine into the helix

Õ. Diminished production of collagen through the rough endoplasmic reticulum

Ö. Asking the legal staff to seek a court injunction

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

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

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

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

Û. Meta-analysis

Ü. Confidence interval

Ý. Analysis of variance (ANOVA)

Þ. Statistical significance (p-value)

SS. Survivorship analysis (Kaplan-Meier)

À. Spinal shock

Á. Neurogenic shock

Â. Hypovolemic shock

Ã. Pulmonary embolism

Ä. Fat embolus syndrome

Å. Lumbar spinal stenosis

Æ. Metastatic disease of the spine

Ç. Rheumatoid lumbar spondylitis

È. Isthmic spondyloloisthesis

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

Ê. Patella alta

Ë. A metal-backed patella

Ì. Varus malalignment of the knee

Í. A posterior cruciate-substituting femoral component

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

Ï. The sesamoids are separated

Ð. The sesamoid is fractured

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

Ò. The dislocation is dorsal and centered

Ó. The proximal phalanx is hyperextended

Ô. Patella

Õ. Tibial stem

Ö. Distal femoral interface

÷. Posterior femoral interface

Ø. Sites of screw fixation for the tibia

Ù. Hallux rigidus

Ú. Fracture of the sesamoid

Û. Disruption of the plantar plate

Ü. Osteonecrosis of the metatarsal head

Ý. Rupture of the flexor hallucis longus

Þ. Gout

Ÿ. Sepsis

Ā. Old trauma

Ā. Rheumatoid arthritis

Ă. Charcot arthroplasty

Ă. Aspiration and steroid injection

Ą. Biopsy, curettage, and allograft bone grafting

Ą. Percutaneous Kirschner wire fixation

Ć. Percutaneous injection of autogenous bone marrow

Ć. Nerve roots

Ĉ. Spinal cord

Ĉ. Sciatic nerve

Ċ. Peroneal nerve

Ċ. Conus medullaris

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

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

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

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

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

Đ. Early and late infection

Ē. Periprosthetic fracture of the femur

Ē. Failure of the patellofemoral and extensor mechanisms

Ĕ. Aseptic loosening of cementing tibial components

Ĕ. Asceptic loosening of cemented femoral components

Ė. Acceptance of the current position of the ankle

Ė. Open reduction and fixation in the epiphysis only

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

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

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

Ě. Resection arthroplasty and local radiation

Ĝ. In situ fusion of the hip

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

Ğ. Excision of heterotopic bone and local radiation

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

Ġ. Closed reduction of both fractures and immediate spica casting

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

Ģ. External fixation of both femora

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

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

Ĥ. Synovial sarcoma

Ħ. Soft-tissue abcess

Ħ. Rhabdomyosarcoma

Ĩ. Eosinophilic granuloma

Ĩ. Nodular pigmented villonodular synovitis

Ī. Changing to a titanium nail

Ī. Changing to a nonslotted nail

Ĭ. Changing the cross-sectional shape of the nail

Ĭ. Increasing the diameter of the nail by 3 mm

Į. Increasing the diameter of the interlocking screws

Į. Fracture healing

İ. Chondrosarcoma

I. Periosteal chondroma

Ĳ. Periosteal osteosarcoma

Ĳ. Dysplasia epiphysealis hemimelica

Ĵ. Demonstrate competence in the subject of the case

Ĵ. Be fellowship trained in the subject of the case

Ķ. Be paid on a contingency basis

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

ĸ. Have been involved in the case as a consultant

Ĺ. Diagnostic arthroscopy

Ĺ. Arthroscopy and subacromial decompression

Ļ. Reduction and fixation of the proximal humeral epiphysis

Ļ. Temporary cessation of throwing

Ľ. Physical therapy for rotator cuff strengthening

Ľ. Oblique popliteal ligament

Ŀ. Lateral capsule

Ŀ. Popliteal tendon

Ł. Fibular collateral ligament

Ł. Posterior oblique ligament

Ń. Radial tear

Ń. Parrot-beak tear

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

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

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

Ň. 0 degrees of abduction, with neural rotation

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

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

Ŋ. 90 degrees of abduction with neutral rotation

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

Ō. Sural

Ŏ. Saphenous and its branches

Ŏ. Posterior tibial and its branches

Ő. Deep peroneal and its branches

Ő. Superficial peroneal and its branches

Œ. Strength

Œ. Stiffness

Ŕ. Shelf life

Ŕ. Antigenicity

Ŗ. Risk of HIV transmission

Ŗ. Indemnification

Ř. Occurrence

Ř. Excess liability

Ś. Claims-made

Ś. Nose

Ŝ. Lateral Y

Ŝ. Scapular AP

Ş. Neutral rotation AP

Ş. Internal rotation AP

Š. External rotation AP

Š. Trauma

Ţ. Hemophilia

Ţ. Reiter’s syndrome

Ť. Rheumatoid arthritis

Ť. Systemic lupus erythematosus

Ŧ. Cast immobilization for 6 weeks

Ŧ. Activity modification and re-evaluation in 2 months

Ũ. Internal fixation with or without bone grafting

Ũ. Retrograde drilling of the defect without articular cartilage penetration

Ū. Drilling of the defect directly through the articular cartilage

Ū. repair or reconstruction of the medial collateral ligament

Ŭ. repair or reconstruction of the medialand lateral collateral ligaments

Ŭ. immobilization for 5 days or less

Ů. immobilization for 14 days

Ů. immobilization for 25 days

Ű. Cystinosis

Ű. Hypophosphatemia

Ų. Renal osteodystrophy

Ų. Primary hyperparathyroidism

Ŵ. Nutritional vitamin D deficiency

Ŵ. Lateral meniscus tear

Ŷ. Popliteus tenosynovitis

Ŷ. Iliotibial band friction syndrome

Ÿ. Peroneal nerve entrapment

Ź. Biceps tendinitis

Ź. Observation

Ż. Removal of the prosthetic components

Ż. Operative exploration and decompression of the peroneal nerve

Ž. Nerve conduction velocity studies

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

S. I

Ƀ. II

Ɓ. III

Ƃ. decreased tissue tension

Ƃ. decreased abductor lever arm

Ƅ. decreased joint reaction force

Ƅ. increased body weight over lever arm

Ɔ. increased polyethylene wear rate

Ƈ. recurrent traumatic anterior dislocation

Ƈ. recurrent traumatic posterior dislocation

Ɖ. traumatic subluxation with no previous dislocation

Ɗ. traumatic anterior subluxation

Ƌ. atraumatic involuntary subluxation

Ƌ. radial

ƍ. axillary

Ǝ. suprascapular

Ə. thoracodorsal

Ɛ. long thoracic

Ƒ. Flexion

Ƒ. Extension

Ɠ. Axial rotation

Ɣ. Left lateral bending

Ƕ. Right lateral bending

Ɩ. Skin

Ɨ. Lung

Ƙ. Brain

Ƙ. Heart

Ƚ. Kidney

ƛ. Thoracoacromial, lateral thoracic, subscapular

Ɯ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɲ. Posterior humeral circumflex, subscapular, thoracacromial

Ƞ. Subscapular, thoracacromial, anterior humeral circumflex

Ɵ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ơ. Respondeat superior

Ơ. Indemnity agreement

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

Ƣ. Comparative negligence-% of involvement

Ƥ. Contributory negligence- resident contributed to the negligence

Ƥ. t-type

Ʀ. both column

Ƨ. transverse

Ƨ. anterior column

Ʃ. anterior column posterior hemitransverse

ƪ. Posterior interosseous

ƫ. Anterior interosseous

Ƭ. Radial

Ƭ. Median

Ʈ. Ulnar

Ư. Shock from hypovolemia

Ư. Associated rupture of the bladder

Ʊ. Arterial bleeding on pelvic angiogram

Ʋ. Presence of a hematoma in the perineum and scrotum

Ƴ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Internal rotation of the femoral component

Explanation

Question 4192

Topic: 10. Pathology and Oncology

What is the most common sequela of turf toe (hyperextension of the first metatarsophalangeal joint)?

. 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.

-. T1-high, T2-high.

.. hypothesis is incorrect or invalid

/. interobserver error rate is 4%.

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

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

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

3. I

4. II

5. IV

6. IX

7. X

8. Cranial setting

9. 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

B. Maximally pronated and elbow extended

C. Maximally pronated and the elbow flexed

D. Maximally supinated and the elbow flexed

E. Maximally supinated and the elbow extended

F. In neutral rotation, with the elbow extended

G. open reduction and internal fixation

H. buddy taping to the adjacent index finger

I. early motion with application of a dynamic banjo splint

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

K. dorsal extension block splinting

L. The name of the manufacturer

M. The manufacturer’s potential liability

N. The physician’s clinical performance

O. The physician’s materials testing data

P. Any royalties the physician receives from the manufacturer

Q. Femoral

R. Obturator

S. Inferior gluteal

T. Superior gluteal

U. Lateral femoral cutaneous

V. open biopsy and a long leg cast

W. open biopsy and wide resection of the tumor

X. a long leg cast and observation

Y. intramedullary stabilization and observation

Z. 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

A. Peroneus tertius to superficial peroneal nerve

B. Extensor hallucis longus to deep peroneal nerve

C. Extensor hallucis longus to extensor digitorum longus

D. reassurance that Medicare will pay for the treatment.

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

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

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

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

I. an onlay iliac crest bone graft.

J. limited weightbearing and observation.

K. removal of the implant and limited weightbearing.

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

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

N. Coronal

O. Sagittal

P. Anteromedial, midway between the sagittal and the coronal

Q. Proximal pins sagittal, distal pins coronal

R. Proximal pins coronal, distal pins sagittal

S. Rheumatoid arthritis

T. Posttraumatic arthritis

U. Degenerative osteoarthritis

V. Osteonecrosis of the tibial plateau

W. Osteonecrosis of the medial femoral condyle

X. Trapeziometacarpal arthrodesis

Y. Osteotomy of the thumb metacarpal

Z. Arthrotomy and joint debridement

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

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

}. Creep

~. Relaxation

. Energy dissipation

. Plastic deformation

. Elastic deformation

. bending

. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

¡. 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.

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

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

¥. hemiarthroplasty

¦. open reduction and internal fixation

§. closed reduction and percutaneous pinning

¨. a sling and early pedulum exercises

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

ª. open acromioplasty

«. open Bankart repair

¬. open subscapularis tendon repair

. inferior capsular shift

®. a supervised physical therapy program

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

°. open reduction and internal fixation through an anterior approach

±. open reduction and internal fixation through a posterior approach

². immobilization with a splint in 45 degrees of abduction for 6 weeks

³. arthroscopically assisted reduction and percutaneous screw fixation

´. Repair of the rotator cuff

Μ. Replacement of the humeral head

¶. Resection arthroplasty

·. Total shoulder arthroplasty

¸. AP and lateral radiographs of the elbow

¹. Diagnositc arthroscopy

º. Aspiration of joint fluid

». An erythrocyte sedimentation rate and CBC

¼. A diagnostic lidocaine injection

½. Insulin-like growth factor (IGF-1)

¾. Fibroblast growth factor (FGF-1)

¿. Platelet-derived growth factor (PDGF)

À. Transforming growth factor beta (TGF-B)

Á. Bone morphogenetic proteins (BMP)

Â. clinical history and radiographic findings.

Ã. technetium bone scan

Ä. flow cytometry pattern of extracted chondrocytes

Å. immunohistochemical staining patterns of a biopsy specimen

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

Ç. Radial

È. Radial recurrent

É. Posterior interosseous

Ê. Superior ulnar recurrent

Ë. Superficial radial circumflex

Ì. Impaired hydroxylation of proline

Í. Failure of cleavage in procollagen

Î. Defective binding sites for hydroxyproline

Ï. Failure to incorporate glycine into the helix

Ð. Diminished production of collagen through the rough endoplasmic reticulum

Ñ. Asking the legal staff to seek a court injunction

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

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

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

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

Ö. Meta-analysis

×. Confidence interval

Ø. Analysis of variance (ANOVA)

Ù. Statistical significance (p-value)

Ú. Survivorship analysis (Kaplan-Meier)

Û. Spinal shock

Ü. Neurogenic shock

Ý. Hypovolemic shock

Þ. Pulmonary embolism

SS. Fat embolus syndrome

À. Lumbar spinal stenosis

Á. Metastatic disease of the spine

Â. Rheumatoid lumbar spondylitis

Ã. Isthmic spondyloloisthesis

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

Å. Patella alta

Æ. A metal-backed patella

Ç. Varus malalignment of the knee

È. A posterior cruciate-substituting femoral component

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

Ê. The sesamoids are separated

Ë. The sesamoid is fractured

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

Í. The dislocation is dorsal and centered

Î. The proximal phalanx is hyperextended

Ï. Patella

Ð. Tibial stem

Ñ. Distal femoral interface

Ò. Posterior femoral interface

Ó. Sites of screw fixation for the tibia

Ô. Hallux rigidus

Õ. Fracture of the sesamoid

Ö. Disruption of the plantar plate

÷. Osteonecrosis of the metatarsal head

Ø. Rupture of the flexor hallucis longus

Ù. Gout

Ú. Sepsis

Û. Old trauma

Ü. Rheumatoid arthritis

Ý. Charcot arthroplasty

Þ. Aspiration and steroid injection

Ÿ. Biopsy, curettage, and allograft bone grafting

Ā. Percutaneous Kirschner wire fixation

Ā. Percutaneous injection of autogenous bone marrow

Ă. Nerve roots

Ă. Spinal cord

Ą. Sciatic nerve

Ą. Peroneal nerve

Ć. Conus medullaris

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

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

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

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

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

Č. Early and late infection

Č. Periprosthetic fracture of the femur

Ď. Failure of the patellofemoral and extensor mechanisms

Ď. Aseptic loosening of cementing tibial components

Đ. Asceptic loosening of cemented femoral components

Đ. Acceptance of the current position of the ankle

Ē. Open reduction and fixation in the epiphysis only

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

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

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

Ė. Resection arthroplasty and local radiation

Ė. In situ fusion of the hip

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

Ę. Excision of heterotopic bone and local radiation

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

Ě. Closed reduction of both fractures and immediate spica casting

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

Ĝ. External fixation of both femora

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

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

Ġ. Synovial sarcoma

Ġ. Soft-tissue abcess

Ģ. Rhabdomyosarcoma

Ģ. Eosinophilic granuloma

Ĥ. Nodular pigmented villonodular synovitis

Ĥ. Changing to a titanium nail

Ħ. Changing to a nonslotted nail

Ħ. Changing the cross-sectional shape of the nail

Ĩ. Increasing the diameter of the nail by 3 mm

Ĩ. Increasing the diameter of the interlocking screws

Ī. Fracture healing

Ī. Chondrosarcoma

Ĭ. Periosteal chondroma

Ĭ. Periosteal osteosarcoma

Į. Dysplasia epiphysealis hemimelica

Į. Demonstrate competence in the subject of the case

İ. Be fellowship trained in the subject of the case

I. Be paid on a contingency basis

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

Ĳ. Have been involved in the case as a consultant

Ĵ. Diagnostic arthroscopy

Ĵ. Arthroscopy and subacromial decompression

Ķ. Reduction and fixation of the proximal humeral epiphysis

Ķ. Temporary cessation of throwing

ĸ. Physical therapy for rotator cuff strengthening

Ĺ. Oblique popliteal ligament

Ĺ. Lateral capsule

Ļ. Popliteal tendon

Ļ. Fibular collateral ligament

Ľ. Posterior oblique ligament

Ľ. Radial tear

Ŀ. Parrot-beak tear

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

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

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

Ń. 0 degrees of abduction, with neural rotation

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

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

Ņ. 90 degrees of abduction with neutral rotation

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

Ň. Sural

ʼN. Saphenous and its branches

Ŋ. Posterior tibial and its branches

Ŋ. Deep peroneal and its branches

Ō. Superficial peroneal and its branches

Ō. Strength

Ŏ. Stiffness

Ŏ. Shelf life

Ő. Antigenicity

Ő. Risk of HIV transmission

Œ. Indemnification

Œ. Occurrence

Ŕ. Excess liability

Ŕ. Claims-made

Ŗ. Nose

Ŗ. Lateral Y

Ř. Scapular AP

Ř. Neutral rotation AP

Ś. Internal rotation AP

Ś. External rotation AP

Ŝ. Trauma

Ŝ. Hemophilia

Ş. Reiter’s syndrome

Ş. Rheumatoid arthritis

Š. Systemic lupus erythematosus

Š. Cast immobilization for 6 weeks

Ţ. Activity modification and re-evaluation in 2 months

Ţ. Internal fixation with or without bone grafting

Ť. Retrograde drilling of the defect without articular cartilage penetration

Ť. Drilling of the defect directly through the articular cartilage

Ŧ. repair or reconstruction of the medial collateral ligament

Ŧ. repair or reconstruction of the medialand lateral collateral ligaments

Ũ. immobilization for 5 days or less

Ũ. immobilization for 14 days

Ū. immobilization for 25 days

Ū. Cystinosis

Ŭ. Hypophosphatemia

Ŭ. Renal osteodystrophy

Ů. Primary hyperparathyroidism

Ů. Nutritional vitamin D deficiency

Ű. Lateral meniscus tear

Ű. Popliteus tenosynovitis

Ų. Iliotibial band friction syndrome

Ų. Peroneal nerve entrapment

Ŵ. Biceps tendinitis

Ŵ. Observation

Ŷ. Removal of the prosthetic components

Ŷ. Operative exploration and decompression of the peroneal nerve

Ÿ. Nerve conduction velocity studies

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

Ź. I

Ż. II

Ż. III

Ž. decreased tissue tension

Ž. decreased abductor lever arm

S. decreased joint reaction force

Ƀ. increased body weight over lever arm

Ɓ. increased polyethylene wear rate

Ƃ. recurrent traumatic anterior dislocation

Ƃ. recurrent traumatic posterior dislocation

Ƅ. traumatic subluxation with no previous dislocation

Ƅ. traumatic anterior subluxation

Ɔ. atraumatic involuntary subluxation

Ƈ. radial

Ƈ. axillary

Ɖ. suprascapular

Ɗ. thoracodorsal

Ƌ. long thoracic

Ƌ. Flexion

ƍ. Extension

Ǝ. Axial rotation

Ə. Left lateral bending

Ɛ. Right lateral bending

Ƒ. Skin

Ƒ. Lung

Ɠ. Brain

Ɣ. Heart

Ƕ. Kidney

Ɩ. Thoracoacromial, lateral thoracic, subscapular

Ɨ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƙ. Posterior humeral circumflex, subscapular, thoracacromial

Ƙ. Subscapular, thoracacromial, anterior humeral circumflex

Ƚ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ƛ. Respondeat superior

Ɯ. Indemnity agreement

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

Ƞ. Comparative negligence-% of involvement

Ɵ. Contributory negligence- resident contributed to the negligence

Ơ. t-type

Ơ. both column

Ƣ. transverse

Ƣ. anterior column

Ƥ. anterior column posterior hemitransverse

Ƥ. Posterior interosseous

Ʀ. Anterior interosseous

Ƨ. Radial

Ƨ. Median

Ʃ. Ulnar

ƪ. Shock from hypovolemia

ƫ. Associated rupture of the bladder

Ƭ. Arterial bleeding on pelvic angiogram

Ƭ. Presence of a hematoma in the perineum and scrotum

Ʈ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Hallux rigidus

Explanation

Question 4193

Topic: 10. Pathology and Oncology

A radiograph of a 12-year-old boy who has had an insidious onset of pain in the right hip for the past 6 weeks shows diffuse narrowing of the joint space. Examination reveals that he is afrebile, and the range of motion of the hip is less than 50% of normal in all planes. Laboratory studies show an erythrocyte sedimentation rate of 21 mm/hr and a WBC of 11,000/mm3. What is the most likely diagnosis?

. 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.

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

.. I

/. II

0. IV

1. IX

2. X

3. Cranial setting

4. Cranial subluxation

5. Odontoid fracture

6. Lysis of the arch of the atlas

7. Atlantoaxial subluxation

8. Retrograde collapse of the endoneurial tubes

9. 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

B. open reduction and internal fixation

C. buddy taping to the adjacent index finger

D. early motion with application of a dynamic banjo splint

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

F. dorsal extension block splinting

G. The name of the manufacturer

H. The manufacturer’s potential liability

I. The physician’s clinical performance

J. The physician’s materials testing data

K. Any royalties the physician receives from the manufacturer

L. Femoral

M. Obturator

N. Inferior gluteal

O. Superior gluteal

P. Lateral femoral cutaneous

Q. open biopsy and a long leg cast

R. open biopsy and wide resection of the tumor

S. a long leg cast and observation

T. intramedullary stabilization and observation

U. Triggering

V. Lateral instability

W. Swan-neck deformity

X. Boutonniere deformity

Y. Loss of distal interphalangeal joint flexion

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

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

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

D. an onlay iliac crest bone graft.

E. limited weightbearing and observation.

F. removal of the implant and limited weightbearing.

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

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

I. Coronal

J. Sagittal

K. Anteromedial, midway between the sagittal and the coronal

L. Proximal pins sagittal, distal pins coronal

M. Proximal pins coronal, distal pins sagittal

N. Rheumatoid arthritis

O. Posttraumatic arthritis

P. Degenerative osteoarthritis

Q. Osteonecrosis of the tibial plateau

R. Osteonecrosis of the medial femoral condyle

S. Trapeziometacarpal arthrodesis

T. Osteotomy of the thumb metacarpal

U. Arthrotomy and joint debridement

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

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

X. Creep

Y. Relaxation

Z. Energy dissipation

{. Plastic deformation

|. Elastic deformation

}. bending

~. axial loading

. high-speed rotation

. direct impact from anteromedial

. crush from anteromedial to posterolateral

. Increase stiffness

. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

¡. open reduction and internal fixation

¢. closed reduction and percutaneous pinning

£. a sling and early pedulum exercises

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

¥. open acromioplasty

¦. open Bankart repair

§. open subscapularis tendon repair

¨. inferior capsular shift

©. a supervised physical therapy program

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

«. open reduction and internal fixation through an anterior approach

¬. open reduction and internal fixation through a posterior approach

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

®. arthroscopically assisted reduction and percutaneous screw fixation

¯. Repair of the rotator cuff

°. Replacement of the humeral head

±. Resection arthroplasty

². Total shoulder arthroplasty

³. AP and lateral radiographs of the elbow

´. Diagnositc arthroscopy

Μ. Aspiration of joint fluid

¶. An erythrocyte sedimentation rate and CBC

·. A diagnostic lidocaine injection

¸. Insulin-like growth factor (IGF-1)

¹. Fibroblast growth factor (FGF-1)

º. Platelet-derived growth factor (PDGF)

». Transforming growth factor beta (TGF-B)

¼. Bone morphogenetic proteins (BMP)

½. clinical history and radiographic findings.

¾. technetium bone scan

¿. flow cytometry pattern of extracted chondrocytes

À. immunohistochemical staining patterns of a biopsy specimen

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

Â. Radial

Ã. Radial recurrent

Ä. Posterior interosseous

Å. Superior ulnar recurrent

Æ. Superficial radial circumflex

Ç. Impaired hydroxylation of proline

È. Failure of cleavage in procollagen

É. Defective binding sites for hydroxyproline

Ê. Failure to incorporate glycine into the helix

Ë. Diminished production of collagen through the rough endoplasmic reticulum

Ì. Asking the legal staff to seek a court injunction

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

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

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

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

Ñ. Meta-analysis

Ò. Confidence interval

Ó. Analysis of variance (ANOVA)

Ô. Statistical significance (p-value)

Õ. Survivorship analysis (Kaplan-Meier)

Ö. Spinal shock

×. Neurogenic shock

Ø. Hypovolemic shock

Ù. Pulmonary embolism

Ú. Fat embolus syndrome

Û. Lumbar spinal stenosis

Ü. Metastatic disease of the spine

Ý. Rheumatoid lumbar spondylitis

Þ. Isthmic spondyloloisthesis

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

À. Patella alta

Á. A metal-backed patella

Â. Varus malalignment of the knee

Ã. A posterior cruciate-substituting femoral component

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

Å. The sesamoids are separated

Æ. The sesamoid is fractured

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

È. The dislocation is dorsal and centered

É. The proximal phalanx is hyperextended

Ê. Patella

Ë. Tibial stem

Ì. Distal femoral interface

Í. Posterior femoral interface

Î. Sites of screw fixation for the tibia

Ï. Hallux rigidus

Ð. Fracture of the sesamoid

Ñ. Disruption of the plantar plate

Ò. Osteonecrosis of the metatarsal head

Ó. Rupture of the flexor hallucis longus

Ô. Gout

Õ. Sepsis

Ö. Old trauma

÷. Rheumatoid arthritis

Ø. Charcot arthroplasty

Ù. Aspiration and steroid injection

Ú. Biopsy, curettage, and allograft bone grafting

Û. Percutaneous Kirschner wire fixation

Ü. Percutaneous injection of autogenous bone marrow

Ý. Nerve roots

Þ. Spinal cord

Ÿ. Sciatic nerve

Ā. Peroneal nerve

Ā. Conus medullaris

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

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

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

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

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

Ć. Early and late infection

Ĉ. Periprosthetic fracture of the femur

Ĉ. Failure of the patellofemoral and extensor mechanisms

Ċ. Aseptic loosening of cementing tibial components

Ċ. Asceptic loosening of cemented femoral components

Č. Acceptance of the current position of the ankle

Č. Open reduction and fixation in the epiphysis only

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

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

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

Đ. Resection arthroplasty and local radiation

Ē. In situ fusion of the hip

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

Ĕ. Excision of heterotopic bone and local radiation

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

Ė. Closed reduction of both fractures and immediate spica casting

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

Ę. External fixation of both femora

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

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

Ě. Synovial sarcoma

Ĝ. Soft-tissue abcess

Ĝ. Rhabdomyosarcoma

Ğ. Eosinophilic granuloma

Ğ. Nodular pigmented villonodular synovitis

Ġ. Changing to a titanium nail

Ġ. Changing to a nonslotted nail

Ģ. Changing the cross-sectional shape of the nail

Ģ. Increasing the diameter of the nail by 3 mm

Ĥ. Increasing the diameter of the interlocking screws

Ĥ. Fracture healing

Ħ. Chondrosarcoma

Ħ. Periosteal chondroma

Ĩ. Periosteal osteosarcoma

Ĩ. Dysplasia epiphysealis hemimelica

Ī. Demonstrate competence in the subject of the case

Ī. Be fellowship trained in the subject of the case

Ĭ. Be paid on a contingency basis

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

Į. Have been involved in the case as a consultant

Į. Diagnostic arthroscopy

İ. Arthroscopy and subacromial decompression

I. Reduction and fixation of the proximal humeral epiphysis

Ĳ. Temporary cessation of throwing

Ĳ. Physical therapy for rotator cuff strengthening

Ĵ. Oblique popliteal ligament

Ĵ. Lateral capsule

Ķ. Popliteal tendon

Ķ. Fibular collateral ligament

ĸ. Posterior oblique ligament

Ĺ. Radial tear

Ĺ. Parrot-beak tear

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

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

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

Ľ. 0 degrees of abduction, with neural rotation

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

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

Ł. 90 degrees of abduction with neutral rotation

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

Ń. Sural

Ń. Saphenous and its branches

Ņ. Posterior tibial and its branches

Ņ. Deep peroneal and its branches

Ň. Superficial peroneal and its branches

Ň. Strength

ʼN. Stiffness

Ŋ. Shelf life

Ŋ. Antigenicity

Ō. Risk of HIV transmission

Ō. Indemnification

Ŏ. Occurrence

Ŏ. Excess liability

Ő. Claims-made

Ő. Nose

Œ. Lateral Y

Œ. Scapular AP

Ŕ. Neutral rotation AP

Ŕ. Internal rotation AP

Ŗ. External rotation AP

Ŗ. Trauma

Ř. Hemophilia

Ř. Reiter’s syndrome

Ś. Rheumatoid arthritis

Ś. Systemic lupus erythematosus

Ŝ. Cast immobilization for 6 weeks

Ŝ. Activity modification and re-evaluation in 2 months

Ş. Internal fixation with or without bone grafting

Ş. Retrograde drilling of the defect without articular cartilage penetration

Š. Drilling of the defect directly through the articular cartilage

Š. repair or reconstruction of the medial collateral ligament

Ţ. repair or reconstruction of the medialand lateral collateral ligaments

Ţ. immobilization for 5 days or less

Ť. immobilization for 14 days

Ť. immobilization for 25 days

Ŧ. Cystinosis

Ŧ. Hypophosphatemia

Ũ. Renal osteodystrophy

Ũ. Primary hyperparathyroidism

Ū. Nutritional vitamin D deficiency

Ū. Lateral meniscus tear

Ŭ. Popliteus tenosynovitis

Ŭ. Iliotibial band friction syndrome

Ů. Peroneal nerve entrapment

Ů. Biceps tendinitis

Ű. Observation

Ű. Removal of the prosthetic components

Ų. Operative exploration and decompression of the peroneal nerve

Ų. Nerve conduction velocity studies

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

Ŵ. I

Ŷ. II

Ŷ. III

Ÿ. decreased tissue tension

Ź. decreased abductor lever arm

Ź. decreased joint reaction force

Ż. increased body weight over lever arm

Ż. increased polyethylene wear rate

Ž. recurrent traumatic anterior dislocation

Ž. recurrent traumatic posterior dislocation

S. traumatic subluxation with no previous dislocation

Ƀ. traumatic anterior subluxation

Ɓ. atraumatic involuntary subluxation

Ƃ. radial

Ƃ. axillary

Ƅ. suprascapular

Ƅ. thoracodorsal

Ɔ. long thoracic

Ƈ. Flexion

Ƈ. Extension

Ɖ. Axial rotation

Ɗ. Left lateral bending

Ƌ. Right lateral bending

Ƌ. Skin

ƍ. Lung

Ǝ. Brain

Ə. Heart

Ɛ. Kidney

Ƒ. Thoracoacromial, lateral thoracic, subscapular

Ƒ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɠ. Posterior humeral circumflex, subscapular, thoracacromial

Ɣ. Subscapular, thoracacromial, anterior humeral circumflex

Ƕ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ɩ. Respondeat superior

Ɨ. Indemnity agreement

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

Ƙ. Comparative negligence-% of involvement

Ƚ. Contributory negligence- resident contributed to the negligence

ƛ. t-type

Ɯ. both column

Ɲ. transverse

Ƞ. anterior column

Ɵ. anterior column posterior hemitransverse

Ơ. Posterior interosseous

Ơ. Anterior interosseous

Ƣ. Radial

Ƣ. Median

Ƥ. Ulnar

Ƥ. Shock from hypovolemia

Ʀ. Associated rupture of the bladder

Ƨ. Arterial bleeding on pelvic angiogram

Ƨ. Presence of a hematoma in the perineum and scrotum

Ʃ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Sickle cell crisis

Explanation

Question 4194

Topic: 10. Pathology and Oncology

Figures 42a and 42b show the sagittal and axial MRI scans of a 24-year-old patient who has sciatia. Which of the following combinations of physical findings is most consistent wit the MRI studies?

. 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

-. X

.. Cranial setting

/. Cranial subluxation

0. Odontoid fracture

1. Lysis of the arch of the atlas

2. Atlantoaxial subluxation

3. Retrograde collapse of the endoneurial tubes

4. Irreversible atrophy of the denervated muscles

5. Elongation of the axons across the zone of injury

6. Sprouting of the axons at the neuromuscular junction

7. Misdirection of the axons across the zone of injury

8. Maximally pronated and elbow extended

9. 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

B. The name of the manufacturer

C. The manufacturer’s potential liability

D. The physician’s clinical performance

E. The physician’s materials testing data

F. Any royalties the physician receives from the manufacturer

G. Femoral

H. Obturator

I. Inferior gluteal

J. Superior gluteal

K. Lateral femoral cutaneous

L. open biopsy and a long leg cast

M. open biopsy and wide resection of the tumor

N. a long leg cast and observation

O. intramedullary stabilization and observation

P. Triggering

Q. Lateral instability

R. Swan-neck deformity

S. Boutonniere deformity

T. Loss of distal interphalangeal joint flexion

U. Peroneus brevis to peroneus longus

V. Peroneus tertius to extensor hallucis longus

W. Peroneus tertius to superficial peroneal nerve

X. Extensor hallucis longus to deep peroneal nerve

Y. Extensor hallucis longus to extensor digitorum longus

Z. 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.

A. removal of the implant and limited weightbearing.

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

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

D. Coronal

E. Sagittal

F. Anteromedial, midway between the sagittal and the coronal

G. Proximal pins sagittal, distal pins coronal

H. Proximal pins coronal, distal pins sagittal

I. Rheumatoid arthritis

J. Posttraumatic arthritis

K. Degenerative osteoarthritis

L. Osteonecrosis of the tibial plateau

M. Osteonecrosis of the medial femoral condyle

N. Trapeziometacarpal arthrodesis

O. Osteotomy of the thumb metacarpal

P. Arthrotomy and joint debridement

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

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

S. Creep

T. Relaxation

U. Energy dissipation

V. Plastic deformation

W. Elastic deformation

X. bending

Y. axial loading

Z. high-speed rotation

{. direct impact from anteromedial

|. crush from anteromedial to posterolateral

}. Increase stiffness

~. Increase fracture toughness

. Increase fatigue strength

. Decrease mechanical strength

. Decrease wear rate

. disuse osteopenia

. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

¡. open Bankart repair

¢. open subscapularis tendon repair

£. inferior capsular shift

¤. a supervised physical therapy program

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

¦. open reduction and internal fixation through an anterior approach

§. open reduction and internal fixation through a posterior approach

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

©. arthroscopically assisted reduction and percutaneous screw fixation

ª. Repair of the rotator cuff

«. Replacement of the humeral head

¬. Resection arthroplasty

. Total shoulder arthroplasty

®. AP and lateral radiographs of the elbow

¯. Diagnositc arthroscopy

°. Aspiration of joint fluid

±. An erythrocyte sedimentation rate and CBC

². A diagnostic lidocaine injection

³. Insulin-like growth factor (IGF-1)

´. Fibroblast growth factor (FGF-1)

Μ. Platelet-derived growth factor (PDGF)

¶. Transforming growth factor beta (TGF-B)

·. Bone morphogenetic proteins (BMP)

¸. clinical history and radiographic findings.

¹. technetium bone scan

º. flow cytometry pattern of extracted chondrocytes

». immunohistochemical staining patterns of a biopsy specimen

¼. histologic features of a biopsy specimen stained with hematoxylin-cosin

½. Radial

¾. Radial recurrent

¿. Posterior interosseous

À. Superior ulnar recurrent

Á. Superficial radial circumflex

Â. Impaired hydroxylation of proline

Ã. Failure of cleavage in procollagen

Ä. Defective binding sites for hydroxyproline

Å. Failure to incorporate glycine into the helix

Æ. Diminished production of collagen through the rough endoplasmic reticulum

Ç. Asking the legal staff to seek a court injunction

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

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

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

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

Ì. Meta-analysis

Í. Confidence interval

Î. Analysis of variance (ANOVA)

Ï. Statistical significance (p-value)

Ð. Survivorship analysis (Kaplan-Meier)

Ñ. Spinal shock

Ò. Neurogenic shock

Ó. Hypovolemic shock

Ô. Pulmonary embolism

Õ. Fat embolus syndrome

Ö. Lumbar spinal stenosis

×. Metastatic disease of the spine

Ø. Rheumatoid lumbar spondylitis

Ù. Isthmic spondyloloisthesis

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

Û. Patella alta

Ü. A metal-backed patella

Ý. Varus malalignment of the knee

Þ. A posterior cruciate-substituting femoral component

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

À. The sesamoids are separated

Á. The sesamoid is fractured

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

Ã. The dislocation is dorsal and centered

Ä. The proximal phalanx is hyperextended

Å. Patella

Æ. Tibial stem

Ç. Distal femoral interface

È. Posterior femoral interface

É. Sites of screw fixation for the tibia

Ê. Hallux rigidus

Ë. Fracture of the sesamoid

Ì. Disruption of the plantar plate

Í. Osteonecrosis of the metatarsal head

Î. Rupture of the flexor hallucis longus

Ï. Gout

Ð. Sepsis

Ñ. Old trauma

Ò. Rheumatoid arthritis

Ó. Charcot arthroplasty

Ô. Aspiration and steroid injection

Õ. Biopsy, curettage, and allograft bone grafting

Ö. Percutaneous Kirschner wire fixation

÷. Percutaneous injection of autogenous bone marrow

Ø. Nerve roots

Ù. Spinal cord

Ú. Sciatic nerve

Û. Peroneal nerve

Ü. Conus medullaris

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

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

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

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

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

Ă. Early and late infection

Ă. Periprosthetic fracture of the femur

Ą. Failure of the patellofemoral and extensor mechanisms

Ą. Aseptic loosening of cementing tibial components

Ć. Asceptic loosening of cemented femoral components

Ć. Acceptance of the current position of the ankle

Ĉ. Open reduction and fixation in the epiphysis only

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

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

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

Č. Resection arthroplasty and local radiation

Č. In situ fusion of the hip

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

Ď. Excision of heterotopic bone and local radiation

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

Đ. Closed reduction of both fractures and immediate spica casting

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

Ē. External fixation of both femora

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

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

Ė. Synovial sarcoma

Ė. Soft-tissue abcess

Ę. Rhabdomyosarcoma

Ę. Eosinophilic granuloma

Ě. Nodular pigmented villonodular synovitis

Ě. Changing to a titanium nail

Ĝ. Changing to a nonslotted nail

Ĝ. Changing the cross-sectional shape of the nail

Ğ. Increasing the diameter of the nail by 3 mm

Ğ. Increasing the diameter of the interlocking screws

Ġ. Fracture healing

Ġ. Chondrosarcoma

Ģ. Periosteal chondroma

Ģ. Periosteal osteosarcoma

Ĥ. Dysplasia epiphysealis hemimelica

Ĥ. Demonstrate competence in the subject of the case

Ħ. Be fellowship trained in the subject of the case

Ħ. Be paid on a contingency basis

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

Ĩ. Have been involved in the case as a consultant

Ī. Diagnostic arthroscopy

Ī. Arthroscopy and subacromial decompression

Ĭ. Reduction and fixation of the proximal humeral epiphysis

Ĭ. Temporary cessation of throwing

Į. Physical therapy for rotator cuff strengthening

Į. Oblique popliteal ligament

İ. Lateral capsule

I. Popliteal tendon

Ĳ. Fibular collateral ligament

Ĳ. Posterior oblique ligament

Ĵ. Radial tear

Ĵ. Parrot-beak tear

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

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

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

Ĺ. 0 degrees of abduction, with neural rotation

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

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

Ļ. 90 degrees of abduction with neutral rotation

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

Ľ. Sural

Ŀ. Saphenous and its branches

Ŀ. Posterior tibial and its branches

Ł. Deep peroneal and its branches

Ł. Superficial peroneal and its branches

Ń. Strength

Ń. Stiffness

Ņ. Shelf life

Ņ. Antigenicity

Ň. Risk of HIV transmission

Ň. Indemnification

ʼN. Occurrence

Ŋ. Excess liability

Ŋ. Claims-made

Ō. Nose

Ō. Lateral Y

Ŏ. Scapular AP

Ŏ. Neutral rotation AP

Ő. Internal rotation AP

Ő. External rotation AP

Œ. Trauma

Œ. Hemophilia

Ŕ. Reiter’s syndrome

Ŕ. Rheumatoid arthritis

Ŗ. Systemic lupus erythematosus

Ŗ. Cast immobilization for 6 weeks

Ř. Activity modification and re-evaluation in 2 months

Ř. Internal fixation with or without bone grafting

Ś. Retrograde drilling of the defect without articular cartilage penetration

Ś. Drilling of the defect directly through the articular cartilage

Ŝ. repair or reconstruction of the medial collateral ligament

Ŝ. repair or reconstruction of the medialand lateral collateral ligaments

Ş. immobilization for 5 days or less

Ş. immobilization for 14 days

Š. immobilization for 25 days

Š. Cystinosis

Ţ. Hypophosphatemia

Ţ. Renal osteodystrophy

Ť. Primary hyperparathyroidism

Ť. Nutritional vitamin D deficiency

Ŧ. Lateral meniscus tear

Ŧ. Popliteus tenosynovitis

Ũ. Iliotibial band friction syndrome

Ũ. Peroneal nerve entrapment

Ū. Biceps tendinitis

Ū. Observation

Ŭ. Removal of the prosthetic components

Ŭ. Operative exploration and decompression of the peroneal nerve

Ů. Nerve conduction velocity studies

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

Ű. I

Ű. II

Ų. III

Ų. decreased tissue tension

Ŵ. decreased abductor lever arm

Ŵ. decreased joint reaction force

Ŷ. increased body weight over lever arm

Ŷ. increased polyethylene wear rate

Ÿ. recurrent traumatic anterior dislocation

Ź. recurrent traumatic posterior dislocation

Ź. traumatic subluxation with no previous dislocation

Ż. traumatic anterior subluxation

Ż. atraumatic involuntary subluxation

Ž. radial

Ž. axillary

S. suprascapular

Ƀ. thoracodorsal

Ɓ. long thoracic

Ƃ. Flexion

Ƃ. Extension

Ƅ. Axial rotation

Ƅ. Left lateral bending

Ɔ. Right lateral bending

Ƈ. Skin

Ƈ. Lung

Ɖ. Brain

Ɗ. Heart

Ƌ. Kidney

Ƌ. Thoracoacromial, lateral thoracic, subscapular

ƍ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ǝ. Posterior humeral circumflex, subscapular, thoracacromial

Ə. Subscapular, thoracacromial, anterior humeral circumflex

Ɛ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƒ. Respondeat superior

Ƒ. Indemnity agreement

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

Ɣ. Comparative negligence-% of involvement

Ƕ. Contributory negligence- resident contributed to the negligence

Ɩ. t-type

Ɨ. both column

Ƙ. transverse

Ƙ. anterior column

Ƚ. anterior column posterior hemitransverse

ƛ. Posterior interosseous

Ɯ. Anterior interosseous

Ɲ. Radial

Ƞ. Median

Ɵ. Ulnar

Ơ. Shock from hypovolemia

Ơ. Associated rupture of the bladder

Ƣ. Arterial bleeding on pelvic angiogram

Ƣ. Presence of a hematoma in the perineum and scrotum

Ƥ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Decreased ankle jerk and positive femoral nerve stretch test

Explanation

Question 4195

Topic: 10. Pathology and Oncology

An otherwise healthy 65-year-old man has had chronic pain in his prosthetic knee for the past 9 months. Repeated aspirations reveal a coagulase-negative staphylococcus infection. To eradicate the infection while maintaining the best possible joint function, management should consist of

. 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

-. Atlantoaxial subluxation

.. Retrograde collapse of the endoneurial tubes

/. Irreversible atrophy of the denervated muscles

0. Elongation of the axons across the zone of injury

1. Sprouting of the axons at the neuromuscular junction

2. Misdirection of the axons across the zone of injury

3. Maximally pronated and elbow extended

4. Maximally pronated and the elbow flexed

5. Maximally supinated and the elbow flexed

6. Maximally supinated and the elbow extended

7. In neutral rotation, with the elbow extended

8. open reduction and internal fixation

9. 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

B. Femoral

C. Obturator

D. Inferior gluteal

E. Superior gluteal

F. Lateral femoral cutaneous

G. open biopsy and a long leg cast

H. open biopsy and wide resection of the tumor

I. a long leg cast and observation

J. intramedullary stabilization and observation

K. Triggering

L. Lateral instability

M. Swan-neck deformity

N. Boutonniere deformity

O. Loss of distal interphalangeal joint flexion

P. Peroneus brevis to peroneus longus

Q. Peroneus tertius to extensor hallucis longus

R. Peroneus tertius to superficial peroneal nerve

S. Extensor hallucis longus to deep peroneal nerve

T. Extensor hallucis longus to extensor digitorum longus

U. reassurance that Medicare will pay for the treatment.

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

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

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

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

Z. 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

A. Anteromedial, midway between the sagittal and the coronal

B. Proximal pins sagittal, distal pins coronal

C. Proximal pins coronal, distal pins sagittal

D. Rheumatoid arthritis

E. Posttraumatic arthritis

F. Degenerative osteoarthritis

G. Osteonecrosis of the tibial plateau

H. Osteonecrosis of the medial femoral condyle

I. Trapeziometacarpal arthrodesis

J. Osteotomy of the thumb metacarpal

K. Arthrotomy and joint debridement

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

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

N. Creep

O. Relaxation

P. Energy dissipation

Q. Plastic deformation

R. Elastic deformation

S. bending

T. axial loading

U. high-speed rotation

V. direct impact from anteromedial

W. crush from anteromedial to posterolateral

X. Increase stiffness

Y. Increase fracture toughness

Z. Increase fatigue strength

{. Decrease mechanical strength

|. Decrease wear rate

}. disuse osteopenia

~. paraendocrine effect of the tumor

. abnormally increased density on the right side

. side effect of the treatment of the lesion

. extensive tumor involvement of the left hip

. Sciatic nerve

. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

¡. open reduction and internal fixation through an anterior approach

¢. open reduction and internal fixation through a posterior approach

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

¤. arthroscopically assisted reduction and percutaneous screw fixation

¥. Repair of the rotator cuff

¦. Replacement of the humeral head

§. Resection arthroplasty

¨. Total shoulder arthroplasty

ª. Diagnositc arthroscopy

«. Aspiration of joint fluid

¬. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

®. Insulin-like growth factor (IGF-1)

¯. Fibroblast growth factor (FGF-1)

°. Platelet-derived growth factor (PDGF)

±. Transforming growth factor beta (TGF-B)

². Bone morphogenetic proteins (BMP)

³. clinical history and radiographic findings.

´. technetium bone scan

Μ. flow cytometry pattern of extracted chondrocytes

¶. immunohistochemical staining patterns of a biopsy specimen

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

¸. Radial

¹. Radial recurrent

º. Posterior interosseous

». Superior ulnar recurrent

¼. Superficial radial circumflex

½. Impaired hydroxylation of proline

¾. Failure of cleavage in procollagen

¿. Defective binding sites for hydroxyproline

À. Failure to incorporate glycine into the helix

Á. Diminished production of collagen through the rough endoplasmic reticulum

Â. Asking the legal staff to seek a court injunction

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

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

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

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

Ç. Meta-analysis

È. Confidence interval

É. Analysis of variance (ANOVA)

Ê. Statistical significance (p-value)

Ë. Survivorship analysis (Kaplan-Meier)

Ì. Spinal shock

Í. Neurogenic shock

Î. Hypovolemic shock

Ï. Pulmonary embolism

Ð. Fat embolus syndrome

Ñ. Lumbar spinal stenosis

Ò. Metastatic disease of the spine

Ó. Rheumatoid lumbar spondylitis

Ô. Isthmic spondyloloisthesis

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

Ö. Patella alta

×. A metal-backed patella

Ø. Varus malalignment of the knee

Ù. A posterior cruciate-substituting femoral component

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

Û. The sesamoids are separated

Ü. The sesamoid is fractured

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

Þ. The dislocation is dorsal and centered

SS. The proximal phalanx is hyperextended

À. Patella

Á. Tibial stem

Â. Distal femoral interface

Ã. Posterior femoral interface

Ä. Sites of screw fixation for the tibia

Å. Hallux rigidus

Æ. Fracture of the sesamoid

Ç. Disruption of the plantar plate

È. Osteonecrosis of the metatarsal head

É. Rupture of the flexor hallucis longus

Ê. Gout

Ë. Sepsis

Ì. Old trauma

Í. Rheumatoid arthritis

Î. Charcot arthroplasty

Ï. Aspiration and steroid injection

Ð. Biopsy, curettage, and allograft bone grafting

Ñ. Percutaneous Kirschner wire fixation

Ò. Percutaneous injection of autogenous bone marrow

Ó. Nerve roots

Ô. Spinal cord

Õ. Sciatic nerve

Ö. Peroneal nerve

÷. Conus medullaris

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

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

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

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

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

Ý. Early and late infection

Þ. Periprosthetic fracture of the femur

Ÿ. Failure of the patellofemoral and extensor mechanisms

Ā. Aseptic loosening of cementing tibial components

Ā. Asceptic loosening of cemented femoral components

Ă. Acceptance of the current position of the ankle

Ă. Open reduction and fixation in the epiphysis only

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

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

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

Ć. Resection arthroplasty and local radiation

Ĉ. In situ fusion of the hip

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

Ċ. Excision of heterotopic bone and local radiation

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

Č. Closed reduction of both fractures and immediate spica casting

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

Ď. External fixation of both femora

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

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

Đ. Synovial sarcoma

Ē. Soft-tissue abcess

Ē. Rhabdomyosarcoma

Ĕ. Eosinophilic granuloma

Ĕ. Nodular pigmented villonodular synovitis

Ė. Changing to a titanium nail

Ė. Changing to a nonslotted nail

Ę. Changing the cross-sectional shape of the nail

Ę. Increasing the diameter of the nail by 3 mm

Ě. Increasing the diameter of the interlocking screws

Ě. Fracture healing

Ĝ. Chondrosarcoma

Ĝ. Periosteal chondroma

Ğ. Periosteal osteosarcoma

Ğ. Dysplasia epiphysealis hemimelica

Ġ. Demonstrate competence in the subject of the case

Ġ. Be fellowship trained in the subject of the case

Ģ. Be paid on a contingency basis

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

Ĥ. Have been involved in the case as a consultant

Ĥ. Diagnostic arthroscopy

Ħ. Arthroscopy and subacromial decompression

Ħ. Reduction and fixation of the proximal humeral epiphysis

Ĩ. Temporary cessation of throwing

Ĩ. Physical therapy for rotator cuff strengthening

Ī. Oblique popliteal ligament

Ī. Lateral capsule

Ĭ. Popliteal tendon

Ĭ. Fibular collateral ligament

Į. Posterior oblique ligament

Į. Radial tear

İ. Parrot-beak tear

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

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

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

Ĵ. 0 degrees of abduction, with neural rotation

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

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

Ķ. 90 degrees of abduction with neutral rotation

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

Ĺ. Sural

Ĺ. Saphenous and its branches

Ļ. Posterior tibial and its branches

Ļ. Deep peroneal and its branches

Ľ. Superficial peroneal and its branches

Ľ. Strength

Ŀ. Stiffness

Ŀ. Shelf life

Ł. Antigenicity

Ł. Risk of HIV transmission

Ń. Indemnification

Ń. Occurrence

Ņ. Excess liability

Ņ. Claims-made

Ň. Nose

Ň. Lateral Y

ʼN. Scapular AP

Ŋ. Neutral rotation AP

Ŋ. Internal rotation AP

Ō. External rotation AP

Ō. Trauma

Ŏ. Hemophilia

Ŏ. Reiter’s syndrome

Ő. Rheumatoid arthritis

Ő. Systemic lupus erythematosus

Œ. Cast immobilization for 6 weeks

Œ. Activity modification and re-evaluation in 2 months

Ŕ. Internal fixation with or without bone grafting

Ŕ. Retrograde drilling of the defect without articular cartilage penetration

Ŗ. Drilling of the defect directly through the articular cartilage

Ŗ. repair or reconstruction of the medial collateral ligament

Ř. repair or reconstruction of the medialand lateral collateral ligaments

Ř. immobilization for 5 days or less

Ś. immobilization for 14 days

Ś. immobilization for 25 days

Ŝ. Cystinosis

Ŝ. Hypophosphatemia

Ş. Renal osteodystrophy

Ş. Primary hyperparathyroidism

Š. Nutritional vitamin D deficiency

Š. Lateral meniscus tear

Ţ. Popliteus tenosynovitis

Ţ. Iliotibial band friction syndrome

Ť. Peroneal nerve entrapment

Ť. Biceps tendinitis

Ŧ. Observation

Ŧ. Removal of the prosthetic components

Ũ. Operative exploration and decompression of the peroneal nerve

Ũ. Nerve conduction velocity studies

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

Ū. I

Ŭ. II

Ŭ. III

Ů. decreased tissue tension

Ů. decreased abductor lever arm

Ű. decreased joint reaction force

Ű. increased body weight over lever arm

Ų. increased polyethylene wear rate

Ų. recurrent traumatic anterior dislocation

Ŵ. recurrent traumatic posterior dislocation

Ŵ. traumatic subluxation with no previous dislocation

Ŷ. traumatic anterior subluxation

Ŷ. atraumatic involuntary subluxation

Ÿ. radial

Ź. axillary

Ź. suprascapular

Ż. thoracodorsal

Ż. long thoracic

Ž. Flexion

Ž. Extension

S. Axial rotation

Ƀ. Left lateral bending

Ɓ. Right lateral bending

Ƃ. Skin

Ƃ. Lung

Ƅ. Brain

Ƅ. Heart

Ɔ. Kidney

Ƈ. Thoracoacromial, lateral thoracic, subscapular

Ƈ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ɖ. Posterior humeral circumflex, subscapular, thoracacromial

Ɗ. Subscapular, thoracacromial, anterior humeral circumflex

Ƌ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƌ. Respondeat superior

ƍ. Indemnity agreement

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

Ə. Comparative negligence-% of involvement

Ɛ. Contributory negligence- resident contributed to the negligence

Ƒ. t-type

Ƒ. both column

Ɠ. transverse

Ɣ. anterior column

Ƕ. anterior column posterior hemitransverse

Ɩ. Posterior interosseous

Ɨ. Anterior interosseous

Ƙ. Radial

Ƙ. Median

Ƚ. Ulnar

ƛ. Shock from hypovolemia

Ɯ. Associated rupture of the bladder

Ɲ. Arterial bleeding on pelvic angiogram

Ƞ. Presence of a hematoma in the perineum and scrotum

Ɵ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Long-term administration of IV and oral antibiotics

Explanation

Question 4196

Topic: 10. Pathology and Oncology

Figures 43a and 43b show the radiographs of an 8-year-old boy who was referred by his gym teacher because of an awkward running pattern. The patient denies any pain in his hips. Examination reveals a mild Trendelenberg gait and decreased internal rotation of the left hip to 25 degrees compared to 40 degrees on the right. What is the most likely diagnosis?

. 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

-. Misdirection of the axons across the zone of injury

.. Maximally pronated and elbow extended

/. Maximally pronated and the elbow flexed

0. Maximally supinated and the elbow flexed

1. Maximally supinated and the elbow extended

2. In neutral rotation, with the elbow extended

3. open reduction and internal fixation

4. buddy taping to the adjacent index finger

5. early motion with application of a dynamic banjo splint

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

7. dorsal extension block splinting

8. The name of the manufacturer

9. 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

A. Lateral femoral cutaneous

B. open biopsy and a long leg cast

C. open biopsy and wide resection of the tumor

D. a long leg cast and observation

E. intramedullary stabilization and observation

F. Triggering

G. Lateral instability

H. Swan-neck deformity

I. Boutonniere deformity

J. Loss of distal interphalangeal joint flexion

K. Peroneus brevis to peroneus longus

L. Peroneus tertius to extensor hallucis longus

M. Peroneus tertius to superficial peroneal nerve

N. Extensor hallucis longus to deep peroneal nerve

O. Extensor hallucis longus to extensor digitorum longus

P. reassurance that Medicare will pay for the treatment.

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

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

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

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

U. an onlay iliac crest bone graft.

V. limited weightbearing and observation.

W. removal of the implant and limited weightbearing.

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

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

Z. 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

A. Degenerative osteoarthritis

B. Osteonecrosis of the tibial plateau

C. Osteonecrosis of the medial femoral condyle

D. Trapeziometacarpal arthrodesis

E. Osteotomy of the thumb metacarpal

F. Arthrotomy and joint debridement

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

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

I. Creep

J. Relaxation

K. Energy dissipation

L. Plastic deformation

M. Elastic deformation

N. bending

O. axial loading

P. high-speed rotation

Q. direct impact from anteromedial

R. crush from anteromedial to posterolateral

S. Increase stiffness

T. Increase fracture toughness

U. Increase fatigue strength

V. Decrease mechanical strength

W. Decrease wear rate

X. disuse osteopenia

Y. paraendocrine effect of the tumor

Z. abnormally increased density on the right side

{. side effect of the treatment of the lesion

|. extensive tumor involvement of the left hip

}. Sciatic nerve

~. Superior gluteal artery

. Profunda femoris artery

. Femoral artery and nerve

. External iliac artery and vein

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

¡. Replacement of the humeral head

¢. Resection arthroplasty

£. Total shoulder arthroplasty

¤. AP and lateral radiographs of the elbow

¥. Diagnositc arthroscopy

¦. Aspiration of joint fluid

§. An erythrocyte sedimentation rate and CBC

¨. A diagnostic lidocaine injection

ª. Fibroblast growth factor (FGF-1)

«. Platelet-derived growth factor (PDGF)

¬. Transforming growth factor beta (TGF-B)

. Bone morphogenetic proteins (BMP)

®. clinical history and radiographic findings.

¯. technetium bone scan

°. flow cytometry pattern of extracted chondrocytes

±. immunohistochemical staining patterns of a biopsy specimen

². histologic features of a biopsy specimen stained with hematoxylin-cosin

³. Radial

´. Radial recurrent

Μ. Posterior interosseous

¶. Superior ulnar recurrent

·. Superficial radial circumflex

¸. Impaired hydroxylation of proline

¹. Failure of cleavage in procollagen

º. Defective binding sites for hydroxyproline

». Failure to incorporate glycine into the helix

¼. Diminished production of collagen through the rough endoplasmic reticulum

½. Asking the legal staff to seek a court injunction

¾. Copying the patient’s chart and giving it to him as he leaves

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

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

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

Â. Meta-analysis

Ã. Confidence interval

Ä. Analysis of variance (ANOVA)

Å. Statistical significance (p-value)

Æ. Survivorship analysis (Kaplan-Meier)

Ç. Spinal shock

È. Neurogenic shock

É. Hypovolemic shock

Ê. Pulmonary embolism

Ë. Fat embolus syndrome

Ì. Lumbar spinal stenosis

Í. Metastatic disease of the spine

Î. Rheumatoid lumbar spondylitis

Ï. Isthmic spondyloloisthesis

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

Ñ. Patella alta

Ò. A metal-backed patella

Ó. Varus malalignment of the knee

Ô. A posterior cruciate-substituting femoral component

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

Ö. The sesamoids are separated

×. The sesamoid is fractured

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

Ù. The dislocation is dorsal and centered

Ú. The proximal phalanx is hyperextended

Û. Patella

Ü. Tibial stem

Ý. Distal femoral interface

Þ. Posterior femoral interface

SS. Sites of screw fixation for the tibia

À. Hallux rigidus

Á. Fracture of the sesamoid

Â. Disruption of the plantar plate

Ã. Osteonecrosis of the metatarsal head

Ä. Rupture of the flexor hallucis longus

Å. Gout

Æ. Sepsis

Ç. Old trauma

È. Rheumatoid arthritis

É. Charcot arthroplasty

Ê. Aspiration and steroid injection

Ë. Biopsy, curettage, and allograft bone grafting

Ì. Percutaneous Kirschner wire fixation

Í. Percutaneous injection of autogenous bone marrow

Î. Nerve roots

Ï. Spinal cord

Ð. Sciatic nerve

Ñ. Peroneal nerve

Ò. Conus medullaris

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

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

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

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

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

Ø. Early and late infection

Ù. Periprosthetic fracture of the femur

Ú. Failure of the patellofemoral and extensor mechanisms

Û. Aseptic loosening of cementing tibial components

Ü. Asceptic loosening of cemented femoral components

Ý. Acceptance of the current position of the ankle

Þ. Open reduction and fixation in the epiphysis only

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

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

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

Ă. Resection arthroplasty and local radiation

Ă. In situ fusion of the hip

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

Ą. Excision of heterotopic bone and local radiation

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

Ć. Closed reduction of both fractures and immediate spica casting

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

Ĉ. External fixation of both femora

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

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

Č. Synovial sarcoma

Č. Soft-tissue abcess

Ď. Rhabdomyosarcoma

Ď. Eosinophilic granuloma

Đ. Nodular pigmented villonodular synovitis

Đ. Changing to a titanium nail

Ē. Changing to a nonslotted nail

Ē. Changing the cross-sectional shape of the nail

Ĕ. Increasing the diameter of the nail by 3 mm

Ĕ. Increasing the diameter of the interlocking screws

Ė. Fracture healing

Ė. Chondrosarcoma

Ę. Periosteal chondroma

Ę. Periosteal osteosarcoma

Ě. Dysplasia epiphysealis hemimelica

Ě. Demonstrate competence in the subject of the case

Ĝ. Be fellowship trained in the subject of the case

Ĝ. Be paid on a contingency basis

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

Ğ. Have been involved in the case as a consultant

Ġ. Diagnostic arthroscopy

Ġ. Arthroscopy and subacromial decompression

Ģ. Reduction and fixation of the proximal humeral epiphysis

Ģ. Temporary cessation of throwing

Ĥ. Physical therapy for rotator cuff strengthening

Ĥ. Oblique popliteal ligament

Ħ. Lateral capsule

Ħ. Popliteal tendon

Ĩ. Fibular collateral ligament

Ĩ. Posterior oblique ligament

Ī. Radial tear

Ī. Parrot-beak tear

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

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

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

Į. 0 degrees of abduction, with neural rotation

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

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

Ĳ. 90 degrees of abduction with neutral rotation

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

Ĵ. Sural

Ĵ. Saphenous and its branches

Ķ. Posterior tibial and its branches

Ķ. Deep peroneal and its branches

ĸ. Superficial peroneal and its branches

Ĺ. Strength

Ĺ. Stiffness

Ļ. Shelf life

Ļ. Antigenicity

Ľ. Risk of HIV transmission

Ľ. Indemnification

Ŀ. Occurrence

Ŀ. Excess liability

Ł. Claims-made

Ł. Nose

Ń. Lateral Y

Ń. Scapular AP

Ņ. Neutral rotation AP

Ņ. Internal rotation AP

Ň. External rotation AP

Ň. Trauma

ʼN. Hemophilia

Ŋ. Reiter’s syndrome

Ŋ. Rheumatoid arthritis

Ō. Systemic lupus erythematosus

Ō. Cast immobilization for 6 weeks

Ŏ. Activity modification and re-evaluation in 2 months

Ŏ. Internal fixation with or without bone grafting

Ő. Retrograde drilling of the defect without articular cartilage penetration

Ő. Drilling of the defect directly through the articular cartilage

Œ. repair or reconstruction of the medial collateral ligament

Œ. repair or reconstruction of the medialand lateral collateral ligaments

Ŕ. immobilization for 5 days or less

Ŕ. immobilization for 14 days

Ŗ. immobilization for 25 days

Ŗ. Cystinosis

Ř. Hypophosphatemia

Ř. Renal osteodystrophy

Ś. Primary hyperparathyroidism

Ś. Nutritional vitamin D deficiency

Ŝ. Lateral meniscus tear

Ŝ. Popliteus tenosynovitis

Ş. Iliotibial band friction syndrome

Ş. Peroneal nerve entrapment

Š. Biceps tendinitis

Š. Observation

Ţ. Removal of the prosthetic components

Ţ. Operative exploration and decompression of the peroneal nerve

Ť. Nerve conduction velocity studies

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

Ŧ. I

Ŧ. II

Ũ. III

Ũ. decreased tissue tension

Ū. decreased abductor lever arm

Ū. decreased joint reaction force

Ŭ. increased body weight over lever arm

Ŭ. increased polyethylene wear rate

Ů. recurrent traumatic anterior dislocation

Ů. recurrent traumatic posterior dislocation

Ű. traumatic subluxation with no previous dislocation

Ű. traumatic anterior subluxation

Ų. atraumatic involuntary subluxation

Ų. radial

Ŵ. axillary

Ŵ. suprascapular

Ŷ. thoracodorsal

Ŷ. long thoracic

Ÿ. Flexion

Ź. Extension

Ź. Axial rotation

Ż. Left lateral bending

Ż. Right lateral bending

Ž. Skin

Ž. Lung

S. Brain

Ƀ. Heart

Ɓ. Kidney

Ƃ. Thoracoacromial, lateral thoracic, subscapular

Ƃ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ƅ. Posterior humeral circumflex, subscapular, thoracacromial

Ƅ. Subscapular, thoracacromial, anterior humeral circumflex

Ɔ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƈ. Respondeat superior

Ƈ. Indemnity agreement

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

Ɗ. Comparative negligence-% of involvement

Ƌ. Contributory negligence- resident contributed to the negligence

Ƌ. t-type

ƍ. both column

Ǝ. transverse

Ə. anterior column

Ɛ. anterior column posterior hemitransverse

Ƒ. Posterior interosseous

Ƒ. Anterior interosseous

Ɠ. Radial

Ɣ. Median

Ƕ. Ulnar

Ɩ. Shock from hypovolemia

Ɨ. Associated rupture of the bladder

Ƙ. Arterial bleeding on pelvic angiogram

Ƙ. Presence of a hematoma in the perineum and scrotum

Ƚ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. SCFE

Explanation

Question 4197

Topic: 10. Pathology and Oncology

A 31-year-old man who is a recent immigrant from Guatemala has had pain in his back and thighs for the past 12 months. History notes a recent diagnosis of gout, and the patient reports falling a distance of 3 feet on his buttocks immediately before the pain began. Examination reveals that he is neurologically intact. Plain radiographs are shown in Figures 44a and 44b, and T2-weighted MRI scans are shown in Figures 44c and 44d. The most likely cause of the pathologic fracture is

. 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

-. In neutral rotation, with the elbow extended

.. open reduction and internal fixation

/. buddy taping to the adjacent index finger

0. early motion with application of a dynamic banjo splint

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

2. dorsal extension block splinting

3. The name of the manufacturer

4. The manufacturer’s potential liability

5. The physician’s clinical performance

6. The physician’s materials testing data

7. Any royalties the physician receives from the manufacturer

8. Femoral

9. 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

A. Triggering

B. Lateral instability

C. Swan-neck deformity

D. Boutonniere deformity

E. Loss of distal interphalangeal joint flexion

F. Peroneus brevis to peroneus longus

G. Peroneus tertius to extensor hallucis longus

H. Peroneus tertius to superficial peroneal nerve

I. Extensor hallucis longus to deep peroneal nerve

J. Extensor hallucis longus to extensor digitorum longus

K. reassurance that Medicare will pay for the treatment.

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

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

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

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

P. an onlay iliac crest bone graft.

Q. limited weightbearing and observation.

R. removal of the implant and limited weightbearing.

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

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

U. Coronal

V. Sagittal

W. Anteromedial, midway between the sagittal and the coronal

X. Proximal pins sagittal, distal pins coronal

Y. Proximal pins coronal, distal pins sagittal

Z. Rheumatoid arthritis

[. Posttraumatic arthritis

\. Degenerative osteoarthritis

]. Osteonecrosis of the tibial plateau

^. Osteonecrosis of the medial femoral condyle

_. Trapeziometacarpal arthrodesis

`. Osteotomy of the thumb metacarpal

A. Arthrotomy and joint debridement

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

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

D. Creep

E. Relaxation

F. Energy dissipation

G. Plastic deformation

H. Elastic deformation

I. bending

J. axial loading

K. high-speed rotation

L. direct impact from anteromedial

M. crush from anteromedial to posterolateral

N. Increase stiffness

O. Increase fracture toughness

P. Increase fatigue strength

Q. Decrease mechanical strength

R. Decrease wear rate

S. disuse osteopenia

T. paraendocrine effect of the tumor

U. abnormally increased density on the right side

V. side effect of the treatment of the lesion

W. extensive tumor involvement of the left hip

X. Sciatic nerve

Y. Superior gluteal artery

Z. Profunda femoris artery

{. Femoral artery and nerve

|. External iliac artery and vein

}. Length

~. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

¡. Aspiration of joint fluid

¢. An erythrocyte sedimentation rate and CBC

£. A diagnostic lidocaine injection

¤. Insulin-like growth factor (IGF-1)

¥. Fibroblast growth factor (FGF-1)

¦. Platelet-derived growth factor (PDGF)

§. Transforming growth factor beta (TGF-B)

¨. Bone morphogenetic proteins (BMP)

ª. technetium bone scan

«. flow cytometry pattern of extracted chondrocytes

¬. immunohistochemical staining patterns of a biopsy specimen

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

®. Radial

¯. Radial recurrent

°. Posterior interosseous

±. Superior ulnar recurrent

². Superficial radial circumflex

³. Impaired hydroxylation of proline

´. Failure of cleavage in procollagen

Μ. Defective binding sites for hydroxyproline

¶. Failure to incorporate glycine into the helix

·. Diminished production of collagen through the rough endoplasmic reticulum

¸. Asking the legal staff to seek a court injunction

¹. Copying the patient’s chart and giving it to him as he leaves

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

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

¼. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

½. Meta-analysis

¾. Confidence interval

¿. Analysis of variance (ANOVA)

À. Statistical significance (p-value)

Á. Survivorship analysis (Kaplan-Meier)

Â. Spinal shock

Ã. Neurogenic shock

Ä. Hypovolemic shock

Å. Pulmonary embolism

Æ. Fat embolus syndrome

Ç. Lumbar spinal stenosis

È. Metastatic disease of the spine

É. Rheumatoid lumbar spondylitis

Ê. Isthmic spondyloloisthesis

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

Ì. Patella alta

Í. A metal-backed patella

Î. Varus malalignment of the knee

Ï. A posterior cruciate-substituting femoral component

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

Ñ. The sesamoids are separated

Ò. The sesamoid is fractured

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

Ô. The dislocation is dorsal and centered

Õ. The proximal phalanx is hyperextended

Ö. Patella

×. Tibial stem

Ø. Distal femoral interface

Ù. Posterior femoral interface

Ú. Sites of screw fixation for the tibia

Û. Hallux rigidus

Ü. Fracture of the sesamoid

Ý. Disruption of the plantar plate

Þ. Osteonecrosis of the metatarsal head

SS. Rupture of the flexor hallucis longus

À. Gout

Á. Sepsis

Â. Old trauma

Ã. Rheumatoid arthritis

Ä. Charcot arthroplasty

Å. Aspiration and steroid injection

Æ. Biopsy, curettage, and allograft bone grafting

Ç. Percutaneous Kirschner wire fixation

È. Percutaneous injection of autogenous bone marrow

É. Nerve roots

Ê. Spinal cord

Ë. Sciatic nerve

Ì. Peroneal nerve

Í. Conus medullaris

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

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

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

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

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

Ó. Early and late infection

Ô. Periprosthetic fracture of the femur

Õ. Failure of the patellofemoral and extensor mechanisms

Ö. Aseptic loosening of cementing tibial components

÷. Asceptic loosening of cemented femoral components

Ø. Acceptance of the current position of the ankle

Ù. Open reduction and fixation in the epiphysis only

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

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

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

Ý. Resection arthroplasty and local radiation

Þ. In situ fusion of the hip

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

Ā. Excision of heterotopic bone and local radiation

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

Ă. Closed reduction of both fractures and immediate spica casting

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

Ą. External fixation of both femora

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

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

Ć. Synovial sarcoma

Ĉ. Soft-tissue abcess

Ĉ. Rhabdomyosarcoma

Ċ. Eosinophilic granuloma

Ċ. Nodular pigmented villonodular synovitis

Č. Changing to a titanium nail

Č. Changing to a nonslotted nail

Ď. Changing the cross-sectional shape of the nail

Ď. Increasing the diameter of the nail by 3 mm

Đ. Increasing the diameter of the interlocking screws

Đ. Fracture healing

Ē. Chondrosarcoma

Ē. Periosteal chondroma

Ĕ. Periosteal osteosarcoma

Ĕ. Dysplasia epiphysealis hemimelica

Ė. Demonstrate competence in the subject of the case

Ė. Be fellowship trained in the subject of the case

Ę. Be paid on a contingency basis

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

Ě. Have been involved in the case as a consultant

Ě. Diagnostic arthroscopy

Ĝ. Arthroscopy and subacromial decompression

Ĝ. Reduction and fixation of the proximal humeral epiphysis

Ğ. Temporary cessation of throwing

Ğ. Physical therapy for rotator cuff strengthening

Ġ. Oblique popliteal ligament

Ġ. Lateral capsule

Ģ. Popliteal tendon

Ģ. Fibular collateral ligament

Ĥ. Posterior oblique ligament

Ĥ. Radial tear

Ħ. Parrot-beak tear

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

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

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

Ī. 0 degrees of abduction, with neural rotation

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

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

Ĭ. 90 degrees of abduction with neutral rotation

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

Į. Sural

İ. Saphenous and its branches

I. Posterior tibial and its branches

Ĳ. Deep peroneal and its branches

Ĳ. Superficial peroneal and its branches

Ĵ. Strength

Ĵ. Stiffness

Ķ. Shelf life

Ķ. Antigenicity

ĸ. Risk of HIV transmission

Ĺ. Indemnification

Ĺ. Occurrence

Ļ. Excess liability

Ļ. Claims-made

Ľ. Nose

Ľ. Lateral Y

Ŀ. Scapular AP

Ŀ. Neutral rotation AP

Ł. Internal rotation AP

Ł. External rotation AP

Ń. Trauma

Ń. Hemophilia

Ņ. Reiter’s syndrome

Ņ. Rheumatoid arthritis

Ň. Systemic lupus erythematosus

Ň. Cast immobilization for 6 weeks

ʼN. Activity modification and re-evaluation in 2 months

Ŋ. Internal fixation with or without bone grafting

Ŋ. Retrograde drilling of the defect without articular cartilage penetration

Ō. Drilling of the defect directly through the articular cartilage

Ō. repair or reconstruction of the medial collateral ligament

Ŏ. repair or reconstruction of the medialand lateral collateral ligaments

Ŏ. immobilization for 5 days or less

Ő. immobilization for 14 days

Ő. immobilization for 25 days

Œ. Cystinosis

Œ. Hypophosphatemia

Ŕ. Renal osteodystrophy

Ŕ. Primary hyperparathyroidism

Ŗ. Nutritional vitamin D deficiency

Ŗ. Lateral meniscus tear

Ř. Popliteus tenosynovitis

Ř. Iliotibial band friction syndrome

Ś. Peroneal nerve entrapment

Ś. Biceps tendinitis

Ŝ. Observation

Ŝ. Removal of the prosthetic components

Ş. Operative exploration and decompression of the peroneal nerve

Ş. Nerve conduction velocity studies

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

Š. I

Ţ. II

Ţ. III

Ť. decreased tissue tension

Ť. decreased abductor lever arm

Ŧ. decreased joint reaction force

Ŧ. increased body weight over lever arm

Ũ. increased polyethylene wear rate

Ũ. recurrent traumatic anterior dislocation

Ū. recurrent traumatic posterior dislocation

Ū. traumatic subluxation with no previous dislocation

Ŭ. traumatic anterior subluxation

Ŭ. atraumatic involuntary subluxation

Ů. radial

Ů. axillary

Ű. suprascapular

Ű. thoracodorsal

Ų. long thoracic

Ų. Flexion

Ŵ. Extension

Ŵ. Axial rotation

Ŷ. Left lateral bending

Ŷ. Right lateral bending

Ÿ. Skin

Ź. Lung

Ź. Brain

Ż. Heart

Ż. Kidney

Ž. Thoracoacromial, lateral thoracic, subscapular

Ž. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

S. Posterior humeral circumflex, subscapular, thoracacromial

Ƀ. Subscapular, thoracacromial, anterior humeral circumflex

Ɓ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ƃ. Respondeat superior

Ƃ. Indemnity agreement

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

Ƅ. Comparative negligence-% of involvement

Ɔ. Contributory negligence- resident contributed to the negligence

Ƈ. t-type

Ƈ. both column

Ɖ. transverse

Ɗ. anterior column

Ƌ. anterior column posterior hemitransverse

Ƌ. Posterior interosseous

ƍ. Anterior interosseous

Ǝ. Radial

Ə. Median

Ɛ. Ulnar

Ƒ. Shock from hypovolemia

Ƒ. Associated rupture of the bladder

Ɠ. Arterial bleeding on pelvic angiogram

Ɣ. Presence of a hematoma in the perineum and scrotum

Ƕ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. gout.

Explanation

Question 4198

Topic: 10. Pathology and Oncology

Osteoarthritic cartilage is characterized by decreased

. 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.

-. dorsal extension block splinting

.. The name of the manufacturer

/. The manufacturer’s potential liability

0. The physician’s clinical performance

1. The physician’s materials testing data

2. Any royalties the physician receives from the manufacturer

3. Femoral

4. Obturator

5. Inferior gluteal

6. Superior gluteal

7. Lateral femoral cutaneous

8. open biopsy and a long leg cast

9. 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

A. Peroneus brevis to peroneus longus

B. Peroneus tertius to extensor hallucis longus

C. Peroneus tertius to superficial peroneal nerve

D. Extensor hallucis longus to deep peroneal nerve

E. Extensor hallucis longus to extensor digitorum longus

F. reassurance that Medicare will pay for the treatment.

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

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

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

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

K. an onlay iliac crest bone graft.

L. limited weightbearing and observation.

M. removal of the implant and limited weightbearing.

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

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

P. Coronal

Q. Sagittal

R. Anteromedial, midway between the sagittal and the coronal

S. Proximal pins sagittal, distal pins coronal

T. Proximal pins coronal, distal pins sagittal

U. Rheumatoid arthritis

V. Posttraumatic arthritis

W. Degenerative osteoarthritis

X. Osteonecrosis of the tibial plateau

Y. Osteonecrosis of the medial femoral condyle

Z. Trapeziometacarpal arthrodesis

[. 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

_. Creep

`. Relaxation

A. Energy dissipation

B. Plastic deformation

C. Elastic deformation

D. bending

E. axial loading

F. high-speed rotation

G. direct impact from anteromedial

H. crush from anteromedial to posterolateral

I. Increase stiffness

J. Increase fracture toughness

K. Increase fatigue strength

L. Decrease mechanical strength

M. Decrease wear rate

N. disuse osteopenia

O. paraendocrine effect of the tumor

P. abnormally increased density on the right side

Q. side effect of the treatment of the lesion

R. extensive tumor involvement of the left hip

S. Sciatic nerve

T. Superior gluteal artery

U. Profunda femoris artery

V. Femoral artery and nerve

W. External iliac artery and vein

X. Length

Y. Moment arm

Z. Total volume

{. Physiologic cross-sectional area

|. Distribution of slow and fast twitch fibers

}. decreasing initiation of action potentials.

~. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

. 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.

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

. Insulin-like growth factor (IGF-1)

. Fibroblast growth factor (FGF-1)

¡. Platelet-derived growth factor (PDGF)

¢. Transforming growth factor beta (TGF-B)

£. Bone morphogenetic proteins (BMP)

¤. clinical history and radiographic findings.

¥. technetium bone scan

¦. flow cytometry pattern of extracted chondrocytes

§. immunohistochemical staining patterns of a biopsy specimen

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

©. Radial

ª. Radial recurrent

«. Posterior interosseous

¬. Superior ulnar recurrent

. Superficial radial circumflex

®. Impaired hydroxylation of proline

¯. Failure of cleavage in procollagen

°. Defective binding sites for hydroxyproline

±. Failure to incorporate glycine into the helix

². Diminished production of collagen through the rough endoplasmic reticulum

³. Asking the legal staff to seek a court injunction

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

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

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

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

¸. Meta-analysis

¹. Confidence interval

º. Analysis of variance (ANOVA)

». Statistical significance (p-value)

¼. Survivorship analysis (Kaplan-Meier)

½. Spinal shock

¾. Neurogenic shock

¿. Hypovolemic shock

À. Pulmonary embolism

Á. Fat embolus syndrome

Â. Lumbar spinal stenosis

Ã. Metastatic disease of the spine

Ä. Rheumatoid lumbar spondylitis

Å. Isthmic spondyloloisthesis

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

Ç. Patella alta

È. A metal-backed patella

É. Varus malalignment of the knee

Ê. A posterior cruciate-substituting femoral component

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

Ì. The sesamoids are separated

Í. The sesamoid is fractured

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

Ï. The dislocation is dorsal and centered

Ð. The proximal phalanx is hyperextended

Ñ. Patella

Ò. Tibial stem

Ó. Distal femoral interface

Ô. Posterior femoral interface

Õ. Sites of screw fixation for the tibia

Ö. Hallux rigidus

×. Fracture of the sesamoid

Ø. Disruption of the plantar plate

Ù. Osteonecrosis of the metatarsal head

Ú. Rupture of the flexor hallucis longus

Û. Gout

Ü. Sepsis

Ý. Old trauma

Þ. Rheumatoid arthritis

SS. Charcot arthroplasty

À. Aspiration and steroid injection

Á. Biopsy, curettage, and allograft bone grafting

Â. Percutaneous Kirschner wire fixation

Ã. Percutaneous injection of autogenous bone marrow

Ä. Nerve roots

Å. Spinal cord

Æ. Sciatic nerve

Ç. Peroneal nerve

È. Conus medullaris

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

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

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

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

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

Î. Early and late infection

Ï. Periprosthetic fracture of the femur

Ð. Failure of the patellofemoral and extensor mechanisms

Ñ. Aseptic loosening of cementing tibial components

Ò. Asceptic loosening of cemented femoral components

Ó. Acceptance of the current position of the ankle

Ô. Open reduction and fixation in the epiphysis only

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

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

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

Ø. Resection arthroplasty and local radiation

Ù. In situ fusion of the hip

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

Û. Excision of heterotopic bone and local radiation

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

Ý. Closed reduction of both fractures and immediate spica casting

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

Ÿ. External fixation of both femora

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

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

Ă. Synovial sarcoma

Ă. Soft-tissue abcess

Ą. Rhabdomyosarcoma

Ą. Eosinophilic granuloma

Ć. Nodular pigmented villonodular synovitis

Ć. Changing to a titanium nail

Ĉ. Changing to a nonslotted nail

Ĉ. Changing the cross-sectional shape of the nail

Ċ. Increasing the diameter of the nail by 3 mm

Ċ. Increasing the diameter of the interlocking screws

Č. Fracture healing

Č. Chondrosarcoma

Ď. Periosteal chondroma

Ď. Periosteal osteosarcoma

Đ. Dysplasia epiphysealis hemimelica

Đ. Demonstrate competence in the subject of the case

Ē. Be fellowship trained in the subject of the case

Ē. Be paid on a contingency basis

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

Ĕ. Have been involved in the case as a consultant

Ė. Diagnostic arthroscopy

Ė. Arthroscopy and subacromial decompression

Ę. Reduction and fixation of the proximal humeral epiphysis

Ę. Temporary cessation of throwing

Ě. Physical therapy for rotator cuff strengthening

Ě. Oblique popliteal ligament

Ĝ. Lateral capsule

Ĝ. Popliteal tendon

Ğ. Fibular collateral ligament

Ğ. Posterior oblique ligament

Ġ. Radial tear

Ġ. Parrot-beak tear

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

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

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

Ĥ. 0 degrees of abduction, with neural rotation

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

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

Ĩ. 90 degrees of abduction with neutral rotation

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

Ī. Sural

Ī. Saphenous and its branches

Ĭ. Posterior tibial and its branches

Ĭ. Deep peroneal and its branches

Į. Superficial peroneal and its branches

Į. Strength

İ. Stiffness

I. Shelf life

Ĳ. Antigenicity

Ĳ. Risk of HIV transmission

Ĵ. Indemnification

Ĵ. Occurrence

Ķ. Excess liability

Ķ. Claims-made

ĸ. Nose

Ĺ. Lateral Y

Ĺ. Scapular AP

Ļ. Neutral rotation AP

Ļ. Internal rotation AP

Ľ. External rotation AP

Ľ. Trauma

Ŀ. Hemophilia

Ŀ. Reiter’s syndrome

Ł. Rheumatoid arthritis

Ł. Systemic lupus erythematosus

Ń. Cast immobilization for 6 weeks

Ń. Activity modification and re-evaluation in 2 months

Ņ. Internal fixation with or without bone grafting

Ņ. Retrograde drilling of the defect without articular cartilage penetration

Ň. Drilling of the defect directly through the articular cartilage

Ň. repair or reconstruction of the medial collateral ligament

ʼN. repair or reconstruction of the medialand lateral collateral ligaments

Ŋ. immobilization for 5 days or less

Ŋ. immobilization for 14 days

Ō. immobilization for 25 days

Ō. Cystinosis

Ŏ. Hypophosphatemia

Ŏ. Renal osteodystrophy

Ő. Primary hyperparathyroidism

Ő. Nutritional vitamin D deficiency

Œ. Lateral meniscus tear

Œ. Popliteus tenosynovitis

Ŕ. Iliotibial band friction syndrome

Ŕ. Peroneal nerve entrapment

Ŗ. Biceps tendinitis

Ŗ. Observation

Ř. Removal of the prosthetic components

Ř. Operative exploration and decompression of the peroneal nerve

Ś. Nerve conduction velocity studies

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

Ŝ. I

Ŝ. II

Ş. III

Ş. decreased tissue tension

Š. decreased abductor lever arm

Š. decreased joint reaction force

Ţ. increased body weight over lever arm

Ţ. increased polyethylene wear rate

Ť. recurrent traumatic anterior dislocation

Ť. recurrent traumatic posterior dislocation

Ŧ. traumatic subluxation with no previous dislocation

Ŧ. traumatic anterior subluxation

Ũ. atraumatic involuntary subluxation

Ũ. radial

Ū. axillary

Ū. suprascapular

Ŭ. thoracodorsal

Ŭ. long thoracic

Ů. Flexion

Ů. Extension

Ű. Axial rotation

Ű. Left lateral bending

Ų. Right lateral bending

Ų. Skin

Ŵ. Lung

Ŵ. Brain

Ŷ. Heart

Ŷ. Kidney

Ÿ. Thoracoacromial, lateral thoracic, subscapular

Ź. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ź. Posterior humeral circumflex, subscapular, thoracacromial

Ż. Subscapular, thoracacromial, anterior humeral circumflex

Ż. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ž. Respondeat superior

Ž. Indemnity agreement

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

Ƀ. Comparative negligence-% of involvement

Ɓ. Contributory negligence- resident contributed to the negligence

Ƃ. t-type

Ƃ. both column

Ƅ. transverse

Ƅ. anterior column

Ɔ. anterior column posterior hemitransverse

Ƈ. Posterior interosseous

Ƈ. Anterior interosseous

Ɖ. Radial

Ɗ. Median

Ƌ. Ulnar

Ƌ. Shock from hypovolemia

ƍ. Associated rupture of the bladder

Ǝ. Arterial bleeding on pelvic angiogram

Ə. Presence of a hematoma in the perineum and scrotum

Ɛ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. water content.

Explanation

Question 4199

Topic: 10. Pathology and Oncology

Which of the following metastatic carcinomas has the worst long-term prognosis?

. 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

-. Any royalties the physician receives from the manufacturer

.. Femoral

/. Obturator

0. Inferior gluteal

1. Superior gluteal

2. Lateral femoral cutaneous

3. open biopsy and a long leg cast

4. open biopsy and wide resection of the tumor

5. a long leg cast and observation

6. intramedullary stabilization and observation

7. Triggering

8. Lateral instability

9. 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

A. reassurance that Medicare will pay for the treatment.

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

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

D. a provision that the patient’s care will be discontinued if he or she does not enroll in the study.

E. a provision that the study will be carried out to completion, whether or not the device is as effective as those currently in existence.

F. an onlay iliac crest bone graft.

G. limited weightbearing and observation.

H. removal of the implant and limited weightbearing.

I. removal of the implant and insertion of a reamed femoral nail.

J. removal of the implant and insertion of an unreamed femoral nail.

K. Coronal

L. Sagittal

M. Anteromedial, midway between the sagittal and the coronal

N. Proximal pins sagittal, distal pins coronal

O. Proximal pins coronal, distal pins sagittal

P. Rheumatoid arthritis

Q. Posttraumatic arthritis

R. Degenerative osteoarthritis

S. Osteonecrosis of the tibial plateau

T. Osteonecrosis of the medial femoral condyle

U. Trapeziometacarpal arthrodesis

V. Osteotomy of the thumb metacarpal

W. Arthrotomy and joint debridement

X. Ligament reconstruction using one half of the flexor carpi radialis

Y. Trapezium resection, tendon interposition, and reconstruction of the ligament

Z. Creep

[. Relaxation

\. Energy dissipation

]. Plastic deformation

^. Elastic deformation

_. bending

`. axial loading

A. high-speed rotation

B. direct impact from anteromedial

C. crush from anteromedial to posterolateral

D. Increase stiffness

E. Increase fracture toughness

F. Increase fatigue strength

G. Decrease mechanical strength

H. Decrease wear rate

I. disuse osteopenia

J. paraendocrine effect of the tumor

K. abnormally increased density on the right side

L. side effect of the treatment of the lesion

M. extensive tumor involvement of the left hip

N. Sciatic nerve

O. Superior gluteal artery

P. Profunda femoris artery

Q. Femoral artery and nerve

R. External iliac artery and vein

S. Length

T. Moment arm

U. Total volume

V. Physiologic cross-sectional area

W. Distribution of slow and fast twitch fibers

X. decreasing initiation of action potentials.

Y. increasing action potential amplitude.

Z. blocking the opening of gated sodium channels.

{. decreasing the number of functional motor units.

|. slowing or stopping action potential propagation through the axon.

}. resection of the metatarsal heads of the first through fifth toes.

~. 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.

. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

. a sling and swathe, with pendulum exercises in 10 days

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

. immobilization with a splint in 45 degrees of abduction for 6 weeks

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

. Insulin-like growth factor (IGF-1)

. Fibroblast growth factor (FGF-1)

. Platelet-derived growth factor (PDGF)

. Transforming growth factor beta (TGF-B)

. Bone morphogenetic proteins (BMP)

. clinical history and radiographic findings.

. technetium bone scan

¡. flow cytometry pattern of extracted chondrocytes

¢. immunohistochemical staining patterns of a biopsy specimen

£. histologic features of a biopsy specimen stained with hematoxylin-cosin

¤. Radial

¥. Radial recurrent

¦. Posterior interosseous

§. Superior ulnar recurrent

¨. Superficial radial circumflex

ª. Failure of cleavage in procollagen

«. Defective binding sites for hydroxyproline

¬. Failure to incorporate glycine into the helix

. Diminished production of collagen through the rough endoplasmic reticulum

®. Asking the legal staff to seek a court injunction

¯. Copying the patient’s chart and giving it to him as he leaves

°. Having the patient sign a written legal contract that specifies acceptable behavior

±. Continuing care of the patient until an appropriate referral can be arranged

². Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

³. Meta-analysis

´. Confidence interval

Μ. Analysis of variance (ANOVA)

¶. Statistical significance (p-value)

·. Survivorship analysis (Kaplan-Meier)

¸. Spinal shock

¹. Neurogenic shock

º. Hypovolemic shock

». Pulmonary embolism

¼. Fat embolus syndrome

½. Lumbar spinal stenosis

¾. Metastatic disease of the spine

¿. Rheumatoid lumbar spondylitis

À. Isthmic spondyloloisthesis

Á. Degenerative spondylolisthesis at L4-5 and L5-S1

Â. Patella alta

Ã. A metal-backed patella

Ä. Varus malalignment of the knee

Å. A posterior cruciate-substituting femoral component

Æ. Lateral subluxation of the patella on a Merchant’s view

Ç. The sesamoids are separated

È. The sesamoid is fractured

É. The proximal phx is on the neck of the metatarsal

Ê. The dislocation is dorsal and centered

Ë. The proximal phalanx is hyperextended

Ì. Patella

Í. Tibial stem

Î. Distal femoral interface

Ï. Posterior femoral interface

Ð. Sites of screw fixation for the tibia

Ñ. Hallux rigidus

Ò. Fracture of the sesamoid

Ó. Disruption of the plantar plate

Ô. Osteonecrosis of the metatarsal head

Õ. Rupture of the flexor hallucis longus

Ö. Gout

×. Sepsis

Ø. Old trauma

Ù. Rheumatoid arthritis

Ú. Charcot arthroplasty

Û. Aspiration and steroid injection

Ü. Biopsy, curettage, and allograft bone grafting

Ý. Percutaneous Kirschner wire fixation

Þ. Percutaneous injection of autogenous bone marrow

SS. Nerve roots

À. Spinal cord

Á. Sciatic nerve

Â. Peroneal nerve

Ã. Conus medullaris

Ä. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

Å. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Æ. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Ç. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

È. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

É. Early and late infection

Ê. Periprosthetic fracture of the femur

Ë. Failure of the patellofemoral and extensor mechanisms

Ì. Aseptic loosening of cementing tibial components

Í. Asceptic loosening of cemented femoral components

Î. Acceptance of the current position of the ankle

Ï. Open reduction and fixation in the epiphysis only

Ð. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ñ. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Ò. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Ó. Resection arthroplasty and local radiation

Ô. In situ fusion of the hip

Õ. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ö. Excision of heterotopic bone and local radiation

÷. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ø. Closed reduction of both fractures and immediate spica casting

Ù. Bilateral skin traction for 3 weeks, followed by spica casting

Ú. External fixation of both femora

Û. External fixation of the left femur and a long leg cast brace for the right femur

Ü. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ý. Synovial sarcoma

Þ. Soft-tissue abcess

Ÿ. Rhabdomyosarcoma

Ā. Eosinophilic granuloma

Ā. Nodular pigmented villonodular synovitis

Ă. Changing to a titanium nail

Ă. Changing to a nonslotted nail

Ą. Changing the cross-sectional shape of the nail

Ą. Increasing the diameter of the nail by 3 mm

Ć. Increasing the diameter of the interlocking screws

Ć. Fracture healing

Ĉ. Chondrosarcoma

Ĉ. Periosteal chondroma

Ċ. Periosteal osteosarcoma

Ċ. Dysplasia epiphysealis hemimelica

Č. Demonstrate competence in the subject of the case

Č. Be fellowship trained in the subject of the case

Ď. Be paid on a contingency basis

Ď. Be board certified by the American Board of Orthopaedic Surgery

Đ. Have been involved in the case as a consultant

Đ. Diagnostic arthroscopy

Ē. Arthroscopy and subacromial decompression

Ē. Reduction and fixation of the proximal humeral epiphysis

Ĕ. Temporary cessation of throwing

Ĕ. Physical therapy for rotator cuff strengthening

Ė. Oblique popliteal ligament

Ė. Lateral capsule

Ę. Popliteal tendon

Ę. Fibular collateral ligament

Ě. Posterior oblique ligament

Ě. Radial tear

Ĝ. Parrot-beak tear

Ĝ. Vertical tear in the “red-red” zone

Ğ. Vertical tear in the “red-white” zone

Ğ. Vertical tear in the “white-white” zone

Ġ. 0 degrees of abduction, with neural rotation

Ġ. 40 degrees of flexion and 60 degrees of internal rotation

Ģ. 45 degrees of flexion and 45 degrees of external rotation

Ģ. 90 degrees of abduction with neutral rotation

Ĥ. 90 degrees of abduction and 90 degrees of external rotation

Ĥ. Sural

Ħ. Saphenous and its branches

Ħ. Posterior tibial and its branches

Ĩ. Deep peroneal and its branches

Ĩ. Superficial peroneal and its branches

Ī. Strength

Ī. Stiffness

Ĭ. Shelf life

Ĭ. Antigenicity

Į. Risk of HIV transmission

Į. Indemnification

İ. Occurrence

I. Excess liability

Ĳ. Claims-made

Ĳ. Nose

Ĵ. Lateral Y

Ĵ. Scapular AP

Ķ. Neutral rotation AP

Ķ. Internal rotation AP

ĸ. External rotation AP

Ĺ. Trauma

Ĺ. Hemophilia

Ļ. Reiter’s syndrome

Ļ. Rheumatoid arthritis

Ľ. Systemic lupus erythematosus

Ľ. Cast immobilization for 6 weeks

Ŀ. Activity modification and re-evaluation in 2 months

Ŀ. Internal fixation with or without bone grafting

Ł. Retrograde drilling of the defect without articular cartilage penetration

Ł. Drilling of the defect directly through the articular cartilage

Ń. repair or reconstruction of the medial collateral ligament

Ń. repair or reconstruction of the medialand lateral collateral ligaments

Ņ. immobilization for 5 days or less

Ņ. immobilization for 14 days

Ň. immobilization for 25 days

Ň. Cystinosis

ʼN. Hypophosphatemia

Ŋ. Renal osteodystrophy

Ŋ. Primary hyperparathyroidism

Ō. Nutritional vitamin D deficiency

Ō. Lateral meniscus tear

Ŏ. Popliteus tenosynovitis

Ŏ. Iliotibial band friction syndrome

Ő. Peroneal nerve entrapment

Ő. Biceps tendinitis

Œ. Observation

Œ. Removal of the prosthetic components

Ŕ. Operative exploration and decompression of the peroneal nerve

Ŕ. Nerve conduction velocity studies

Ŗ. Loosening of the primary dressings and knee flexion to 30 degrees

Ŗ. I

Ř. II

Ř. III

Ś. decreased tissue tension

Ś. decreased abductor lever arm

Ŝ. decreased joint reaction force

Ŝ. increased body weight over lever arm

Ş. increased polyethylene wear rate

Ş. recurrent traumatic anterior dislocation

Š. recurrent traumatic posterior dislocation

Š. traumatic subluxation with no previous dislocation

Ţ. traumatic anterior subluxation

Ţ. atraumatic involuntary subluxation

Ť. radial

Ť. axillary

Ŧ. suprascapular

Ŧ. thoracodorsal

Ũ. long thoracic

Ũ. Flexion

Ū. Extension

Ū. Axial rotation

Ŭ. Left lateral bending

Ŭ. Right lateral bending

Ů. Skin

Ů. Lung

Ű. Brain

Ű. Heart

Ų. Kidney

Ų. Thoracoacromial, lateral thoracic, subscapular

Ŵ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ŵ. Posterior humeral circumflex, subscapular, thoracacromial

Ŷ. Subscapular, thoracacromial, anterior humeral circumflex

Ŷ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ÿ. Respondeat superior

Ź. Indemnity agreement

Ź. Hold harmless agreement- attempt to shift liability from company to physician

Ż. Comparative negligence-% of involvement

Ż. Contributory negligence- resident contributed to the negligence

Ž. t-type

Ž. both column

S. transverse

Ƀ. anterior column

Ɓ. anterior column posterior hemitransverse

Ƃ. Posterior interosseous

Ƃ. Anterior interosseous

Ƅ. Radial

Ƅ. Median

Ɔ. Ulnar

Ƈ. Shock from hypovolemia

Ƈ. Associated rupture of the bladder

Ɖ. Arterial bleeding on pelvic angiogram

Ɗ. Presence of a hematoma in the perineum and scrotum

Ƌ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Lung

Explanation

Question 4200

Topic: 10. Pathology and Oncology

The Magnetic resonance imaging signal characteristics of a high-grade soft-tissue sarcoma are best described as

. 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

,. Superior gluteal

-. Lateral femoral cutaneous

.. open biopsy and a long leg cast

/. open biopsy and wide resection of the tumor

0. a long leg cast and observation

1. intramedullary stabilization and observation

2. Triggering

3. Lateral instability

4. Swan-neck deformity

5. Boutonniere deformity

6. Loss of distal interphalangeal joint flexion

7. Peroneus brevis to peroneus longus

8. Peroneus tertius to extensor hallucis longus

9. 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.

B. limited weightbearing and observation.

C. removal of the implant and limited weightbearing.

D. removal of the implant and insertion of a reamed femoral nail.

E. removal of the implant and insertion of an unreamed femoral nail.

F. Coronal

G. Sagittal

H. Anteromedial, midway between the sagittal and the coronal

I. Proximal pins sagittal, distal pins coronal

J. Proximal pins coronal, distal pins sagittal

K. Rheumatoid arthritis

L. Posttraumatic arthritis

M. Degenerative osteoarthritis

N. Osteonecrosis of the tibial plateau

O. Osteonecrosis of the medial femoral condyle

P. Trapeziometacarpal arthrodesis

Q. Osteotomy of the thumb metacarpal

R. Arthrotomy and joint debridement

S. Ligament reconstruction using one half of the flexor carpi radialis

T. Trapezium resection, tendon interposition, and reconstruction of the ligament

U. Creep

V. Relaxation

W. Energy dissipation

X. Plastic deformation

Y. Elastic deformation

Z. bending

[. axial loading

\. high-speed rotation

]. direct impact from anteromedial

^. crush from anteromedial to posterolateral

_. Increase stiffness

`. Increase fracture toughness

A. Increase fatigue strength

B. Decrease mechanical strength

C. Decrease wear rate

D. disuse osteopenia

E. paraendocrine effect of the tumor

F. abnormally increased density on the right side

G. side effect of the treatment of the lesion

H. extensive tumor involvement of the left hip

I. Sciatic nerve

J. Superior gluteal artery

K. Profunda femoris artery

L. Femoral artery and nerve

M. External iliac artery and vein

N. Length

O. Moment arm

P. Total volume

Q. Physiologic cross-sectional area

R. Distribution of slow and fast twitch fibers

S. decreasing initiation of action potentials.

T. increasing action potential amplitude.

U. blocking the opening of gated sodium channels.

V. decreasing the number of functional motor units.

W. slowing or stopping action potential propagation through the axon.

X. resection of the metatarsal heads of the first through fifth toes.

Y. Silastic MP joint arthroplasties of the first through fifth toes.

Z. fusion of the hallux MP joint and resection arthroplasty of the 2nd through fifth metatarsal heads.

{. fusion of hallux MP joint and distal osteotomy of the 2nd through 5th MT.

|. plantar condylectomy of the 2nd through 5th MT heads & resection of proximal phx of the hallux.

}. hemiarthroplasty

~. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

. a sling and swathe for 6 weeks, followed by shoulder rehabilitation

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

. a sling and swathe, with pendulum exercises in 10 days

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

. immobilization with a splint in 45 degrees of abduction for 6 weeks

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

. Insulin-like growth factor (IGF-1)

. Fibroblast growth factor (FGF-1)

. Platelet-derived growth factor (PDGF)

. Transforming growth factor beta (TGF-B)

. Bone morphogenetic proteins (BMP)

. clinical history and radiographic findings.

. technetium bone scan

. flow cytometry pattern of extracted chondrocytes

. immunohistochemical staining patterns of a biopsy specimen

. histologic features of a biopsy specimen stained with hematoxylin-cosin

. Radial

. Radial recurrent

¡. Posterior interosseous

¢. Superior ulnar recurrent

£. Superficial radial circumflex

¤. Impaired hydroxylation of proline

¥. Failure of cleavage in procollagen

¦. Defective binding sites for hydroxyproline

§. Failure to incorporate glycine into the helix

¨. Diminished production of collagen through the rough endoplasmic reticulum

ª. Copying the patient’s chart and giving it to him as he leaves

«. Having the patient sign a written legal contract that specifies acceptable behavior

¬. Continuing care of the patient until an appropriate referral can be arranged

. Transferring the patient to another orthopaedic surgeon without disclosing the realreason for why the patient is being transferred

®. Meta-analysis

¯. Confidence interval

°. Analysis of variance (ANOVA)

±. Statistical significance (p-value)

². Survivorship analysis (Kaplan-Meier)

³. Spinal shock

´. Neurogenic shock

Μ. Hypovolemic shock

¶. Pulmonary embolism

·. Fat embolus syndrome

¸. Lumbar spinal stenosis

¹. Metastatic disease of the spine

º. Rheumatoid lumbar spondylitis

». Isthmic spondyloloisthesis

¼. Degenerative spondylolisthesis at L4-5 and L5-S1

½. Patella alta

¾. A metal-backed patella

¿. Varus malalignment of the knee

À. A posterior cruciate-substituting femoral component

Á. Lateral subluxation of the patella on a Merchant’s view

Â. The sesamoids are separated

Ã. The sesamoid is fractured

Ä. The proximal phx is on the neck of the metatarsal

Å. The dislocation is dorsal and centered

Æ. The proximal phalanx is hyperextended

Ç. Patella

È. Tibial stem

É. Distal femoral interface

Ê. Posterior femoral interface

Ë. Sites of screw fixation for the tibia

Ì. Hallux rigidus

Í. Fracture of the sesamoid

Î. Disruption of the plantar plate

Ï. Osteonecrosis of the metatarsal head

Ð. Rupture of the flexor hallucis longus

Ñ. Gout

Ò. Sepsis

Ó. Old trauma

Ô. Rheumatoid arthritis

Õ. Charcot arthroplasty

Ö. Aspiration and steroid injection

×. Biopsy, curettage, and allograft bone grafting

Ø. Percutaneous Kirschner wire fixation

Ù. Percutaneous injection of autogenous bone marrow

Ú. Nerve roots

Û. Spinal cord

Ü. Sciatic nerve

Ý. Peroneal nerve

Þ. Conus medullaris

SS. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

À. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

Á. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

Â. Soft tissue and bone that are potentially contaminated with bacteria in the setting of a prosthetic joint infection

Ã. Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

Ä. Early and late infection

Å. Periprosthetic fracture of the femur

Æ. Failure of the patellofemoral and extensor mechanisms

Ç. Aseptic loosening of cementing tibial components

È. Asceptic loosening of cemented femoral components

É. Acceptance of the current position of the ankle

Ê. Open reduction and fixation in the epiphysis only

Ë. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

Ì. Closed reduction by eversion of the ankle and application of a bivalved long leg cast

Í. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

Î. Resection arthroplasty and local radiation

Ï. In situ fusion of the hip

Ð. Excision of heterotopic bone, total hip arthroplasty, and oral indomethacin

Ñ. Excision of heterotopic bone and local radiation

Ò. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

Ó. Closed reduction of both fractures and immediate spica casting

Ô. Bilateral skin traction for 3 weeks, followed by spica casting

Õ. External fixation of both femora

Ö. External fixation of the left femur and a long leg cast brace for the right femur

÷. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

Ø. Synovial sarcoma

Ù. Soft-tissue abcess

Ú. Rhabdomyosarcoma

Û. Eosinophilic granuloma

Ü. Nodular pigmented villonodular synovitis

Ý. Changing to a titanium nail

Þ. Changing to a nonslotted nail

Ÿ. Changing the cross-sectional shape of the nail

Ā. Increasing the diameter of the nail by 3 mm

Ā. Increasing the diameter of the interlocking screws

Ă. Fracture healing

Ă. Chondrosarcoma

Ą. Periosteal chondroma

Ą. Periosteal osteosarcoma

Ć. Dysplasia epiphysealis hemimelica

Ć. Demonstrate competence in the subject of the case

Ĉ. Be fellowship trained in the subject of the case

Ĉ. Be paid on a contingency basis

Ċ. Be board certified by the American Board of Orthopaedic Surgery

Ċ. Have been involved in the case as a consultant

Č. Diagnostic arthroscopy

Č. Arthroscopy and subacromial decompression

Ď. Reduction and fixation of the proximal humeral epiphysis

Ď. Temporary cessation of throwing

Đ. Physical therapy for rotator cuff strengthening

Đ. Oblique popliteal ligament

Ē. Lateral capsule

Ē. Popliteal tendon

Ĕ. Fibular collateral ligament

Ĕ. Posterior oblique ligament

Ė. Radial tear

Ė. Parrot-beak tear

Ę. Vertical tear in the “red-red” zone

Ę. Vertical tear in the “red-white” zone

Ě. Vertical tear in the “white-white” zone

Ě. 0 degrees of abduction, with neural rotation

Ĝ. 40 degrees of flexion and 60 degrees of internal rotation

Ĝ. 45 degrees of flexion and 45 degrees of external rotation

Ğ. 90 degrees of abduction with neutral rotation

Ğ. 90 degrees of abduction and 90 degrees of external rotation

Ġ. Sural

Ġ. Saphenous and its branches

Ģ. Posterior tibial and its branches

Ģ. Deep peroneal and its branches

Ĥ. Superficial peroneal and its branches

Ĥ. Strength

Ħ. Stiffness

Ħ. Shelf life

Ĩ. Antigenicity

Ĩ. Risk of HIV transmission

Ī. Indemnification

Ī. Occurrence

Ĭ. Excess liability

Ĭ. Claims-made

Į. Nose

Į. Lateral Y

İ. Scapular AP

I. Neutral rotation AP

Ĳ. Internal rotation AP

Ĳ. External rotation AP

Ĵ. Trauma

Ĵ. Hemophilia

Ķ. Reiter’s syndrome

Ķ. Rheumatoid arthritis

ĸ. Systemic lupus erythematosus

Ĺ. Cast immobilization for 6 weeks

Ĺ. Activity modification and re-evaluation in 2 months

Ļ. Internal fixation with or without bone grafting

Ļ. Retrograde drilling of the defect without articular cartilage penetration

Ľ. Drilling of the defect directly through the articular cartilage

Ľ. repair or reconstruction of the medial collateral ligament

Ŀ. repair or reconstruction of the medialand lateral collateral ligaments

Ŀ. immobilization for 5 days or less

Ł. immobilization for 14 days

Ł. immobilization for 25 days

Ń. Cystinosis

Ń. Hypophosphatemia

Ņ. Renal osteodystrophy

Ņ. Primary hyperparathyroidism

Ň. Nutritional vitamin D deficiency

Ň. Lateral meniscus tear

ʼN. Popliteus tenosynovitis

Ŋ. Iliotibial band friction syndrome

Ŋ. Peroneal nerve entrapment

Ō. Biceps tendinitis

Ō. Observation

Ŏ. Removal of the prosthetic components

Ŏ. Operative exploration and decompression of the peroneal nerve

Ő. Nerve conduction velocity studies

Ő. Loosening of the primary dressings and knee flexion to 30 degrees

Œ. I

Œ. II

Ŕ. III

Ŕ. decreased tissue tension

Ŗ. decreased abductor lever arm

Ŗ. decreased joint reaction force

Ř. increased body weight over lever arm

Ř. increased polyethylene wear rate

Ś. recurrent traumatic anterior dislocation

Ś. recurrent traumatic posterior dislocation

Ŝ. traumatic subluxation with no previous dislocation

Ŝ. traumatic anterior subluxation

Ş. atraumatic involuntary subluxation

Ş. radial

Š. axillary

Š. suprascapular

Ţ. thoracodorsal

Ţ. long thoracic

Ť. Flexion

Ť. Extension

Ŧ. Axial rotation

Ŧ. Left lateral bending

Ũ. Right lateral bending

Ũ. Skin

Ū. Lung

Ū. Brain

Ŭ. Heart

Ŭ. Kidney

Ů. Thoracoacromial, lateral thoracic, subscapular

Ů. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ű. Posterior humeral circumflex, subscapular, thoracacromial

Ű. Subscapular, thoracacromial, anterior humeral circumflex

Ų. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ų. Respondeat superior

Ŵ. Indemnity agreement

Ŵ. Hold harmless agreement- attempt to shift liability from company to physician

Ŷ. Comparative negligence-% of involvement

Ŷ. Contributory negligence- resident contributed to the negligence

Ÿ. t-type

Ź. both column

Ź. transverse

Ż. anterior column

Ż. anterior column posterior hemitransverse

Ž. Posterior interosseous

Ž. Anterior interosseous

S. Radial

Ƀ. Median

Ɓ. Ulnar

Ƃ. Shock from hypovolemia

Ƃ. Associated rupture of the bladder

Ƅ. Arterial bleeding on pelvic angiogram

Ƅ. Presence of a hematoma in the perineum and scrotum

Ɔ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. T1-low, T2-low.

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10. Pathology and Oncology MCQs

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