What is the predominant collagen type in osteoarthritic articular cartilage?

Correct Answer: I. Explanation:

A patient undergoes an acute repair of a laceration of the median nerve in the antecubital fossa. A lack of functional recovery 6 months later is most likely due to

Correct Answer: Retrograde collapse of the endoneurial tubes. Explanation:

A 25 year-old amateur baseball player sustained a dorsal fracture-dislocation of the proximal interphalangeal joint of his long finger. He underwent closed reduction 3 hours ago. Examination reveals

Correct Answer: open reduction and internal fixation. Explanation:

An orthopaedic surgeon who is the developer of a knee arthroplasty system is discussing treatment options with a patient who has tricompartmental osteoarthritis. As a part of this discussion, the ort

Correct Answer: The name of the manufacturer. Explanation:

Which of the following nerves lying between the gluteus medius and minimus is at risk for injury in a lateral approach to the hip?

Correct Answer: Femoral. Explanation:

A patient sustains a closed dorsal dislocation of the proximal interphalangeal joint of the middle finger without an associated fracture. Closed treatment results in a cocentric stable reduction. The

Correct Answer: Triggering. Explanation:

To maximally resist apex anterior angulation in the tibia, the pins of a unilateral external fixator should be oriented in which of the following planes?

Correct Answer: Coronal. Explanation:

Resurfacing the patella during a total knee replacement is strongly indicated when the diagnosis is

Correct Answer: Rheumatoid arthritis. Explanation:

The change over time in strain of a material under a constant load is defined as

Correct Answer: Creep. Explanation:

What is the usual mechanism of injury for the fracture shown in Figures 49a and 49b?

Correct Answer: bending. Explanation:

Gamma ray irradiation for sterilization of ultra-high molecular weight polyethylene in an oxygen environment can have what effect on the material?

Correct Answer: Increase stiffness. Explanation:

Clinic OS

Q: A “p value” of 4% (p=0.04) indicates that the

Correct Answer: hypothesis is incorrect or invalid. Explanation:

Q: Which of the following conditions associated with rheumatoid arthritis of the cervical spine is shown in the flexion-extension views in figures 45a and 45b?

Correct Answer: Cranial setting. Explanation:

Q: To prevent injury to the posterior interosseous nerve during the approach for reduction and fixation of a fracture of the radial head, anterior retraction should be performed with the forearm

Correct Answer: Maximally pronated and elbow extended. Explanation:

Q: Figure 46 shows the lateral radiograph of a 5 year-old girl who has a fracture of the left tibia as a result of minimal trauma. Examination shows no skin lesions or birthmarks, and family history is u

Correct Answer: open biopsy and a long leg cast. Explanation:

Question 4201

Topic: 10. Pathology and Oncology

A “p value” of 4% (p=0.04) indicates that the

. hypothesis is incorrect or invalid

. interobserver error rate is 4%.

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

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

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

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

!. The physician’s clinical performance

". The physician’s materials testing data

#. Any royalties the physician receives from the manufacturer

$. Femoral

%. Obturator

&. Inferior gluteal

'. Superior gluteal

(. Lateral femoral cutaneous

). open biopsy and a long leg cast

*. open biopsy and wide resection of the tumor

+. a long leg cast and observation

,. intramedullary stabilization and observation

-. Triggering

.. Lateral instability

/. Swan-neck deformity

0. Boutonniere deformity

1. Loss of distal interphalangeal joint flexion

2. Peroneus brevis to peroneus longus

3. Peroneus tertius to extensor hallucis longus

4. Peroneus tertius to superficial peroneal nerve

5. Extensor hallucis longus to deep peroneal nerve

6. Extensor hallucis longus to extensor digitorum longus

7. reassurance that Medicare will pay for the treatment.

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

9. 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.

A. Coronal

B. Sagittal

C. Anteromedial, midway between the sagittal and the coronal

D. Proximal pins sagittal, distal pins coronal

E. Proximal pins coronal, distal pins sagittal

F. Rheumatoid arthritis

G. Posttraumatic arthritis

H. Degenerative osteoarthritis

I. Osteonecrosis of the tibial plateau

J. Osteonecrosis of the medial femoral condyle

K. Trapeziometacarpal arthrodesis

L. Osteotomy of the thumb metacarpal

M. Arthrotomy and joint debridement

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

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

P. Creep

Q. Relaxation

R. Energy dissipation

S. Plastic deformation

T. Elastic deformation

U. bending

V. axial loading

W. high-speed rotation

X. direct impact from anteromedial

Y. crush from anteromedial to posterolateral

Z. Increase stiffness

[. Increase fracture toughness

\. Increase fatigue strength

]. Decrease mechanical strength

^. Decrease wear rate

_. disuse osteopenia

`. paraendocrine effect of the tumor

A. abnormally increased density on the right side

B. side effect of the treatment of the lesion

C. extensive tumor involvement of the left hip

D. Sciatic nerve

E. Superior gluteal artery

F. Profunda femoris artery

G. Femoral artery and nerve

H. External iliac artery and vein

I. Length

J. Moment arm

K. Total volume

L. Physiologic cross-sectional area

M. Distribution of slow and fast twitch fibers

N. decreasing initiation of action potentials.

O. increasing action potential amplitude.

P. blocking the opening of gated sodium channels.

Q. decreasing the number of functional motor units.

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

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

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

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

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

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

X. hemiarthroplasty

Y. open reduction and internal fixation

Z. 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

¤. 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

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

©. Meta-analysis

ª. Confidence interval

«. Analysis of variance (ANOVA)

¬. Statistical significance (p-value)

. Survivorship analysis (Kaplan-Meier)

®. Spinal shock

¯. Neurogenic shock

°. Hypovolemic shock

±. Pulmonary embolism

². Fat embolus syndrome

³. Lumbar spinal stenosis

´. Metastatic disease of the spine

Μ. Rheumatoid lumbar spondylitis

¶. Isthmic spondyloloisthesis

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

¸. Patella alta

¹. A metal-backed patella

º. Varus malalignment of the knee

». A posterior cruciate-substituting femoral component

¼. Lateral subluxation of the patella on a Merchant’s view

½. The sesamoids are separated

¾. The sesamoid is fractured

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

À. The dislocation is dorsal and centered

Á. The proximal phalanx is hyperextended

Â. Patella

Ã. Tibial stem

Ä. Distal femoral interface

Å. Posterior femoral interface

Æ. Sites of screw fixation for the tibia

Ç. Hallux rigidus

È. Fracture of the sesamoid

É. Disruption of the plantar plate

Ê. Osteonecrosis of the metatarsal head

Ë. Rupture of the flexor hallucis longus

Ì. Gout

Í. Sepsis

Î. Old trauma

Ï. Rheumatoid arthritis

Ð. Charcot arthroplasty

Ñ. Aspiration and steroid injection

Ò. Biopsy, curettage, and allograft bone grafting

Ó. Percutaneous Kirschner wire fixation

Ô. Percutaneous injection of autogenous bone marrow

Õ. Nerve roots

Ö. Spinal cord

×. Sciatic nerve

Ø. Peroneal nerve

Ù. Conus medullaris

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

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

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

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

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

SS. Early and late infection

À. Periprosthetic fracture of the femur

Á. Failure of the patellofemoral and extensor mechanisms

Â. Aseptic loosening of cementing tibial components

Ã. Asceptic loosening of cemented femoral components

Ä. Acceptance of the current position of the ankle

Å. Open reduction and fixation in the epiphysis only

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

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

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

É. Resection arthroplasty and local radiation

Ê. In situ fusion of the hip

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

Ì. Excision of heterotopic bone and local radiation

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

Î. Closed reduction of both fractures and immediate spica casting

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

Ð. External fixation of both femora

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

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

Ó. Synovial sarcoma

Ô. Soft-tissue abcess

Õ. Rhabdomyosarcoma

Ö. Eosinophilic granuloma

÷. Nodular pigmented villonodular synovitis

Ø. Changing to a titanium nail

Ù. Changing to a nonslotted nail

Ú. Changing the cross-sectional shape of the nail

Û. Increasing the diameter of the nail by 3 mm

Ü. Increasing the diameter of the interlocking screws

Ý. Fracture healing

Þ. Chondrosarcoma

Ÿ. Periosteal chondroma

Ā. Periosteal osteosarcoma

Ā. Dysplasia epiphysealis hemimelica

Ă. Demonstrate competence in the subject of the case

Ă. Be fellowship trained in the subject of the case

Ą. Be paid on a contingency basis

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

Ć. Have been involved in the case as a consultant

Ć. Diagnostic arthroscopy

Ĉ. Arthroscopy and subacromial decompression

Ĉ. Reduction and fixation of the proximal humeral epiphysis

Ċ. Temporary cessation of throwing

Ċ. Physical therapy for rotator cuff strengthening

Č. Oblique popliteal ligament

Č. Lateral capsule

Ď. Popliteal tendon

Ď. Fibular collateral ligament

Đ. Posterior oblique ligament

Đ. Radial tear

Ē. Parrot-beak tear

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

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

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

Ė. 0 degrees of abduction, with neural rotation

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

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

Ę. 90 degrees of abduction with neutral rotation

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

Ě. Sural

Ĝ. Saphenous and its branches

Ĝ. Posterior tibial and its branches

Ğ. Deep peroneal and its branches

Ğ. Superficial peroneal and its branches

Ġ. Strength

Ġ. Stiffness

Ģ. Shelf life

Ģ. Antigenicity

Ĥ. Risk of HIV transmission

Ĥ. Indemnification

Ħ. Occurrence

Ħ. Excess liability

Ĩ. Claims-made

Ĩ. Nose

Ī. Lateral Y

Ī. Scapular AP

Ĭ. Neutral rotation AP

Ĭ. Internal rotation AP

Į. External rotation AP

Į. Trauma

İ. Hemophilia

I. Reiter’s syndrome

Ĳ. Rheumatoid arthritis

Ĳ. Systemic lupus erythematosus

Ĵ. Cast immobilization for 6 weeks

Ĵ. Activity modification and re-evaluation in 2 months

Ķ. Internal fixation with or without bone grafting

Ķ. Retrograde drilling of the defect without articular cartilage penetration

ĸ. Drilling of the defect directly through the articular cartilage

Ĺ. repair or reconstruction of the medial collateral ligament

Ĺ. repair or reconstruction of the medialand lateral collateral ligaments

Ļ. immobilization for 5 days or less

Ļ. immobilization for 14 days

Ľ. immobilization for 25 days

Ľ. Cystinosis

Ŀ. Hypophosphatemia

Ŀ. Renal osteodystrophy

Ł. Primary hyperparathyroidism

Ł. Nutritional vitamin D deficiency

Ń. Lateral meniscus tear

Ń. Popliteus tenosynovitis

Ņ. Iliotibial band friction syndrome

Ņ. Peroneal nerve entrapment

Ň. Biceps tendinitis

Ň. Observation

ʼN. Removal of the prosthetic components

Ŋ. Operative exploration and decompression of the peroneal nerve

Ŋ. Nerve conduction velocity studies

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

Ō. I

Ŏ. II

Ŏ. III

Ő. decreased tissue tension

Ő. decreased abductor lever arm

Œ. decreased joint reaction force

Œ. increased body weight over lever arm

Ŕ. increased polyethylene wear rate

Ŕ. recurrent traumatic anterior dislocation

Ŗ. recurrent traumatic posterior dislocation

Ŗ. traumatic subluxation with no previous dislocation

Ř. traumatic anterior subluxation

Ř. atraumatic involuntary subluxation

Ś. radial

Ś. axillary

Ŝ. suprascapular

Ŝ. thoracodorsal

Ş. long thoracic

Ş. Flexion

Š. Extension

Š. Axial rotation

Ţ. Left lateral bending

Ţ. Right lateral bending

Ť. Skin

Ť. Lung

Ŧ. Brain

Ŧ. Heart

Ũ. Kidney

Ũ. Thoracoacromial, lateral thoracic, subscapular

Ū. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ū. Posterior humeral circumflex, subscapular, thoracacromial

Ŭ. Subscapular, thoracacromial, anterior humeral circumflex

Ŭ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ů. Respondeat superior

Ů. Indemnity agreement

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

Ű. Comparative negligence-% of involvement

Ų. Contributory negligence- resident contributed to the negligence

Ų. t-type

Ŵ. both column

Ŵ. transverse

Ŷ. anterior column

Ŷ. anterior column posterior hemitransverse

Ÿ. Posterior interosseous

Ź. Anterior interosseous

Ź. Radial

Ż. Median

Ż. Ulnar

Ž. Shock from hypovolemia

Ž. Associated rupture of the bladder

S. Arterial bleeding on pelvic angiogram

Ƀ. Presence of a hematoma in the perineum and scrotum

Ɓ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. hypothesis is incorrect or invalid

Explanation

Question 4202

Topic: 10. Pathology and Oncology

What is the predominant collagen type in osteoarthritic articular cartilage?

. I

. II

. IV

. IX

. X

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

!. Inferior gluteal

". Superior gluteal

#. Lateral femoral cutaneous

$. open biopsy and a long leg cast

%. open biopsy and wide resection of the tumor

&. a long leg cast and observation

'. intramedullary stabilization and observation

(. Triggering

). Lateral instability

*. Swan-neck deformity

+. Boutonniere deformity

,. Loss of distal interphalangeal joint flexion

-. Peroneus brevis to peroneus longus

.. Peroneus tertius to extensor hallucis longus

/. Peroneus tertius to superficial peroneal nerve

0. Extensor hallucis longus to deep peroneal nerve

1. Extensor hallucis longus to extensor digitorum longus

2. reassurance that Medicare will pay for the treatment.

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

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

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

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

7. an onlay iliac crest bone graft.

8. limited weightbearing and observation.

9. 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

B. Posttraumatic arthritis

C. Degenerative osteoarthritis

D. Osteonecrosis of the tibial plateau

E. Osteonecrosis of the medial femoral condyle

F. Trapeziometacarpal arthrodesis

G. Osteotomy of the thumb metacarpal

H. Arthrotomy and joint debridement

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

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

K. Creep

L. Relaxation

M. Energy dissipation

N. Plastic deformation

O. Elastic deformation

P. bending

Q. axial loading

R. high-speed rotation

S. direct impact from anteromedial

T. crush from anteromedial to posterolateral

U. Increase stiffness

V. Increase fracture toughness

W. Increase fatigue strength

X. Decrease mechanical strength

Y. Decrease wear rate

Z. 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

A. Profunda femoris artery

B. Femoral artery and nerve

C. External iliac artery and vein

D. Length

E. Moment arm

F. Total volume

G. Physiologic cross-sectional area

H. Distribution of slow and fast twitch fibers

I. decreasing initiation of action potentials.

J. increasing action potential amplitude.

K. blocking the opening of gated sodium channels.

L. decreasing the number of functional motor units.

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

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

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

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

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

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

S. hemiarthroplasty

T. open reduction and internal fixation

U. closed reduction and percutaneous pinning

V. a sling and early pedulum exercises

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

X. open acromioplasty

Y. open Bankart repair

Z. 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

. 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

£. 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)

¨. Survivorship analysis (Kaplan-Meier)

©. Spinal shock

ª. Neurogenic shock

«. Hypovolemic shock

¬. Pulmonary embolism

. Fat embolus syndrome

®. Lumbar spinal stenosis

¯. Metastatic disease of the spine

°. Rheumatoid lumbar spondylitis

±. Isthmic spondyloloisthesis

². Degenerative spondylolisthesis at L4-5 and L5-S1

³. Patella alta

´. A metal-backed patella

Μ. Varus malalignment of the knee

¶. A posterior cruciate-substituting femoral component

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

¸. The sesamoids are separated

¹. The sesamoid is fractured

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

». The dislocation is dorsal and centered

¼. The proximal phalanx is hyperextended

½. Patella

¾. Tibial stem

¿. Distal femoral interface

À. Posterior femoral interface

Á. Sites of screw fixation for the tibia

Â. Hallux rigidus

Ã. Fracture of the sesamoid

Ä. Disruption of the plantar plate

Å. Osteonecrosis of the metatarsal head

Æ. Rupture of the flexor hallucis longus

Ç. Gout

È. Sepsis

É. Old trauma

Ê. Rheumatoid arthritis

Ë. Charcot arthroplasty

Ì. Aspiration and steroid injection

Í. Biopsy, curettage, and allograft bone grafting

Î. Percutaneous Kirschner wire fixation

Ï. Percutaneous injection of autogenous bone marrow

Ð. Nerve roots

Ñ. Spinal cord

Ò. Sciatic nerve

Ó. Peroneal nerve

Ô. Conus medullaris

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

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

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

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

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

Ú. Early and late infection

Û. Periprosthetic fracture of the femur

Ü. Failure of the patellofemoral and extensor mechanisms

Ý. Aseptic loosening of cementing tibial components

Þ. Asceptic loosening of cemented femoral components

SS. Acceptance of the current position of the ankle

À. Open reduction and fixation in the epiphysis only

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

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

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

Ä. Resection arthroplasty and local radiation

Å. In situ fusion of the hip

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

Ç. Excision of heterotopic bone and local radiation

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

É. Closed reduction of both fractures and immediate spica casting

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

Ë. External fixation of both femora

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

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

Î. Synovial sarcoma

Ï. Soft-tissue abcess

Ð. Rhabdomyosarcoma

Ñ. Eosinophilic granuloma

Ò. Nodular pigmented villonodular synovitis

Ó. Changing to a titanium nail

Ô. Changing to a nonslotted nail

Õ. Changing the cross-sectional shape of the nail

Ö. Increasing the diameter of the nail by 3 mm

÷. Increasing the diameter of the interlocking screws

Ø. Fracture healing

Ù. Chondrosarcoma

Ú. Periosteal chondroma

Û. Periosteal osteosarcoma

Ü. Dysplasia epiphysealis hemimelica

Ý. Demonstrate competence in the subject of the case

Þ. Be fellowship trained in the subject of the case

Ÿ. Be paid on a contingency basis

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

Ā. Have been involved in the case as a consultant

Ă. Diagnostic arthroscopy

Ă. Arthroscopy and subacromial decompression

Ą. Reduction and fixation of the proximal humeral epiphysis

Ą. Temporary cessation of throwing

Ć. Physical therapy for rotator cuff strengthening

Ć. Oblique popliteal ligament

Ĉ. Lateral capsule

Ĉ. Popliteal tendon

Ċ. Fibular collateral ligament

Ċ. Posterior oblique ligament

Č. Radial tear

Č. Parrot-beak tear

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

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

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

Đ. 0 degrees of abduction, with neural rotation

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

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

Ĕ. 90 degrees of abduction with neutral rotation

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

Ė. Sural

Ė. Saphenous and its branches

Ę. Posterior tibial and its branches

Ę. Deep peroneal and its branches

Ě. Superficial peroneal and its branches

Ě. Strength

Ĝ. Stiffness

Ĝ. Shelf life

Ğ. Antigenicity

Ğ. Risk of HIV transmission

Ġ. Indemnification

Ġ. Occurrence

Ģ. Excess liability

Ģ. Claims-made

Ĥ. Nose

Ĥ. Lateral Y

Ħ. Scapular AP

Ħ. Neutral rotation AP

Ĩ. Internal rotation AP

Ĩ. External rotation AP

Ī. Trauma

Ī. Hemophilia

Ĭ. Reiter’s syndrome

Ĭ. Rheumatoid arthritis

Į. Systemic lupus erythematosus

Į. Cast immobilization for 6 weeks

İ. Activity modification and re-evaluation in 2 months

I. Internal fixation with or without bone grafting

Ĳ. Retrograde drilling of the defect without articular cartilage penetration

Ĳ. Drilling of the defect directly through the articular cartilage

Ĵ. repair or reconstruction of the medial collateral ligament

Ĵ. repair or reconstruction of the medialand lateral collateral ligaments

Ķ. immobilization for 5 days or less

Ķ. immobilization for 14 days

ĸ. immobilization for 25 days

Ĺ. Cystinosis

Ĺ. Hypophosphatemia

Ļ. Renal osteodystrophy

Ļ. Primary hyperparathyroidism

Ľ. Nutritional vitamin D deficiency

Ľ. Lateral meniscus tear

Ŀ. Popliteus tenosynovitis

Ŀ. Iliotibial band friction syndrome

Ł. Peroneal nerve entrapment

Ł. Biceps tendinitis

Ń. Observation

Ń. Removal of the prosthetic components

Ņ. Operative exploration and decompression of the peroneal nerve

Ņ. Nerve conduction velocity studies

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

Ň. I

ʼN. II

Ŋ. III

Ŋ. decreased tissue tension

Ō. decreased abductor lever arm

Ō. decreased joint reaction force

Ŏ. increased body weight over lever arm

Ŏ. increased polyethylene wear rate

Ő. recurrent traumatic anterior dislocation

Ő. recurrent traumatic posterior dislocation

Œ. traumatic subluxation with no previous dislocation

Œ. traumatic anterior subluxation

Ŕ. atraumatic involuntary subluxation

Ŕ. radial

Ŗ. axillary

Ŗ. suprascapular

Ř. thoracodorsal

Ř. long thoracic

Ś. Flexion

Ś. Extension

Ŝ. Axial rotation

Ŝ. Left lateral bending

Ş. Right lateral bending

Ş. Skin

Š. Lung

Š. Brain

Ţ. Heart

Ţ. Kidney

Ť. Thoracoacromial, lateral thoracic, subscapular

Ť. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ŧ. Posterior humeral circumflex, subscapular, thoracacromial

Ŧ. Subscapular, thoracacromial, anterior humeral circumflex

Ũ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ũ. Respondeat superior

Ū. Indemnity agreement

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

Ŭ. Comparative negligence-% of involvement

Ŭ. Contributory negligence- resident contributed to the negligence

Ů. t-type

Ů. both column

Ű. transverse

Ű. anterior column

Ų. anterior column posterior hemitransverse

Ų. Posterior interosseous

Ŵ. Anterior interosseous

Ŵ. Radial

Ŷ. Median

Ŷ. Ulnar

Ÿ. Shock from hypovolemia

Ź. Associated rupture of the bladder

Ź. Arterial bleeding on pelvic angiogram

Ż. Presence of a hematoma in the perineum and scrotum

Ż. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. I

Explanation

Question 4203

Topic: 10. Pathology and Oncology

Which of the following conditions associated with rheumatoid arthritis of the cervical spine is shown in the flexion-extension views in figures 45a and 45b?

. Cranial setting

. Cranial subluxation

. Odontoid fracture

. Lysis of the arch of the atlas

. Atlantoaxial subluxation

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

!. a long leg cast and observation

". intramedullary stabilization and observation

#. Triggering

$. Lateral instability

%. Swan-neck deformity

&. Boutonniere deformity

'. Loss of distal interphalangeal joint flexion

(. Peroneus brevis to peroneus longus

). Peroneus tertius to extensor hallucis longus

*. Peroneus tertius to superficial peroneal nerve

+. Extensor hallucis longus to deep peroneal nerve

,. 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.

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

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

2. an onlay iliac crest bone graft.

3. limited weightbearing and observation.

4. removal of the implant and limited weightbearing.

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

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

7. Coronal

8. Sagittal

9. 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

B. Osteotomy of the thumb metacarpal

C. Arthrotomy and joint debridement

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

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

F. Creep

G. Relaxation

H. Energy dissipation

I. Plastic deformation

J. Elastic deformation

K. bending

L. axial loading

M. high-speed rotation

N. direct impact from anteromedial

O. crush from anteromedial to posterolateral

P. Increase stiffness

Q. Increase fracture toughness

R. Increase fatigue strength

S. Decrease mechanical strength

T. Decrease wear rate

U. disuse osteopenia

V. paraendocrine effect of the tumor

W. abnormally increased density on the right side

X. side effect of the treatment of the lesion

Y. extensive tumor involvement of the left hip

Z. Sciatic nerve

[. Superior gluteal artery

\. Profunda femoris artery

]. Femoral artery and nerve

^. External iliac artery and vein

_. Length

`. Moment arm

A. Total volume

B. Physiologic cross-sectional area

C. Distribution of slow and fast twitch fibers

D. decreasing initiation of action potentials.

E. increasing action potential amplitude.

F. blocking the opening of gated sodium channels.

G. decreasing the number of functional motor units.

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

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

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

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

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

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

N. hemiarthroplasty

O. open reduction and internal fixation

P. closed reduction and percutaneous pinning

Q. a sling and early pedulum exercises

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

S. open acromioplasty

T. open Bankart repair

U. open subscapularis tendon repair

V. inferior capsular shift

W. a supervised physical therapy program

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

Y. open reduction and internal fixation through an anterior approach

Z. 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

. 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

. 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)

£. Survivorship analysis (Kaplan-Meier)

¤. Spinal shock

¥. Neurogenic shock

¦. Hypovolemic shock

§. Pulmonary embolism

¨. Fat embolus syndrome

©. Lumbar spinal stenosis

ª. Metastatic disease of the spine

«. Rheumatoid lumbar spondylitis

¬. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

®. Patella alta

¯. A metal-backed patella

°. Varus malalignment of the knee

±. A posterior cruciate-substituting femoral component

². Lateral subluxation of the patella on a Merchant’s view

³. The sesamoids are separated

´. The sesamoid is fractured

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

¶. The dislocation is dorsal and centered

·. The proximal phalanx is hyperextended

¸. Patella

¹. Tibial stem

º. Distal femoral interface

». Posterior femoral interface

¼. Sites of screw fixation for the tibia

½. Hallux rigidus

¾. Fracture of the sesamoid

¿. Disruption of the plantar plate

À. Osteonecrosis of the metatarsal head

Á. Rupture of the flexor hallucis longus

Â. Gout

Ã. Sepsis

Ä. Old trauma

Å. Rheumatoid arthritis

Æ. Charcot arthroplasty

Ç. Aspiration and steroid injection

È. Biopsy, curettage, and allograft bone grafting

É. Percutaneous Kirschner wire fixation

Ê. Percutaneous injection of autogenous bone marrow

Ë. Nerve roots

Ì. Spinal cord

Í. Sciatic nerve

Î. Peroneal nerve

Ï. Conus medullaris

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

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

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

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

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

Õ. Early and late infection

Ö. Periprosthetic fracture of the femur

×. Failure of the patellofemoral and extensor mechanisms

Ø. Aseptic loosening of cementing tibial components

Ù. Asceptic loosening of cemented femoral components

Ú. Acceptance of the current position of the ankle

Û. Open reduction and fixation in the epiphysis only

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

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

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

SS. Resection arthroplasty and local radiation

À. In situ fusion of the hip

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

Â. Excision of heterotopic bone and local radiation

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

Ä. Closed reduction of both fractures and immediate spica casting

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

Æ. External fixation of both femora

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

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

É. Synovial sarcoma

Ê. Soft-tissue abcess

Ë. Rhabdomyosarcoma

Ì. Eosinophilic granuloma

Í. Nodular pigmented villonodular synovitis

Î. Changing to a titanium nail

Ï. Changing to a nonslotted nail

Ð. Changing the cross-sectional shape of the nail

Ñ. Increasing the diameter of the nail by 3 mm

Ò. Increasing the diameter of the interlocking screws

Ó. Fracture healing

Ô. Chondrosarcoma

Õ. Periosteal chondroma

Ö. Periosteal osteosarcoma

÷. Dysplasia epiphysealis hemimelica

Ø. Demonstrate competence in the subject of the case

Ù. Be fellowship trained in the subject of the case

Ú. Be paid on a contingency basis

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

Ü. Have been involved in the case as a consultant

Ý. Diagnostic arthroscopy

Þ. Arthroscopy and subacromial decompression

Ÿ. Reduction and fixation of the proximal humeral epiphysis

Ā. Temporary cessation of throwing

Ā. Physical therapy for rotator cuff strengthening

Ă. Oblique popliteal ligament

Ă. Lateral capsule

Ą. Popliteal tendon

Ą. Fibular collateral ligament

Ć. Posterior oblique ligament

Ć. Radial tear

Ĉ. Parrot-beak tear

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

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

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

Č. 0 degrees of abduction, with neural rotation

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

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

Ď. 90 degrees of abduction with neutral rotation

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

Đ. Sural

Ē. Saphenous and its branches

Ē. Posterior tibial and its branches

Ĕ. Deep peroneal and its branches

Ĕ. Superficial peroneal and its branches

Ė. Strength

Ė. Stiffness

Ę. Shelf life

Ę. Antigenicity

Ě. Risk of HIV transmission

Ě. Indemnification

Ĝ. Occurrence

Ĝ. Excess liability

Ğ. Claims-made

Ğ. Nose

Ġ. Lateral Y

Ġ. Scapular AP

Ģ. Neutral rotation AP

Ģ. Internal rotation AP

Ĥ. External rotation AP

Ĥ. Trauma

Ħ. Hemophilia

Ħ. Reiter’s syndrome

Ĩ. Rheumatoid arthritis

Ĩ. Systemic lupus erythematosus

Ī. Cast immobilization for 6 weeks

Ī. Activity modification and re-evaluation in 2 months

Ĭ. Internal fixation with or without bone grafting

Ĭ. Retrograde drilling of the defect without articular cartilage penetration

Į. Drilling of the defect directly through the articular cartilage

Į. repair or reconstruction of the medial collateral ligament

İ. repair or reconstruction of the medialand lateral collateral ligaments

I. immobilization for 5 days or less

Ĳ. immobilization for 14 days

Ĳ. immobilization for 25 days

Ĵ. Cystinosis

Ĵ. Hypophosphatemia

Ķ. Renal osteodystrophy

Ķ. Primary hyperparathyroidism

ĸ. Nutritional vitamin D deficiency

Ĺ. Lateral meniscus tear

Ĺ. Popliteus tenosynovitis

Ļ. Iliotibial band friction syndrome

Ļ. Peroneal nerve entrapment

Ľ. Biceps tendinitis

Ľ. Observation

Ŀ. Removal of the prosthetic components

Ŀ. Operative exploration and decompression of the peroneal nerve

Ł. Nerve conduction velocity studies

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

Ń. I

Ń. II

Ņ. III

Ņ. decreased tissue tension

Ň. decreased abductor lever arm

Ň. decreased joint reaction force

ʼN. increased body weight over lever arm

Ŋ. increased polyethylene wear rate

Ŋ. recurrent traumatic anterior dislocation

Ō. recurrent traumatic posterior dislocation

Ō. traumatic subluxation with no previous dislocation

Ŏ. traumatic anterior subluxation

Ŏ. atraumatic involuntary subluxation

Ő. radial

Ő. axillary

Œ. suprascapular

Œ. thoracodorsal

Ŕ. long thoracic

Ŕ. Flexion

Ŗ. Extension

Ŗ. Axial rotation

Ř. Left lateral bending

Ř. Right lateral bending

Ś. Skin

Ś. Lung

Ŝ. Brain

Ŝ. Heart

Ş. Kidney

Ş. Thoracoacromial, lateral thoracic, subscapular

Š. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Š. Posterior humeral circumflex, subscapular, thoracacromial

Ţ. Subscapular, thoracacromial, anterior humeral circumflex

Ţ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ť. Respondeat superior

Ť. Indemnity agreement

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

Ŧ. Comparative negligence-% of involvement

Ũ. Contributory negligence- resident contributed to the negligence

Ũ. t-type

Ū. both column

Ū. transverse

Ŭ. anterior column

Ŭ. anterior column posterior hemitransverse

Ů. Posterior interosseous

Ů. Anterior interosseous

Ű. Radial

Ű. Median

Ų. Ulnar

Ų. Shock from hypovolemia

Ŵ. Associated rupture of the bladder

Ŵ. Arterial bleeding on pelvic angiogram

Ŷ. Presence of a hematoma in the perineum and scrotum

Ŷ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Cranial setting

Explanation

Question 4204

Topic: 10. Pathology and Oncology

A patient undergoes an acute repair of a laceration of the median nerve in the antecubital fossa. A lack of functional recovery 6 months later is most likely due to

. Retrograde collapse of the endoneurial tubes

. Irreversible atrophy of the denervated muscles

. Elongation of the axons across the zone of injury

. Sprouting of the axons at the neuromuscular junction

. Misdirection of the axons across the zone of injury

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

. a long leg cast and observation

. intramedullary stabilization and observation

. Triggering

. Lateral instability

. Swan-neck deformity

!. Boutonniere deformity

". Loss of distal interphalangeal joint flexion

#. Peroneus brevis to peroneus longus

$. Peroneus tertius to extensor hallucis longus

%. Peroneus tertius to superficial peroneal nerve

&. Extensor hallucis longus to deep peroneal nerve

'. Extensor hallucis longus to extensor digitorum longus

(. reassurance that Medicare will pay for the treatment.

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

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

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

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

-. an onlay iliac crest bone graft.

.. limited weightbearing and observation.

/. removal of the implant and limited weightbearing.

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

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

2. Coronal

3. Sagittal

4. Anteromedial, midway between the sagittal and the coronal

5. Proximal pins sagittal, distal pins coronal

6. Proximal pins coronal, distal pins sagittal

7. Rheumatoid arthritis

8. Posttraumatic arthritis

9. 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

B. Relaxation

C. Energy dissipation

D. Plastic deformation

E. Elastic deformation

F. bending

G. axial loading

H. high-speed rotation

I. direct impact from anteromedial

J. crush from anteromedial to posterolateral

K. Increase stiffness

L. Increase fracture toughness

M. Increase fatigue strength

N. Decrease mechanical strength

O. Decrease wear rate

P. disuse osteopenia

Q. paraendocrine effect of the tumor

R. abnormally increased density on the right side

S. side effect of the treatment of the lesion

T. extensive tumor involvement of the left hip

U. Sciatic nerve

V. Superior gluteal artery

W. Profunda femoris artery

X. Femoral artery and nerve

Y. External iliac artery and vein

Z. 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.

A. blocking the opening of gated sodium channels.

B. decreasing the number of functional motor units.

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

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

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

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

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

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

I. hemiarthroplasty

J. open reduction and internal fixation

K. closed reduction and percutaneous pinning

L. a sling and early pedulum exercises

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

N. open acromioplasty

O. open Bankart repair

P. open subscapularis tendon repair

Q. inferior capsular shift

R. a supervised physical therapy program

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

T. open reduction and internal fixation through an anterior approach

U. open reduction and internal fixation through a posterior approach

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

W. arthroscopically assisted reduction and percutaneous screw fixation

X. Repair of the rotator cuff

Y. Replacement of the humeral head

Z. 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

. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

¡. Hypovolemic shock

¢. Pulmonary embolism

£. Fat embolus syndrome

¤. Lumbar spinal stenosis

¥. Metastatic disease of the spine

¦. Rheumatoid lumbar spondylitis

§. Isthmic spondyloloisthesis

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

©. Patella alta

ª. A metal-backed patella

«. Varus malalignment of the knee

¬. A posterior cruciate-substituting femoral component

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

®. The sesamoids are separated

¯. The sesamoid is fractured

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

±. The dislocation is dorsal and centered

². The proximal phalanx is hyperextended

³. Patella

´. Tibial stem

Μ. Distal femoral interface

¶. Posterior femoral interface

·. Sites of screw fixation for the tibia

¸. Hallux rigidus

¹. Fracture of the sesamoid

º. Disruption of the plantar plate

». Osteonecrosis of the metatarsal head

¼. Rupture of the flexor hallucis longus

½. Gout

¾. Sepsis

¿. Old trauma

À. Rheumatoid arthritis

Á. Charcot arthroplasty

Â. Aspiration and steroid injection

Ã. Biopsy, curettage, and allograft bone grafting

Ä. Percutaneous Kirschner wire fixation

Å. Percutaneous injection of autogenous bone marrow

Æ. Nerve roots

Ç. Spinal cord

È. Sciatic nerve

É. Peroneal nerve

Ê. Conus medullaris

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

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

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

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

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

Ð. Early and late infection

Ñ. Periprosthetic fracture of the femur

Ò. Failure of the patellofemoral and extensor mechanisms

Ó. Aseptic loosening of cementing tibial components

Ô. Asceptic loosening of cemented femoral components

Õ. Acceptance of the current position of the ankle

Ö. Open reduction and fixation in the epiphysis only

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

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

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

Ú. Resection arthroplasty and local radiation

Û. In situ fusion of the hip

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

Ý. Excision of heterotopic bone and local radiation

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

SS. Closed reduction of both fractures and immediate spica casting

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

Á. External fixation of both femora

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

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

Ä. Synovial sarcoma

Å. Soft-tissue abcess

Æ. Rhabdomyosarcoma

Ç. Eosinophilic granuloma

È. Nodular pigmented villonodular synovitis

É. Changing to a titanium nail

Ê. Changing to a nonslotted nail

Ë. Changing the cross-sectional shape of the nail

Ì. Increasing the diameter of the nail by 3 mm

Í. Increasing the diameter of the interlocking screws

Î. Fracture healing

Ï. Chondrosarcoma

Ð. Periosteal chondroma

Ñ. Periosteal osteosarcoma

Ò. Dysplasia epiphysealis hemimelica

Ó. Demonstrate competence in the subject of the case

Ô. Be fellowship trained in the subject of the case

Õ. Be paid on a contingency basis

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

÷. Have been involved in the case as a consultant

Ø. Diagnostic arthroscopy

Ù. Arthroscopy and subacromial decompression

Ú. Reduction and fixation of the proximal humeral epiphysis

Û. Temporary cessation of throwing

Ü. Physical therapy for rotator cuff strengthening

Ý. Oblique popliteal ligament

Þ. Lateral capsule

Ÿ. Popliteal tendon

Ā. Fibular collateral ligament

Ā. Posterior oblique ligament

Ă. Radial tear

Ă. Parrot-beak tear

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

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

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

Ć. 0 degrees of abduction, with neural rotation

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

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

Ċ. 90 degrees of abduction with neutral rotation

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

Č. Sural

Č. Saphenous and its branches

Ď. Posterior tibial and its branches

Ď. Deep peroneal and its branches

Đ. Superficial peroneal and its branches

Đ. Strength

Ē. Stiffness

Ē. Shelf life

Ĕ. Antigenicity

Ĕ. Risk of HIV transmission

Ė. Indemnification

Ė. Occurrence

Ę. Excess liability

Ę. Claims-made

Ě. Nose

Ě. Lateral Y

Ĝ. Scapular AP

Ĝ. Neutral rotation AP

Ğ. Internal rotation AP

Ğ. External rotation AP

Ġ. Trauma

Ġ. Hemophilia

Ģ. Reiter’s syndrome

Ģ. Rheumatoid arthritis

Ĥ. Systemic lupus erythematosus

Ĥ. Cast immobilization for 6 weeks

Ħ. Activity modification and re-evaluation in 2 months

Ħ. Internal fixation with or without bone grafting

Ĩ. Retrograde drilling of the defect without articular cartilage penetration

Ĩ. Drilling of the defect directly through the articular cartilage

Ī. repair or reconstruction of the medial collateral ligament

Ī. repair or reconstruction of the medialand lateral collateral ligaments

Ĭ. immobilization for 5 days or less

Ĭ. immobilization for 14 days

Į. immobilization for 25 days

Į. Cystinosis

İ. Hypophosphatemia

I. Renal osteodystrophy

Ĳ. Primary hyperparathyroidism

Ĳ. Nutritional vitamin D deficiency

Ĵ. Lateral meniscus tear

Ĵ. Popliteus tenosynovitis

Ķ. Iliotibial band friction syndrome

Ķ. Peroneal nerve entrapment

ĸ. Biceps tendinitis

Ĺ. Observation

Ĺ. Removal of the prosthetic components

Ļ. Operative exploration and decompression of the peroneal nerve

Ļ. Nerve conduction velocity studies

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

Ľ. I

Ŀ. II

Ŀ. III

Ł. decreased tissue tension

Ł. decreased abductor lever arm

Ń. decreased joint reaction force

Ń. increased body weight over lever arm

Ņ. increased polyethylene wear rate

Ņ. recurrent traumatic anterior dislocation

Ň. recurrent traumatic posterior dislocation

Ň. traumatic subluxation with no previous dislocation

ʼN. traumatic anterior subluxation

Ŋ. atraumatic involuntary subluxation

Ŋ. radial

Ō. axillary

Ō. suprascapular

Ŏ. thoracodorsal

Ŏ. long thoracic

Ő. Flexion

Ő. Extension

Œ. Axial rotation

Œ. Left lateral bending

Ŕ. Right lateral bending

Ŕ. Skin

Ŗ. Lung

Ŗ. Brain

Ř. Heart

Ř. Kidney

Ś. Thoracoacromial, lateral thoracic, subscapular

Ś. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ŝ. Posterior humeral circumflex, subscapular, thoracacromial

Ŝ. Subscapular, thoracacromial, anterior humeral circumflex

Ş. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ş. Respondeat superior

Š. Indemnity agreement

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

Ţ. Comparative negligence-% of involvement

Ţ. Contributory negligence- resident contributed to the negligence

Ť. t-type

Ť. both column

Ŧ. transverse

Ŧ. anterior column

Ũ. anterior column posterior hemitransverse

Ũ. Posterior interosseous

Ū. Anterior interosseous

Ū. Radial

Ŭ. Median

Ŭ. Ulnar

Ů. Shock from hypovolemia

Ů. Associated rupture of the bladder

Ű. Arterial bleeding on pelvic angiogram

Ű. Presence of a hematoma in the perineum and scrotum

Ų. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Retrograde collapse of the endoneurial tubes

Explanation

Question 4205

Topic: 10. Pathology and Oncology

To prevent injury to the posterior interosseous nerve during the approach for reduction and fixation of a fracture of the radial head, anterior retraction should be performed with the forearm

. Maximally pronated and elbow extended

. Maximally pronated and the elbow flexed

. Maximally supinated and the elbow flexed

. Maximally supinated and the elbow extended

. In neutral rotation, with the elbow extended

. open reduction and internal fixation

. buddy taping to the adjacent index finger

. early motion with application of a dynamic banjo splint

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

. dorsal extension block splinting

. The name of the manufacturer

. The manufacturer’s potential liability

. The physician’s clinical performance

. The physician’s materials testing data

. Any royalties the physician receives from the manufacturer

. Femoral

. Obturator

. Inferior gluteal

. Superior gluteal

. Lateral femoral cutaneous

. open biopsy and a long leg cast

. open biopsy and wide resection of the tumor

. a long leg cast and observation

. intramedullary stabilization and observation

. Triggering

. Lateral instability

. Swan-neck deformity

. Boutonniere deformity

. Loss of distal interphalangeal joint flexion

. Peroneus brevis to peroneus longus

. Peroneus tertius to extensor hallucis longus

. Peroneus tertius to superficial peroneal nerve

!. Extensor hallucis longus to deep peroneal nerve

". Extensor hallucis longus to extensor digitorum longus

#. reassurance that Medicare will pay for the treatment.

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

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

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

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

(. an onlay iliac crest bone graft.

). limited weightbearing and observation.

*. removal of the implant and limited weightbearing.

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

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

-. Coronal

.. Sagittal

/. Anteromedial, midway between the sagittal and the coronal

0. Proximal pins sagittal, distal pins coronal

1. Proximal pins coronal, distal pins sagittal

2. Rheumatoid arthritis

3. Posttraumatic arthritis

4. Degenerative osteoarthritis

5. Osteonecrosis of the tibial plateau

6. Osteonecrosis of the medial femoral condyle

7. Trapeziometacarpal arthrodesis

8. Osteotomy of the thumb metacarpal

9. 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

B. axial loading

C. high-speed rotation

D. direct impact from anteromedial

E. crush from anteromedial to posterolateral

F. Increase stiffness

G. Increase fracture toughness

H. Increase fatigue strength

I. Decrease mechanical strength

J. Decrease wear rate

K. disuse osteopenia

L. paraendocrine effect of the tumor

M. abnormally increased density on the right side

N. side effect of the treatment of the lesion

O. extensive tumor involvement of the left hip

P. Sciatic nerve

Q. Superior gluteal artery

R. Profunda femoris artery

S. Femoral artery and nerve

T. External iliac artery and vein

U. Length

V. Moment arm

W. Total volume

X. Physiologic cross-sectional area

Y. Distribution of slow and fast twitch fibers

Z. 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.

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

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

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

D. hemiarthroplasty

E. open reduction and internal fixation

F. closed reduction and percutaneous pinning

G. a sling and early pedulum exercises

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

I. open acromioplasty

J. open Bankart repair

K. open subscapularis tendon repair

L. inferior capsular shift

M. a supervised physical therapy program

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

O. open reduction and internal fixation through an anterior approach

P. open reduction and internal fixation through a posterior approach

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

R. arthroscopically assisted reduction and percutaneous screw fixation

S. Repair of the rotator cuff

T. Replacement of the humeral head

U. Resection arthroplasty

V. Total shoulder arthroplasty

W. AP and lateral radiographs of the elbow

X. Diagnositc arthroscopy

Y. Aspiration of joint fluid

Z. 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

. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

¡. Rheumatoid lumbar spondylitis

¢. Isthmic spondyloloisthesis

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

¤. Patella alta

¥. A metal-backed patella

¦. Varus malalignment of the knee

§. A posterior cruciate-substituting femoral component

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

©. The sesamoids are separated

ª. The sesamoid is fractured

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

¬. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

®. Patella

¯. Tibial stem

°. Distal femoral interface

±. Posterior femoral interface

². Sites of screw fixation for the tibia

³. Hallux rigidus

´. Fracture of the sesamoid

Μ. Disruption of the plantar plate

¶. Osteonecrosis of the metatarsal head

·. Rupture of the flexor hallucis longus

¸. Gout

¹. Sepsis

º. Old trauma

». Rheumatoid arthritis

¼. Charcot arthroplasty

½. Aspiration and steroid injection

¾. Biopsy, curettage, and allograft bone grafting

¿. Percutaneous Kirschner wire fixation

À. Percutaneous injection of autogenous bone marrow

Á. Nerve roots

Â. Spinal cord

Ã. Sciatic nerve

Ä. Peroneal nerve

Å. Conus medullaris

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

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

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

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

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

Ë. Early and late infection

Ì. Periprosthetic fracture of the femur

Í. Failure of the patellofemoral and extensor mechanisms

Î. Aseptic loosening of cementing tibial components

Ï. Asceptic loosening of cemented femoral components

Ð. Acceptance of the current position of the ankle

Ñ. Open reduction and fixation in the epiphysis only

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

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

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

Õ. Resection arthroplasty and local radiation

Ö. In situ fusion of the hip

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

Ø. Excision of heterotopic bone and local radiation

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

Ú. Closed reduction of both fractures and immediate spica casting

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

Ü. External fixation of both femora

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

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

SS. Synovial sarcoma

À. Soft-tissue abcess

Á. Rhabdomyosarcoma

Â. Eosinophilic granuloma

Ã. Nodular pigmented villonodular synovitis

Ä. Changing to a titanium nail

Å. Changing to a nonslotted nail

Æ. Changing the cross-sectional shape of the nail

Ç. Increasing the diameter of the nail by 3 mm

È. Increasing the diameter of the interlocking screws

É. Fracture healing

Ê. Chondrosarcoma

Ë. Periosteal chondroma

Ì. Periosteal osteosarcoma

Í. Dysplasia epiphysealis hemimelica

Î. Demonstrate competence in the subject of the case

Ï. Be fellowship trained in the subject of the case

Ð. Be paid on a contingency basis

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

Ò. Have been involved in the case as a consultant

Ó. Diagnostic arthroscopy

Ô. Arthroscopy and subacromial decompression

Õ. Reduction and fixation of the proximal humeral epiphysis

Ö. Temporary cessation of throwing

÷. Physical therapy for rotator cuff strengthening

Ø. Oblique popliteal ligament

Ù. Lateral capsule

Ú. Popliteal tendon

Û. Fibular collateral ligament

Ü. Posterior oblique ligament

Ý. Radial tear

Þ. Parrot-beak tear

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

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

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

Ă. 0 degrees of abduction, with neural rotation

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

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

Ą. 90 degrees of abduction with neutral rotation

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

Ć. Sural

Ĉ. Saphenous and its branches

Ĉ. Posterior tibial and its branches

Ċ. Deep peroneal and its branches

Ċ. Superficial peroneal and its branches

Č. Strength

Č. Stiffness

Ď. Shelf life

Ď. Antigenicity

Đ. Risk of HIV transmission

Đ. Indemnification

Ē. Occurrence

Ē. Excess liability

Ĕ. Claims-made

Ĕ. Nose

Ė. Lateral Y

Ė. Scapular AP

Ę. Neutral rotation AP

Ę. Internal rotation AP

Ě. External rotation AP

Ě. Trauma

Ĝ. Hemophilia

Ĝ. Reiter’s syndrome

Ğ. Rheumatoid arthritis

Ğ. Systemic lupus erythematosus

Ġ. Cast immobilization for 6 weeks

Ġ. Activity modification and re-evaluation in 2 months

Ģ. Internal fixation with or without bone grafting

Ģ. Retrograde drilling of the defect without articular cartilage penetration

Ĥ. Drilling of the defect directly through the articular cartilage

Ĥ. repair or reconstruction of the medial collateral ligament

Ħ. repair or reconstruction of the medialand lateral collateral ligaments

Ħ. immobilization for 5 days or less

Ĩ. immobilization for 14 days

Ĩ. immobilization for 25 days

Ī. Cystinosis

Ī. Hypophosphatemia

Ĭ. Renal osteodystrophy

Ĭ. Primary hyperparathyroidism

Į. Nutritional vitamin D deficiency

Į. Lateral meniscus tear

İ. Popliteus tenosynovitis

I. Iliotibial band friction syndrome

Ĳ. Peroneal nerve entrapment

Ĳ. Biceps tendinitis

Ĵ. Observation

Ĵ. Removal of the prosthetic components

Ķ. Operative exploration and decompression of the peroneal nerve

Ķ. Nerve conduction velocity studies

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

Ĺ. I

Ĺ. II

Ļ. III

Ļ. decreased tissue tension

Ľ. decreased abductor lever arm

Ľ. decreased joint reaction force

Ŀ. increased body weight over lever arm

Ŀ. increased polyethylene wear rate

Ł. recurrent traumatic anterior dislocation

Ł. recurrent traumatic posterior dislocation

Ń. traumatic subluxation with no previous dislocation

Ń. traumatic anterior subluxation

Ņ. atraumatic involuntary subluxation

Ņ. radial

Ň. axillary

Ň. suprascapular

ʼN. thoracodorsal

Ŋ. long thoracic

Ŋ. Flexion

Ō. Extension

Ō. Axial rotation

Ŏ. Left lateral bending

Ŏ. Right lateral bending

Ő. Skin

Ő. Lung

Œ. Brain

Œ. Heart

Ŕ. Kidney

Ŕ. Thoracoacromial, lateral thoracic, subscapular

Ŗ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ŗ. Posterior humeral circumflex, subscapular, thoracacromial

Ř. Subscapular, thoracacromial, anterior humeral circumflex

Ř. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ś. Respondeat superior

Ś. Indemnity agreement

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

Ŝ. Comparative negligence-% of involvement

Ş. Contributory negligence- resident contributed to the negligence

Ş. t-type

Š. both column

Š. transverse

Ţ. anterior column

Ţ. anterior column posterior hemitransverse

Ť. Posterior interosseous

Ť. Anterior interosseous

Ŧ. Radial

Ŧ. Median

Ũ. Ulnar

Ũ. Shock from hypovolemia

Ū. Associated rupture of the bladder

Ū. Arterial bleeding on pelvic angiogram

Ŭ. Presence of a hematoma in the perineum and scrotum

Ŭ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Maximally pronated and elbow extended

Explanation

Question 4206

Topic: 10. Pathology and Oncology

A 25 year-old amateur baseball player sustained a dorsal fracture-dislocation of the proximal interphalangeal joint of his long finger. He underwent closed reduction 3 hours ago. Examination reveals mild laxity of the radial collateral fragment involving 30% of the volar articular surface of the middle phalanx. Management should now include

. 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

-. Rheumatoid arthritis

.. Posttraumatic arthritis

/. Degenerative osteoarthritis

0. Osteonecrosis of the tibial plateau

1. Osteonecrosis of the medial femoral condyle

2. Trapeziometacarpal arthrodesis

3. Osteotomy of the thumb metacarpal

4. Arthrotomy and joint debridement

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

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

7. Creep

8. Relaxation

9. Energy dissipation

:. Plastic deformation

;. Elastic deformation

<. bending

=. axial loading

>. high-speed rotation

?. direct impact from anteromedial

@. crush from anteromedial to posterolateral

A. Increase stiffness

B. Increase fracture toughness

C. Increase fatigue strength

D. Decrease mechanical strength

E. Decrease wear rate

F. disuse osteopenia

G. paraendocrine effect of the tumor

H. abnormally increased density on the right side

I. side effect of the treatment of the lesion

J. extensive tumor involvement of the left hip

K. Sciatic nerve

L. Superior gluteal artery

M. Profunda femoris artery

N. Femoral artery and nerve

O. External iliac artery and vein

P. Length

Q. Moment arm

R. Total volume

S. Physiologic cross-sectional area

T. Distribution of slow and fast twitch fibers

U. decreasing initiation of action potentials.

V. increasing action potential amplitude.

W. blocking the opening of gated sodium channels.

X. decreasing the number of functional motor units.

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

Z. 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

A. closed reduction and percutaneous pinning

B. a sling and early pedulum exercises

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

D. open acromioplasty

E. open Bankart repair

F. open subscapularis tendon repair

G. inferior capsular shift

H. a supervised physical therapy program

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

J. open reduction and internal fixation through an anterior approach

K. open reduction and internal fixation through a posterior approach

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

M. arthroscopically assisted reduction and percutaneous screw fixation

N. Repair of the rotator cuff

O. Replacement of the humeral head

P. Resection arthroplasty

Q. Total shoulder arthroplasty

R. AP and lateral radiographs of the elbow

S. Diagnositc arthroscopy

T. Aspiration of joint fluid

U. An erythrocyte sedimentation rate and CBC

V. A diagnostic lidocaine injection

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

X. Fibroblast growth factor (FGF-1)

Y. Platelet-derived growth factor (PDGF)

Z. 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

. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

¡. Varus malalignment of the knee

¢. A posterior cruciate-substituting femoral component

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

¤. The sesamoids are separated

¥. The sesamoid is fractured

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

§. The dislocation is dorsal and centered

¨. The proximal phalanx is hyperextended

©. Patella

ª. Tibial stem

«. Distal femoral interface

¬. Posterior femoral interface

. Sites of screw fixation for the tibia

®. Hallux rigidus

¯. Fracture of the sesamoid

°. Disruption of the plantar plate

±. Osteonecrosis of the metatarsal head

². Rupture of the flexor hallucis longus

³. Gout

´. Sepsis

Μ. Old trauma

¶. Rheumatoid arthritis

·. Charcot arthroplasty

¸. Aspiration and steroid injection

¹. Biopsy, curettage, and allograft bone grafting

º. Percutaneous Kirschner wire fixation

». Percutaneous injection of autogenous bone marrow

¼. Nerve roots

½. Spinal cord

¾. Sciatic nerve

¿. Peroneal nerve

À. Conus medullaris

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

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

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

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

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

Æ. Early and late infection

Ç. Periprosthetic fracture of the femur

È. Failure of the patellofemoral and extensor mechanisms

É. Aseptic loosening of cementing tibial components

Ê. Asceptic loosening of cemented femoral components

Ë. Acceptance of the current position of the ankle

Ì. Open reduction and fixation in the epiphysis only

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

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

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

Ð. Resection arthroplasty and local radiation

Ñ. In situ fusion of the hip

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

Ó. Excision of heterotopic bone and local radiation

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

Õ. Closed reduction of both fractures and immediate spica casting

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

×. External fixation of both femora

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

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

Ú. Synovial sarcoma

Û. Soft-tissue abcess

Ü. Rhabdomyosarcoma

Ý. Eosinophilic granuloma

Þ. Nodular pigmented villonodular synovitis

SS. Changing to a titanium nail

À. Changing to a nonslotted nail

Á. Changing the cross-sectional shape of the nail

Â. Increasing the diameter of the nail by 3 mm

Ã. Increasing the diameter of the interlocking screws

Ä. Fracture healing

Å. Chondrosarcoma

Æ. Periosteal chondroma

Ç. Periosteal osteosarcoma

È. Dysplasia epiphysealis hemimelica

É. Demonstrate competence in the subject of the case

Ê. Be fellowship trained in the subject of the case

Ë. Be paid on a contingency basis

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

Í. Have been involved in the case as a consultant

Î. Diagnostic arthroscopy

Ï. Arthroscopy and subacromial decompression

Ð. Reduction and fixation of the proximal humeral epiphysis

Ñ. Temporary cessation of throwing

Ò. Physical therapy for rotator cuff strengthening

Ó. Oblique popliteal ligament

Ô. Lateral capsule

Õ. Popliteal tendon

Ö. Fibular collateral ligament

÷. Posterior oblique ligament

Ø. Radial tear

Ù. Parrot-beak tear

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

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

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

Ý. 0 degrees of abduction, with neural rotation

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

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

Ā. 90 degrees of abduction with neutral rotation

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

Ă. Sural

Ă. Saphenous and its branches

Ą. Posterior tibial and its branches

Ą. Deep peroneal and its branches

Ć. Superficial peroneal and its branches

Ć. Strength

Ĉ. Stiffness

Ĉ. Shelf life

Ċ. Antigenicity

Ċ. Risk of HIV transmission

Č. Indemnification

Č. Occurrence

Ď. Excess liability

Ď. Claims-made

Đ. Nose

Đ. Lateral Y

Ē. Scapular AP

Ē. Neutral rotation AP

Ĕ. Internal rotation AP

Ĕ. External rotation AP

Ė. Trauma

Ė. Hemophilia

Ę. Reiter’s syndrome

Ę. Rheumatoid arthritis

Ě. Systemic lupus erythematosus

Ě. Cast immobilization for 6 weeks

Ĝ. Activity modification and re-evaluation in 2 months

Ĝ. Internal fixation with or without bone grafting

Ğ. Retrograde drilling of the defect without articular cartilage penetration

Ğ. Drilling of the defect directly through the articular cartilage

Ġ. repair or reconstruction of the medial collateral ligament

Ġ. repair or reconstruction of the medialand lateral collateral ligaments

Ģ. immobilization for 5 days or less

Ģ. immobilization for 14 days

Ĥ. immobilization for 25 days

Ĥ. Cystinosis

Ħ. Hypophosphatemia

Ħ. Renal osteodystrophy

Ĩ. Primary hyperparathyroidism

Ĩ. Nutritional vitamin D deficiency

Ī. Lateral meniscus tear

Ī. Popliteus tenosynovitis

Ĭ. Iliotibial band friction syndrome

Ĭ. Peroneal nerve entrapment

Į. Biceps tendinitis

Į. Observation

İ. Removal of the prosthetic components

I. Operative exploration and decompression of the peroneal nerve

Ĳ. Nerve conduction velocity studies

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

Ĵ. I

Ĵ. II

Ķ. III

Ķ. decreased tissue tension

ĸ. decreased abductor lever arm

Ĺ. decreased joint reaction force

Ĺ. increased body weight over lever arm

Ļ. increased polyethylene wear rate

Ļ. recurrent traumatic anterior dislocation

Ľ. recurrent traumatic posterior dislocation

Ľ. traumatic subluxation with no previous dislocation

Ŀ. traumatic anterior subluxation

Ŀ. atraumatic involuntary subluxation

Ł. radial

Ł. axillary

Ń. suprascapular

Ń. thoracodorsal

Ņ. long thoracic

Ņ. Flexion

Ň. Extension

Ň. Axial rotation

ʼN. Left lateral bending

Ŋ. Right lateral bending

Ŋ. Skin

Ō. Lung

Ō. Brain

Ŏ. Heart

Ŏ. Kidney

Ő. Thoracoacromial, lateral thoracic, subscapular

Ő. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Œ. Posterior humeral circumflex, subscapular, thoracacromial

Œ. Subscapular, thoracacromial, anterior humeral circumflex

Ŕ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ŕ. Respondeat superior

Ŗ. Indemnity agreement

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

Ř. Comparative negligence-% of involvement

Ř. Contributory negligence- resident contributed to the negligence

Ś. t-type

Ś. both column

Ŝ. transverse

Ŝ. anterior column

Ş. anterior column posterior hemitransverse

Ş. Posterior interosseous

Š. Anterior interosseous

Š. Radial

Ţ. Median

Ţ. Ulnar

Ť. Shock from hypovolemia

Ť. Associated rupture of the bladder

Ŧ. Arterial bleeding on pelvic angiogram

Ŧ. Presence of a hematoma in the perineum and scrotum

Ũ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. open reduction and internal fixation

Explanation

Question 4207

Topic: 10. Pathology and Oncology

An orthopaedic surgeon who is the developer of a knee arthroplasty system is discussing treatment options with a patient who has tricompartmental osteoarthritis. As a part of this discussion, the orthopaedic surgeon has an obligation to disclose

. 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

-. Trapeziometacarpal arthrodesis

.. Osteotomy of the thumb metacarpal

/. Arthrotomy and joint debridement

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

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

2. Creep

3. Relaxation

4. Energy dissipation

5. Plastic deformation

6. Elastic deformation

7. bending

8. axial loading

9. 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

B. paraendocrine effect of the tumor

C. abnormally increased density on the right side

D. side effect of the treatment of the lesion

E. extensive tumor involvement of the left hip

F. Sciatic nerve

G. Superior gluteal artery

H. Profunda femoris artery

I. Femoral artery and nerve

J. External iliac artery and vein

K. Length

L. Moment arm

M. Total volume

N. Physiologic cross-sectional area

O. Distribution of slow and fast twitch fibers

P. decreasing initiation of action potentials.

Q. increasing action potential amplitude.

R. blocking the opening of gated sodium channels.

S. decreasing the number of functional motor units.

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

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

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

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

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

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

Z. 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

A. open subscapularis tendon repair

B. inferior capsular shift

C. a supervised physical therapy program

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

E. open reduction and internal fixation through an anterior approach

F. open reduction and internal fixation through a posterior approach

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

H. arthroscopically assisted reduction and percutaneous screw fixation

I. Repair of the rotator cuff

J. Replacement of the humeral head

K. Resection arthroplasty

L. Total shoulder arthroplasty

M. AP and lateral radiographs of the elbow

N. Diagnositc arthroscopy

O. Aspiration of joint fluid

P. An erythrocyte sedimentation rate and CBC

Q. A diagnostic lidocaine injection

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

S. Fibroblast growth factor (FGF-1)

T. Platelet-derived growth factor (PDGF)

U. Transforming growth factor beta (TGF-B)

V. Bone morphogenetic proteins (BMP)

W. clinical history and radiographic findings.

X. technetium bone scan

Y. flow cytometry pattern of extracted chondrocytes

Z. 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

. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

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

¢. The dislocation is dorsal and centered

£. The proximal phalanx is hyperextended

¤. Patella

¥. Tibial stem

¦. Distal femoral interface

§. Posterior femoral interface

¨. Sites of screw fixation for the tibia

©. Hallux rigidus

ª. Fracture of the sesamoid

«. Disruption of the plantar plate

¬. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

®. Gout

¯. Sepsis

°. Old trauma

±. Rheumatoid arthritis

². Charcot arthroplasty

³. Aspiration and steroid injection

´. Biopsy, curettage, and allograft bone grafting

Μ. Percutaneous Kirschner wire fixation

¶. Percutaneous injection of autogenous bone marrow

·. Nerve roots

¸. Spinal cord

¹. Sciatic nerve

º. Peroneal nerve

». Conus medullaris

¼. Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

½. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

¾. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

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

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

Á. Early and late infection

Â. Periprosthetic fracture of the femur

Ã. Failure of the patellofemoral and extensor mechanisms

Ä. Aseptic loosening of cementing tibial components

Å. Asceptic loosening of cemented femoral components

Æ. Acceptance of the current position of the ankle

Ç. Open reduction and fixation in the epiphysis only

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

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

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

Ë. Resection arthroplasty and local radiation

Ì. In situ fusion of the hip

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

Î. Excision of heterotopic bone and local radiation

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

Ð. Closed reduction of both fractures and immediate spica casting

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

Ò. External fixation of both femora

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

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

Õ. Synovial sarcoma

Ö. Soft-tissue abcess

×. Rhabdomyosarcoma

Ø. Eosinophilic granuloma

Ù. Nodular pigmented villonodular synovitis

Ú. Changing to a titanium nail

Û. Changing to a nonslotted nail

Ü. Changing the cross-sectional shape of the nail

Ý. Increasing the diameter of the nail by 3 mm

Þ. Increasing the diameter of the interlocking screws

SS. Fracture healing

À. Chondrosarcoma

Á. Periosteal chondroma

Â. Periosteal osteosarcoma

Ã. Dysplasia epiphysealis hemimelica

Ä. Demonstrate competence in the subject of the case

Å. Be fellowship trained in the subject of the case

Æ. Be paid on a contingency basis

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

È. Have been involved in the case as a consultant

É. Diagnostic arthroscopy

Ê. Arthroscopy and subacromial decompression

Ë. Reduction and fixation of the proximal humeral epiphysis

Ì. Temporary cessation of throwing

Í. Physical therapy for rotator cuff strengthening

Î. Oblique popliteal ligament

Ï. Lateral capsule

Ð. Popliteal tendon

Ñ. Fibular collateral ligament

Ò. Posterior oblique ligament

Ó. Radial tear

Ô. Parrot-beak tear

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

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

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

Ø. 0 degrees of abduction, with neural rotation

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

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

Û. 90 degrees of abduction with neutral rotation

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

Ý. Sural

Þ. Saphenous and its branches

Ÿ. Posterior tibial and its branches

Ā. Deep peroneal and its branches

Ā. Superficial peroneal and its branches

Ă. Strength

Ă. Stiffness

Ą. Shelf life

Ą. Antigenicity

Ć. Risk of HIV transmission

Ć. Indemnification

Ĉ. Occurrence

Ĉ. Excess liability

Ċ. Claims-made

Ċ. Nose

Č. Lateral Y

Č. Scapular AP

Ď. Neutral rotation AP

Ď. Internal rotation AP

Đ. External rotation AP

Đ. Trauma

Ē. Hemophilia

Ē. Reiter’s syndrome

Ĕ. Rheumatoid arthritis

Ĕ. Systemic lupus erythematosus

Ė. Cast immobilization for 6 weeks

Ė. Activity modification and re-evaluation in 2 months

Ę. Internal fixation with or without bone grafting

Ę. Retrograde drilling of the defect without articular cartilage penetration

Ě. Drilling of the defect directly through the articular cartilage

Ě. repair or reconstruction of the medial collateral ligament

Ĝ. repair or reconstruction of the medialand lateral collateral ligaments

Ĝ. immobilization for 5 days or less

Ğ. immobilization for 14 days

Ğ. immobilization for 25 days

Ġ. Cystinosis

Ġ. Hypophosphatemia

Ģ. Renal osteodystrophy

Ģ. Primary hyperparathyroidism

Ĥ. Nutritional vitamin D deficiency

Ĥ. Lateral meniscus tear

Ħ. Popliteus tenosynovitis

Ħ. Iliotibial band friction syndrome

Ĩ. Peroneal nerve entrapment

Ĩ. Biceps tendinitis

Ī. Observation

Ī. Removal of the prosthetic components

Ĭ. Operative exploration and decompression of the peroneal nerve

Ĭ. Nerve conduction velocity studies

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

Į. I

İ. II

I. III

Ĳ. decreased tissue tension

Ĳ. decreased abductor lever arm

Ĵ. decreased joint reaction force

Ĵ. increased body weight over lever arm

Ķ. increased polyethylene wear rate

Ķ. recurrent traumatic anterior dislocation

ĸ. recurrent traumatic posterior dislocation

Ĺ. traumatic subluxation with no previous dislocation

Ĺ. traumatic anterior subluxation

Ļ. atraumatic involuntary subluxation

Ļ. radial

Ľ. axillary

Ľ. suprascapular

Ŀ. thoracodorsal

Ŀ. long thoracic

Ł. Flexion

Ł. Extension

Ń. Axial rotation

Ń. Left lateral bending

Ņ. Right lateral bending

Ņ. Skin

Ň. Lung

Ň. Brain

ʼN. Heart

Ŋ. Kidney

Ŋ. Thoracoacromial, lateral thoracic, subscapular

Ō. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ō. Posterior humeral circumflex, subscapular, thoracacromial

Ŏ. Subscapular, thoracacromial, anterior humeral circumflex

Ŏ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ő. Respondeat superior

Ő. Indemnity agreement

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

Œ. Comparative negligence-% of involvement

Ŕ. Contributory negligence- resident contributed to the negligence

Ŕ. t-type

Ŗ. both column

Ŗ. transverse

Ř. anterior column

Ř. anterior column posterior hemitransverse

Ś. Posterior interosseous

Ś. Anterior interosseous

Ŝ. Radial

Ŝ. Median

Ş. Ulnar

Ş. Shock from hypovolemia

Š. Associated rupture of the bladder

Š. Arterial bleeding on pelvic angiogram

Ţ. Presence of a hematoma in the perineum and scrotum

Ţ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. The name of the manufacturer

Explanation

Question 4208

Topic: 10. Pathology and Oncology

Which of the following nerves lying between the gluteus medius and minimus is at risk for injury in a lateral approach to the hip?

. 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

-. Creep

.. Relaxation

/. Energy dissipation

0. Plastic deformation

1. Elastic deformation

2. bending

3. axial loading

4. high-speed rotation

5. direct impact from anteromedial

6. crush from anteromedial to posterolateral

7. Increase stiffness

8. Increase fracture toughness

9. 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

B. Superior gluteal artery

C. Profunda femoris artery

D. Femoral artery and nerve

E. External iliac artery and vein

F. Length

G. Moment arm

H. Total volume

I. Physiologic cross-sectional area

J. Distribution of slow and fast twitch fibers

K. decreasing initiation of action potentials.

L. increasing action potential amplitude.

M. blocking the opening of gated sodium channels.

N. decreasing the number of functional motor units.

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

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

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

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

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

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

U. hemiarthroplasty

V. open reduction and internal fixation

W. closed reduction and percutaneous pinning

X. a sling and early pedulum exercises

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

Z. 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

A. open reduction and internal fixation through a posterior approach

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

C. arthroscopically assisted reduction and percutaneous screw fixation

D. Repair of the rotator cuff

E. Replacement of the humeral head

F. Resection arthroplasty

G. Total shoulder arthroplasty

H. AP and lateral radiographs of the elbow

I. Diagnositc arthroscopy

J. Aspiration of joint fluid

K. An erythrocyte sedimentation rate and CBC

L. A diagnostic lidocaine injection

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

N. Fibroblast growth factor (FGF-1)

O. Platelet-derived growth factor (PDGF)

P. Transforming growth factor beta (TGF-B)

Q. Bone morphogenetic proteins (BMP)

R. clinical history and radiographic findings.

S. technetium bone scan

T. flow cytometry pattern of extracted chondrocytes

U. immunohistochemical staining patterns of a biopsy specimen

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

W. Radial

X. Radial recurrent

Y. Posterior interosseous

Z. 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

. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

¡. Distal femoral interface

¢. Posterior femoral interface

£. Sites of screw fixation for the tibia

¤. Hallux rigidus

¥. Fracture of the sesamoid

¦. Disruption of the plantar plate

§. Osteonecrosis of the metatarsal head

¨. Rupture of the flexor hallucis longus

©. Gout

ª. Sepsis

«. Old trauma

¬. Rheumatoid arthritis

. Charcot arthroplasty

®. Aspiration and steroid injection

¯. Biopsy, curettage, and allograft bone grafting

°. Percutaneous Kirschner wire fixation

±. Percutaneous injection of autogenous bone marrow

². Nerve roots

³. Spinal cord

´. Sciatic nerve

Μ. Peroneal nerve

¶. Conus medullaris

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

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

¹. Enveloping pseudocapsular scar tissue that develops around a prosthetic hip following surgical capsulectomy

º. 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

¼. Early and late infection

½. Periprosthetic fracture of the femur

¾. Failure of the patellofemoral and extensor mechanisms

¿. Aseptic loosening of cementing tibial components

À. Asceptic loosening of cemented femoral components

Á. Acceptance of the current position of the ankle

Â. Open reduction and fixation in the epiphysis only

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

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

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

Æ. Resection arthroplasty and local radiation

Ç. In situ fusion of the hip

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

É. Excision of heterotopic bone and local radiation

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

Ë. Closed reduction of both fractures and immediate spica casting

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

Í. External fixation of both femora

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

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

Ð. Synovial sarcoma

Ñ. Soft-tissue abcess

Ò. Rhabdomyosarcoma

Ó. Eosinophilic granuloma

Ô. Nodular pigmented villonodular synovitis

Õ. Changing to a titanium nail

Ö. Changing to a nonslotted nail

×. Changing the cross-sectional shape of the nail

Ø. Increasing the diameter of the nail by 3 mm

Ù. Increasing the diameter of the interlocking screws

Ú. Fracture healing

Û. Chondrosarcoma

Ü. Periosteal chondroma

Ý. Periosteal osteosarcoma

Þ. Dysplasia epiphysealis hemimelica

SS. Demonstrate competence in the subject of the case

À. Be fellowship trained in the subject of the case

Á. Be paid on a contingency basis

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

Ã. Have been involved in the case as a consultant

Ä. Diagnostic arthroscopy

Å. Arthroscopy and subacromial decompression

Æ. Reduction and fixation of the proximal humeral epiphysis

Ç. Temporary cessation of throwing

È. Physical therapy for rotator cuff strengthening

É. Oblique popliteal ligament

Ê. Lateral capsule

Ë. Popliteal tendon

Ì. Fibular collateral ligament

Í. Posterior oblique ligament

Î. Radial tear

Ï. Parrot-beak tear

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

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

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

Ó. 0 degrees of abduction, with neural rotation

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

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

Ö. 90 degrees of abduction with neutral rotation

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

Ø. Sural

Ù. Saphenous and its branches

Ú. Posterior tibial and its branches

Û. Deep peroneal and its branches

Ü. Superficial peroneal and its branches

Ý. Strength

Þ. Stiffness

Ÿ. Shelf life

Ā. Antigenicity

Ā. Risk of HIV transmission

Ă. Indemnification

Ă. Occurrence

Ą. Excess liability

Ą. Claims-made

Ć. Nose

Ć. Lateral Y

Ĉ. Scapular AP

Ĉ. Neutral rotation AP

Ċ. Internal rotation AP

Ċ. External rotation AP

Č. Trauma

Č. Hemophilia

Ď. Reiter’s syndrome

Ď. Rheumatoid arthritis

Đ. Systemic lupus erythematosus

Đ. Cast immobilization for 6 weeks

Ē. Activity modification and re-evaluation in 2 months

Ē. Internal fixation with or without bone grafting

Ĕ. Retrograde drilling of the defect without articular cartilage penetration

Ĕ. Drilling of the defect directly through the articular cartilage

Ė. repair or reconstruction of the medial collateral ligament

Ė. repair or reconstruction of the medialand lateral collateral ligaments

Ę. immobilization for 5 days or less

Ę. immobilization for 14 days

Ě. immobilization for 25 days

Ě. Cystinosis

Ĝ. Hypophosphatemia

Ĝ. Renal osteodystrophy

Ğ. Primary hyperparathyroidism

Ğ. Nutritional vitamin D deficiency

Ġ. Lateral meniscus tear

Ġ. Popliteus tenosynovitis

Ģ. Iliotibial band friction syndrome

Ģ. Peroneal nerve entrapment

Ĥ. Biceps tendinitis

Ĥ. Observation

Ħ. Removal of the prosthetic components

Ħ. Operative exploration and decompression of the peroneal nerve

Ĩ. Nerve conduction velocity studies

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

Ī. I

Ī. II

Ĭ. III

Ĭ. decreased tissue tension

Į. decreased abductor lever arm

Į. decreased joint reaction force

İ. increased body weight over lever arm

I. increased polyethylene wear rate

Ĳ. recurrent traumatic anterior dislocation

Ĳ. recurrent traumatic posterior dislocation

Ĵ. traumatic subluxation with no previous dislocation

Ĵ. traumatic anterior subluxation

Ķ. atraumatic involuntary subluxation

Ķ. radial

ĸ. axillary

Ĺ. suprascapular

Ĺ. thoracodorsal

Ļ. long thoracic

Ļ. Flexion

Ľ. Extension

Ľ. Axial rotation

Ŀ. Left lateral bending

Ŀ. Right lateral bending

Ł. Skin

Ł. Lung

Ń. Brain

Ń. Heart

Ņ. Kidney

Ņ. Thoracoacromial, lateral thoracic, subscapular

Ň. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ň. Posterior humeral circumflex, subscapular, thoracacromial

ʼN. Subscapular, thoracacromial, anterior humeral circumflex

Ŋ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ŋ. Respondeat superior

Ō. Indemnity agreement

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

Ŏ. Comparative negligence-% of involvement

Ŏ. Contributory negligence- resident contributed to the negligence

Ő. t-type

Ő. both column

Œ. transverse

Œ. anterior column

Ŕ. anterior column posterior hemitransverse

Ŕ. Posterior interosseous

Ŗ. Anterior interosseous

Ŗ. Radial

Ř. Median

Ř. Ulnar

Ś. Shock from hypovolemia

Ś. Associated rupture of the bladder

Ŝ. Arterial bleeding on pelvic angiogram

Ŝ. Presence of a hematoma in the perineum and scrotum

Ş. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Femoral

Explanation

Question 4209

Topic: 10. Pathology and Oncology

Figure 46 shows the lateral radiograph of a 5 year-old girl who has a fracture of the left tibia as a result of minimal trauma. Examination shows no skin lesions or birthmarks, and family history is unremarkable. Laboratory studies are normal. Management at this time should include
1/. open biopsy and plating

. 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

-. bending

.. axial loading

/. high-speed rotation

0. direct impact from anteromedial

1. crush from anteromedial to posterolateral

2. Increase stiffness

3. Increase fracture toughness

4. Increase fatigue strength

5. Decrease mechanical strength

6. Decrease wear rate

7. disuse osteopenia

8. paraendocrine effect of the tumor

9. 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

B. Moment arm

C. Total volume

D. Physiologic cross-sectional area

E. Distribution of slow and fast twitch fibers

F. decreasing initiation of action potentials.

G. increasing action potential amplitude.

H. blocking the opening of gated sodium channels.

I. decreasing the number of functional motor units.

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

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

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

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

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

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

P. hemiarthroplasty

Q. open reduction and internal fixation

R. closed reduction and percutaneous pinning

S. a sling and early pedulum exercises

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

U. open acromioplasty

V. open Bankart repair

W. open subscapularis tendon repair

X. inferior capsular shift

Y. a supervised physical therapy program

Z. 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

A. Resection arthroplasty

B. Total shoulder arthroplasty

C. AP and lateral radiographs of the elbow

D. Diagnositc arthroscopy

E. Aspiration of joint fluid

F. An erythrocyte sedimentation rate and CBC

G. A diagnostic lidocaine injection

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

I. Fibroblast growth factor (FGF-1)

J. Platelet-derived growth factor (PDGF)

K. Transforming growth factor beta (TGF-B)

L. Bone morphogenetic proteins (BMP)

M. clinical history and radiographic findings.

N. technetium bone scan

O. flow cytometry pattern of extracted chondrocytes

P. immunohistochemical staining patterns of a biopsy specimen

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

R. Radial

S. Radial recurrent

T. Posterior interosseous

U. Superior ulnar recurrent

V. Superficial radial circumflex

W. Impaired hydroxylation of proline

X. Failure of cleavage in procollagen

Y. Defective binding sites for hydroxyproline

Z. 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

. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

¡. Disruption of the plantar plate

¢. Osteonecrosis of the metatarsal head

£. Rupture of the flexor hallucis longus

¤. Gout

¥. Sepsis

¦. Old trauma

§. Rheumatoid arthritis

¨. Charcot arthroplasty

©. Aspiration and steroid injection

ª. Biopsy, curettage, and allograft bone grafting

«. Percutaneous Kirschner wire fixation

¬. Percutaneous injection of autogenous bone marrow

. Nerve roots

®. Spinal cord

¯. Sciatic nerve

°. Peroneal nerve

±. Conus medullaris

². Extent of bone penetrated by reaming, prosthetic components, or acrylic cement

³. Periprosthetic regions that are accessible to joint fluid and particulate wear debris

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

Μ. 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

·. Early and late infection

¸. Periprosthetic fracture of the femur

¹. Failure of the patellofemoral and extensor mechanisms

º. Aseptic loosening of cementing tibial components

». Asceptic loosening of cemented femoral components

¼. Acceptance of the current position of the ankle

½. Open reduction and fixation in the epiphysis only

¾. ORIF with a small-fragment T-plate from the malleolus up to the metaphysis

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

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

Á. Resection arthroplasty and local radiation

Â. In situ fusion of the hip

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

Ä. Excision of heterotopic bone and local radiation

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

Æ. Closed reduction of both fractures and immediate spica casting

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

È. External fixation of both femora

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

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

Ë. Synovial sarcoma

Ì. Soft-tissue abcess

Í. Rhabdomyosarcoma

Î. Eosinophilic granuloma

Ï. Nodular pigmented villonodular synovitis

Ð. Changing to a titanium nail

Ñ. Changing to a nonslotted nail

Ò. Changing the cross-sectional shape of the nail

Ó. Increasing the diameter of the nail by 3 mm

Ô. Increasing the diameter of the interlocking screws

Õ. Fracture healing

Ö. Chondrosarcoma

×. Periosteal chondroma

Ø. Periosteal osteosarcoma

Ù. Dysplasia epiphysealis hemimelica

Ú. Demonstrate competence in the subject of the case

Û. Be fellowship trained in the subject of the case

Ü. Be paid on a contingency basis

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

Þ. Have been involved in the case as a consultant

SS. Diagnostic arthroscopy

À. Arthroscopy and subacromial decompression

Á. Reduction and fixation of the proximal humeral epiphysis

Â. Temporary cessation of throwing

Ã. Physical therapy for rotator cuff strengthening

Ä. Oblique popliteal ligament

Å. Lateral capsule

Æ. Popliteal tendon

Ç. Fibular collateral ligament

È. Posterior oblique ligament

É. Radial tear

Ê. Parrot-beak tear

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

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

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

Î. 0 degrees of abduction, with neural rotation

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

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

Ñ. 90 degrees of abduction with neutral rotation

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

Ó. Sural

Ô. Saphenous and its branches

Õ. Posterior tibial and its branches

Ö. Deep peroneal and its branches

÷. Superficial peroneal and its branches

Ø. Strength

Ù. Stiffness

Ú. Shelf life

Û. Antigenicity

Ü. Risk of HIV transmission

Ý. Indemnification

Þ. Occurrence

Ÿ. Excess liability

Ā. Claims-made

Ā. Nose

Ă. Lateral Y

Ă. Scapular AP

Ą. Neutral rotation AP

Ą. Internal rotation AP

Ć. External rotation AP

Ć. Trauma

Ĉ. Hemophilia

Ĉ. Reiter’s syndrome

Ċ. Rheumatoid arthritis

Ċ. Systemic lupus erythematosus

Č. Cast immobilization for 6 weeks

Č. Activity modification and re-evaluation in 2 months

Ď. Internal fixation with or without bone grafting

Ď. Retrograde drilling of the defect without articular cartilage penetration

Đ. Drilling of the defect directly through the articular cartilage

Đ. repair or reconstruction of the medial collateral ligament

Ē. repair or reconstruction of the medialand lateral collateral ligaments

Ē. immobilization for 5 days or less

Ĕ. immobilization for 14 days

Ĕ. immobilization for 25 days

Ė. Cystinosis

Ė. Hypophosphatemia

Ę. Renal osteodystrophy

Ę. Primary hyperparathyroidism

Ě. Nutritional vitamin D deficiency

Ě. Lateral meniscus tear

Ĝ. Popliteus tenosynovitis

Ĝ. Iliotibial band friction syndrome

Ğ. Peroneal nerve entrapment

Ğ. Biceps tendinitis

Ġ. Observation

Ġ. Removal of the prosthetic components

Ģ. Operative exploration and decompression of the peroneal nerve

Ģ. Nerve conduction velocity studies

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

Ĥ. I

Ħ. II

Ħ. III

Ĩ. decreased tissue tension

Ĩ. decreased abductor lever arm

Ī. decreased joint reaction force

Ī. increased body weight over lever arm

Ĭ. increased polyethylene wear rate

Ĭ. recurrent traumatic anterior dislocation

Į. recurrent traumatic posterior dislocation

Į. traumatic subluxation with no previous dislocation

İ. traumatic anterior subluxation

I. atraumatic involuntary subluxation

Ĳ. radial

Ĳ. axillary

Ĵ. suprascapular

Ĵ. thoracodorsal

Ķ. long thoracic

Ķ. Flexion

ĸ. Extension

Ĺ. Axial rotation

Ĺ. Left lateral bending

Ļ. Right lateral bending

Ļ. Skin

Ľ. Lung

Ľ. Brain

Ŀ. Heart

Ŀ. Kidney

Ł. Thoracoacromial, lateral thoracic, subscapular

Ł. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ń. Posterior humeral circumflex, subscapular, thoracacromial

Ń. Subscapular, thoracacromial, anterior humeral circumflex

Ņ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ņ. Respondeat superior

Ň. Indemnity agreement

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

ʼN. Comparative negligence-% of involvement

Ŋ. Contributory negligence- resident contributed to the negligence

Ŋ. t-type

Ō. both column

Ō. transverse

Ŏ. anterior column

Ŏ. anterior column posterior hemitransverse

Ő. Posterior interosseous

Ő. Anterior interosseous

Œ. Radial

Œ. Median

Ŕ. Ulnar

Ŕ. Shock from hypovolemia

Ŗ. Associated rupture of the bladder

Ŗ. Arterial bleeding on pelvic angiogram

Ř. Presence of a hematoma in the perineum and scrotum

Ř. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. open biopsy and a long leg cast

Explanation

Question 4210

Topic: 10. Pathology and Oncology

A patient sustains a closed dorsal dislocation of the proximal interphalangeal joint of the middle finger without an associated fracture. Closed treatment results in a cocentric stable reduction. The finger is not immobilized. Which of the following conditions may appear 1 year later?

. 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

.. Increase stiffness

/. Increase fracture toughness

0. Increase fatigue strength

1. Decrease mechanical strength

2. Decrease wear rate

3. disuse osteopenia

4. paraendocrine effect of the tumor

5. abnormally increased density on the right side

6. side effect of the treatment of the lesion

7. extensive tumor involvement of the left hip

8. Sciatic nerve

9. Superior gluteal artery

:. Profunda femoris artery

;. Femoral artery and nerve

<. External iliac artery and vein

=. Length

>. Moment arm

?. Total volume

@. Physiologic cross-sectional area

A. Distribution of slow and fast twitch fibers

B. decreasing initiation of action potentials.

C. increasing action potential amplitude.

D. blocking the opening of gated sodium channels.

E. decreasing the number of functional motor units.

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

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

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

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

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

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

L. hemiarthroplasty

M. open reduction and internal fixation

N. closed reduction and percutaneous pinning

O. a sling and early pedulum exercises

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

Q. open acromioplasty

R. open Bankart repair

S. open subscapularis tendon repair

T. inferior capsular shift

U. a supervised physical therapy program

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

W. open reduction and internal fixation through an anterior approach

X. open reduction and internal fixation through a posterior approach

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

Z. 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

A. Aspiration of joint fluid

B. An erythrocyte sedimentation rate and CBC

C. A diagnostic lidocaine injection

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

E. Fibroblast growth factor (FGF-1)

F. Platelet-derived growth factor (PDGF)

G. Transforming growth factor beta (TGF-B)

H. Bone morphogenetic proteins (BMP)

I. clinical history and radiographic findings.

J. technetium bone scan

K. flow cytometry pattern of extracted chondrocytes

L. immunohistochemical staining patterns of a biopsy specimen

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

N. Radial

O. Radial recurrent

P. Posterior interosseous

Q. Superior ulnar recurrent

R. Superficial radial circumflex

S. Impaired hydroxylation of proline

T. Failure of cleavage in procollagen

U. Defective binding sites for hydroxyproline

V. Failure to incorporate glycine into the helix

W. Diminished production of collagen through the rough endoplasmic reticulum

X. Asking the legal staff to seek a court injunction

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

Z. 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)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

¡. Sepsis

¢. Old trauma

£. Rheumatoid arthritis

¤. Charcot arthroplasty

¥. Aspiration and steroid injection

¦. Biopsy, curettage, and allograft bone grafting

§. Percutaneous Kirschner wire fixation

¨. Percutaneous injection of autogenous bone marrow

©. Nerve roots

ª. Spinal cord

«. Sciatic nerve

¬. Peroneal nerve

. Conus medullaris

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

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

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

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

². Potential intrapelvic joint space communication created by acetabular fixation screws or intrapelvic extruded acrylic cement

³. Early and late infection

´. Periprosthetic fracture of the femur

Μ. Failure of the patellofemoral and extensor mechanisms

¶. Aseptic loosening of cementing tibial components

·. Asceptic loosening of cemented femoral components

¸. Acceptance of the current position of the ankle

¹. Open reduction and fixation in the epiphysis only

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

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

¼. CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

½. Resection arthroplasty and local radiation

¾. In situ fusion of the hip

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

À. Excision of heterotopic bone and local radiation

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

Â. Closed reduction of both fractures and immediate spica casting

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

Ä. External fixation of both femora

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

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

Ç. Synovial sarcoma

È. Soft-tissue abcess

É. Rhabdomyosarcoma

Ê. Eosinophilic granuloma

Ë. Nodular pigmented villonodular synovitis

Ì. Changing to a titanium nail

Í. Changing to a nonslotted nail

Î. Changing the cross-sectional shape of the nail

Ï. Increasing the diameter of the nail by 3 mm

Ð. Increasing the diameter of the interlocking screws

Ñ. Fracture healing

Ò. Chondrosarcoma

Ó. Periosteal chondroma

Ô. Periosteal osteosarcoma

Õ. Dysplasia epiphysealis hemimelica

Ö. Demonstrate competence in the subject of the case

×. Be fellowship trained in the subject of the case

Ø. Be paid on a contingency basis

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

Ú. Have been involved in the case as a consultant

Û. Diagnostic arthroscopy

Ü. Arthroscopy and subacromial decompression

Ý. Reduction and fixation of the proximal humeral epiphysis

Þ. Temporary cessation of throwing

SS. Physical therapy for rotator cuff strengthening

À. Oblique popliteal ligament

Á. Lateral capsule

Â. Popliteal tendon

Ã. Fibular collateral ligament

Ä. Posterior oblique ligament

Å. Radial tear

Æ. Parrot-beak tear

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

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

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

Ê. 0 degrees of abduction, with neural rotation

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

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

Í. 90 degrees of abduction with neutral rotation

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

Ï. Sural

Ð. Saphenous and its branches

Ñ. Posterior tibial and its branches

Ò. Deep peroneal and its branches

Ó. Superficial peroneal and its branches

Ô. Strength

Õ. Stiffness

Ö. Shelf life

÷. Antigenicity

Ø. Risk of HIV transmission

Ù. Indemnification

Ú. Occurrence

Û. Excess liability

Ü. Claims-made

Ý. Nose

Þ. Lateral Y

Ÿ. Scapular AP

Ā. Neutral rotation AP

Ā. Internal rotation AP

Ă. External rotation AP

Ă. Trauma

Ą. Hemophilia

Ą. Reiter’s syndrome

Ć. Rheumatoid arthritis

Ć. Systemic lupus erythematosus

Ĉ. Cast immobilization for 6 weeks

Ĉ. Activity modification and re-evaluation in 2 months

Ċ. Internal fixation with or without bone grafting

Ċ. Retrograde drilling of the defect without articular cartilage penetration

Č. Drilling of the defect directly through the articular cartilage

Č. repair or reconstruction of the medial collateral ligament

Ď. repair or reconstruction of the medialand lateral collateral ligaments

Ď. immobilization for 5 days or less

Đ. immobilization for 14 days

Đ. immobilization for 25 days

Ē. Cystinosis

Ē. Hypophosphatemia

Ĕ. Renal osteodystrophy

Ĕ. Primary hyperparathyroidism

Ė. Nutritional vitamin D deficiency

Ė. Lateral meniscus tear

Ę. Popliteus tenosynovitis

Ę. Iliotibial band friction syndrome

Ě. Peroneal nerve entrapment

Ě. Biceps tendinitis

Ĝ. Observation

Ĝ. Removal of the prosthetic components

Ğ. Operative exploration and decompression of the peroneal nerve

Ğ. Nerve conduction velocity studies

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

Ġ. I

Ģ. II

Ģ. III

Ĥ. decreased tissue tension

Ĥ. decreased abductor lever arm

Ħ. decreased joint reaction force

Ħ. increased body weight over lever arm

Ĩ. increased polyethylene wear rate

Ĩ. recurrent traumatic anterior dislocation

Ī. recurrent traumatic posterior dislocation

Ī. traumatic subluxation with no previous dislocation

Ĭ. traumatic anterior subluxation

Ĭ. atraumatic involuntary subluxation

Į. radial

Į. axillary

İ. suprascapular

I. thoracodorsal

Ĳ. long thoracic

Ĳ. Flexion

Ĵ. Extension

Ĵ. Axial rotation

Ķ. Left lateral bending

Ķ. Right lateral bending

ĸ. Skin

Ĺ. Lung

Ĺ. Brain

Ļ. Heart

Ļ. Kidney

Ľ. Thoracoacromial, lateral thoracic, subscapular

Ľ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ŀ. Posterior humeral circumflex, subscapular, thoracacromial

Ŀ. Subscapular, thoracacromial, anterior humeral circumflex

Ł. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ł. Respondeat superior

Ń. Indemnity agreement

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

Ņ. Comparative negligence-% of involvement

Ņ. Contributory negligence- resident contributed to the negligence

Ň. t-type

Ň. both column

ʼN. transverse

Ŋ. anterior column

Ŋ. anterior column posterior hemitransverse

Ō. Posterior interosseous

Ō. Anterior interosseous

Ŏ. Radial

Ŏ. Median

Ő. Ulnar

Ő. Shock from hypovolemia

Œ. Associated rupture of the bladder

Œ. Arterial bleeding on pelvic angiogram

Ŕ. Presence of a hematoma in the perineum and scrotum

Ŕ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Triggering

Explanation

Question 4211

Topic: 10. Pathology and Oncology

What is the standard interval for placement of an anterolateral portal in ankle arthroscopy?

. 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

.. disuse osteopenia

/. paraendocrine effect of the tumor

0. abnormally increased density on the right side

1. side effect of the treatment of the lesion

2. extensive tumor involvement of the left hip

3. Sciatic nerve

4. Superior gluteal artery

5. Profunda femoris artery

6. Femoral artery and nerve

7. External iliac artery and vein

8. Length

9. 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.

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

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

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

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

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

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

G. hemiarthroplasty

H. open reduction and internal fixation

I. closed reduction and percutaneous pinning

J. a sling and early pedulum exercises

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

L. open acromioplasty

M. open Bankart repair

N. open subscapularis tendon repair

O. inferior capsular shift

P. a supervised physical therapy program

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

R. open reduction and internal fixation through an anterior approach

S. open reduction and internal fixation through a posterior approach

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

U. arthroscopically assisted reduction and percutaneous screw fixation

V. Repair of the rotator cuff

W. Replacement of the humeral head

X. Resection arthroplasty

Y. Total shoulder arthroplasty

Z. 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)

A. Platelet-derived growth factor (PDGF)

B. Transforming growth factor beta (TGF-B)

C. Bone morphogenetic proteins (BMP)

D. clinical history and radiographic findings.

E. technetium bone scan

F. flow cytometry pattern of extracted chondrocytes

G. immunohistochemical staining patterns of a biopsy specimen

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

I. Radial

J. Radial recurrent

K. Posterior interosseous

L. Superior ulnar recurrent

M. Superficial radial circumflex

N. Impaired hydroxylation of proline

O. Failure of cleavage in procollagen

P. Defective binding sites for hydroxyproline

Q. Failure to incorporate glycine into the helix

R. Diminished production of collagen through the rough endoplasmic reticulum

S. Asking the legal staff to seek a court injunction

T. Copying the patient’s chart and giving it to him as he leaves

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

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

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

X. Meta-analysis

Y. Confidence interval

Z. Analysis of variance (ANOVA)

{. Statistical significance (p-value)

|. Survivorship analysis (Kaplan-Meier)

}. Spinal shock

~. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

¡. Biopsy, curettage, and allograft bone grafting

¢. Percutaneous Kirschner wire fixation

£. Percutaneous injection of autogenous bone marrow

¤. Nerve roots

¥. Spinal cord

¦. Sciatic nerve

§. Peroneal nerve

¨. Conus medullaris

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

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

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

¬. 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

®. Early and late infection

¯. Periprosthetic fracture of the femur

°. Failure of the patellofemoral and extensor mechanisms

±. Aseptic loosening of cementing tibial components

². Asceptic loosening of cemented femoral components

³. Acceptance of the current position of the ankle

´. Open reduction and fixation in the epiphysis only

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

¶. 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

¸. Resection arthroplasty and local radiation

¹. In situ fusion of the hip

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

». Excision of heterotopic bone and local radiation

¼. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

½. Closed reduction of both fractures and immediate spica casting

¾. Bilateral skin traction for 3 weeks, followed by spica casting

¿. External fixation of both femora

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

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

Â. Synovial sarcoma

Ã. Soft-tissue abcess

Ä. Rhabdomyosarcoma

Å. Eosinophilic granuloma

Æ. Nodular pigmented villonodular synovitis

Ç. Changing to a titanium nail

È. Changing to a nonslotted nail

É. Changing the cross-sectional shape of the nail

Ê. Increasing the diameter of the nail by 3 mm

Ë. Increasing the diameter of the interlocking screws

Ì. Fracture healing

Í. Chondrosarcoma

Î. Periosteal chondroma

Ï. Periosteal osteosarcoma

Ð. Dysplasia epiphysealis hemimelica

Ñ. Demonstrate competence in the subject of the case

Ò. Be fellowship trained in the subject of the case

Ó. Be paid on a contingency basis

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

Õ. Have been involved in the case as a consultant

Ö. Diagnostic arthroscopy

×. Arthroscopy and subacromial decompression

Ø. Reduction and fixation of the proximal humeral epiphysis

Ù. Temporary cessation of throwing

Ú. Physical therapy for rotator cuff strengthening

Û. Oblique popliteal ligament

Ü. Lateral capsule

Ý. Popliteal tendon

Þ. Fibular collateral ligament

SS. Posterior oblique ligament

À. Radial tear

Á. Parrot-beak tear

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

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

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

Å. 0 degrees of abduction, with neural rotation

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

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

È. 90 degrees of abduction with neutral rotation

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

Ê. Sural

Ë. Saphenous and its branches

Ì. Posterior tibial and its branches

Í. Deep peroneal and its branches

Î. Superficial peroneal and its branches

Ï. Strength

Ð. Stiffness

Ñ. Shelf life

Ò. Antigenicity

Ó. Risk of HIV transmission

Ô. Indemnification

Õ. Occurrence

Ö. Excess liability

÷. Claims-made

Ø. Nose

Ù. Lateral Y

Ú. Scapular AP

Û. Neutral rotation AP

Ü. Internal rotation AP

Ý. External rotation AP

Þ. Trauma

Ÿ. Hemophilia

Ā. Reiter’s syndrome

Ā. Rheumatoid arthritis

Ă. Systemic lupus erythematosus

Ă. Cast immobilization for 6 weeks

Ą. Activity modification and re-evaluation in 2 months

Ą. Internal fixation with or without bone grafting

Ć. Retrograde drilling of the defect without articular cartilage penetration

Ć. Drilling of the defect directly through the articular cartilage

Ĉ. repair or reconstruction of the medial collateral ligament

Ĉ. repair or reconstruction of the medialand lateral collateral ligaments

Ċ. immobilization for 5 days or less

Ċ. immobilization for 14 days

Č. immobilization for 25 days

Č. Cystinosis

Ď. Hypophosphatemia

Ď. Renal osteodystrophy

Đ. Primary hyperparathyroidism

Đ. Nutritional vitamin D deficiency

Ē. Lateral meniscus tear

Ē. Popliteus tenosynovitis

Ĕ. Iliotibial band friction syndrome

Ĕ. Peroneal nerve entrapment

Ė. Biceps tendinitis

Ė. Observation

Ę. Removal of the prosthetic components

Ę. Operative exploration and decompression of the peroneal nerve

Ě. Nerve conduction velocity studies

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

Ĝ. I

Ĝ. II

Ğ. III

Ğ. decreased tissue tension

Ġ. decreased abductor lever arm

Ġ. decreased joint reaction force

Ģ. increased body weight over lever arm

Ģ. increased polyethylene wear rate

Ĥ. recurrent traumatic anterior dislocation

Ĥ. recurrent traumatic posterior dislocation

Ħ. traumatic subluxation with no previous dislocation

Ħ. traumatic anterior subluxation

Ĩ. atraumatic involuntary subluxation

Ĩ. radial

Ī. axillary

Ī. suprascapular

Ĭ. thoracodorsal

Ĭ. long thoracic

Į. Flexion

Į. Extension

İ. Axial rotation

I. Left lateral bending

Ĳ. Right lateral bending

Ĳ. Skin

Ĵ. Lung

Ĵ. Brain

Ķ. Heart

Ķ. Kidney

ĸ. Thoracoacromial, lateral thoracic, subscapular

Ĺ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ĺ. Posterior humeral circumflex, subscapular, thoracacromial

Ļ. Subscapular, thoracacromial, anterior humeral circumflex

Ļ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ľ. Respondeat superior

Ľ. Indemnity agreement

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

Ŀ. Comparative negligence-% of involvement

Ł. Contributory negligence- resident contributed to the negligence

Ł. t-type

Ń. both column

Ń. transverse

Ņ. anterior column

Ņ. anterior column posterior hemitransverse

Ň. Posterior interosseous

Ň. Anterior interosseous

ʼN. Radial

Ŋ. Median

Ŋ. Ulnar

Ō. Shock from hypovolemia

Ō. Associated rupture of the bladder

Ŏ. Arterial bleeding on pelvic angiogram

Ŏ. Presence of a hematoma in the perineum and scrotum

Ő. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Peroneus brevis to peroneus longus

Explanation

Question 4212

Topic: 10. Pathology and Oncology

A clinical trial is being conducted on a new orthopaedic device that is different from existing devices that are moderately successful, but have frequent complications when used to treat fractures in the elderly. To comply with international standards for clinical trials, the investigator must include in the study design

. 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

.. Sciatic nerve

/. Superior gluteal artery

0. Profunda femoris artery

1. Femoral artery and nerve

2. External iliac artery and vein

3. Length

4. Moment arm

5. Total volume

6. Physiologic cross-sectional area

7. Distribution of slow and fast twitch fibers

8. decreasing initiation of action potentials.

9. 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.

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

B. hemiarthroplasty

C. open reduction and internal fixation

D. closed reduction and percutaneous pinning

E. a sling and early pedulum exercises

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

G. open acromioplasty

H. open Bankart repair

I. open subscapularis tendon repair

J. inferior capsular shift

K. a supervised physical therapy program

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

M. open reduction and internal fixation through an anterior approach

N. open reduction and internal fixation through a posterior approach

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

P. arthroscopically assisted reduction and percutaneous screw fixation

Q. Repair of the rotator cuff

R. Replacement of the humeral head

S. Resection arthroplasty

T. Total shoulder arthroplasty

U. AP and lateral radiographs of the elbow

V. Diagnositc arthroscopy

W. Aspiration of joint fluid

X. An erythrocyte sedimentation rate and CBC

Y. A diagnostic lidocaine injection

Z. 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

A. flow cytometry pattern of extracted chondrocytes

B. immunohistochemical staining patterns of a biopsy specimen

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

D. Radial

E. Radial recurrent

F. Posterior interosseous

G. Superior ulnar recurrent

H. Superficial radial circumflex

I. Impaired hydroxylation of proline

J. Failure of cleavage in procollagen

K. Defective binding sites for hydroxyproline

L. Failure to incorporate glycine into the helix

M. Diminished production of collagen through the rough endoplasmic reticulum

N. Asking the legal staff to seek a court injunction

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

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

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

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

S. Meta-analysis

T. Confidence interval

U. Analysis of variance (ANOVA)

V. Statistical significance (p-value)

W. Survivorship analysis (Kaplan-Meier)

X. Spinal shock

Y. Neurogenic shock

Z. Hypovolemic shock

{. Pulmonary embolism

|. Fat embolus syndrome

}. Lumbar spinal stenosis

~. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

¡. Sciatic nerve

¢. Peroneal nerve

£. Conus medullaris

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

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

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

§. 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

©. Early and late infection

ª. Periprosthetic fracture of the femur

«. Failure of the patellofemoral and extensor mechanisms

¬. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

®. Acceptance of the current position of the ankle

¯. Open reduction and fixation in the epiphysis only

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

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

². CRUGA and fixation with a malleolar screw from the malleolus into the metaphysis

³. Resection arthroplasty and local radiation

´. In situ fusion of the hip

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

¶. Excision of heterotopic bone and local radiation

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

¸. Closed reduction of both fractures and immediate spica casting

¹. Bilateral skin traction for 3 weeks, followed by spica casting

º. External fixation of both femora

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

¼. External fixation of the left femur and use of a reamed intramedullary nail in the right femur

½. Synovial sarcoma

¾. Soft-tissue abcess

¿. Rhabdomyosarcoma

À. Eosinophilic granuloma

Á. Nodular pigmented villonodular synovitis

Â. Changing to a titanium nail

Ã. Changing to a nonslotted nail

Ä. Changing the cross-sectional shape of the nail

Å. Increasing the diameter of the nail by 3 mm

Æ. Increasing the diameter of the interlocking screws

Ç. Fracture healing

È. Chondrosarcoma

É. Periosteal chondroma

Ê. Periosteal osteosarcoma

Ë. Dysplasia epiphysealis hemimelica

Ì. Demonstrate competence in the subject of the case

Í. Be fellowship trained in the subject of the case

Î. Be paid on a contingency basis

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

Ð. Have been involved in the case as a consultant

Ñ. Diagnostic arthroscopy

Ò. Arthroscopy and subacromial decompression

Ó. Reduction and fixation of the proximal humeral epiphysis

Ô. Temporary cessation of throwing

Õ. Physical therapy for rotator cuff strengthening

Ö. Oblique popliteal ligament

×. Lateral capsule

Ø. Popliteal tendon

Ù. Fibular collateral ligament

Ú. Posterior oblique ligament

Û. Radial tear

Ü. Parrot-beak tear

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

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

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

À. 0 degrees of abduction, with neural rotation

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

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

Ã. 90 degrees of abduction with neutral rotation

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

Å. Sural

Æ. Saphenous and its branches

Ç. Posterior tibial and its branches

È. Deep peroneal and its branches

É. Superficial peroneal and its branches

Ê. Strength

Ë. Stiffness

Ì. Shelf life

Í. Antigenicity

Î. Risk of HIV transmission

Ï. Indemnification

Ð. Occurrence

Ñ. Excess liability

Ò. Claims-made

Ó. Nose

Ô. Lateral Y

Õ. Scapular AP

Ö. Neutral rotation AP

÷. Internal rotation AP

Ø. External rotation AP

Ù. Trauma

Ú. Hemophilia

Û. Reiter’s syndrome

Ü. Rheumatoid arthritis

Ý. Systemic lupus erythematosus

Þ. Cast immobilization for 6 weeks

Ÿ. Activity modification and re-evaluation in 2 months

Ā. Internal fixation with or without bone grafting

Ā. Retrograde drilling of the defect without articular cartilage penetration

Ă. Drilling of the defect directly through the articular cartilage

Ă. repair or reconstruction of the medial collateral ligament

Ą. repair or reconstruction of the medialand lateral collateral ligaments

Ą. immobilization for 5 days or less

Ć. immobilization for 14 days

Ć. immobilization for 25 days

Ĉ. Cystinosis

Ĉ. Hypophosphatemia

Ċ. Renal osteodystrophy

Ċ. Primary hyperparathyroidism

Č. Nutritional vitamin D deficiency

Č. Lateral meniscus tear

Ď. Popliteus tenosynovitis

Ď. Iliotibial band friction syndrome

Đ. Peroneal nerve entrapment

Đ. Biceps tendinitis

Ē. Observation

Ē. Removal of the prosthetic components

Ĕ. Operative exploration and decompression of the peroneal nerve

Ĕ. Nerve conduction velocity studies

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

Ė. I

Ę. II

Ę. III

Ě. decreased tissue tension

Ě. decreased abductor lever arm

Ĝ. decreased joint reaction force

Ĝ. increased body weight over lever arm

Ğ. increased polyethylene wear rate

Ğ. recurrent traumatic anterior dislocation

Ġ. recurrent traumatic posterior dislocation

Ġ. traumatic subluxation with no previous dislocation

Ģ. traumatic anterior subluxation

Ģ. atraumatic involuntary subluxation

Ĥ. radial

Ĥ. axillary

Ħ. suprascapular

Ħ. thoracodorsal

Ĩ. long thoracic

Ĩ. Flexion

Ī. Extension

Ī. Axial rotation

Ĭ. Left lateral bending

Ĭ. Right lateral bending

Į. Skin

Į. Lung

İ. Brain

I. Heart

Ĳ. Kidney

Ĳ. Thoracoacromial, lateral thoracic, subscapular

Ĵ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ĵ. Posterior humeral circumflex, subscapular, thoracacromial

Ķ. Subscapular, thoracacromial, anterior humeral circumflex

Ķ. Lateral thoracic, anterior humeral circumflex, thoracacromial

ĸ. Respondeat superior

Ĺ. Indemnity agreement

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

Ļ. Comparative negligence-% of involvement

Ļ. Contributory negligence- resident contributed to the negligence

Ľ. t-type

Ľ. both column

Ŀ. transverse

Ŀ. anterior column

Ł. anterior column posterior hemitransverse

Ł. Posterior interosseous

Ń. Anterior interosseous

Ń. Radial

Ņ. Median

Ņ. Ulnar

Ň. Shock from hypovolemia

Ň. Associated rupture of the bladder

ʼN. Arterial bleeding on pelvic angiogram

Ŋ. Presence of a hematoma in the perineum and scrotum

Ŋ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. reassurance that Medicare will pay for the treatment.

Explanation

Question 4213

Topic: 10. Pathology and Oncology

Figure 48 shows a current lateral radiograph of a 23-year-old man who sustained a closed femoral diaphyseal fracture 5 months ago. Treatment consisted of placement of a retrograde femoral nail for the femoral fracture. The patient now reports a sudden onset of pain in the midthigh and cannot bear weight on his leg. Management should consist of

. 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

.. Length

/. Moment arm

0. Total volume

1. Physiologic cross-sectional area

2. Distribution of slow and fast twitch fibers

3. decreasing initiation of action potentials.

4. increasing action potential amplitude.

5. blocking the opening of gated sodium channels.

6. decreasing the number of functional motor units.

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

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

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

B. open acromioplasty

C. open Bankart repair

D. open subscapularis tendon repair

E. inferior capsular shift

F. a supervised physical therapy program

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

H. open reduction and internal fixation through an anterior approach

I. open reduction and internal fixation through a posterior approach

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

K. arthroscopically assisted reduction and percutaneous screw fixation

L. Repair of the rotator cuff

M. Replacement of the humeral head

N. Resection arthroplasty

O. Total shoulder arthroplasty

P. AP and lateral radiographs of the elbow

Q. Diagnositc arthroscopy

R. Aspiration of joint fluid

S. An erythrocyte sedimentation rate and CBC

T. A diagnostic lidocaine injection

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

V. Fibroblast growth factor (FGF-1)

W. Platelet-derived growth factor (PDGF)

X. Transforming growth factor beta (TGF-B)

Y. Bone morphogenetic proteins (BMP)

Z. 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

A. Posterior interosseous

B. Superior ulnar recurrent

C. Superficial radial circumflex

D. Impaired hydroxylation of proline

E. Failure of cleavage in procollagen

F. Defective binding sites for hydroxyproline

G. Failure to incorporate glycine into the helix

H. Diminished production of collagen through the rough endoplasmic reticulum

I. Asking the legal staff to seek a court injunction

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

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

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

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

N. Meta-analysis

O. Confidence interval

P. Analysis of variance (ANOVA)

Q. Statistical significance (p-value)

R. Survivorship analysis (Kaplan-Meier)

S. Spinal shock

T. Neurogenic shock

U. Hypovolemic shock

V. Pulmonary embolism

W. Fat embolus syndrome

X. Lumbar spinal stenosis

Y. Metastatic disease of the spine

Z. Rheumatoid lumbar spondylitis

{. Isthmic spondyloloisthesis

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

}. Patella alta

~. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

¢. 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

¤. Early and late infection

¥. Periprosthetic fracture of the femur

¦. Failure of the patellofemoral and extensor mechanisms

§. Aseptic loosening of cementing tibial components

¨. Asceptic loosening of cemented femoral components

©. Acceptance of the current position of the ankle

ª. Open reduction and fixation in the epiphysis only

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

¬. 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

®. Resection arthroplasty and local radiation

¯. In situ fusion of the hip

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

±. Excision of heterotopic bone and local radiation

². Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

³. Closed reduction of both fractures and immediate spica casting

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

Μ. External fixation of both femora

¶. 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

¸. Synovial sarcoma

¹. Soft-tissue abcess

º. Rhabdomyosarcoma

». Eosinophilic granuloma

¼. Nodular pigmented villonodular synovitis

½. Changing to a titanium nail

¾. Changing to a nonslotted nail

¿. Changing the cross-sectional shape of the nail

À. Increasing the diameter of the nail by 3 mm

Á. Increasing the diameter of the interlocking screws

Â. Fracture healing

Ã. Chondrosarcoma

Ä. Periosteal chondroma

Å. Periosteal osteosarcoma

Æ. Dysplasia epiphysealis hemimelica

Ç. Demonstrate competence in the subject of the case

È. Be fellowship trained in the subject of the case

É. Be paid on a contingency basis

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

Ë. Have been involved in the case as a consultant

Ì. Diagnostic arthroscopy

Í. Arthroscopy and subacromial decompression

Î. Reduction and fixation of the proximal humeral epiphysis

Ï. Temporary cessation of throwing

Ð. Physical therapy for rotator cuff strengthening

Ñ. Oblique popliteal ligament

Ò. Lateral capsule

Ó. Popliteal tendon

Ô. Fibular collateral ligament

Õ. Posterior oblique ligament

Ö. Radial tear

×. Parrot-beak tear

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

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

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

Û. 0 degrees of abduction, with neural rotation

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

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

Þ. 90 degrees of abduction with neutral rotation

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

À. Sural

Á. Saphenous and its branches

Â. Posterior tibial and its branches

Ã. Deep peroneal and its branches

Ä. Superficial peroneal and its branches

Å. Strength

Æ. Stiffness

Ç. Shelf life

È. Antigenicity

É. Risk of HIV transmission

Ê. Indemnification

Ë. Occurrence

Ì. Excess liability

Í. Claims-made

Î. Nose

Ï. Lateral Y

Ð. Scapular AP

Ñ. Neutral rotation AP

Ò. Internal rotation AP

Ó. External rotation AP

Ô. Trauma

Õ. Hemophilia

Ö. Reiter’s syndrome

÷. Rheumatoid arthritis

Ø. Systemic lupus erythematosus

Ù. Cast immobilization for 6 weeks

Ú. Activity modification and re-evaluation in 2 months

Û. Internal fixation with or without bone grafting

Ü. Retrograde drilling of the defect without articular cartilage penetration

Ý. Drilling of the defect directly through the articular cartilage

Þ. repair or reconstruction of the medial collateral ligament

Ÿ. repair or reconstruction of the medialand lateral collateral ligaments

Ā. immobilization for 5 days or less

Ā. immobilization for 14 days

Ă. immobilization for 25 days

Ă. Cystinosis

Ą. Hypophosphatemia

Ą. Renal osteodystrophy

Ć. Primary hyperparathyroidism

Ć. Nutritional vitamin D deficiency

Ĉ. Lateral meniscus tear

Ĉ. Popliteus tenosynovitis

Ċ. Iliotibial band friction syndrome

Ċ. Peroneal nerve entrapment

Č. Biceps tendinitis

Č. Observation

Ď. Removal of the prosthetic components

Ď. Operative exploration and decompression of the peroneal nerve

Đ. Nerve conduction velocity studies

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

Ē. I

Ē. II

Ĕ. III

Ĕ. decreased tissue tension

Ė. decreased abductor lever arm

Ė. decreased joint reaction force

Ę. increased body weight over lever arm

Ę. increased polyethylene wear rate

Ě. recurrent traumatic anterior dislocation

Ě. recurrent traumatic posterior dislocation

Ĝ. traumatic subluxation with no previous dislocation

Ĝ. traumatic anterior subluxation

Ğ. atraumatic involuntary subluxation

Ğ. radial

Ġ. axillary

Ġ. suprascapular

Ģ. thoracodorsal

Ģ. long thoracic

Ĥ. Flexion

Ĥ. Extension

Ħ. Axial rotation

Ħ. Left lateral bending

Ĩ. Right lateral bending

Ĩ. Skin

Ī. Lung

Ī. Brain

Ĭ. Heart

Ĭ. Kidney

Į. Thoracoacromial, lateral thoracic, subscapular

Į. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

İ. Posterior humeral circumflex, subscapular, thoracacromial

I. Subscapular, thoracacromial, anterior humeral circumflex

Ĳ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ĳ. Respondeat superior

Ĵ. Indemnity agreement

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

Ķ. Comparative negligence-% of involvement

Ķ. Contributory negligence- resident contributed to the negligence

ĸ. t-type

Ĺ. both column

Ĺ. transverse

Ļ. anterior column

Ļ. anterior column posterior hemitransverse

Ľ. Posterior interosseous

Ľ. Anterior interosseous

Ŀ. Radial

Ŀ. Median

Ł. Ulnar

Ł. Shock from hypovolemia

Ń. Associated rupture of the bladder

Ń. Arterial bleeding on pelvic angiogram

Ņ. Presence of a hematoma in the perineum and scrotum

Ņ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. an onlay iliac crest bone graft.

Explanation

Question 4214

Topic: 10. Pathology and Oncology

To maximally resist apex anterior angulation in the tibia, the pins of a unilateral external fixator should be oriented in which of the following planes?

. 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

.. decreasing initiation of action potentials.

/. increasing action potential amplitude.

0. blocking the opening of gated sodium channels.

1. decreasing the number of functional motor units.

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

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

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

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

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

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

8. hemiarthroplasty

9. 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. a supervised physical therapy program

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

C. open reduction and internal fixation through an anterior approach

D. open reduction and internal fixation through a posterior approach

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

F. arthroscopically assisted reduction and percutaneous screw fixation

G. Repair of the rotator cuff

H. Replacement of the humeral head

I. Resection arthroplasty

J. Total shoulder arthroplasty

K. AP and lateral radiographs of the elbow

L. Diagnositc arthroscopy

M. Aspiration of joint fluid

N. An erythrocyte sedimentation rate and CBC

O. A diagnostic lidocaine injection

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

Q. Fibroblast growth factor (FGF-1)

R. Platelet-derived growth factor (PDGF)

S. Transforming growth factor beta (TGF-B)

T. Bone morphogenetic proteins (BMP)

U. clinical history and radiographic findings.

V. technetium bone scan

W. flow cytometry pattern of extracted chondrocytes

X. immunohistochemical staining patterns of a biopsy specimen

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

Z. Radial

[. Radial recurrent

\. Posterior interosseous

]. Superior ulnar recurrent

^. Superficial radial circumflex

_. Impaired hydroxylation of proline

`. Failure of cleavage in procollagen

A. Defective binding sites for hydroxyproline

B. Failure to incorporate glycine into the helix

C. Diminished production of collagen through the rough endoplasmic reticulum

D. Asking the legal staff to seek a court injunction

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

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

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

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

I. Meta-analysis

J. Confidence interval

K. Analysis of variance (ANOVA)

L. Statistical significance (p-value)

M. Survivorship analysis (Kaplan-Meier)

N. Spinal shock

O. Neurogenic shock

P. Hypovolemic shock

Q. Pulmonary embolism

R. Fat embolus syndrome

S. Lumbar spinal stenosis

T. Metastatic disease of the spine

U. Rheumatoid lumbar spondylitis

V. Isthmic spondyloloisthesis

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

X. Patella alta

Y. A metal-backed patella

Z. Varus malalignment of the knee

{. A posterior cruciate-substituting femoral component

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

}. The sesamoids are separated

~. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

¡. Failure of the patellofemoral and extensor mechanisms

¢. Aseptic loosening of cementing tibial components

£. Asceptic loosening of cemented femoral components

¤. Acceptance of the current position of the ankle

¥. Open reduction and fixation in the epiphysis only

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

§. 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

ª. In situ fusion of the hip

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

¬. Excision of heterotopic bone and local radiation

. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

®. Closed reduction of both fractures and immediate spica casting

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

°. External fixation of both femora

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

². External fixation of the left femur and use of a reamed intramedullary nail in the right femur

³. Synovial sarcoma

´. Soft-tissue abcess

Μ. Rhabdomyosarcoma

¶. Eosinophilic granuloma

·. Nodular pigmented villonodular synovitis

¸. Changing to a titanium nail

¹. Changing to a nonslotted nail

º. Changing the cross-sectional shape of the nail

». Increasing the diameter of the nail by 3 mm

¼. Increasing the diameter of the interlocking screws

½. Fracture healing

¾. Chondrosarcoma

¿. Periosteal chondroma

À. Periosteal osteosarcoma

Á. Dysplasia epiphysealis hemimelica

Â. Demonstrate competence in the subject of the case

Ã. Be fellowship trained in the subject of the case

Ä. Be paid on a contingency basis

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

Æ. Have been involved in the case as a consultant

Ç. Diagnostic arthroscopy

È. Arthroscopy and subacromial decompression

É. Reduction and fixation of the proximal humeral epiphysis

Ê. Temporary cessation of throwing

Ë. Physical therapy for rotator cuff strengthening

Ì. Oblique popliteal ligament

Í. Lateral capsule

Î. Popliteal tendon

Ï. Fibular collateral ligament

Ð. Posterior oblique ligament

Ñ. Radial tear

Ò. Parrot-beak tear

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

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

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

Ö. 0 degrees of abduction, with neural rotation

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

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

Ù. 90 degrees of abduction with neutral rotation

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

Û. Sural

Ü. Saphenous and its branches

Ý. Posterior tibial and its branches

Þ. Deep peroneal and its branches

SS. Superficial peroneal and its branches

À. Strength

Á. Stiffness

Â. Shelf life

Ã. Antigenicity

Ä. Risk of HIV transmission

Å. Indemnification

Æ. Occurrence

Ç. Excess liability

È. Claims-made

É. Nose

Ê. Lateral Y

Ë. Scapular AP

Ì. Neutral rotation AP

Í. Internal rotation AP

Î. External rotation AP

Ï. Trauma

Ð. Hemophilia

Ñ. Reiter’s syndrome

Ò. Rheumatoid arthritis

Ó. Systemic lupus erythematosus

Ô. Cast immobilization for 6 weeks

Õ. Activity modification and re-evaluation in 2 months

Ö. Internal fixation with or without bone grafting

÷. Retrograde drilling of the defect without articular cartilage penetration

Ø. Drilling of the defect directly through the articular cartilage

Ù. repair or reconstruction of the medial collateral ligament

Ú. repair or reconstruction of the medialand lateral collateral ligaments

Û. immobilization for 5 days or less

Ü. immobilization for 14 days

Ý. immobilization for 25 days

Þ. Cystinosis

Ÿ. Hypophosphatemia

Ā. Renal osteodystrophy

Ā. Primary hyperparathyroidism

Ă. Nutritional vitamin D deficiency

Ă. Lateral meniscus tear

Ą. Popliteus tenosynovitis

Ą. Iliotibial band friction syndrome

Ć. Peroneal nerve entrapment

Ć. Biceps tendinitis

Ĉ. Observation

Ĉ. Removal of the prosthetic components

Ċ. Operative exploration and decompression of the peroneal nerve

Ċ. Nerve conduction velocity studies

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

Č. I

Ď. II

Ď. III

Đ. decreased tissue tension

Đ. decreased abductor lever arm

Ē. decreased joint reaction force

Ē. increased body weight over lever arm

Ĕ. increased polyethylene wear rate

Ĕ. recurrent traumatic anterior dislocation

Ė. recurrent traumatic posterior dislocation

Ė. traumatic subluxation with no previous dislocation

Ę. traumatic anterior subluxation

Ę. atraumatic involuntary subluxation

Ě. radial

Ě. axillary

Ĝ. suprascapular

Ĝ. thoracodorsal

Ğ. long thoracic

Ğ. Flexion

Ġ. Extension

Ġ. Axial rotation

Ģ. Left lateral bending

Ģ. Right lateral bending

Ĥ. Skin

Ĥ. Lung

Ħ. Brain

Ħ. Heart

Ĩ. Kidney

Ĩ. Thoracoacromial, lateral thoracic, subscapular

Ī. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ī. Posterior humeral circumflex, subscapular, thoracacromial

Ĭ. Subscapular, thoracacromial, anterior humeral circumflex

Ĭ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Į. Respondeat superior

Į. Indemnity agreement

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

I. Comparative negligence-% of involvement

Ĳ. Contributory negligence- resident contributed to the negligence

Ĳ. t-type

Ĵ. both column

Ĵ. transverse

Ķ. anterior column

Ķ. anterior column posterior hemitransverse

ĸ. Posterior interosseous

Ĺ. Anterior interosseous

Ĺ. Radial

Ļ. Median

Ļ. Ulnar

Ľ. Shock from hypovolemia

Ľ. Associated rupture of the bladder

Ŀ. Arterial bleeding on pelvic angiogram

Ŀ. Presence of a hematoma in the perineum and scrotum

Ł. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Coronal

Explanation

Question 4215

Topic: 10. Pathology and Oncology

Resurfacing the patella during a total knee replacement is strongly indicated when the diagnosis is

. 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.

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

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

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

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

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

3. hemiarthroplasty

4. open reduction and internal fixation

5. closed reduction and percutaneous pinning

6. a sling and early pedulum exercises

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

8. open acromioplasty

9. 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

A. arthroscopically assisted reduction and percutaneous screw fixation

B. Repair of the rotator cuff

C. Replacement of the humeral head

D. Resection arthroplasty

E. Total shoulder arthroplasty

F. AP and lateral radiographs of the elbow

G. Diagnositc arthroscopy

H. Aspiration of joint fluid

I. An erythrocyte sedimentation rate and CBC

J. A diagnostic lidocaine injection

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

L. Fibroblast growth factor (FGF-1)

M. Platelet-derived growth factor (PDGF)

N. Transforming growth factor beta (TGF-B)

O. Bone morphogenetic proteins (BMP)

P. clinical history and radiographic findings.

Q. technetium bone scan

R. flow cytometry pattern of extracted chondrocytes

S. immunohistochemical staining patterns of a biopsy specimen

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

U. Radial

V. Radial recurrent

W. Posterior interosseous

X. Superior ulnar recurrent

Y. Superficial radial circumflex

Z. 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

_. Asking the legal staff to seek a court injunction

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

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

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

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

D. Meta-analysis

E. Confidence interval

F. Analysis of variance (ANOVA)

G. Statistical significance (p-value)

H. Survivorship analysis (Kaplan-Meier)

I. Spinal shock

J. Neurogenic shock

K. Hypovolemic shock

L. Pulmonary embolism

M. Fat embolus syndrome

N. Lumbar spinal stenosis

O. Metastatic disease of the spine

P. Rheumatoid lumbar spondylitis

Q. Isthmic spondyloloisthesis

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

S. Patella alta

T. A metal-backed patella

U. Varus malalignment of the knee

V. A posterior cruciate-substituting femoral component

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

X. The sesamoids are separated

Y. The sesamoid is fractured

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

{. The dislocation is dorsal and centered

|. The proximal phalanx is hyperextended

}. Patella

~. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

¢. 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

¤. Resection arthroplasty and local radiation

¥. In situ fusion of the hip

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

§. Excision of heterotopic bone and local radiation

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

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

«. External fixation of both femora

¬. 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

®. Synovial sarcoma

¯. Soft-tissue abcess

°. Rhabdomyosarcoma

±. Eosinophilic granuloma

². Nodular pigmented villonodular synovitis

³. Changing to a titanium nail

´. Changing to a nonslotted nail

Μ. Changing the cross-sectional shape of the nail

¶. Increasing the diameter of the nail by 3 mm

·. Increasing the diameter of the interlocking screws

¸. Fracture healing

¹. Chondrosarcoma

º. Periosteal chondroma

». Periosteal osteosarcoma

¼. Dysplasia epiphysealis hemimelica

½. Demonstrate competence in the subject of the case

¾. Be fellowship trained in the subject of the case

¿. Be paid on a contingency basis

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

Á. Have been involved in the case as a consultant

Â. Diagnostic arthroscopy

Ã. Arthroscopy and subacromial decompression

Ä. Reduction and fixation of the proximal humeral epiphysis

Å. Temporary cessation of throwing

Æ. Physical therapy for rotator cuff strengthening

Ç. Oblique popliteal ligament

È. Lateral capsule

É. Popliteal tendon

Ê. Fibular collateral ligament

Ë. Posterior oblique ligament

Ì. Radial tear

Í. Parrot-beak tear

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

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

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

Ñ. 0 degrees of abduction, with neural rotation

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

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

Ô. 90 degrees of abduction with neutral rotation

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

Ö. Sural

×. Saphenous and its branches

Ø. Posterior tibial and its branches

Ù. Deep peroneal and its branches

Ú. Superficial peroneal and its branches

Û. Strength

Ü. Stiffness

Ý. Shelf life

Þ. Antigenicity

SS. Risk of HIV transmission

À. Indemnification

Á. Occurrence

Â. Excess liability

Ã. Claims-made

Ä. Nose

Å. Lateral Y

Æ. Scapular AP

Ç. Neutral rotation AP

È. Internal rotation AP

É. External rotation AP

Ê. Trauma

Ë. Hemophilia

Ì. Reiter’s syndrome

Í. Rheumatoid arthritis

Î. Systemic lupus erythematosus

Ï. Cast immobilization for 6 weeks

Ð. Activity modification and re-evaluation in 2 months

Ñ. Internal fixation with or without bone grafting

Ò. Retrograde drilling of the defect without articular cartilage penetration

Ó. Drilling of the defect directly through the articular cartilage

Ô. repair or reconstruction of the medial collateral ligament

Õ. repair or reconstruction of the medialand lateral collateral ligaments

Ö. immobilization for 5 days or less

÷. immobilization for 14 days

Ø. immobilization for 25 days

Ù. Cystinosis

Ú. Hypophosphatemia

Û. Renal osteodystrophy

Ü. Primary hyperparathyroidism

Ý. Nutritional vitamin D deficiency

Þ. Lateral meniscus tear

Ÿ. Popliteus tenosynovitis

Ā. Iliotibial band friction syndrome

Ā. Peroneal nerve entrapment

Ă. Biceps tendinitis

Ă. Observation

Ą. Removal of the prosthetic components

Ą. Operative exploration and decompression of the peroneal nerve

Ć. Nerve conduction velocity studies

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

Ĉ. I

Ĉ. II

Ċ. III

Ċ. decreased tissue tension

Č. decreased abductor lever arm

Č. decreased joint reaction force

Ď. increased body weight over lever arm

Ď. increased polyethylene wear rate

Đ. recurrent traumatic anterior dislocation

Đ. recurrent traumatic posterior dislocation

Ē. traumatic subluxation with no previous dislocation

Ē. traumatic anterior subluxation

Ĕ. atraumatic involuntary subluxation

Ĕ. radial

Ė. axillary

Ė. suprascapular

Ę. thoracodorsal

Ę. long thoracic

Ě. Flexion

Ě. Extension

Ĝ. Axial rotation

Ĝ. Left lateral bending

Ğ. Right lateral bending

Ğ. Skin

Ġ. Lung

Ġ. Brain

Ģ. Heart

Ģ. Kidney

Ĥ. Thoracoacromial, lateral thoracic, subscapular

Ĥ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ħ. Posterior humeral circumflex, subscapular, thoracacromial

Ħ. Subscapular, thoracacromial, anterior humeral circumflex

Ĩ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ĩ. Respondeat superior

Ī. Indemnity agreement

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

Ĭ. Comparative negligence-% of involvement

Ĭ. Contributory negligence- resident contributed to the negligence

Į. t-type

Į. both column

İ. transverse

I. anterior column

Ĳ. anterior column posterior hemitransverse

Ĳ. Posterior interosseous

Ĵ. Anterior interosseous

Ĵ. Radial

Ķ. Median

Ķ. Ulnar

ĸ. Shock from hypovolemia

Ĺ. Associated rupture of the bladder

Ĺ. Arterial bleeding on pelvic angiogram

Ļ. Presence of a hematoma in the perineum and scrotum

Ļ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Rheumatoid arthritis

Explanation

Question 4216

Topic: 10. Pathology and Oncology

A 34-year- woman has pain at the base of the thumb that worsens é pinching activities. Nonsurgical treatment has failed to provide relief. Examination reveals that the basilar joint is hypermobile, tender and painful when stressed. A radiograph of the trapeziometacarpal joint shows normal contour with widening when compared with the opposite side. Management should consist of

. 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.

.. hemiarthroplasty

/. open reduction and internal fixation

0. closed reduction and percutaneous pinning

1. a sling and early pedulum exercises

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

3. open acromioplasty

4. open Bankart repair

5. open subscapularis tendon repair

6. inferior capsular shift

7. a supervised physical therapy program

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

9. 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. AP and lateral radiographs of the elbow

B. Diagnositc arthroscopy

C. Aspiration of joint fluid

D. An erythrocyte sedimentation rate and CBC

E. A diagnostic lidocaine injection

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

G. Fibroblast growth factor (FGF-1)

H. Platelet-derived growth factor (PDGF)

I. Transforming growth factor beta (TGF-B)

J. Bone morphogenetic proteins (BMP)

K. clinical history and radiographic findings.

L. technetium bone scan

M. flow cytometry pattern of extracted chondrocytes

N. immunohistochemical staining patterns of a biopsy specimen

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

P. Radial

Q. Radial recurrent

R. Posterior interosseous

S. Superior ulnar recurrent

T. Superficial radial circumflex

U. Impaired hydroxylation of proline

V. Failure of cleavage in procollagen

W. Defective binding sites for hydroxyproline

X. Failure to incorporate glycine into the helix

Y. Diminished production of collagen through the rough endoplasmic reticulum

Z. 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

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

_. Meta-analysis

`. Confidence interval

A. Analysis of variance (ANOVA)

B. Statistical significance (p-value)

C. Survivorship analysis (Kaplan-Meier)

D. Spinal shock

E. Neurogenic shock

F. Hypovolemic shock

G. Pulmonary embolism

H. Fat embolus syndrome

I. Lumbar spinal stenosis

J. Metastatic disease of the spine

K. Rheumatoid lumbar spondylitis

L. Isthmic spondyloloisthesis

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

N. Patella alta

O. A metal-backed patella

P. Varus malalignment of the knee

Q. A posterior cruciate-substituting femoral component

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

S. The sesamoids are separated

T. The sesamoid is fractured

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

V. The dislocation is dorsal and centered

W. The proximal phalanx is hyperextended

X. Patella

Y. Tibial stem

Z. Distal femoral interface

{. Posterior femoral interface

|. Sites of screw fixation for the tibia

}. Hallux rigidus

~. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

. 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

. Resection arthroplasty and local radiation

. In situ fusion of the hip

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

¢. Excision of heterotopic bone and local radiation

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

¤. Closed reduction of both fractures and immediate spica casting

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

¦. External fixation of both femora

§. 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

ª. Soft-tissue abcess

«. Rhabdomyosarcoma

¬. Eosinophilic granuloma

. Nodular pigmented villonodular synovitis

®. Changing to a titanium nail

¯. Changing to a nonslotted nail

°. Changing the cross-sectional shape of the nail

±. Increasing the diameter of the nail by 3 mm

². Increasing the diameter of the interlocking screws

³. Fracture healing

´. Chondrosarcoma

Μ. Periosteal chondroma

¶. Periosteal osteosarcoma

·. Dysplasia epiphysealis hemimelica

¸. Demonstrate competence in the subject of the case

¹. Be fellowship trained in the subject of the case

º. Be paid on a contingency basis

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

¼. Have been involved in the case as a consultant

½. Diagnostic arthroscopy

¾. Arthroscopy and subacromial decompression

¿. Reduction and fixation of the proximal humeral epiphysis

À. Temporary cessation of throwing

Á. Physical therapy for rotator cuff strengthening

Â. Oblique popliteal ligament

Ã. Lateral capsule

Ä. Popliteal tendon

Å. Fibular collateral ligament

Æ. Posterior oblique ligament

Ç. Radial tear

È. Parrot-beak tear

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

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

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

Ì. 0 degrees of abduction, with neural rotation

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

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

Ï. 90 degrees of abduction with neutral rotation

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

Ñ. Sural

Ò. Saphenous and its branches

Ó. Posterior tibial and its branches

Ô. Deep peroneal and its branches

Õ. Superficial peroneal and its branches

Ö. Strength

×. Stiffness

Ø. Shelf life

Ù. Antigenicity

Ú. Risk of HIV transmission

Û. Indemnification

Ü. Occurrence

Ý. Excess liability

Þ. Claims-made

SS. Nose

À. Lateral Y

Á. Scapular AP

Â. Neutral rotation AP

Ã. Internal rotation AP

Ä. External rotation AP

Å. Trauma

Æ. Hemophilia

Ç. Reiter’s syndrome

È. Rheumatoid arthritis

É. Systemic lupus erythematosus

Ê. Cast immobilization for 6 weeks

Ë. Activity modification and re-evaluation in 2 months

Ì. Internal fixation with or without bone grafting

Í. Retrograde drilling of the defect without articular cartilage penetration

Î. Drilling of the defect directly through the articular cartilage

Ï. repair or reconstruction of the medial collateral ligament

Ð. repair or reconstruction of the medialand lateral collateral ligaments

Ñ. immobilization for 5 days or less

Ò. immobilization for 14 days

Ó. immobilization for 25 days

Ô. Cystinosis

Õ. Hypophosphatemia

Ö. Renal osteodystrophy

÷. Primary hyperparathyroidism

Ø. Nutritional vitamin D deficiency

Ù. Lateral meniscus tear

Ú. Popliteus tenosynovitis

Û. Iliotibial band friction syndrome

Ü. Peroneal nerve entrapment

Ý. Biceps tendinitis

Þ. Observation

Ÿ. Removal of the prosthetic components

Ā. Operative exploration and decompression of the peroneal nerve

Ā. Nerve conduction velocity studies

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

Ă. I

Ą. II

Ą. III

Ć. decreased tissue tension

Ć. decreased abductor lever arm

Ĉ. decreased joint reaction force

Ĉ. increased body weight over lever arm

Ċ. increased polyethylene wear rate

Ċ. recurrent traumatic anterior dislocation

Č. recurrent traumatic posterior dislocation

Č. traumatic subluxation with no previous dislocation

Ď. traumatic anterior subluxation

Ď. atraumatic involuntary subluxation

Đ. radial

Đ. axillary

Ē. suprascapular

Ē. thoracodorsal

Ĕ. long thoracic

Ĕ. Flexion

Ė. Extension

Ė. Axial rotation

Ę. Left lateral bending

Ę. Right lateral bending

Ě. Skin

Ě. Lung

Ĝ. Brain

Ĝ. Heart

Ğ. Kidney

Ğ. Thoracoacromial, lateral thoracic, subscapular

Ġ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ġ. Posterior humeral circumflex, subscapular, thoracacromial

Ģ. Subscapular, thoracacromial, anterior humeral circumflex

Ģ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ĥ. Respondeat superior

Ĥ. Indemnity agreement

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

Ħ. Comparative negligence-% of involvement

Ĩ. Contributory negligence- resident contributed to the negligence

Ĩ. t-type

Ī. both column

Ī. transverse

Ĭ. anterior column

Ĭ. anterior column posterior hemitransverse

Į. Posterior interosseous

Į. Anterior interosseous

İ. Radial

I. Median

Ĳ. Ulnar

Ĳ. Shock from hypovolemia

Ĵ. Associated rupture of the bladder

Ĵ. Arterial bleeding on pelvic angiogram

Ķ. Presence of a hematoma in the perineum and scrotum

Ķ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Trapeziometacarpal arthrodesis

Explanation

Question 4217

Topic: 10. Pathology and Oncology

The change over time in strain of a material under a constant load is defined as

. 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

.. open acromioplasty

/. open Bankart repair

0. open subscapularis tendon repair

1. inferior capsular shift

2. a supervised physical therapy program

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

4. open reduction and internal fixation through an anterior approach

5. open reduction and internal fixation through a posterior approach

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

7. arthroscopically assisted reduction and percutaneous screw fixation

8. Repair of the rotator cuff

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

B. Fibroblast growth factor (FGF-1)

C. Platelet-derived growth factor (PDGF)

D. Transforming growth factor beta (TGF-B)

E. Bone morphogenetic proteins (BMP)

F. clinical history and radiographic findings.

G. technetium bone scan

H. flow cytometry pattern of extracted chondrocytes

I. immunohistochemical staining patterns of a biopsy specimen

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

K. Radial

L. Radial recurrent

M. Posterior interosseous

N. Superior ulnar recurrent

O. Superficial radial circumflex

P. Impaired hydroxylation of proline

Q. Failure of cleavage in procollagen

R. Defective binding sites for hydroxyproline

S. Failure to incorporate glycine into the helix

T. Diminished production of collagen through the rough endoplasmic reticulum

U. Asking the legal staff to seek a court injunction

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

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

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

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

Z. Meta-analysis

[. Confidence interval

\. Analysis of variance (ANOVA)

]. Statistical significance (p-value)

^. Survivorship analysis (Kaplan-Meier)

_. Spinal shock

`. Neurogenic shock

A. Hypovolemic shock

B. Pulmonary embolism

C. Fat embolus syndrome

D. Lumbar spinal stenosis

E. Metastatic disease of the spine

F. Rheumatoid lumbar spondylitis

G. Isthmic spondyloloisthesis

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

I. Patella alta

J. A metal-backed patella

K. Varus malalignment of the knee

L. A posterior cruciate-substituting femoral component

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

N. The sesamoids are separated

O. The sesamoid is fractured

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

Q. The dislocation is dorsal and centered

R. The proximal phalanx is hyperextended

S. Patella

T. Tibial stem

U. Distal femoral interface

V. Posterior femoral interface

W. Sites of screw fixation for the tibia

X. Hallux rigidus

Y. Fracture of the sesamoid

Z. Disruption of the plantar plate

{. Osteonecrosis of the metatarsal head

|. Rupture of the flexor hallucis longus

}. Gout

~. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

. 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

. Resection arthroplasty and local radiation

. In situ fusion of the hip

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

. Excision of heterotopic bone and local radiation

. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

. Closed reduction of both fractures and immediate spica casting

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

¡. External fixation of both femora

¢. 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

¤. Synovial sarcoma

¥. Soft-tissue abcess

¦. Rhabdomyosarcoma

§. Eosinophilic granuloma

¨. Nodular pigmented villonodular synovitis

ª. Changing to a nonslotted nail

«. Changing the cross-sectional shape of the nail

¬. Increasing the diameter of the nail by 3 mm

. Increasing the diameter of the interlocking screws

®. Fracture healing

¯. Chondrosarcoma

°. Periosteal chondroma

±. Periosteal osteosarcoma

². Dysplasia epiphysealis hemimelica

³. Demonstrate competence in the subject of the case

´. Be fellowship trained in the subject of the case

Μ. Be paid on a contingency basis

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

·. Have been involved in the case as a consultant

¸. Diagnostic arthroscopy

¹. Arthroscopy and subacromial decompression

º. Reduction and fixation of the proximal humeral epiphysis

». Temporary cessation of throwing

¼. Physical therapy for rotator cuff strengthening

½. Oblique popliteal ligament

¾. Lateral capsule

¿. Popliteal tendon

À. Fibular collateral ligament

Á. Posterior oblique ligament

Â. Radial tear

Ã. Parrot-beak tear

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

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

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

Ç. 0 degrees of abduction, with neural rotation

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

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

Ê. 90 degrees of abduction with neutral rotation

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

Ì. Sural

Í. Saphenous and its branches

Î. Posterior tibial and its branches

Ï. Deep peroneal and its branches

Ð. Superficial peroneal and its branches

Ñ. Strength

Ò. Stiffness

Ó. Shelf life

Ô. Antigenicity

Õ. Risk of HIV transmission

Ö. Indemnification

×. Occurrence

Ø. Excess liability

Ù. Claims-made

Ú. Nose

Û. Lateral Y

Ü. Scapular AP

Ý. Neutral rotation AP

Þ. Internal rotation AP

SS. External rotation AP

À. Trauma

Á. Hemophilia

Â. Reiter’s syndrome

Ã. Rheumatoid arthritis

Ä. Systemic lupus erythematosus

Å. Cast immobilization for 6 weeks

Æ. Activity modification and re-evaluation in 2 months

Ç. Internal fixation with or without bone grafting

È. Retrograde drilling of the defect without articular cartilage penetration

É. Drilling of the defect directly through the articular cartilage

Ê. repair or reconstruction of the medial collateral ligament

Ë. repair or reconstruction of the medialand lateral collateral ligaments

Ì. immobilization for 5 days or less

Í. immobilization for 14 days

Î. immobilization for 25 days

Ï. Cystinosis

Ð. Hypophosphatemia

Ñ. Renal osteodystrophy

Ò. Primary hyperparathyroidism

Ó. Nutritional vitamin D deficiency

Ô. Lateral meniscus tear

Õ. Popliteus tenosynovitis

Ö. Iliotibial band friction syndrome

÷. Peroneal nerve entrapment

Ø. Biceps tendinitis

Ù. Observation

Ú. Removal of the prosthetic components

Û. Operative exploration and decompression of the peroneal nerve

Ü. Nerve conduction velocity studies

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

Þ. I

Ÿ. II

Ā. III

Ā. decreased tissue tension

Ă. decreased abductor lever arm

Ă. decreased joint reaction force

Ą. increased body weight over lever arm

Ą. increased polyethylene wear rate

Ć. recurrent traumatic anterior dislocation

Ć. recurrent traumatic posterior dislocation

Ĉ. traumatic subluxation with no previous dislocation

Ĉ. traumatic anterior subluxation

Ċ. atraumatic involuntary subluxation

Ċ. radial

Č. axillary

Č. suprascapular

Ď. thoracodorsal

Ď. long thoracic

Đ. Flexion

Đ. Extension

Ē. Axial rotation

Ē. Left lateral bending

Ĕ. Right lateral bending

Ĕ. Skin

Ė. Lung

Ė. Brain

Ę. Heart

Ę. Kidney

Ě. Thoracoacromial, lateral thoracic, subscapular

Ě. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ĝ. Posterior humeral circumflex, subscapular, thoracacromial

Ĝ. Subscapular, thoracacromial, anterior humeral circumflex

Ğ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ğ. Respondeat superior

Ġ. Indemnity agreement

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

Ģ. Comparative negligence-% of involvement

Ģ. Contributory negligence- resident contributed to the negligence

Ĥ. t-type

Ĥ. both column

Ħ. transverse

Ħ. anterior column

Ĩ. anterior column posterior hemitransverse

Ĩ. Posterior interosseous

Ī. Anterior interosseous

Ī. Radial

Ĭ. Median

Ĭ. Ulnar

Į. Shock from hypovolemia

Į. Associated rupture of the bladder

İ. Arterial bleeding on pelvic angiogram

I. Presence of a hematoma in the perineum and scrotum

Ĳ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Creep

Explanation

Question 4218

Topic: 10. Pathology and Oncology

What is the usual mechanism of injury for the fracture shown in Figures 49a and 49b?

. 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 sling and swathe, with pendulum exercises in 10 days

/. open reduction and internal fixation through an anterior approach

0. open reduction and internal fixation through a posterior approach

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

2. arthroscopically assisted reduction and percutaneous screw fixation

3. Repair of the rotator cuff

4. Replacement of the humeral head

5. Resection arthroplasty

6. Total shoulder arthroplasty

7. AP and lateral radiographs of the elbow

8. Diagnositc arthroscopy

9. 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. clinical history and radiographic findings.

B. technetium bone scan

C. flow cytometry pattern of extracted chondrocytes

D. immunohistochemical staining patterns of a biopsy specimen

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

F. Radial

G. Radial recurrent

H. Posterior interosseous

I. Superior ulnar recurrent

J. Superficial radial circumflex

K. Impaired hydroxylation of proline

L. Failure of cleavage in procollagen

M. Defective binding sites for hydroxyproline

N. Failure to incorporate glycine into the helix

O. Diminished production of collagen through the rough endoplasmic reticulum

P. Asking the legal staff to seek a court injunction

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

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

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

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

U. Meta-analysis

V. Confidence interval

W. Analysis of variance (ANOVA)

X. Statistical significance (p-value)

Y. Survivorship analysis (Kaplan-Meier)

Z. Spinal shock

[. Neurogenic shock

\. Hypovolemic shock

]. Pulmonary embolism

^. Fat embolus syndrome

_. Lumbar spinal stenosis

`. Metastatic disease of the spine

A. Rheumatoid lumbar spondylitis

B. Isthmic spondyloloisthesis

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

D. Patella alta

E. A metal-backed patella

F. Varus malalignment of the knee

G. A posterior cruciate-substituting femoral component

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

I. The sesamoids are separated

J. The sesamoid is fractured

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

L. The dislocation is dorsal and centered

M. The proximal phalanx is hyperextended

N. Patella

O. Tibial stem

P. Distal femoral interface

Q. Posterior femoral interface

R. Sites of screw fixation for the tibia

S. Hallux rigidus

T. Fracture of the sesamoid

U. Disruption of the plantar plate

V. Osteonecrosis of the metatarsal head

W. Rupture of the flexor hallucis longus

X. Gout

Y. Sepsis

Z. Old trauma

{. Rheumatoid arthritis

|. Charcot arthroplasty

}. Aspiration and steroid injection

~. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

. 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

. Resection arthroplasty and local radiation

. In situ fusion of the hip

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

. Excision of heterotopic bone and local radiation

. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

. Closed reduction of both fractures and immediate spica casting

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

. External fixation of both femora

. 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

. Synovial sarcoma

. Soft-tissue abcess

¡. Rhabdomyosarcoma

¢. Eosinophilic granuloma

£. Nodular pigmented villonodular synovitis

¤. Changing to a titanium nail

¥. Changing to a nonslotted nail

¦. Changing the cross-sectional shape of the nail

§. Increasing the diameter of the nail by 3 mm

¨. Increasing the diameter of the interlocking screws

ª. Chondrosarcoma

«. Periosteal chondroma

¬. Periosteal osteosarcoma

. Dysplasia epiphysealis hemimelica

®. Demonstrate competence in the subject of the case

¯. Be fellowship trained in the subject of the case

°. Be paid on a contingency basis

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

². Have been involved in the case as a consultant

³. Diagnostic arthroscopy

´. Arthroscopy and subacromial decompression

Μ. Reduction and fixation of the proximal humeral epiphysis

¶. Temporary cessation of throwing

·. Physical therapy for rotator cuff strengthening

¸. Oblique popliteal ligament

¹. Lateral capsule

º. Popliteal tendon

». Fibular collateral ligament

¼. Posterior oblique ligament

½. Radial tear

¾. Parrot-beak tear

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

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

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

Â. 0 degrees of abduction, with neural rotation

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

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

Å. 90 degrees of abduction with neutral rotation

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

Ç. Sural

È. Saphenous and its branches

É. Posterior tibial and its branches

Ê. Deep peroneal and its branches

Ë. Superficial peroneal and its branches

Ì. Strength

Í. Stiffness

Î. Shelf life

Ï. Antigenicity

Ð. Risk of HIV transmission

Ñ. Indemnification

Ò. Occurrence

Ó. Excess liability

Ô. Claims-made

Õ. Nose

Ö. Lateral Y

×. Scapular AP

Ø. Neutral rotation AP

Ù. Internal rotation AP

Ú. External rotation AP

Û. Trauma

Ü. Hemophilia

Ý. Reiter’s syndrome

Þ. Rheumatoid arthritis

SS. Systemic lupus erythematosus

À. Cast immobilization for 6 weeks

Á. Activity modification and re-evaluation in 2 months

Â. Internal fixation with or without bone grafting

Ã. Retrograde drilling of the defect without articular cartilage penetration

Ä. Drilling of the defect directly through the articular cartilage

Å. repair or reconstruction of the medial collateral ligament

Æ. repair or reconstruction of the medialand lateral collateral ligaments

Ç. immobilization for 5 days or less

È. immobilization for 14 days

É. immobilization for 25 days

Ê. Cystinosis

Ë. Hypophosphatemia

Ì. Renal osteodystrophy

Í. Primary hyperparathyroidism

Î. Nutritional vitamin D deficiency

Ï. Lateral meniscus tear

Ð. Popliteus tenosynovitis

Ñ. Iliotibial band friction syndrome

Ò. Peroneal nerve entrapment

Ó. Biceps tendinitis

Ô. Observation

Õ. Removal of the prosthetic components

Ö. Operative exploration and decompression of the peroneal nerve

÷. Nerve conduction velocity studies

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

Ù. I

Ú. II

Û. III

Ü. decreased tissue tension

Ý. decreased abductor lever arm

Þ. decreased joint reaction force

Ÿ. increased body weight over lever arm

Ā. increased polyethylene wear rate

Ā. recurrent traumatic anterior dislocation

Ă. recurrent traumatic posterior dislocation

Ă. traumatic subluxation with no previous dislocation

Ą. traumatic anterior subluxation

Ą. atraumatic involuntary subluxation

Ć. radial

Ć. axillary

Ĉ. suprascapular

Ĉ. thoracodorsal

Ċ. long thoracic

Ċ. Flexion

Č. Extension

Č. Axial rotation

Ď. Left lateral bending

Ď. Right lateral bending

Đ. Skin

Đ. Lung

Ē. Brain

Ē. Heart

Ĕ. Kidney

Ĕ. Thoracoacromial, lateral thoracic, subscapular

Ė. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ė. Posterior humeral circumflex, subscapular, thoracacromial

Ę. Subscapular, thoracacromial, anterior humeral circumflex

Ę. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ě. Respondeat superior

Ě. Indemnity agreement

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

Ĝ. Comparative negligence-% of involvement

Ğ. Contributory negligence- resident contributed to the negligence

Ğ. t-type

Ġ. both column

Ġ. transverse

Ģ. anterior column

Ģ. anterior column posterior hemitransverse

Ĥ. Posterior interosseous

Ĥ. Anterior interosseous

Ħ. Radial

Ħ. Median

Ĩ. Ulnar

Ĩ. Shock from hypovolemia

Ī. Associated rupture of the bladder

Ī. Arterial bleeding on pelvic angiogram

Ĭ. Presence of a hematoma in the perineum and scrotum

Ĭ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. bending

Explanation

Question 4219

Topic: 10. Pathology and Oncology

Gamma ray irradiation for sterilization of ultra-high molecular weight polyethylene in an oxygen environment can have what effect on the material?

. 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

.. Repair of the rotator cuff

/. Replacement of the humeral head

0. Resection arthroplasty

1. Total shoulder arthroplasty

2. AP and lateral radiographs of the elbow

3. Diagnositc arthroscopy

4. Aspiration of joint fluid

5. An erythrocyte sedimentation rate and CBC

6. A diagnostic lidocaine injection

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

8. Fibroblast growth factor (FGF-1)

9. 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

A. Radial

B. Radial recurrent

C. Posterior interosseous

D. Superior ulnar recurrent

E. Superficial radial circumflex

F. Impaired hydroxylation of proline

G. Failure of cleavage in procollagen

H. Defective binding sites for hydroxyproline

I. Failure to incorporate glycine into the helix

J. Diminished production of collagen through the rough endoplasmic reticulum

K. Asking the legal staff to seek a court injunction

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

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

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

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

P. Meta-analysis

Q. Confidence interval

R. Analysis of variance (ANOVA)

S. Statistical significance (p-value)

T. Survivorship analysis (Kaplan-Meier)

U. Spinal shock

V. Neurogenic shock

W. Hypovolemic shock

X. Pulmonary embolism

Y. Fat embolus syndrome

Z. Lumbar spinal stenosis

[. Metastatic disease of the spine

\. Rheumatoid lumbar spondylitis

]. Isthmic spondyloloisthesis

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

_. Patella alta

`. A metal-backed patella

A. Varus malalignment of the knee

B. A posterior cruciate-substituting femoral component

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

D. The sesamoids are separated

E. The sesamoid is fractured

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

G. The dislocation is dorsal and centered

H. The proximal phalanx is hyperextended

I. Patella

J. Tibial stem

K. Distal femoral interface

L. Posterior femoral interface

M. Sites of screw fixation for the tibia

N. Hallux rigidus

O. Fracture of the sesamoid

P. Disruption of the plantar plate

Q. Osteonecrosis of the metatarsal head

R. Rupture of the flexor hallucis longus

S. Gout

T. Sepsis

U. Old trauma

V. Rheumatoid arthritis

W. Charcot arthroplasty

X. Aspiration and steroid injection

Y. Biopsy, curettage, and allograft bone grafting

Z. Percutaneous Kirschner wire fixation

{. Percutaneous injection of autogenous bone marrow

|. Nerve roots

}. Spinal cord

~. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

. 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

. Resection arthroplasty and local radiation

. In situ fusion of the hip

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

. Excision of heterotopic bone and local radiation

. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

. Closed reduction of both fractures and immediate spica casting

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

. External fixation of both femora

. 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

. Synovial sarcoma

. Soft-tissue abcess

. Rhabdomyosarcoma

. Eosinophilic granuloma

. Nodular pigmented villonodular synovitis

. Changing to a titanium nail

. Changing to a nonslotted nail

¡. Changing the cross-sectional shape of the nail

¢. Increasing the diameter of the nail by 3 mm

£. Increasing the diameter of the interlocking screws

¤. Fracture healing

¥. Chondrosarcoma

¦. Periosteal chondroma

§. Periosteal osteosarcoma

¨. Dysplasia epiphysealis hemimelica

ª. Be fellowship trained in the subject of the case

«. Be paid on a contingency basis

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

. Have been involved in the case as a consultant

®. Diagnostic arthroscopy

¯. Arthroscopy and subacromial decompression

°. Reduction and fixation of the proximal humeral epiphysis

±. Temporary cessation of throwing

². Physical therapy for rotator cuff strengthening

³. Oblique popliteal ligament

´. Lateral capsule

Μ. Popliteal tendon

¶. Fibular collateral ligament

·. Posterior oblique ligament

¸. Radial tear

¹. Parrot-beak tear

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

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

¼. Vertical tear in the “white-white” zone

½. 0 degrees of abduction, with neural rotation

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

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

À. 90 degrees of abduction with neutral rotation

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

Â. Sural

Ã. Saphenous and its branches

Ä. Posterior tibial and its branches

Å. Deep peroneal and its branches

Æ. Superficial peroneal and its branches

Ç. Strength

È. Stiffness

É. Shelf life

Ê. Antigenicity

Ë. Risk of HIV transmission

Ì. Indemnification

Í. Occurrence

Î. Excess liability

Ï. Claims-made

Ð. Nose

Ñ. Lateral Y

Ò. Scapular AP

Ó. Neutral rotation AP

Ô. Internal rotation AP

Õ. External rotation AP

Ö. Trauma

×. Hemophilia

Ø. Reiter’s syndrome

Ù. Rheumatoid arthritis

Ú. Systemic lupus erythematosus

Û. Cast immobilization for 6 weeks

Ü. Activity modification and re-evaluation in 2 months

Ý. Internal fixation with or without bone grafting

Þ. Retrograde drilling of the defect without articular cartilage penetration

SS. Drilling of the defect directly through the articular cartilage

À. repair or reconstruction of the medial collateral ligament

Á. repair or reconstruction of the medialand lateral collateral ligaments

Â. immobilization for 5 days or less

Ã. immobilization for 14 days

Ä. immobilization for 25 days

Å. Cystinosis

Æ. Hypophosphatemia

Ç. Renal osteodystrophy

È. Primary hyperparathyroidism

É. Nutritional vitamin D deficiency

Ê. Lateral meniscus tear

Ë. Popliteus tenosynovitis

Ì. Iliotibial band friction syndrome

Í. Peroneal nerve entrapment

Î. Biceps tendinitis

Ï. Observation

Ð. Removal of the prosthetic components

Ñ. Operative exploration and decompression of the peroneal nerve

Ò. Nerve conduction velocity studies

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

Ô. I

Õ. II

Ö. III

÷. decreased tissue tension

Ø. decreased abductor lever arm

Ù. decreased joint reaction force

Ú. increased body weight over lever arm

Û. increased polyethylene wear rate

Ü. recurrent traumatic anterior dislocation

Ý. recurrent traumatic posterior dislocation

Þ. traumatic subluxation with no previous dislocation

Ÿ. traumatic anterior subluxation

Ā. atraumatic involuntary subluxation

Ā. radial

Ă. axillary

Ă. suprascapular

Ą. thoracodorsal

Ą. long thoracic

Ć. Flexion

Ć. Extension

Ĉ. Axial rotation

Ĉ. Left lateral bending

Ċ. Right lateral bending

Ċ. Skin

Č. Lung

Č. Brain

Ď. Heart

Ď. Kidney

Đ. Thoracoacromial, lateral thoracic, subscapular

Đ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ē. Posterior humeral circumflex, subscapular, thoracacromial

Ē. Subscapular, thoracacromial, anterior humeral circumflex

Ĕ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ĕ. Respondeat superior

Ė. Indemnity agreement

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

Ę. Comparative negligence-% of involvement

Ę. Contributory negligence- resident contributed to the negligence

Ě. t-type

Ě. both column

Ĝ. transverse

Ĝ. anterior column

Ğ. anterior column posterior hemitransverse

Ğ. Posterior interosseous

Ġ. Anterior interosseous

Ġ. Radial

Ģ. Median

Ģ. Ulnar

Ĥ. Shock from hypovolemia

Ĥ. Associated rupture of the bladder

Ħ. Arterial bleeding on pelvic angiogram

Ħ. Presence of a hematoma in the perineum and scrotum

Ĩ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Increase stiffness

Explanation

Question 4220

Topic: 10. Pathology and Oncology

-
The radiograph shown in Figure 50a and the CT scan shown in Figure 50b reveal a lesion in the left femoral neck of a 12-year-old boy who has pain in the left hip. The most likely cause of the osteopenia of the left proximal femur is

. 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

-. AP and lateral radiographs of the elbow

.. Diagnositc arthroscopy

/. Aspiration of joint fluid

0. An erythrocyte sedimentation rate and CBC

1. A diagnostic lidocaine injection

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

3. Fibroblast growth factor (FGF-1)

4. Platelet-derived growth factor (PDGF)

5. Transforming growth factor beta (TGF-B)

6. Bone morphogenetic proteins (BMP)

7. clinical history and radiographic findings.

8. technetium bone scan

9. 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. Impaired hydroxylation of proline

B. Failure of cleavage in procollagen

C. Defective binding sites for hydroxyproline

D. Failure to incorporate glycine into the helix

E. Diminished production of collagen through the rough endoplasmic reticulum

F. Asking the legal staff to seek a court injunction

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

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

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

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

K. Meta-analysis

L. Confidence interval

M. Analysis of variance (ANOVA)

N. Statistical significance (p-value)

O. Survivorship analysis (Kaplan-Meier)

P. Spinal shock

Q. Neurogenic shock

R. Hypovolemic shock

S. Pulmonary embolism

T. Fat embolus syndrome

U. Lumbar spinal stenosis

V. Metastatic disease of the spine

W. Rheumatoid lumbar spondylitis

X. Isthmic spondyloloisthesis

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

Z. Patella alta

[. A metal-backed patella

\. Varus malalignment of the knee

]. A posterior cruciate-substituting femoral component

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

_. The sesamoids are separated

`. The sesamoid is fractured

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

B. The dislocation is dorsal and centered

C. The proximal phalanx is hyperextended

D. Patella

E. Tibial stem

F. Distal femoral interface

G. Posterior femoral interface

H. Sites of screw fixation for the tibia

I. Hallux rigidus

J. Fracture of the sesamoid

K. Disruption of the plantar plate

L. Osteonecrosis of the metatarsal head

M. Rupture of the flexor hallucis longus

N. Gout

O. Sepsis

P. Old trauma

Q. Rheumatoid arthritis

R. Charcot arthroplasty

S. Aspiration and steroid injection

T. Biopsy, curettage, and allograft bone grafting

U. Percutaneous Kirschner wire fixation

V. Percutaneous injection of autogenous bone marrow

W. Nerve roots

X. Spinal cord

Y. Sciatic nerve

Z. Peroneal nerve

{. Conus medullaris

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

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

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

. 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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

. Aseptic loosening of cementing tibial components

. Asceptic loosening of cemented femoral components

. Acceptance of the current position of the ankle

. Open reduction and fixation in the epiphysis only

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

. 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

. Resection arthroplasty and local radiation

. In situ fusion of the hip

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

. Excision of heterotopic bone and local radiation

. Excision of heterotopic bone, hemiarthroplasty, and oral indomethacin

. Closed reduction of both fractures and immediate spica casting

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

. External fixation of both femora

. 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

. Synovial sarcoma

. Soft-tissue abcess

. Rhabdomyosarcoma

. Eosinophilic granuloma

. Nodular pigmented villonodular synovitis

. Changing to a titanium nail

. Changing to a nonslotted nail

. Changing the cross-sectional shape of the nail

. Increasing the diameter of the nail by 3 mm

. Increasing the diameter of the interlocking screws

. Fracture healing

. Chondrosarcoma

¡. Periosteal chondroma

¢. Periosteal osteosarcoma

£. Dysplasia epiphysealis hemimelica

¤. Demonstrate competence in the subject of the case

¥. Be fellowship trained in the subject of the case

¦. Be paid on a contingency basis

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

¨. Have been involved in the case as a consultant

ª. Arthroscopy and subacromial decompression

«. Reduction and fixation of the proximal humeral epiphysis

¬. Temporary cessation of throwing

. Physical therapy for rotator cuff strengthening

®. Oblique popliteal ligament

¯. Lateral capsule

°. Popliteal tendon

±. Fibular collateral ligament

². Posterior oblique ligament

³. Radial tear

´. Parrot-beak tear

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

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

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

¸. 0 degrees of abduction, with neural rotation

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

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

». 90 degrees of abduction with neutral rotation

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

½. Sural

¾. Saphenous and its branches

¿. Posterior tibial and its branches

À. Deep peroneal and its branches

Á. Superficial peroneal and its branches

Â. Strength

Ã. Stiffness

Ä. Shelf life

Å. Antigenicity

Æ. Risk of HIV transmission

Ç. Indemnification

È. Occurrence

É. Excess liability

Ê. Claims-made

Ë. Nose

Ì. Lateral Y

Í. Scapular AP

Î. Neutral rotation AP

Ï. Internal rotation AP

Ð. External rotation AP

Ñ. Trauma

Ò. Hemophilia

Ó. Reiter’s syndrome

Ô. Rheumatoid arthritis

Õ. Systemic lupus erythematosus

Ö. Cast immobilization for 6 weeks

×. Activity modification and re-evaluation in 2 months

Ø. Internal fixation with or without bone grafting

Ù. Retrograde drilling of the defect without articular cartilage penetration

Ú. Drilling of the defect directly through the articular cartilage

Û. repair or reconstruction of the medial collateral ligament

Ü. repair or reconstruction of the medialand lateral collateral ligaments

Ý. immobilization for 5 days or less

Þ. immobilization for 14 days

SS. immobilization for 25 days

À. Cystinosis

Á. Hypophosphatemia

Â. Renal osteodystrophy

Ã. Primary hyperparathyroidism

Ä. Nutritional vitamin D deficiency

Å. Lateral meniscus tear

Æ. Popliteus tenosynovitis

Ç. Iliotibial band friction syndrome

È. Peroneal nerve entrapment

É. Biceps tendinitis

Ê. Observation

Ë. Removal of the prosthetic components

Ì. Operative exploration and decompression of the peroneal nerve

Í. Nerve conduction velocity studies

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

Ï. I

Ð. II

Ñ. III

Ò. decreased tissue tension

Ó. decreased abductor lever arm

Ô. decreased joint reaction force

Õ. increased body weight over lever arm

Ö. increased polyethylene wear rate

÷. recurrent traumatic anterior dislocation

Ø. recurrent traumatic posterior dislocation

Ù. traumatic subluxation with no previous dislocation

Ú. traumatic anterior subluxation

Û. atraumatic involuntary subluxation

Ü. radial

Ý. axillary

Þ. suprascapular

Ÿ. thoracodorsal

Ā. long thoracic

Ā. Flexion

Ă. Extension

Ă. Axial rotation

Ą. Left lateral bending

Ą. Right lateral bending

Ć. Skin

Ć. Lung

Ĉ. Brain

Ĉ. Heart

Ċ. Kidney

Ċ. Thoracoacromial, lateral thoracic, subscapular

Č. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Č. Posterior humeral circumflex, subscapular, thoracacromial

Ď. Subscapular, thoracacromial, anterior humeral circumflex

Ď. Lateral thoracic, anterior humeral circumflex, thoracacromial

Đ. Respondeat superior

Đ. Indemnity agreement

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

Ē. Comparative negligence-% of involvement

Ĕ. Contributory negligence- resident contributed to the negligence

Ĕ. t-type

Ė. both column

Ė. transverse

Ę. anterior column

Ę. anterior column posterior hemitransverse

Ě. Posterior interosseous

Ě. Anterior interosseous

Ĝ. Radial

Ĝ. Median

Ğ. Ulnar

Ğ. Shock from hypovolemia

Ġ. Associated rupture of the bladder

Ġ. Arterial bleeding on pelvic angiogram

Ģ. Presence of a hematoma in the perineum and scrotum

Ģ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. disuse osteopenia

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10. Pathology and Oncology MCQs

Correct Answer & Explanation

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Correct Answer & Explanation

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