Demyelination diseases as multiple sclerosis and Guillain-Barre $ create neurologic symptoms by

Correct Answer: decreasing initiation of action potentials.. Explanation:

Figure 56 shows the radiograph of a 38-year-old patient with polyarticular rheumatoid arthritis who has severe pain in the shoulder. Non-surgical treatment has failed to provide relief. Treatment sho

Correct Answer: Repair of the rotator cuff. Explanation:

Acondroplasia and other chondrodysplasias are caused by mutations in the receptors of which of the following families of growth factors?

Correct Answer: Insulin-like growth factor (IGF-1). Explanation:

The diagnostic distinction between a benign enchondroma and a low- grade intramedually chondrosarcoma is based primarily on the

Correct Answer: clinical history and radiographic findings.. Explanation:

Clinic OS

Q: ofhat parameter is most commonly used to estimate the maximum tension a muscle can generating?

Correct Answer: Length. Explanation:

Q: Figure 51 shows the standing AP radiograph of a 56-year old woman who has multiple toe deformities and pain beneath the metatarsal heads. Shoe modification has failed to provide relief. In addition to

Correct Answer: resection of the metatarsal heads of the first through fifth toes.. Explanation:

Q: An active, right-handed 71-year-old woman fell on her left shoulder and sustained the injury shown in the radiographs in 52a and 52b and the CT scan in 52c. Management should consist of

Correct Answer: hemiarthroplasty. Explanation:

Q: Figure 53 shows the MRI scan of a 53-year-old carnival worker who has pain and swelling in the left shoulder as a result of attempting to stop a roller coaster car with his arm. Examination reveals de

Correct Answer: open acromioplasty. Explanation:

Q: A 45-year-old man sustains the shoulder injury shown in the radiographs in Figure 55a and 55b and the CT scan in Figures 55c and 55d. Management should consist of

Correct Answer: a sling and swathe, with pendulum exercises in 10 days. Explanation:

Q: Figure 57a and 57b show the radiographs of a 57-year-old man who has pain inthe ulnar side of the wrist and hand. Examination shows tenderness at the base of the hypothenar area. Additional diagnostic

Correct Answer: AP and lateral radiographs of the elbow. Explanation:

Question 4221

Topic: 10. Pathology and Oncology

ofhat parameter is most commonly used to estimate the maximum tension a muscle can generating?

. Length

. Moment arm

. Total volume

. Physiologic cross-sectional area

. Distribution of slow and fast twitch fibers

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

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

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

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

!. Resection arthroplasty

". Total shoulder arthroplasty

#. AP and lateral radiographs of the elbow

$. Diagnositc arthroscopy

%. Aspiration of joint fluid

&. An erythrocyte sedimentation rate and CBC

'. A diagnostic lidocaine injection

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

). Fibroblast growth factor (FGF-1)

*. Platelet-derived growth factor (PDGF)

+. Transforming growth factor beta (TGF-B)

,. Bone morphogenetic proteins (BMP)

-. clinical history and radiographic findings.

.. technetium bone scan

/. flow cytometry pattern of extracted chondrocytes

0. immunohistochemical staining patterns of a biopsy specimen

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

2. Radial

3. Radial recurrent

4. Posterior interosseous

5. Superior ulnar recurrent

6. Superficial radial circumflex

7. Impaired hydroxylation of proline

8. Failure of cleavage in procollagen

9. 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

A. Meta-analysis

B. Confidence interval

C. Analysis of variance (ANOVA)

D. Statistical significance (p-value)

E. Survivorship analysis (Kaplan-Meier)

F. Spinal shock

G. Neurogenic shock

H. Hypovolemic shock

I. Pulmonary embolism

J. Fat embolus syndrome

K. Lumbar spinal stenosis

L. Metastatic disease of the spine

M. Rheumatoid lumbar spondylitis

N. Isthmic spondyloloisthesis

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

P. Patella alta

Q. A metal-backed patella

R. Varus malalignment of the knee

S. A posterior cruciate-substituting femoral component

T. Lateral subluxation of the patella on a Merchant’s view

U. The sesamoids are separated

V. The sesamoid is fractured

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

X. The dislocation is dorsal and centered

Y. The proximal phalanx is hyperextended

Z. Patella

[. Tibial stem

\. Distal femoral interface

]. Posterior femoral interface

^. Sites of screw fixation for the tibia

_. Hallux rigidus

`. Fracture of the sesamoid

A. Disruption of the plantar plate

B. Osteonecrosis of the metatarsal head

C. Rupture of the flexor hallucis longus

D. Gout

E. Sepsis

F. Old trauma

G. Rheumatoid arthritis

H. Charcot arthroplasty

I. Aspiration and steroid injection

J. Biopsy, curettage, and allograft bone grafting

K. Percutaneous Kirschner wire fixation

L. Percutaneous injection of autogenous bone marrow

M. Nerve roots

N. Spinal cord

O. Sciatic nerve

P. Peroneal nerve

Q. Conus medullaris

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

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

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

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

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

W. Early and late infection

X. Periprosthetic fracture of the femur

Y. Failure of the patellofemoral and extensor mechanisms

Z. 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

. Diagnostic arthroscopy

. 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

¨. Posterior oblique ligament

©. Radial tear

ª. Parrot-beak tear

«. 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

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

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

±. 90 degrees of abduction with neutral rotation

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

³. Sural

´. Saphenous and its branches

Μ. Posterior tibial and its branches

¶. Deep peroneal and its branches

·. Superficial peroneal and its branches

¸. Strength

¹. Stiffness

º. Shelf life

». Antigenicity

¼. Risk of HIV transmission

½. Indemnification

¾. Occurrence

¿. Excess liability

À. Claims-made

Á. Nose

Â. Lateral Y

Ã. Scapular AP

Ä. Neutral rotation AP

Å. Internal rotation AP

Æ. External rotation AP

Ç. Trauma

È. Hemophilia

É. Reiter’s syndrome

Ê. Rheumatoid arthritis

Ë. Systemic lupus erythematosus

Ì. Cast immobilization for 6 weeks

Í. Activity modification and re-evaluation in 2 months

Î. Internal fixation with or without bone grafting

Ï. Retrograde drilling of the defect without articular cartilage penetration

Ð. Drilling of the defect directly through the articular cartilage

Ñ. repair or reconstruction of the medial collateral ligament

Ò. repair or reconstruction of the medialand lateral collateral ligaments

Ó. immobilization for 5 days or less

Ô. immobilization for 14 days

Õ. immobilization for 25 days

Ö. Cystinosis

×. Hypophosphatemia

Ø. Renal osteodystrophy

Ù. Primary hyperparathyroidism

Ú. Nutritional vitamin D deficiency

Û. Lateral meniscus tear

Ü. Popliteus tenosynovitis

Ý. Iliotibial band friction syndrome

Þ. Peroneal nerve entrapment

SS. Biceps tendinitis

À. Observation

Á. Removal of the prosthetic components

Â. Operative exploration and decompression of the peroneal nerve

Ã. Nerve conduction velocity studies

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

Å. I

Æ. II

Ç. III

È. decreased tissue tension

É. decreased abductor lever arm

Ê. decreased joint reaction force

Ë. increased body weight over lever arm

Ì. increased polyethylene wear rate

Í. recurrent traumatic anterior dislocation

Î. recurrent traumatic posterior dislocation

Ï. traumatic subluxation with no previous dislocation

Ð. traumatic anterior subluxation

Ñ. atraumatic involuntary subluxation

Ò. radial

Ó. axillary

Ô. suprascapular

Õ. thoracodorsal

Ö. long thoracic

÷. Flexion

Ø. Extension

Ù. Axial rotation

Ú. Left lateral bending

Û. Right lateral bending

Ü. Skin

Ý. Lung

Þ. Brain

Ÿ. Heart

Ā. Kidney

Ā. Thoracoacromial, lateral thoracic, subscapular

Ă. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ă. Posterior humeral circumflex, subscapular, thoracacromial

Ą. Subscapular, thoracacromial, anterior humeral circumflex

Ą. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ć. Respondeat superior

Ć. Indemnity agreement

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

Ĉ. Comparative negligence-% of involvement

Ċ. Contributory negligence- resident contributed to the negligence

Ċ. t-type

Č. both column

Č. transverse

Ď. anterior column

Ď. anterior column posterior hemitransverse

Đ. Posterior interosseous

Đ. Anterior interosseous

Ē. Radial

Ē. Median

Ĕ. Ulnar

Ĕ. Shock from hypovolemia

Ė. Associated rupture of the bladder

Ė. Arterial bleeding on pelvic angiogram

Ę. Presence of a hematoma in the perineum and scrotum

Ę. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Length

Explanation

Question 4222

Topic: 10. Pathology and Oncology

Demyelination diseases as multiple sclerosis and Guillain-Barre $ create neurologic symptoms by

. decreasing initiation of action potentials.

. increasing action potential amplitude.

. blocking the opening of gated sodium channels.

. decreasing the number of functional motor units.

. slowing or stopping action potential propagation through the axon.

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

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

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

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

!. An erythrocyte sedimentation rate and CBC

". A diagnostic lidocaine injection

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

$. Fibroblast growth factor (FGF-1)

%. Platelet-derived growth factor (PDGF)

&. Transforming growth factor beta (TGF-B)

'. Bone morphogenetic proteins (BMP)

(. clinical history and radiographic findings.

). technetium bone scan

*. flow cytometry pattern of extracted chondrocytes

+. immunohistochemical staining patterns of a biopsy specimen

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

-. Radial

.. Radial recurrent

/. Posterior interosseous

0. Superior ulnar recurrent

1. Superficial radial circumflex

2. Impaired hydroxylation of proline

3. Failure of cleavage in procollagen

4. Defective binding sites for hydroxyproline

5. Failure to incorporate glycine into the helix

6. Diminished production of collagen through the rough endoplasmic reticulum

7. Asking the legal staff to seek a court injunction

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

9. 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)

A. Spinal shock

B. Neurogenic shock

C. Hypovolemic shock

D. Pulmonary embolism

E. Fat embolus syndrome

F. Lumbar spinal stenosis

G. Metastatic disease of the spine

H. Rheumatoid lumbar spondylitis

I. Isthmic spondyloloisthesis

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

K. Patella alta

L. A metal-backed patella

M. Varus malalignment of the knee

N. A posterior cruciate-substituting femoral component

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

P. The sesamoids are separated

Q. The sesamoid is fractured

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

S. The dislocation is dorsal and centered

T. The proximal phalanx is hyperextended

U. Patella

V. Tibial stem

W. Distal femoral interface

X. Posterior femoral interface

Y. Sites of screw fixation for the tibia

Z. Hallux rigidus

[. Fracture of the sesamoid

\. Disruption of the plantar plate

]. Osteonecrosis of the metatarsal head

^. Rupture of the flexor hallucis longus

_. Gout

`. Sepsis

A. Old trauma

B. Rheumatoid arthritis

C. Charcot arthroplasty

D. Aspiration and steroid injection

E. Biopsy, curettage, and allograft bone grafting

F. Percutaneous Kirschner wire fixation

G. Percutaneous injection of autogenous bone marrow

H. Nerve roots

I. Spinal cord

J. Sciatic nerve

K. Peroneal nerve

L. Conus medullaris

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

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

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

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

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

R. Early and late infection

S. Periprosthetic fracture of the femur

T. Failure of the patellofemoral and extensor mechanisms

U. Aseptic loosening of cementing tibial components

V. Asceptic loosening of cemented femoral components

W. Acceptance of the current position of the ankle

X. Open reduction and fixation in the epiphysis only

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

Z. 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

. Diagnostic arthroscopy

. 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

£. Posterior oblique ligament

¤. Radial tear

¥. Parrot-beak tear

¦. 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

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

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

¬. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

®. Sural

¯. Saphenous and its branches

°. Posterior tibial and its branches

±. Deep peroneal and its branches

². Superficial peroneal and its branches

³. Strength

´. Stiffness

Μ. Shelf life

¶. Antigenicity

·. Risk of HIV transmission

¸. Indemnification

¹. Occurrence

º. Excess liability

». Claims-made

¼. Nose

½. Lateral Y

¾. Scapular AP

¿. Neutral rotation AP

À. Internal rotation AP

Á. External rotation AP

Â. Trauma

Ã. Hemophilia

Ä. Reiter’s syndrome

Å. Rheumatoid arthritis

Æ. Systemic lupus erythematosus

Ç. Cast immobilization for 6 weeks

È. Activity modification and re-evaluation in 2 months

É. Internal fixation with or without bone grafting

Ê. Retrograde drilling of the defect without articular cartilage penetration

Ë. Drilling of the defect directly through the articular cartilage

Ì. repair or reconstruction of the medial collateral ligament

Í. repair or reconstruction of the medialand lateral collateral ligaments

Î. immobilization for 5 days or less

Ï. immobilization for 14 days

Ð. immobilization for 25 days

Ñ. Cystinosis

Ò. Hypophosphatemia

Ó. Renal osteodystrophy

Ô. Primary hyperparathyroidism

Õ. Nutritional vitamin D deficiency

Ö. Lateral meniscus tear

×. Popliteus tenosynovitis

Ø. Iliotibial band friction syndrome

Ù. Peroneal nerve entrapment

Ú. Biceps tendinitis

Û. Observation

Ü. Removal of the prosthetic components

Ý. Operative exploration and decompression of the peroneal nerve

Þ. Nerve conduction velocity studies

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

À. I

Á. II

Â. III

Ã. decreased tissue tension

Ä. decreased abductor lever arm

Å. decreased joint reaction force

Æ. increased body weight over lever arm

Ç. increased polyethylene wear rate

È. recurrent traumatic anterior dislocation

É. recurrent traumatic posterior dislocation

Ê. traumatic subluxation with no previous dislocation

Ë. traumatic anterior subluxation

Ì. atraumatic involuntary subluxation

Í. radial

Î. axillary

Ï. suprascapular

Ð. thoracodorsal

Ñ. long thoracic

Ò. Flexion

Ó. Extension

Ô. Axial rotation

Õ. Left lateral bending

Ö. Right lateral bending

÷. Skin

Ø. Lung

Ù. Brain

Ú. Heart

Û. Kidney

Ü. Thoracoacromial, lateral thoracic, subscapular

Ý. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Þ. Posterior humeral circumflex, subscapular, thoracacromial

Ÿ. Subscapular, thoracacromial, anterior humeral circumflex

Ā. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ā. Respondeat superior

Ă. Indemnity agreement

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

Ą. Comparative negligence-% of involvement

Ą. Contributory negligence- resident contributed to the negligence

Ć. t-type

Ć. both column

Ĉ. transverse

Ĉ. anterior column

Ċ. anterior column posterior hemitransverse

Ċ. Posterior interosseous

Č. Anterior interosseous

Č. Radial

Ď. Median

Ď. Ulnar

Đ. Shock from hypovolemia

Đ. Associated rupture of the bladder

Ē. Arterial bleeding on pelvic angiogram

Ē. Presence of a hematoma in the perineum and scrotum

Ĕ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. decreasing initiation of action potentials.

Explanation

Question 4223

Topic: 10. Pathology and Oncology

Figure 51 shows the standing AP radiograph of a 56-year old woman who has multiple toe deformities and pain beneath the metatarsal heads. Shoe modification has failed to provide relief. In addition to correction of the proximal interphalangeal joint deformities, surgical treatment should consist of

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

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

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

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

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

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

. Insulin-like growth factor (IGF-1)

. Fibroblast growth factor (FGF-1)

. Platelet-derived growth factor (PDGF)

!. Transforming growth factor beta (TGF-B)

". Bone morphogenetic proteins (BMP)

#. clinical history and radiographic findings.

$. technetium bone scan

%. flow cytometry pattern of extracted chondrocytes

&. immunohistochemical staining patterns of a biopsy specimen

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

(. Radial

). Radial recurrent

*. Posterior interosseous

+. Superior ulnar recurrent

,. Superficial radial circumflex

-. Impaired hydroxylation of proline

.. Failure of cleavage in procollagen

/. Defective binding sites for hydroxyproline

0. Failure to incorporate glycine into the helix

1. Diminished production of collagen through the rough endoplasmic reticulum

2. Asking the legal staff to seek a court injunction

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

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

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

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

7. Meta-analysis

8. Confidence interval

9. Analysis of variance (ANOVA)

:. Statistical significance (p-value)

;. Survivorship analysis (Kaplan-Meier)

<. Spinal shock

=. Neurogenic shock

>. Hypovolemic shock

?. Pulmonary embolism

@. Fat embolus syndrome

A. Lumbar spinal stenosis

B. Metastatic disease of the spine

C. Rheumatoid lumbar spondylitis

D. Isthmic spondyloloisthesis

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

F. Patella alta

G. A metal-backed patella

H. Varus malalignment of the knee

I. A posterior cruciate-substituting femoral component

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

K. The sesamoids are separated

L. The sesamoid is fractured

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

N. The dislocation is dorsal and centered

O. The proximal phalanx is hyperextended

P. Patella

Q. Tibial stem

R. Distal femoral interface

S. Posterior femoral interface

T. Sites of screw fixation for the tibia

U. Hallux rigidus

V. Fracture of the sesamoid

W. Disruption of the plantar plate

X. Osteonecrosis of the metatarsal head

Y. Rupture of the flexor hallucis longus

Z. Gout

[. Sepsis

\. Old trauma

]. Rheumatoid arthritis

^. Charcot arthroplasty

_. Aspiration and steroid injection

`. Biopsy, curettage, and allograft bone grafting

A. Percutaneous Kirschner wire fixation

B. Percutaneous injection of autogenous bone marrow

C. Nerve roots

D. Spinal cord

E. Sciatic nerve

F. Peroneal nerve

G. Conus medullaris

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

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

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

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

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

M. Early and late infection

N. Periprosthetic fracture of the femur

O. Failure of the patellofemoral and extensor mechanisms

P. Aseptic loosening of cementing tibial components

Q. Asceptic loosening of cemented femoral components

R. Acceptance of the current position of the ankle

S. Open reduction and fixation in the epiphysis only

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

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

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

W. Resection arthroplasty and local radiation

X. In situ fusion of the hip

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

Z. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

¡. 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

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

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

§. 90 degrees of abduction with neutral rotation

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

©. Sural

ª. Saphenous and its branches

«. Posterior tibial and its branches

¬. Deep peroneal and its branches

. Superficial peroneal and its branches

®. Strength

¯. Stiffness

°. Shelf life

±. Antigenicity

². Risk of HIV transmission

³. Indemnification

´. Occurrence

Μ. Excess liability

¶. Claims-made

·. Nose

¸. Lateral Y

¹. Scapular AP

º. Neutral rotation AP

». Internal rotation AP

¼. External rotation AP

½. Trauma

¾. Hemophilia

¿. Reiter’s syndrome

À. Rheumatoid arthritis

Á. Systemic lupus erythematosus

Â. Cast immobilization for 6 weeks

Ã. Activity modification and re-evaluation in 2 months

Ä. Internal fixation with or without bone grafting

Å. Retrograde drilling of the defect without articular cartilage penetration

Æ. Drilling of the defect directly through the articular cartilage

Ç. repair or reconstruction of the medial collateral ligament

È. repair or reconstruction of the medialand lateral collateral ligaments

É. immobilization for 5 days or less

Ê. immobilization for 14 days

Ë. immobilization for 25 days

Ì. Cystinosis

Í. Hypophosphatemia

Î. Renal osteodystrophy

Ï. Primary hyperparathyroidism

Ð. Nutritional vitamin D deficiency

Ñ. Lateral meniscus tear

Ò. Popliteus tenosynovitis

Ó. Iliotibial band friction syndrome

Ô. Peroneal nerve entrapment

Õ. Biceps tendinitis

Ö. Observation

×. Removal of the prosthetic components

Ø. Operative exploration and decompression of the peroneal nerve

Ù. Nerve conduction velocity studies

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

Û. I

Ü. II

Ý. III

Þ. decreased tissue tension

SS. decreased abductor lever arm

À. decreased joint reaction force

Á. increased body weight over lever arm

Â. increased polyethylene wear rate

Ã. recurrent traumatic anterior dislocation

Ä. recurrent traumatic posterior dislocation

Å. traumatic subluxation with no previous dislocation

Æ. traumatic anterior subluxation

Ç. atraumatic involuntary subluxation

È. radial

É. axillary

Ê. suprascapular

Ë. thoracodorsal

Ì. long thoracic

Í. Flexion

Î. Extension

Ï. Axial rotation

Ð. Left lateral bending

Ñ. Right lateral bending

Ò. Skin

Ó. Lung

Ô. Brain

Õ. Heart

Ö. Kidney

÷. Thoracoacromial, lateral thoracic, subscapular

Ø. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ù. Posterior humeral circumflex, subscapular, thoracacromial

Ú. Subscapular, thoracacromial, anterior humeral circumflex

Û. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ü. Respondeat superior

Ý. Indemnity agreement

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

Ÿ. Comparative negligence-% of involvement

Ā. Contributory negligence- resident contributed to the negligence

Ā. t-type

Ă. both column

Ă. transverse

Ą. anterior column

Ą. anterior column posterior hemitransverse

Ć. Posterior interosseous

Ć. Anterior interosseous

Ĉ. Radial

Ĉ. Median

Ċ. Ulnar

Ċ. Shock from hypovolemia

Č. Associated rupture of the bladder

Č. Arterial bleeding on pelvic angiogram

Ď. Presence of a hematoma in the perineum and scrotum

Ď. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

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

Explanation

Question 4224

Topic: 10. Pathology and Oncology

An active, right-handed 71-year-old woman fell on her left shoulder and sustained the injury shown in the radiographs in 52a and 52b and the CT scan in 52c. Management should consist of

. hemiarthroplasty

. open reduction and internal fixation

. closed reduction and percutaneous pinning

. a sling and early pedulum exercises

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

. open acromioplasty

. open Bankart repair

. open subscapularis tendon repair

. inferior capsular shift

. a supervised physical therapy program

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

. open reduction and internal fixation through an anterior approach

. open reduction and internal fixation through a posterior approach

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

. arthroscopically assisted reduction and percutaneous screw fixation

. Repair of the rotator cuff

. Replacement of the humeral head

. Resection arthroplasty

. Total shoulder arthroplasty

. AP and lateral radiographs of the elbow

. Diagnositc arthroscopy

. Aspiration of joint fluid

. An erythrocyte sedimentation rate and CBC

. A diagnostic lidocaine injection

. Insulin-like growth factor (IGF-1)

. Fibroblast growth factor (FGF-1)

. Platelet-derived growth factor (PDGF)

. Transforming growth factor beta (TGF-B)

. Bone morphogenetic proteins (BMP)

. clinical history and radiographic findings.

. technetium bone scan

. flow cytometry pattern of extracted chondrocytes

!. immunohistochemical staining patterns of a biopsy specimen

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

#. Radial

$. Radial recurrent

%. Posterior interosseous

&. Superior ulnar recurrent

'. Superficial radial circumflex

(. Impaired hydroxylation of proline

). Failure of cleavage in procollagen

*. Defective binding sites for hydroxyproline

+. Failure to incorporate glycine into the helix

,. Diminished production of collagen through the rough endoplasmic reticulum

-. 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

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

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

2. Meta-analysis

3. Confidence interval

4. Analysis of variance (ANOVA)

5. Statistical significance (p-value)

6. Survivorship analysis (Kaplan-Meier)

7. Spinal shock

8. Neurogenic shock

9. 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

A. Patella alta

B. A metal-backed patella

C. Varus malalignment of the knee

D. A posterior cruciate-substituting femoral component

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

F. The sesamoids are separated

G. The sesamoid is fractured

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

I. The dislocation is dorsal and centered

J. The proximal phalanx is hyperextended

K. Patella

L. Tibial stem

M. Distal femoral interface

N. Posterior femoral interface

O. Sites of screw fixation for the tibia

P. Hallux rigidus

Q. Fracture of the sesamoid

R. Disruption of the plantar plate

S. Osteonecrosis of the metatarsal head

T. Rupture of the flexor hallucis longus

U. Gout

V. Sepsis

W. Old trauma

X. Rheumatoid arthritis

Y. Charcot arthroplasty

Z. 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

A. Peroneal nerve

B. Conus medullaris

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

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

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

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

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

H. Early and late infection

I. Periprosthetic fracture of the femur

J. Failure of the patellofemoral and extensor mechanisms

K. Aseptic loosening of cementing tibial components

L. Asceptic loosening of cemented femoral components

M. Acceptance of the current position of the ankle

N. Open reduction and fixation in the epiphysis only

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

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

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

R. Resection arthroplasty and local radiation

S. In situ fusion of the hip

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

U. Excision of heterotopic bone and local radiation

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

W. Closed reduction of both fractures and immediate spica casting

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

Y. External fixation of both femora

Z. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

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

¢. 90 degrees of abduction with neutral rotation

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

¤. Sural

¥. Saphenous and its branches

¦. Posterior tibial and its branches

§. Deep peroneal and its branches

¨. Superficial peroneal and its branches

©. Strength

ª. Stiffness

«. Shelf life

¬. Antigenicity

. Risk of HIV transmission

®. Indemnification

¯. Occurrence

°. Excess liability

±. Claims-made

². Nose

³. Lateral Y

´. Scapular AP

Μ. Neutral rotation AP

¶. Internal rotation AP

·. External rotation AP

¸. Trauma

¹. Hemophilia

º. Reiter’s syndrome

». Rheumatoid arthritis

¼. Systemic lupus erythematosus

½. Cast immobilization for 6 weeks

¾. Activity modification and re-evaluation in 2 months

¿. Internal fixation with or without bone grafting

À. Retrograde drilling of the defect without articular cartilage penetration

Á. Drilling of the defect directly through the articular cartilage

Â. repair or reconstruction of the medial collateral ligament

Ã. repair or reconstruction of the medialand lateral collateral ligaments

Ä. immobilization for 5 days or less

Å. immobilization for 14 days

Æ. immobilization for 25 days

Ç. Cystinosis

È. Hypophosphatemia

É. Renal osteodystrophy

Ê. Primary hyperparathyroidism

Ë. Nutritional vitamin D deficiency

Ì. Lateral meniscus tear

Í. Popliteus tenosynovitis

Î. Iliotibial band friction syndrome

Ï. Peroneal nerve entrapment

Ð. Biceps tendinitis

Ñ. Observation

Ò. Removal of the prosthetic components

Ó. Operative exploration and decompression of the peroneal nerve

Ô. Nerve conduction velocity studies

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

Ö. I

×. II

Ø. III

Ù. decreased tissue tension

Ú. decreased abductor lever arm

Û. decreased joint reaction force

Ü. increased body weight over lever arm

Ý. increased polyethylene wear rate

Þ. recurrent traumatic anterior dislocation

SS. recurrent traumatic posterior dislocation

À. traumatic subluxation with no previous dislocation

Á. traumatic anterior subluxation

Â. atraumatic involuntary subluxation

Ã. radial

Ä. axillary

Å. suprascapular

Æ. thoracodorsal

Ç. long thoracic

È. Flexion

É. Extension

Ê. Axial rotation

Ë. Left lateral bending

Ì. Right lateral bending

Í. Skin

Î. Lung

Ï. Brain

Ð. Heart

Ñ. Kidney

Ò. Thoracoacromial, lateral thoracic, subscapular

Ó. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ô. Posterior humeral circumflex, subscapular, thoracacromial

Õ. Subscapular, thoracacromial, anterior humeral circumflex

Ö. Lateral thoracic, anterior humeral circumflex, thoracacromial

÷. Respondeat superior

Ø. Indemnity agreement

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

Ú. Comparative negligence-% of involvement

Û. Contributory negligence- resident contributed to the negligence

Ü. t-type

Ý. both column

Þ. transverse

Ÿ. anterior column

Ā. anterior column posterior hemitransverse

Ā. Posterior interosseous

Ă. Anterior interosseous

Ă. Radial

Ą. Median

Ą. Ulnar

Ć. Shock from hypovolemia

Ć. Associated rupture of the bladder

Ĉ. Arterial bleeding on pelvic angiogram

Ĉ. Presence of a hematoma in the perineum and scrotum

Ċ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. hemiarthroplasty

Explanation

Question 4225

Topic: 10. Pathology and Oncology

Figure 53 shows the MRI scan of a 53-year-old carnival worker who has pain and swelling in the left shoulder as a result of attempting to stop a roller coaster car with his arm. Examination reveals decreased ROM, apprehension, and inability to move the dorsum of his hand away from his back. Treatment should consist of

. 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

.. Confidence interval

/. Analysis of variance (ANOVA)

0. Statistical significance (p-value)

1. Survivorship analysis (Kaplan-Meier)

2. Spinal shock

3. Neurogenic shock

4. Hypovolemic shock

5. Pulmonary embolism

6. Fat embolus syndrome

7. Lumbar spinal stenosis

8. Metastatic disease of the spine

9. 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

A. The sesamoids are separated

B. The sesamoid is fractured

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

D. The dislocation is dorsal and centered

E. The proximal phalanx is hyperextended

F. Patella

G. Tibial stem

H. Distal femoral interface

I. Posterior femoral interface

J. Sites of screw fixation for the tibia

K. Hallux rigidus

L. Fracture of the sesamoid

M. Disruption of the plantar plate

N. Osteonecrosis of the metatarsal head

O. Rupture of the flexor hallucis longus

P. Gout

Q. Sepsis

R. Old trauma

S. Rheumatoid arthritis

T. Charcot arthroplasty

U. Aspiration and steroid injection

V. Biopsy, curettage, and allograft bone grafting

W. Percutaneous Kirschner wire fixation

X. Percutaneous injection of autogenous bone marrow

Y. Nerve roots

Z. 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

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

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

C. Early and late infection

D. Periprosthetic fracture of the femur

E. Failure of the patellofemoral and extensor mechanisms

F. Aseptic loosening of cementing tibial components

G. Asceptic loosening of cemented femoral components

H. Acceptance of the current position of the ankle

I. Open reduction and fixation in the epiphysis only

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

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

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

M. Resection arthroplasty and local radiation

N. In situ fusion of the hip

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

P. Excision of heterotopic bone and local radiation

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

R. Closed reduction of both fractures and immediate spica casting

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

T. External fixation of both femora

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

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

W. Synovial sarcoma

X. Soft-tissue abcess

Y. Rhabdomyosarcoma

Z. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

¡. Posterior tibial and its branches

¢. Deep peroneal and its branches

£. Superficial peroneal and its branches

¤. Strength

¥. Stiffness

¦. Shelf life

§. Antigenicity

¨. Risk of HIV transmission

©. Indemnification

ª. Occurrence

«. Excess liability

¬. Claims-made

. Nose

®. Lateral Y

¯. Scapular AP

°. Neutral rotation AP

±. Internal rotation AP

². External rotation AP

³. Trauma

´. Hemophilia

Μ. Reiter’s syndrome

¶. Rheumatoid arthritis

·. Systemic lupus erythematosus

¸. Cast immobilization for 6 weeks

¹. Activity modification and re-evaluation in 2 months

º. Internal fixation with or without bone grafting

». Retrograde drilling of the defect without articular cartilage penetration

¼. Drilling of the defect directly through the articular cartilage

½. repair or reconstruction of the medial collateral ligament

¾. repair or reconstruction of the medialand lateral collateral ligaments

¿. immobilization for 5 days or less

À. immobilization for 14 days

Á. immobilization for 25 days

Â. Cystinosis

Ã. Hypophosphatemia

Ä. Renal osteodystrophy

Å. Primary hyperparathyroidism

Æ. Nutritional vitamin D deficiency

Ç. Lateral meniscus tear

È. Popliteus tenosynovitis

É. Iliotibial band friction syndrome

Ê. Peroneal nerve entrapment

Ë. Biceps tendinitis

Ì. Observation

Í. Removal of the prosthetic components

Î. Operative exploration and decompression of the peroneal nerve

Ï. Nerve conduction velocity studies

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

Ñ. I

Ò. II

Ó. III

Ô. decreased tissue tension

Õ. decreased abductor lever arm

Ö. decreased joint reaction force

×. increased body weight over lever arm

Ø. increased polyethylene wear rate

Ù. recurrent traumatic anterior dislocation

Ú. recurrent traumatic posterior dislocation

Û. traumatic subluxation with no previous dislocation

Ü. traumatic anterior subluxation

Ý. atraumatic involuntary subluxation

Þ. radial

SS. axillary

À. suprascapular

Á. thoracodorsal

Â. long thoracic

Ã. Flexion

Ä. Extension

Å. Axial rotation

Æ. Left lateral bending

Ç. Right lateral bending

È. Skin

É. Lung

Ê. Brain

Ë. Heart

Ì. Kidney

Í. Thoracoacromial, lateral thoracic, subscapular

Î. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ï. Posterior humeral circumflex, subscapular, thoracacromial

Ð. Subscapular, thoracacromial, anterior humeral circumflex

Ñ. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ò. Respondeat superior

Ó. Indemnity agreement

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

Õ. Comparative negligence-% of involvement

Ö. Contributory negligence- resident contributed to the negligence

÷. t-type

Ø. both column

Ù. transverse

Ú. anterior column

Û. anterior column posterior hemitransverse

Ü. Posterior interosseous

Ý. Anterior interosseous

Þ. Radial

Ÿ. Median

Ā. Ulnar

Ā. Shock from hypovolemia

Ă. Associated rupture of the bladder

Ă. Arterial bleeding on pelvic angiogram

Ą. Presence of a hematoma in the perineum and scrotum

Ą. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. open acromioplasty

Explanation

Question 4226

Topic: 10. Pathology and Oncology

A 45-year-old man sustains the shoulder injury shown in the radiographs in Figure 55a and 55b and the CT scan in Figures 55c and 55d. Management should consist of

. 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

.. Neurogenic shock

/. Hypovolemic shock

0. Pulmonary embolism

1. Fat embolus syndrome

2. Lumbar spinal stenosis

3. Metastatic disease of the spine

4. Rheumatoid lumbar spondylitis

5. Isthmic spondyloloisthesis

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

7. Patella alta

8. A metal-backed patella

9. 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

A. Patella

B. Tibial stem

C. Distal femoral interface

D. Posterior femoral interface

E. Sites of screw fixation for the tibia

F. Hallux rigidus

G. Fracture of the sesamoid

H. Disruption of the plantar plate

I. Osteonecrosis of the metatarsal head

J. Rupture of the flexor hallucis longus

K. Gout

L. Sepsis

M. Old trauma

N. Rheumatoid arthritis

O. Charcot arthroplasty

P. Aspiration and steroid injection

Q. Biopsy, curettage, and allograft bone grafting

R. Percutaneous Kirschner wire fixation

S. Percutaneous injection of autogenous bone marrow

T. Nerve roots

U. Spinal cord

V. Sciatic nerve

W. Peroneal nerve

X. Conus medullaris

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

Z. 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

A. Aseptic loosening of cementing tibial components

B. Asceptic loosening of cemented femoral components

C. Acceptance of the current position of the ankle

D. Open reduction and fixation in the epiphysis only

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

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

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

H. Resection arthroplasty and local radiation

I. In situ fusion of the hip

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

K. Excision of heterotopic bone and local radiation

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

M. Closed reduction of both fractures and immediate spica casting

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

O. External fixation of both femora

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

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

R. Synovial sarcoma

S. Soft-tissue abcess

T. Rhabdomyosarcoma

U. Eosinophilic granuloma

V. Nodular pigmented villonodular synovitis

W. Changing to a titanium nail

X. Changing to a nonslotted nail

Y. Changing the cross-sectional shape of the nail

Z. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

. Posterior tibial and its branches

. Deep peroneal and its branches

. Superficial peroneal and its branches

. Strength

. Stiffness

¡. Shelf life

¢. Antigenicity

£. Risk of HIV transmission

¤. Indemnification

¥. Occurrence

¦. Excess liability

§. Claims-made

¨. Nose

©. Lateral Y

ª. Scapular AP

«. Neutral rotation AP

¬. Internal rotation AP

. External rotation AP

®. Trauma

¯. Hemophilia

°. Reiter’s syndrome

±. Rheumatoid arthritis

². Systemic lupus erythematosus

³. Cast immobilization for 6 weeks

´. Activity modification and re-evaluation in 2 months

Μ. Internal fixation with or without bone grafting

¶. Retrograde drilling of the defect without articular cartilage penetration

·. Drilling of the defect directly through the articular cartilage

¸. repair or reconstruction of the medial collateral ligament

¹. repair or reconstruction of the medialand lateral collateral ligaments

º. immobilization for 5 days or less

». immobilization for 14 days

¼. immobilization for 25 days

½. Cystinosis

¾. Hypophosphatemia

¿. Renal osteodystrophy

À. Primary hyperparathyroidism

Á. Nutritional vitamin D deficiency

Â. Lateral meniscus tear

Ã. Popliteus tenosynovitis

Ä. Iliotibial band friction syndrome

Å. Peroneal nerve entrapment

Æ. Biceps tendinitis

Ç. Observation

È. Removal of the prosthetic components

É. Operative exploration and decompression of the peroneal nerve

Ê. Nerve conduction velocity studies

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

Ì. I

Í. II

Î. III

Ï. decreased tissue tension

Ð. decreased abductor lever arm

Ñ. decreased joint reaction force

Ò. increased body weight over lever arm

Ó. increased polyethylene wear rate

Ô. recurrent traumatic anterior dislocation

Õ. recurrent traumatic posterior dislocation

Ö. traumatic subluxation with no previous dislocation

×. traumatic anterior subluxation

Ø. atraumatic involuntary subluxation

Ù. radial

Ú. axillary

Û. suprascapular

Ü. thoracodorsal

Ý. long thoracic

Þ. Flexion

SS. Extension

À. Axial rotation

Á. Left lateral bending

Â. Right lateral bending

Ã. Skin

Ä. Lung

Å. Brain

Æ. Heart

Ç. Kidney

È. Thoracoacromial, lateral thoracic, subscapular

É. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ê. Posterior humeral circumflex, subscapular, thoracacromial

Ë. Subscapular, thoracacromial, anterior humeral circumflex

Ì. Lateral thoracic, anterior humeral circumflex, thoracacromial

Í. Respondeat superior

Î. Indemnity agreement

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

Ð. Comparative negligence-% of involvement

Ñ. Contributory negligence- resident contributed to the negligence

Ò. t-type

Ó. both column

Ô. transverse

Õ. anterior column

Ö. anterior column posterior hemitransverse

÷. Posterior interosseous

Ø. Anterior interosseous

Ù. Radial

Ú. Median

Û. Ulnar

Ü. Shock from hypovolemia

Ý. Associated rupture of the bladder

Þ. Arterial bleeding on pelvic angiogram

Ÿ. Presence of a hematoma in the perineum and scrotum

Ā. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

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

Explanation

Question 4227

Topic: 10. Pathology and Oncology

Figure 56 shows the radiograph of a 38-year-old patient with polyarticular rheumatoid arthritis who has severe pain in the shoulder. Non-surgical treatment has failed to provide relief. Treatment should now consist of
1/. Arthrodesis

. 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

.. Metastatic disease of the spine

/. Rheumatoid lumbar spondylitis

0. Isthmic spondyloloisthesis

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

2. Patella alta

3. A metal-backed patella

4. Varus malalignment of the knee

5. A posterior cruciate-substituting femoral component

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

7. The sesamoids are separated

8. The sesamoid is fractured

9. 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

A. Hallux rigidus

B. Fracture of the sesamoid

C. Disruption of the plantar plate

D. Osteonecrosis of the metatarsal head

E. Rupture of the flexor hallucis longus

F. Gout

G. Sepsis

H. Old trauma

I. Rheumatoid arthritis

J. Charcot arthroplasty

K. Aspiration and steroid injection

L. Biopsy, curettage, and allograft bone grafting

M. Percutaneous Kirschner wire fixation

N. Percutaneous injection of autogenous bone marrow

O. Nerve roots

P. Spinal cord

Q. Sciatic nerve

R. Peroneal nerve

S. Conus medullaris

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

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

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

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

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

Y. Early and late infection

Z. 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

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

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

C. Resection arthroplasty and local radiation

D. In situ fusion of the hip

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

F. Excision of heterotopic bone and local radiation

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

H. Closed reduction of both fractures and immediate spica casting

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

J. External fixation of both femora

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

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

M. Synovial sarcoma

N. Soft-tissue abcess

O. Rhabdomyosarcoma

P. Eosinophilic granuloma

Q. Nodular pigmented villonodular synovitis

R. Changing to a titanium nail

S. Changing to a nonslotted nail

T. Changing the cross-sectional shape of the nail

U. Increasing the diameter of the nail by 3 mm

V. Increasing the diameter of the interlocking screws

W. Fracture healing

X. Chondrosarcoma

Y. Periosteal chondroma

Z. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

. Posterior tibial and its branches

. Deep peroneal and its branches

. Superficial peroneal and its branches

. Strength

. Stiffness

. Shelf life

. Antigenicity

. Risk of HIV transmission

. Indemnification

. Occurrence

¡. Excess liability

¢. Claims-made

£. Nose

¤. Lateral Y

¥. Scapular AP

¦. Neutral rotation AP

§. Internal rotation AP

¨. External rotation AP

©. Trauma

ª. Hemophilia

«. Reiter’s syndrome

¬. Rheumatoid arthritis

. Systemic lupus erythematosus

®. Cast immobilization for 6 weeks

¯. Activity modification and re-evaluation in 2 months

°. Internal fixation with or without bone grafting

±. Retrograde drilling of the defect without articular cartilage penetration

². Drilling of the defect directly through the articular cartilage

³. repair or reconstruction of the medial collateral ligament

´. repair or reconstruction of the medialand lateral collateral ligaments

Μ. immobilization for 5 days or less

¶. immobilization for 14 days

·. immobilization for 25 days

¸. Cystinosis

¹. Hypophosphatemia

º. Renal osteodystrophy

». Primary hyperparathyroidism

¼. Nutritional vitamin D deficiency

½. Lateral meniscus tear

¾. Popliteus tenosynovitis

¿. Iliotibial band friction syndrome

À. Peroneal nerve entrapment

Á. Biceps tendinitis

Â. Observation

Ã. Removal of the prosthetic components

Ä. Operative exploration and decompression of the peroneal nerve

Å. Nerve conduction velocity studies

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

Ç. I

È. II

É. III

Ê. decreased tissue tension

Ë. decreased abductor lever arm

Ì. decreased joint reaction force

Í. increased body weight over lever arm

Î. increased polyethylene wear rate

Ï. recurrent traumatic anterior dislocation

Ð. recurrent traumatic posterior dislocation

Ñ. traumatic subluxation with no previous dislocation

Ò. traumatic anterior subluxation

Ó. atraumatic involuntary subluxation

Ô. radial

Õ. axillary

Ö. suprascapular

×. thoracodorsal

Ø. long thoracic

Ù. Flexion

Ú. Extension

Û. Axial rotation

Ü. Left lateral bending

Ý. Right lateral bending

Þ. Skin

SS. Lung

À. Brain

Á. Heart

Â. Kidney

Ã. Thoracoacromial, lateral thoracic, subscapular

Ä. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Å. Posterior humeral circumflex, subscapular, thoracacromial

Æ. Subscapular, thoracacromial, anterior humeral circumflex

Ç. Lateral thoracic, anterior humeral circumflex, thoracacromial

È. Respondeat superior

É. Indemnity agreement

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

Ë. Comparative negligence-% of involvement

Ì. Contributory negligence- resident contributed to the negligence

Í. t-type

Î. both column

Ï. transverse

Ð. anterior column

Ñ. anterior column posterior hemitransverse

Ò. Posterior interosseous

Ó. Anterior interosseous

Ô. Radial

Õ. Median

Ö. Ulnar

÷. Shock from hypovolemia

Ø. Associated rupture of the bladder

Ù. Arterial bleeding on pelvic angiogram

Ú. Presence of a hematoma in the perineum and scrotum

Û. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Repair of the rotator cuff

Explanation

Question 4228

Topic: 10. Pathology and Oncology

Figure 57a and 57b show the radiographs of a 57-year-old man who has pain in
the ulnar side of the wrist and hand. Examination shows tenderness at the base of the hypothenar area. Additional diagnostic testing should include

. 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 metal-backed patella

0. Varus malalignment of the knee

1. A posterior cruciate-substituting femoral component

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

3. The sesamoids are separated

4. The sesamoid is fractured

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

6. The dislocation is dorsal and centered

7. The proximal phalanx is hyperextended

8. Patella

9. 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

A. Rupture of the flexor hallucis longus

B. Gout

C. Sepsis

D. Old trauma

E. Rheumatoid arthritis

F. Charcot arthroplasty

G. Aspiration and steroid injection

H. Biopsy, curettage, and allograft bone grafting

I. Percutaneous Kirschner wire fixation

J. Percutaneous injection of autogenous bone marrow

K. Nerve roots

L. Spinal cord

M. Sciatic nerve

N. Peroneal nerve

O. Conus medullaris

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

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

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

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

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

U. Early and late infection

V. Periprosthetic fracture of the femur

W. Failure of the patellofemoral and extensor mechanisms

X. Aseptic loosening of cementing tibial components

Y. Asceptic loosening of cemented femoral components

Z. 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

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

B. Excision of heterotopic bone and local radiation

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

D. Closed reduction of both fractures and immediate spica casting

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

F. External fixation of both femora

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

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

I. Synovial sarcoma

J. Soft-tissue abcess

K. Rhabdomyosarcoma

L. Eosinophilic granuloma

M. Nodular pigmented villonodular synovitis

N. Changing to a titanium nail

O. Changing to a nonslotted nail

P. Changing the cross-sectional shape of the nail

Q. Increasing the diameter of the nail by 3 mm

R. Increasing the diameter of the interlocking screws

S. Fracture healing

T. Chondrosarcoma

U. Periosteal chondroma

V. Periosteal osteosarcoma

W. Dysplasia epiphysealis hemimelica

X. Demonstrate competence in the subject of the case

Y. Be fellowship trained in the subject of the case

Z. 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

. Physical therapy for rotator cuff strengthening

. Oblique popliteal ligament

. Lateral capsule

. Popliteal tendon

. Fibular collateral ligament

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

. Posterior tibial and its branches

. Deep peroneal and its branches

. Superficial peroneal and its branches

. Strength

. Stiffness

. Shelf life

. Antigenicity

. Risk of HIV transmission

. Indemnification

. Occurrence

. Excess liability

. Claims-made

. Nose

. Lateral Y

¡. Scapular AP

¢. Neutral rotation AP

£. Internal rotation AP

¤. External rotation AP

¥. Trauma

¦. Hemophilia

§. Reiter’s syndrome

¨. Rheumatoid arthritis

ª. Cast immobilization for 6 weeks

«. Activity modification and re-evaluation in 2 months

¬. Internal fixation with or without bone grafting

. Retrograde drilling of the defect without articular cartilage penetration

®. Drilling of the defect directly through the articular cartilage

¯. repair or reconstruction of the medial collateral ligament

°. repair or reconstruction of the medialand lateral collateral ligaments

±. immobilization for 5 days or less

². immobilization for 14 days

³. immobilization for 25 days

´. Cystinosis

Μ. Hypophosphatemia

¶. Renal osteodystrophy

·. Primary hyperparathyroidism

¸. Nutritional vitamin D deficiency

¹. Lateral meniscus tear

º. Popliteus tenosynovitis

». Iliotibial band friction syndrome

¼. Peroneal nerve entrapment

½. Biceps tendinitis

¾. Observation

¿. Removal of the prosthetic components

À. Operative exploration and decompression of the peroneal nerve

Á. Nerve conduction velocity studies

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

Ã. I

Ä. II

Å. III

Æ. decreased tissue tension

Ç. decreased abductor lever arm

È. decreased joint reaction force

É. increased body weight over lever arm

Ê. increased polyethylene wear rate

Ë. recurrent traumatic anterior dislocation

Ì. recurrent traumatic posterior dislocation

Í. traumatic subluxation with no previous dislocation

Î. traumatic anterior subluxation

Ï. atraumatic involuntary subluxation

Ð. radial

Ñ. axillary

Ò. suprascapular

Ó. thoracodorsal

Ô. long thoracic

Õ. Flexion

Ö. Extension

×. Axial rotation

Ø. Left lateral bending

Ù. Right lateral bending

Ú. Skin

Û. Lung

Ü. Brain

Ý. Heart

Þ. Kidney

SS. Thoracoacromial, lateral thoracic, subscapular

À. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Á. Posterior humeral circumflex, subscapular, thoracacromial

Â. Subscapular, thoracacromial, anterior humeral circumflex

Ã. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ä. Respondeat superior

Å. Indemnity agreement

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

Ç. Comparative negligence-% of involvement

È. Contributory negligence- resident contributed to the negligence

É. t-type

Ê. both column

Ë. transverse

Ì. anterior column

Í. anterior column posterior hemitransverse

Î. Posterior interosseous

Ï. Anterior interosseous

Ð. Radial

Ñ. Median

Ò. Ulnar

Ó. Shock from hypovolemia

Ô. Associated rupture of the bladder

Õ. Arterial bleeding on pelvic angiogram

Ö. Presence of a hematoma in the perineum and scrotum

÷. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. AP and lateral radiographs of the elbow

Explanation

Question 4229

Topic: 10. Pathology and Oncology

Acondroplasia and other chondrodysplasias are caused by mutations in

the

receptors of which of the following families of growth factors?

. 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

/. The sesamoid is fractured

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

1. The dislocation is dorsal and centered

2. The proximal phalanx is hyperextended

3. Patella

4. Tibial stem

5. Distal femoral interface

6. Posterior femoral interface

7. Sites of screw fixation for the tibia

8. Hallux rigidus

9. 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

A. Charcot arthroplasty

B. Aspiration and steroid injection

C. Biopsy, curettage, and allograft bone grafting

D. Percutaneous Kirschner wire fixation

E. Percutaneous injection of autogenous bone marrow

F. Nerve roots

G. Spinal cord

H. Sciatic nerve

I. Peroneal nerve

J. Conus medullaris

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

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

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

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

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

P. Early and late infection

Q. Periprosthetic fracture of the femur

R. Failure of the patellofemoral and extensor mechanisms

S. Aseptic loosening of cementing tibial components

T. Asceptic loosening of cemented femoral components

U. Acceptance of the current position of the ankle

V. Open reduction and fixation in the epiphysis only

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

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

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

Z. 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

A. External fixation of both femora

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

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

D. Synovial sarcoma

E. Soft-tissue abcess

F. Rhabdomyosarcoma

G. Eosinophilic granuloma

H. Nodular pigmented villonodular synovitis

I. Changing to a titanium nail

J. Changing to a nonslotted nail

K. Changing the cross-sectional shape of the nail

L. Increasing the diameter of the nail by 3 mm

M. Increasing the diameter of the interlocking screws

N. Fracture healing

O. Chondrosarcoma

P. Periosteal chondroma

Q. Periosteal osteosarcoma

R. Dysplasia epiphysealis hemimelica

S. Demonstrate competence in the subject of the case

T. Be fellowship trained in the subject of the case

U. Be paid on a contingency basis

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

W. Have been involved in the case as a consultant

X. Diagnostic arthroscopy

Y. Arthroscopy and subacromial decompression

Z. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

. Posterior tibial and its branches

. Deep peroneal and its branches

. Superficial peroneal and its branches

. Strength

. Stiffness

. Shelf life

. Antigenicity

. Risk of HIV transmission

. Indemnification

. Occurrence

. Excess liability

. Claims-made

. Nose

. Lateral Y

. Scapular AP

. Neutral rotation AP

. Internal rotation AP

. External rotation AP

. Trauma

¡. Hemophilia

¢. Reiter’s syndrome

£. Rheumatoid arthritis

¤. Systemic lupus erythematosus

¥. Cast immobilization for 6 weeks

¦. Activity modification and re-evaluation in 2 months

§. Internal fixation with or without bone grafting

¨. Retrograde drilling of the defect without articular cartilage penetration

ª. repair or reconstruction of the medial collateral ligament

«. repair or reconstruction of the medialand lateral collateral ligaments

¬. immobilization for 5 days or less

. immobilization for 14 days

®. immobilization for 25 days

¯. Cystinosis

°. Hypophosphatemia

±. Renal osteodystrophy

². Primary hyperparathyroidism

³. Nutritional vitamin D deficiency

´. Lateral meniscus tear

Μ. Popliteus tenosynovitis

¶. Iliotibial band friction syndrome

·. Peroneal nerve entrapment

¸. Biceps tendinitis

¹. Observation

º. Removal of the prosthetic components

». Operative exploration and decompression of the peroneal nerve

¼. Nerve conduction velocity studies

½. Loosening of the primary dressings and knee flexion to 30 degrees

¾. I

¿. II

À. III

Á. decreased tissue tension

Â. decreased abductor lever arm

Ã. decreased joint reaction force

Ä. increased body weight over lever arm

Å. increased polyethylene wear rate

Æ. recurrent traumatic anterior dislocation

Ç. recurrent traumatic posterior dislocation

È. traumatic subluxation with no previous dislocation

É. traumatic anterior subluxation

Ê. atraumatic involuntary subluxation

Ë. radial

Ì. axillary

Í. suprascapular

Î. thoracodorsal

Ï. long thoracic

Ð. Flexion

Ñ. Extension

Ò. Axial rotation

Ó. Left lateral bending

Ô. Right lateral bending

Õ. Skin

Ö. Lung

×. Brain

Ø. Heart

Ù. Kidney

Ú. Thoracoacromial, lateral thoracic, subscapular

Û. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ü. Posterior humeral circumflex, subscapular, thoracacromial

Ý. Subscapular, thoracacromial, anterior humeral circumflex

Þ. Lateral thoracic, anterior humeral circumflex, thoracacromial

SS. Respondeat superior

À. Indemnity agreement

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

Â. Comparative negligence-% of involvement

Ã. Contributory negligence- resident contributed to the negligence

Ä. t-type

Å. both column

Æ. transverse

Ç. anterior column

È. anterior column posterior hemitransverse

É. Posterior interosseous

Ê. Anterior interosseous

Ë. Radial

Ì. Median

Í. Ulnar

Î. Shock from hypovolemia

Ï. Associated rupture of the bladder

Ð. Arterial bleeding on pelvic angiogram

Ñ. Presence of a hematoma in the perineum and scrotum

Ò. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Insulin-like growth factor (IGF-1)

Explanation

Question 4230

Topic: 10. Pathology and Oncology

The diagnostic distinction between a benign enchondroma and a low-

grade

intramedually chondrosarcoma is based primarily on the

. 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

/. Tibial stem

0. Distal femoral interface

1. Posterior femoral interface

2. Sites of screw fixation for the tibia

3. Hallux rigidus

4. Fracture of the sesamoid

5. Disruption of the plantar plate

6. Osteonecrosis of the metatarsal head

7. Rupture of the flexor hallucis longus

8. Gout

9. 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

A. Nerve roots

B. Spinal cord

C. Sciatic nerve

D. Peroneal nerve

E. Conus medullaris

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

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

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

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

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

K. Early and late infection

L. Periprosthetic fracture of the femur

M. Failure of the patellofemoral and extensor mechanisms

N. Aseptic loosening of cementing tibial components

O. Asceptic loosening of cemented femoral components

P. Acceptance of the current position of the ankle

Q. Open reduction and fixation in the epiphysis only

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

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

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

U. Resection arthroplasty and local radiation

V. In situ fusion of the hip

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

X. Excision of heterotopic bone and local radiation

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

Z. 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

A. Rhabdomyosarcoma

B. Eosinophilic granuloma

C. Nodular pigmented villonodular synovitis

D. Changing to a titanium nail

E. Changing to a nonslotted nail

F. Changing the cross-sectional shape of the nail

G. Increasing the diameter of the nail by 3 mm

H. Increasing the diameter of the interlocking screws

I. Fracture healing

J. Chondrosarcoma

K. Periosteal chondroma

L. Periosteal osteosarcoma

M. Dysplasia epiphysealis hemimelica

N. Demonstrate competence in the subject of the case

O. Be fellowship trained in the subject of the case

P. Be paid on a contingency basis

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

R. Have been involved in the case as a consultant

S. Diagnostic arthroscopy

T. Arthroscopy and subacromial decompression

U. Reduction and fixation of the proximal humeral epiphysis

V. Temporary cessation of throwing

W. Physical therapy for rotator cuff strengthening

X. Oblique popliteal ligament

Y. Lateral capsule

Z. Popliteal tendon

{. Fibular collateral ligament

|. Posterior oblique ligament

}. Radial tear

~. Parrot-beak tear

. 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

. 40 degrees of flexion and 60 degrees of internal rotation

. 45 degrees of flexion and 45 degrees of external rotation

. 90 degrees of abduction with neutral rotation

. 90 degrees of abduction and 90 degrees of external rotation

. Sural

. Saphenous and its branches

. Posterior tibial and its branches

. Deep peroneal and its branches

. Superficial peroneal and its branches

. Strength

. Stiffness

. Shelf life

. Antigenicity

. Risk of HIV transmission

. Indemnification

. Occurrence

. Excess liability

. Claims-made

. Nose

. Lateral Y

. Scapular AP

. Neutral rotation AP

. Internal rotation AP

. External rotation AP

. Trauma

. Hemophilia

. Reiter’s syndrome

. Rheumatoid arthritis

. Systemic lupus erythematosus

. Cast immobilization for 6 weeks

¡. Activity modification and re-evaluation in 2 months

¢. Internal fixation with or without bone grafting

£. Retrograde drilling of the defect without articular cartilage penetration

¤. Drilling of the defect directly through the articular cartilage

¥. repair or reconstruction of the medial collateral ligament

¦. repair or reconstruction of the medialand lateral collateral ligaments

§. immobilization for 5 days or less

¨. immobilization for 14 days

ª. Cystinosis

«. Hypophosphatemia

¬. Renal osteodystrophy

. Primary hyperparathyroidism

®. Nutritional vitamin D deficiency

¯. Lateral meniscus tear

°. Popliteus tenosynovitis

±. Iliotibial band friction syndrome

². Peroneal nerve entrapment

³. Biceps tendinitis

´. Observation

Μ. Removal of the prosthetic components

¶. Operative exploration and decompression of the peroneal nerve

·. Nerve conduction velocity studies

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

¹. I

º. II

». III

¼. decreased tissue tension

½. decreased abductor lever arm

¾. decreased joint reaction force

¿. increased body weight over lever arm

À. increased polyethylene wear rate

Á. recurrent traumatic anterior dislocation

Â. recurrent traumatic posterior dislocation

Ã. traumatic subluxation with no previous dislocation

Ä. traumatic anterior subluxation

Å. atraumatic involuntary subluxation

Æ. radial

Ç. axillary

È. suprascapular

É. thoracodorsal

Ê. long thoracic

Ë. Flexion

Ì. Extension

Í. Axial rotation

Î. Left lateral bending

Ï. Right lateral bending

Ð. Skin

Ñ. Lung

Ò. Brain

Ó. Heart

Ô. Kidney

Õ. Thoracoacromial, lateral thoracic, subscapular

Ö. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

×. Posterior humeral circumflex, subscapular, thoracacromial

Ø. Subscapular, thoracacromial, anterior humeral circumflex

Ù. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ú. Respondeat superior

Û. Indemnity agreement

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

Ý. Comparative negligence-% of involvement

Þ. Contributory negligence- resident contributed to the negligence

SS. t-type

À. both column

Á. transverse

Â. anterior column

Ã. anterior column posterior hemitransverse

Ä. Posterior interosseous

Å. Anterior interosseous

Æ. Radial

Ç. Median

È. Ulnar

É. Shock from hypovolemia

Ê. Associated rupture of the bladder

Ë. Arterial bleeding on pelvic angiogram

Ì. Presence of a hematoma in the perineum and scrotum

Í. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. clinical history and radiographic findings.

Explanation

Question 4231

Topic: 10. Pathology and Oncology

A 6-year-old boy has had increasing pain and a mass in the suprapatellar region of the right femur for the past week. Examination of the mass reveals it may be firm, immobile, and tender to palpitation. The patient has no systemic symptoms. Laboratory studies show a WBC of 7000 per cubic millimeter, a hematocrit of 40%, and an erythrocyte sedimentation rate of 10 mm/hr. radiographs are normal. Figures 64a and 64b show saggital and axial T1-weighted MRI scans. Figure 64c shows frozen section pathology of the biopsy specimen. What is the most likely diagnosis?

. 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

. Diagnostic arthroscopy

. 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

. Posterior oblique ligament

. Radial tear

. Parrot-beak tear

!. 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

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

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

'. 90 degrees of abduction with neutral rotation

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

). Sural

*. Saphenous and its branches

+. Posterior tibial and its branches

,. Deep peroneal and its branches

-. Superficial peroneal and its branches

.. Strength

/. Stiffness

0. Shelf life

1. Antigenicity

2. Risk of HIV transmission

3. Indemnification

4. Occurrence

5. Excess liability

6. Claims-made

7. Nose

8. Lateral Y

9. Scapular AP

:. Neutral rotation AP

;. Internal rotation AP

<. External rotation AP

=. Trauma

>. Hemophilia

?. Reiter’s syndrome

@. Rheumatoid arthritis

A. Systemic lupus erythematosus

B. Cast immobilization for 6 weeks

C. Activity modification and re-evaluation in 2 months

D. Internal fixation with or without bone grafting

E. Retrograde drilling of the defect without articular cartilage penetration

F. Drilling of the defect directly through the articular cartilage

G. repair or reconstruction of the medial collateral ligament

H. repair or reconstruction of the medialand lateral collateral ligaments

I. immobilization for 5 days or less

J. immobilization for 14 days

K. immobilization for 25 days

L. Cystinosis

M. Hypophosphatemia

N. Renal osteodystrophy

O. Primary hyperparathyroidism

P. Nutritional vitamin D deficiency

Q. Lateral meniscus tear

R. Popliteus tenosynovitis

S. Iliotibial band friction syndrome

T. Peroneal nerve entrapment

U. Biceps tendinitis

V. Observation

W. Removal of the prosthetic components

X. Operative exploration and decompression of the peroneal nerve

Y. Nerve conduction velocity studies

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

[. I

\. II

]. III

^. decreased tissue tension

_. decreased abductor lever arm

`. decreased joint reaction force

A. increased body weight over lever arm

B. increased polyethylene wear rate

C. recurrent traumatic anterior dislocation

D. recurrent traumatic posterior dislocation

E. traumatic subluxation with no previous dislocation

F. traumatic anterior subluxation

G. atraumatic involuntary subluxation

H. radial

I. axillary

J. suprascapular

K. thoracodorsal

L. long thoracic

M. Flexion

N. Extension

O. Axial rotation

P. Left lateral bending

Q. Right lateral bending

R. Skin

S. Lung

T. Brain

U. Heart

V. Kidney

W. Thoracoacromial, lateral thoracic, subscapular

X. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Y. Posterior humeral circumflex, subscapular, thoracacromial

Z. Subscapular, thoracacromial, anterior humeral circumflex

{. Lateral thoracic, anterior humeral circumflex, thoracacromial

|. Respondeat superior

}. Indemnity agreement

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

. Comparative negligence-% of involvement

. Contributory negligence- resident contributed to the negligence

. t-type

. both column

. transverse

. anterior column

. anterior column posterior hemitransverse

. Posterior interosseous

. Anterior interosseous

. Radial

. Median

. Ulnar

. Shock from hypovolemia

. Associated rupture of the bladder

. Arterial bleeding on pelvic angiogram

. Presence of a hematoma in the perineum and scrotum

. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Synovial sarcoma

The clinical and radiographic presentation points to Ewing sarcoma. Ewing sarcoma is classically driven by the t(11;22)(q24;q12) chromosomal translocation, which results in the EWS-FLI1 fusion protein in about 85-90% of cases. t(X;18) is associated with synovial sarcoma, and t(2;13) is seen in alveolar rhabdomyosarcoma.

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10. Pathology and Oncology MCQs

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