While under a physician’s care, a 45-year-old man verbally abuses the staff and nurses who are attempting to carry out orders. A decision to discharge the patient is best carried out by

Correct Answer: Asking the legal staff to seek a court injunction. Explanation:

A consecutive series of 50 patients is randomized to receive either treatment A or treatment B. At a 10-year follow up, patient satisfaction with treatment is measured. Which of the following statist

Correct Answer: Meta-analysis. Explanation:

A 19-year-old man sustains a complete spinal cord injury at the C7 level as a result of diving into a lake. He has a blood pressure of 90/50 mm Hg, a pulse of 60/min, and respirations of 20/min. Thes

Correct Answer: Spinal shock. Explanation:

Figures 59a and 59b show the plain radiographs, and Figures 59c and 59d show the CT scan of a 77-year-old woman who has had pain in her back and both buttocks for the past 6 months. She reports that

Correct Answer: Lumbar spinal stenosis. Explanation:

Clinic OS

Q: Which of the following statements most accurately describes the vascular supply to the scaphoid and its clinical implication in the setting of trauma?

Correct Answer: Blood supply enters the distal pole and dorsal ridge via branches of the radial artery, supplying the proximal pole in a retrograde fashion.. Explanation: The scaphoid is predominantly supplied by the dorsal carpal branch of the radial artery, which enters at the dorsal ridge (distal to the waist) and supplies the proximal pole via retrograde intraosseous flow. This retrograde blood supply is why proximal pole fractures have a high rate of nonunion an

Q: In a Young-Burgess Anteroposterior Compression II (APC II) pelvic ring injury, which of the following posterior ligamentous structures typically remains intact, distinguishing it from an APC III injur

Correct Answer: Sacrospinous ligament. Explanation: An APC II injury involves widening of the pubic symphysis (or vertical pubic rami fractures) and rupture of the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The posterior sacroiliac ligaments remain intact, preventing vertical instability. An APC III injury involves complete disru

Q: A 30-year-old male sustains a closed, high-energy tibial shaft fracture and complains of unremitting pain out of proportion to his injury. His blood pressure is 130/80 mmHg. Compartment pressures are

Correct Answer: Delta P (Diastolic Blood Pressure minus compartment pressure) < 30 mmHg. Explanation: The most reliable indicator for acute compartment syndrome is the Delta P, calculated as the Diastolic Blood Pressure minus the absolute compartment pressure. A Delta P of less than 30 mmHg signifies inadequate tissue perfusion and is the standard threshold indicating the need for immediate fascioto

Q: In applying a locking compression plate (LCP) for a diaphyseal fracture, what is the primary biomechanical advantage compared to a conventional non-locking plate?

Correct Answer: It provides a rigid fixed-angle construct that does not require compression to the bone.. Explanation: Locking plates provide a fixed-angle construct, where stability relies on the threaded screw-plate interface rather than friction between the plate and the underlying bone. This preserves periosteal blood supply and avoids the need for perfect contouring of the plate to the bone surface.

Q: A 24-year-old male sustains bilateral closed femoral shaft fractures. Thirty-six hours after admission, he develops confusion, a petechial rash over his axillae, and dyspnea. Which of the following is

Correct Answer: Petechial rash. Explanation: According to Gurd and Wilson's criteria for Fat Embolism Syndrome, the three major criteria are respiratory insufficiency, cerebral involvement (neurologic signs), and a petechial rash. Tachycardia, fever, jaundice, renal changes, and sudden drops in hemoglobin or platelets are considered minor crit

Q: A 28-year-old male polytrauma patient is intubated in the ICU after a motor vehicle accident. He has a comminuted tibia fracture. The nursing staff notes a tense calf. Which of the following criteria

Correct Answer: Diastolic blood pressure minus compartment pressure < 30 mmHg. Explanation: In obtunded or polytrauma patients where clinical examination is unreliable, the delta pressure is the most accurate diagnostic parameter for acute compartment syndrome. A delta pressure (Diastolic Blood Pressure - Compartment Pressure) of less than 30 mmHg is the accepted threshold indicating the n

Q: According to the Young-Burgess classification system for pelvic ring fractures, an Anteroposterior Compression Type III (APC-III) injury is characterized by complete pelvic instability. This requires

Correct Answer: Anterior sacroiliac ligaments, posterior sacroiliac ligaments, sacrotuberous, and sacrospinous ligaments. Explanation: An APC-III injury indicates complete dissociation of the hemipelvis from the sacrum. It is characterized by symphyseal diastasis (or anterior rami fractures) along with complete disruption of the pelvic floor (sacrotuberous and sacrospinous ligaments) and both the anterior and posterior sacroiliac l

Q: A 30-year-old male sustains a closed tibial shaft fracture. He complains of severe pain out of proportion to the injury. Which measurement best confirms the diagnosis of acute compartment syndrome?

Correct Answer: Diastolic blood pressure minus compartment pressure < 30 mmHg. Explanation: The delta P (diastolic blood pressure minus compartment pressure) is the most reliable indicator of compartment syndrome. A delta P of less than 30 mmHg is considered diagnostic and warrants emergent fasciotomy.

Q: A 25-year-old male is involved in a high-speed motor vehicle collision and sustains an APC-II pelvic ring injury. What is the primary anatomic structure disrupted that defines this specific injury pat

Correct Answer: Posterior sacroiliac ligaments. Explanation: An APC-II (Anteroposterior Compression II) pelvic fracture is characterized by widening of the pubic symphysis and disruption of the anterior sacroiliac ligaments, sacrotuberous, and sacrospinous ligaments. The posterior sacroiliac ligaments remain intact, maintaining vertical stability.

Q: A 24-year-old male with bilateral femur fractures develops hypoxemia, altered mental status, and a petechial rash 48 hours after admission. Which of the following is considered a major criterion for F

Correct Answer: Petechial rash. Explanation: Gurd and Wilson's major criteria for Fat Embolism Syndrome include respiratory insufficiency, cerebral involvement (altered mental status), and a petechial rash. Tachycardia, fever, and thrombocytopenia are minor criteria.

Question 10261

Topic: 2. Trauma

Which of the following statements most accurately describes the vascular supply to the scaphoid and its clinical implication in the setting of trauma?

. The primary blood supply enters volarly via the superficial palmar arch, making distal pole fractures prone to AVN.

. Blood supply enters the distal pole and dorsal ridge via branches of the radial artery, supplying the proximal pole in a retrograde fashion.

. The proximal pole is supplied directly by the anterior interosseous artery, ensuring reliable healing in proximal third fractures.

. The scaphoid receives an abundant, redundant blood supply from both radial and ulnar arteries, making AVN a rare complication.

. Vascularity relies primarily on the radioscaphocapitate ligament, meaning ligamentous injury strictly dictates AVN risk.

Correct Answer & Explanation

. Blood supply enters the distal pole and dorsal ridge via branches of the radial artery, supplying the proximal pole in a retrograde fashion.

Explanation

The scaphoid is predominantly supplied by the dorsal carpal branch of the radial artery, which enters at the dorsal ridge (distal to the waist) and supplies the proximal pole via retrograde intraosseous flow. This retrograde blood supply is why proximal pole fractures have a high rate of nonunion and avascular necrosis.

Question 10262

Topic: Pelvic & Acetabular Trauma

In a Young-Burgess Anteroposterior Compression II (APC II) pelvic ring injury, which of the following posterior ligamentous structures typically remains intact, distinguishing it from an APC III injury?

. Symphyseal ligaments

. Sacrotuberous ligament

. Anterior sacroiliac ligament

. Posterior sacroiliac ligament

. Sacrospinous ligament

Correct Answer & Explanation

. Sacrospinous ligament

Explanation

An APC II injury involves widening of the pubic symphysis (or vertical pubic rami fractures) and rupture of the anterior sacroiliac, sacrotuberous, and sacrospinous ligaments. The posterior sacroiliac ligaments remain intact, preventing vertical instability. An APC III injury involves complete disruption of both anterior and posterior SI ligaments, resulting in spinopelvic dissociation.

Question 10263

Topic: 2. Trauma

A 30-year-old male sustains a closed, high-energy tibial shaft fracture and complains of unremitting pain out of proportion to his injury. His blood pressure is 130/80 mmHg. Compartment pressures are measured. Which of the following values provides the most reliable threshold for diagnosing acute compartment syndrome and indicating urgent fasciotomy?

. Absolute compartment pressure > 20 mmHg

. Absolute compartment pressure > 25 mmHg

. Delta P (Mean Arterial Pressure minus compartment pressure) < 40 mmHg

. Delta P (Diastolic Blood Pressure minus compartment pressure) < 30 mmHg

. Delta P (Systolic Blood Pressure minus compartment pressure) < 50 mmHg

Correct Answer & Explanation

. Delta P (Diastolic Blood Pressure minus compartment pressure) < 30 mmHg

Explanation

The most reliable indicator for acute compartment syndrome is the Delta P, calculated as the Diastolic Blood Pressure minus the absolute compartment pressure. A Delta P of less than 30 mmHg signifies inadequate tissue perfusion and is the standard threshold indicating the need for immediate fasciotomy.

Question 10264

Topic: 2. Trauma

In applying a locking compression plate (LCP) for a diaphyseal fracture, what is the primary biomechanical advantage compared to a conventional non-locking plate?

. It relies on friction between the plate and bone for stability.

. It provides a rigid fixed-angle construct that does not require compression to the bone.

. It primarily increases the pull-out strength of individual screws in healthy cortical bone.

. It guarantees primary bone healing through absolute stability in all configurations.

. It requires precise contouring to the bone surface to prevent loss of reduction.

Correct Answer & Explanation

. It provides a rigid fixed-angle construct that does not require compression to the bone.

Explanation

Locking plates provide a fixed-angle construct, where stability relies on the threaded screw-plate interface rather than friction between the plate and the underlying bone. This preserves periosteal blood supply and avoids the need for perfect contouring of the plate to the bone surface.

Question 10265

Topic: 2. Trauma

A 24-year-old male sustains bilateral closed femoral shaft fractures. Thirty-six hours after admission, he develops confusion, a petechial rash over his axillae, and dyspnea. Which of the following is considered a 'major criterion' for the diagnosis of Fat Embolism Syndrome according to Gurd and Wilson's criteria?

. Tachycardia > 120 beats/minute

. Fever > 39°C

. Petechial rash

. Jaundice

. Renal dysfunction (oliguria)

Correct Answer & Explanation

. Petechial rash

Explanation

According to Gurd and Wilson's criteria for Fat Embolism Syndrome, the three major criteria are respiratory insufficiency, cerebral involvement (neurologic signs), and a petechial rash. Tachycardia, fever, jaundice, renal changes, and sudden drops in hemoglobin or platelets are considered minor criteria.

Question 10266

Topic: 2. Trauma

A 28-year-old male polytrauma patient is intubated in the ICU after a motor vehicle accident. He has a comminuted tibia fracture. The nursing staff notes a tense calf. Which of the following criteria is the most reliable threshold for diagnosing acute compartment syndrome and proceeding with fasciotomy in this obtunded patient?

. Absolute compartment pressure > 30 mmHg

. Absolute compartment pressure > 45 mmHg

. Diastolic blood pressure minus compartment pressure < 30 mmHg

. Mean arterial pressure minus compartment pressure < 30 mmHg

. Systolic blood pressure minus compartment pressure < 30 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

In obtunded or polytrauma patients where clinical examination is unreliable, the delta pressure is the most accurate diagnostic parameter for acute compartment syndrome. A delta pressure (Diastolic Blood Pressure - Compartment Pressure) of less than 30 mmHg is the accepted threshold indicating the need for emergent fasciotomy, as it accounts for the perfusion gradient better than an absolute pressure measurement.

Question 10267

Topic: Pelvic & Acetabular Trauma

According to the Young-Burgess classification system for pelvic ring fractures, an Anteroposterior Compression Type III (APC-III) injury is characterized by complete pelvic instability. This requires the disruption of the anterior ring as well as which of the following ligamentous structures?

. Anterior sacroiliac ligaments only

. Anterior sacroiliac ligaments, posterior sacroiliac ligaments, sacrotuberous, and sacrospinous ligaments

. Sacrotuberous and sacrospinous ligaments only

. Posterior sacroiliac ligaments and iliolumbar ligaments only

. Sacrospinous and iliolumbar ligaments only

Correct Answer & Explanation

. Anterior sacroiliac ligaments, posterior sacroiliac ligaments, sacrotuberous, and sacrospinous ligaments

Explanation

An APC-III injury indicates complete dissociation of the hemipelvis from the sacrum. It is characterized by symphyseal diastasis (or anterior rami fractures) along with complete disruption of the pelvic floor (sacrotuberous and sacrospinous ligaments) and both the anterior and posterior sacroiliac ligaments, leading to complete rotational and vertical instability.

Question 10268

Topic: 2. Trauma

A 30-year-old male sustains a closed tibial shaft fracture. He complains of severe pain out of proportion to the injury. Which measurement best confirms the diagnosis of acute compartment syndrome?

. Absolute compartment pressure > 20 mmHg

. Absolute compartment pressure > 30 mmHg

. Diastolic blood pressure minus compartment pressure < 30 mmHg

. Mean arterial pressure minus compartment pressure < 40 mmHg

. Systolic blood pressure minus compartment pressure < 20 mmHg

Correct Answer & Explanation

. Diastolic blood pressure minus compartment pressure < 30 mmHg

Explanation

The delta P (diastolic blood pressure minus compartment pressure) is the most reliable indicator of compartment syndrome. A delta P of less than 30 mmHg is considered diagnostic and warrants emergent fasciotomy.

Question 10269

Topic: Pelvic & Acetabular Trauma

A 25-year-old male is involved in a high-speed motor vehicle collision and sustains an APC-II pelvic ring injury. What is the primary anatomic structure disrupted that defines this specific injury pattern?

. Anterior sacroiliac ligaments

. Posterior sacroiliac ligaments

. Sacrotuberous ligament

. Iliolumbar ligament

. Sacrospinous ligament

Correct Answer & Explanation

. Posterior sacroiliac ligaments

Explanation

An APC-II (Anteroposterior Compression II) pelvic fracture is characterized by widening of the pubic symphysis and disruption of the anterior sacroiliac ligaments, sacrotuberous, and sacrospinous ligaments. The posterior sacroiliac ligaments remain intact, maintaining vertical stability.

Question 10270

Topic: 2. Trauma

A 24-year-old male with bilateral femur fractures develops hypoxemia, altered mental status, and a petechial rash 48 hours after admission. Which of the following is considered a major criterion for Fat Embolism Syndrome according to Gurd and Wilson?

. Tachycardia > 120 bpm

. Fever > 39 degrees Celsius

. Petechial rash

. Thrombocytopenia

. Jaundice

Correct Answer & Explanation

. Petechial rash

Explanation

Gurd and Wilson's major criteria for Fat Embolism Syndrome include respiratory insufficiency, cerebral involvement (altered mental status), and a petechial rash. Tachycardia, fever, and thrombocytopenia are minor criteria.

Question 10271

Topic: 2. Trauma

A 24-year-old male sustains a closed femoral shaft fracture. Forty-eight hours post-admission, he develops sudden onset tachypnea, confusion, and a petechial rash over his axillae. Which of the following is the most definitive primary prevention strategy for this clinical syndrome?

. Prophylactic systemic corticosteroids

. Early surgical stabilization of the long bone fracture

. Administration of therapeutic low-molecular-weight heparin

. High-dose intravenous ascorbic acid

. Prophylactic placement of an inferior vena cava filter

Correct Answer & Explanation

. Early surgical stabilization of the long bone fracture

Explanation

The patient is exhibiting classic Gurd's criteria for Fat Embolism Syndrome (FES). Early surgical stabilization of long bone fractures (typically within 24 hours) is the most proven and effective method for the primary prevention of FES.

Question 10272

Topic: 2. Trauma

-
The flap outlined in Figure 58 is based on septocutaneous perforators from what artery?

. Radial

. Radial recurrent

. Posterior interosseous

. Superior ulnar recurrent

. Superficial radial circumflex

. Impaired hydroxylation of proline

. Failure of cleavage in procollagen

. Defective binding sites for hydroxyproline

. Failure to incorporate glycine into the helix

. Diminished production of collagen through the rough endoplasmic reticulum

. Asking the legal staff to seek a court injunction

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

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

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

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

. Meta-analysis

. Confidence interval

. Analysis of variance (ANOVA)

. Statistical significance (p-value)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

!. Varus malalignment of the knee

". A posterior cruciate-substituting femoral component

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

$. The sesamoids are separated

%. The sesamoid is fractured

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

'. The dislocation is dorsal and centered

(. The proximal phalanx is hyperextended

). Patella

*. Tibial stem

+. Distal femoral interface

,. Posterior femoral interface

-. Sites of screw fixation for the tibia

.. Hallux rigidus

/. Fracture of the sesamoid

0. Disruption of the plantar plate

1. Osteonecrosis of the metatarsal head

2. Rupture of the flexor hallucis longus

3. Gout

4. Sepsis

5. Old trauma

6. Rheumatoid arthritis

7. Charcot arthroplasty

8. Aspiration and steroid injection

9. Biopsy, curettage, and allograft bone grafting

:. Percutaneous Kirschner wire fixation

;. Percutaneous injection of autogenous bone marrow

<. Nerve roots

=. Spinal cord

>. Sciatic nerve

?. Peroneal nerve

@. Conus medullaris

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

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

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

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

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

F. Early and late infection

G. Periprosthetic fracture of the femur

H. Failure of the patellofemoral and extensor mechanisms

I. Aseptic loosening of cementing tibial components

J. Asceptic loosening of cemented femoral components

K. Acceptance of the current position of the ankle

L. Open reduction and fixation in the epiphysis only

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

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

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

P. Resection arthroplasty and local radiation

Q. In situ fusion of the hip

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

S. Excision of heterotopic bone and local radiation

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

U. Closed reduction of both fractures and immediate spica casting

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

W. External fixation of both femora

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

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

Z. Synovial sarcoma

[. Soft-tissue abcess

\. Rhabdomyosarcoma

]. Eosinophilic granuloma

^. Nodular pigmented villonodular synovitis

_. Changing to a titanium nail

`. Changing to a nonslotted nail

A. Changing the cross-sectional shape of the nail

B. Increasing the diameter of the nail by 3 mm

C. Increasing the diameter of the interlocking screws

D. Fracture healing

E. Chondrosarcoma

F. Periosteal chondroma

G. Periosteal osteosarcoma

H. Dysplasia epiphysealis hemimelica

I. Demonstrate competence in the subject of the case

J. Be fellowship trained in the subject of the case

K. Be paid on a contingency basis

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

M. Have been involved in the case as a consultant

N. Diagnostic arthroscopy

O. Arthroscopy and subacromial decompression

P. Reduction and fixation of the proximal humeral epiphysis

Q. Temporary cessation of throwing

R. Physical therapy for rotator cuff strengthening

S. Oblique popliteal ligament

T. Lateral capsule

U. Popliteal tendon

V. Fibular collateral ligament

W. Posterior oblique ligament

X. Radial tear

Y. Parrot-beak tear

Z. 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

¤. immobilization for 25 days

¥. Cystinosis

¦. Hypophosphatemia

§. Renal osteodystrophy

¨. Primary hyperparathyroidism

©. Nutritional vitamin D deficiency

ª. Lateral meniscus tear

«. Popliteus tenosynovitis

¬. Iliotibial band friction syndrome

. Peroneal nerve entrapment

®. Biceps tendinitis

¯. Observation

°. Removal of the prosthetic components

±. Operative exploration and decompression of the peroneal nerve

². Nerve conduction velocity studies

³. Loosening of the primary dressings and knee flexion to 30 degrees

´. I

Μ. II

¶. III

·. decreased tissue tension

¸. decreased abductor lever arm

¹. decreased joint reaction force

º. increased body weight over lever arm

». increased polyethylene wear rate

¼. recurrent traumatic anterior dislocation

½. recurrent traumatic posterior dislocation

¾. traumatic subluxation with no previous dislocation

¿. traumatic anterior subluxation

À. atraumatic involuntary subluxation

Á. radial

Â. axillary

Ã. suprascapular

Ä. thoracodorsal

Å. long thoracic

Æ. Flexion

Ç. Extension

È. Axial rotation

É. Left lateral bending

Ê. Right lateral bending

Ë. Skin

Ì. Lung

Í. Brain

Î. Heart

Ï. Kidney

Ð. Thoracoacromial, lateral thoracic, subscapular

Ñ. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ò. Posterior humeral circumflex, subscapular, thoracacromial

Ó. Subscapular, thoracacromial, anterior humeral circumflex

Ô. Lateral thoracic, anterior humeral circumflex, thoracacromial

Õ. Respondeat superior

Ö. Indemnity agreement

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

Ø. Comparative negligence-% of involvement

Ù. Contributory negligence- resident contributed to the negligence

Ú. t-type

Û. both column

Ü. transverse

Ý. anterior column

Þ. anterior column posterior hemitransverse

SS. Posterior interosseous

À. Anterior interosseous

Á. Radial

Â. Median

Ã. Ulnar

Ä. Shock from hypovolemia

Å. Associated rupture of the bladder

Æ. Arterial bleeding on pelvic angiogram

Ç. Presence of a hematoma in the perineum and scrotum

È. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Radial

Explanation

Question 10273

Topic: 2. Trauma

What defect in collagen synthesis is caused by a lack of vitamin C?

. Impaired hydroxylation of proline

. Failure of cleavage in procollagen

. Defective binding sites for hydroxyproline

. Failure to incorporate glycine into the helix

. Diminished production of collagen through the rough endoplasmic reticulum

. Asking the legal staff to seek a court injunction

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

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

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

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

. Meta-analysis

. Confidence interval

. Analysis of variance (ANOVA)

. Statistical significance (p-value)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

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

". The dislocation is dorsal and centered

#. The proximal phalanx is hyperextended

$. Patella

%. Tibial stem

&. Distal femoral interface

'. Posterior femoral interface

(. Sites of screw fixation for the tibia

). Hallux rigidus

*. Fracture of the sesamoid

+. Disruption of the plantar plate

,. Osteonecrosis of the metatarsal head

-. Rupture of the flexor hallucis longus

.. Gout

/. Sepsis

0. Old trauma

1. Rheumatoid arthritis

2. Charcot arthroplasty

3. Aspiration and steroid injection

4. Biopsy, curettage, and allograft bone grafting

5. Percutaneous Kirschner wire fixation

6. Percutaneous injection of autogenous bone marrow

7. Nerve roots

8. Spinal cord

9. Sciatic nerve

:. Peroneal nerve

;. Conus medullaris

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

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

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

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

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

A. Early and late infection

B. Periprosthetic fracture of the femur

C. Failure of the patellofemoral and extensor mechanisms

D. Aseptic loosening of cementing tibial components

E. Asceptic loosening of cemented femoral components

F. Acceptance of the current position of the ankle

G. Open reduction and fixation in the epiphysis only

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

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

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

K. Resection arthroplasty and local radiation

L. In situ fusion of the hip

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

N. Excision of heterotopic bone and local radiation

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

P. Closed reduction of both fractures and immediate spica casting

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

R. External fixation of both femora

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

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

U. Synovial sarcoma

V. Soft-tissue abcess

W. Rhabdomyosarcoma

X. Eosinophilic granuloma

Y. Nodular pigmented villonodular synovitis

Z. 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

A. Periosteal chondroma

B. Periosteal osteosarcoma

C. Dysplasia epiphysealis hemimelica

D. Demonstrate competence in the subject of the case

E. Be fellowship trained in the subject of the case

F. Be paid on a contingency basis

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

H. Have been involved in the case as a consultant

I. Diagnostic arthroscopy

J. Arthroscopy and subacromial decompression

K. Reduction and fixation of the proximal humeral epiphysis

L. Temporary cessation of throwing

M. Physical therapy for rotator cuff strengthening

N. Oblique popliteal ligament

O. Lateral capsule

P. Popliteal tendon

Q. Fibular collateral ligament

R. Posterior oblique ligament

S. Radial tear

T. Parrot-beak tear

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

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

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

X. 0 degrees of abduction, with neural rotation

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

Z. 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

. immobilization for 25 days

. Cystinosis

¡. Hypophosphatemia

¢. Renal osteodystrophy

£. Primary hyperparathyroidism

¤. Nutritional vitamin D deficiency

¥. Lateral meniscus tear

¦. Popliteus tenosynovitis

§. Iliotibial band friction syndrome

¨. Peroneal nerve entrapment

©. Biceps tendinitis

ª. Observation

«. 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

¯. I

°. II

±. III

². decreased tissue tension

³. decreased abductor lever arm

´. decreased joint reaction force

Μ. increased body weight over lever arm

¶. increased polyethylene wear rate

·. recurrent traumatic anterior dislocation

¸. recurrent traumatic posterior dislocation

¹. traumatic subluxation with no previous dislocation

º. traumatic anterior subluxation

». atraumatic involuntary subluxation

¼. radial

½. axillary

¾. suprascapular

¿. thoracodorsal

À. long thoracic

Á. Flexion

Â. Extension

Ã. Axial rotation

Ä. Left lateral bending

Å. Right lateral bending

Æ. Skin

Ç. Lung

È. Brain

É. Heart

Ê. Kidney

Ë. Thoracoacromial, lateral thoracic, subscapular

Ì. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Í. Posterior humeral circumflex, subscapular, thoracacromial

Î. Subscapular, thoracacromial, anterior humeral circumflex

Ï. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ð. Respondeat superior

Ñ. Indemnity agreement

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

Ó. Comparative negligence-% of involvement

Ô. Contributory negligence- resident contributed to the negligence

Õ. t-type

Ö. both column

×. transverse

Ø. anterior column

Ù. anterior column posterior hemitransverse

Ú. Posterior interosseous

Û. Anterior interosseous

Ü. Radial

Ý. Median

Þ. Ulnar

SS. Shock from hypovolemia

À. Associated rupture of the bladder

Á. Arterial bleeding on pelvic angiogram

Â. Presence of a hematoma in the perineum and scrotum

Ã. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Impaired hydroxylation of proline

Explanation

Question 10274

Topic: 2. Trauma

While under a physician’s care, a 45-year-old man verbally abuses the staff and nurses who are attempting to carry out orders. A decision to discharge the patient is best carried out by

. Asking the legal staff to seek a court injunction

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

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

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

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

. Meta-analysis

. Confidence interval

. Analysis of variance (ANOVA)

. Statistical significance (p-value)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

!. Distal femoral interface

". Posterior femoral interface

#. Sites of screw fixation for the tibia

$. Hallux rigidus

%. Fracture of the sesamoid

&. Disruption of the plantar plate

'. Osteonecrosis of the metatarsal head

(. Rupture of the flexor hallucis longus

). Gout

*. Sepsis

+. Old trauma

,. Rheumatoid arthritis

-. Charcot arthroplasty

.. Aspiration and steroid injection

/. Biopsy, curettage, and allograft bone grafting

0. Percutaneous Kirschner wire fixation

1. Percutaneous injection of autogenous bone marrow

2. Nerve roots

3. Spinal cord

4. Sciatic nerve

5. Peroneal nerve

6. Conus medullaris

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

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

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

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

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

<. Early and late infection

=. Periprosthetic fracture of the femur

>. Failure of the patellofemoral and extensor mechanisms

?. Aseptic loosening of cementing tibial components

@. Asceptic loosening of cemented femoral components

A. Acceptance of the current position of the ankle

B. Open reduction and fixation in the epiphysis only

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

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

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

F. Resection arthroplasty and local radiation

G. In situ fusion of the hip

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

I. Excision of heterotopic bone and local radiation

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

K. Closed reduction of both fractures and immediate spica casting

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

M. External fixation of both femora

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

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

P. Synovial sarcoma

Q. Soft-tissue abcess

R. Rhabdomyosarcoma

S. Eosinophilic granuloma

T. Nodular pigmented villonodular synovitis

U. Changing to a titanium nail

V. Changing to a nonslotted nail

W. Changing the cross-sectional shape of the nail

X. Increasing the diameter of the nail by 3 mm

Y. Increasing the diameter of the interlocking screws

Z. 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

A. Be paid on a contingency basis

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

C. Have been involved in the case as a consultant

D. Diagnostic arthroscopy

E. Arthroscopy and subacromial decompression

F. Reduction and fixation of the proximal humeral epiphysis

G. Temporary cessation of throwing

H. Physical therapy for rotator cuff strengthening

I. Oblique popliteal ligament

J. Lateral capsule

K. Popliteal tendon

L. Fibular collateral ligament

M. Posterior oblique ligament

N. Radial tear

O. Parrot-beak tear

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

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

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

S. 0 degrees of abduction, with neural rotation

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

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

V. 90 degrees of abduction with neutral rotation

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

X. Sural

Y. Saphenous and its branches

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

¡. Popliteus tenosynovitis

¢. Iliotibial band friction syndrome

£. Peroneal nerve entrapment

¤. Biceps tendinitis

¥. Observation

¦. 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

ª. I

«. II

¬. III

. decreased tissue tension

®. decreased abductor lever arm

¯. decreased joint reaction force

°. increased body weight over lever arm

±. increased polyethylene wear rate

². recurrent traumatic anterior dislocation

³. recurrent traumatic posterior dislocation

´. traumatic subluxation with no previous dislocation

Μ. traumatic anterior subluxation

¶. atraumatic involuntary subluxation

·. radial

¸. axillary

¹. suprascapular

º. thoracodorsal

». long thoracic

¼. Flexion

½. Extension

¾. Axial rotation

¿. Left lateral bending

À. Right lateral bending

Á. Skin

Â. Lung

Ã. Brain

Ä. Heart

Å. Kidney

Æ. Thoracoacromial, lateral thoracic, subscapular

Ç. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

È. Posterior humeral circumflex, subscapular, thoracacromial

É. Subscapular, thoracacromial, anterior humeral circumflex

Ê. Lateral thoracic, anterior humeral circumflex, thoracacromial

Ë. Respondeat superior

Ì. Indemnity agreement

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

Î. Comparative negligence-% of involvement

Ï. Contributory negligence- resident contributed to the negligence

Ð. t-type

Ñ. both column

Ò. transverse

Ó. anterior column

Ô. anterior column posterior hemitransverse

Õ. Posterior interosseous

Ö. Anterior interosseous

×. Radial

Ø. Median

Ù. Ulnar

Ú. Shock from hypovolemia

Û. Associated rupture of the bladder

Ü. Arterial bleeding on pelvic angiogram

Ý. Presence of a hematoma in the perineum and scrotum

Þ. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Asking the legal staff to seek a court injunction

Explanation

Question 10275

Topic: 2. Trauma

A consecutive series of 50 patients is randomized to receive either treatment A or treatment B. At a 10-year follow up, patient satisfaction with treatment is measured. Which of the following statistical calculations will provide the most information regarding the magnitude of possible differences between the two groups of patients?

. Meta-analysis

. Confidence interval

. Analysis of variance (ANOVA)

. Statistical significance (p-value)

. Survivorship analysis (Kaplan-Meier)

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

!. Disruption of the plantar plate

". Osteonecrosis of the metatarsal head

#. Rupture of the flexor hallucis longus

$. Gout

%. Sepsis

&. Old trauma

'. Rheumatoid arthritis

(. Charcot arthroplasty

). Aspiration and steroid injection

*. Biopsy, curettage, and allograft bone grafting

+. Percutaneous Kirschner wire fixation

,. Percutaneous injection of autogenous bone marrow

-. Nerve roots

.. Spinal cord

/. Sciatic nerve

0. Peroneal nerve

1. Conus medullaris

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

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

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

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

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

7. Early and late infection

8. Periprosthetic fracture of the femur

9. Failure of the patellofemoral and extensor mechanisms

:. Aseptic loosening of cementing tibial components

;. Asceptic loosening of cemented femoral components

<. Acceptance of the current position of the ankle

=. Open reduction and fixation in the epiphysis only

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

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

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

A. Resection arthroplasty and local radiation

B. In situ fusion of the hip

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

D. Excision of heterotopic bone and local radiation

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

F. Closed reduction of both fractures and immediate spica casting

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

H. External fixation of both femora

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

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

K. Synovial sarcoma

L. Soft-tissue abcess

M. Rhabdomyosarcoma

N. Eosinophilic granuloma

O. Nodular pigmented villonodular synovitis

P. Changing to a titanium nail

Q. Changing to a nonslotted nail

R. Changing the cross-sectional shape of the nail

S. Increasing the diameter of the nail by 3 mm

T. Increasing the diameter of the interlocking screws

U. Fracture healing

V. Chondrosarcoma

W. Periosteal chondroma

X. Periosteal osteosarcoma

Y. Dysplasia epiphysealis hemimelica

Z. 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

A. Reduction and fixation of the proximal humeral epiphysis

B. Temporary cessation of throwing

C. Physical therapy for rotator cuff strengthening

D. Oblique popliteal ligament

E. Lateral capsule

F. Popliteal tendon

G. Fibular collateral ligament

H. Posterior oblique ligament

I. Radial tear

J. Parrot-beak tear

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

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

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

N. 0 degrees of abduction, with neural rotation

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

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

Q. 90 degrees of abduction with neutral rotation

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

S. Sural

T. Saphenous and its branches

U. Posterior tibial and its branches

V. Deep peroneal and its branches

W. Superficial peroneal and its branches

X. Strength

Y. Stiffness

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

¡. 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

¥. I

¦. II

§. III

¨. decreased tissue tension

©. decreased abductor lever arm

ª. decreased joint reaction force

«. increased body weight over lever arm

¬. increased polyethylene wear rate

. recurrent traumatic anterior dislocation

®. recurrent traumatic posterior dislocation

¯. traumatic subluxation with no previous dislocation

°. traumatic anterior subluxation

±. atraumatic involuntary subluxation

². radial

³. axillary

´. suprascapular

Μ. thoracodorsal

¶. long thoracic

·. Flexion

¸. Extension

¹. Axial rotation

º. Left lateral bending

». Right lateral bending

¼. Skin

½. Lung

¾. Brain

¿. Heart

À. Kidney

Á. Thoracoacromial, lateral thoracic, subscapular

Â. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

Ã. Posterior humeral circumflex, subscapular, thoracacromial

Ä. Subscapular, thoracacromial, anterior humeral circumflex

Å. Lateral thoracic, anterior humeral circumflex, thoracacromial

Æ. Respondeat superior

Ç. Indemnity agreement

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

É. Comparative negligence-% of involvement

Ê. Contributory negligence- resident contributed to the negligence

Ë. t-type

Ì. both column

Í. transverse

Î. anterior column

Ï. anterior column posterior hemitransverse

Ð. Posterior interosseous

Ñ. Anterior interosseous

Ò. Radial

Ó. Median

Ô. Ulnar

Õ. Shock from hypovolemia

Ö. Associated rupture of the bladder

×. Arterial bleeding on pelvic angiogram

Ø. Presence of a hematoma in the perineum and scrotum

Ù. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Meta-analysis

Explanation

Question 10276

Topic: 2. Trauma

A 19-year-old man sustains a complete spinal cord injury at the C7 level as a result of diving into a lake. He has a blood pressure of 90/50 mm Hg, a pulse of 60/min, and respirations of 20/min. These values most likely signify

. Spinal shock

. Neurogenic shock

. Hypovolemic shock

. Pulmonary embolism

. Fat embolus syndrome

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

!. Old trauma

". Rheumatoid arthritis

#. Charcot arthroplasty

$. Aspiration and steroid injection

%. Biopsy, curettage, and allograft bone grafting

&. Percutaneous Kirschner wire fixation

'. Percutaneous injection of autogenous bone marrow

(. Nerve roots

). Spinal cord

*. Sciatic nerve

+. Peroneal nerve

,. Conus medullaris

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

.. 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

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

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

2. Early and late infection

3. Periprosthetic fracture of the femur

4. Failure of the patellofemoral and extensor mechanisms

5. Aseptic loosening of cementing tibial components

6. Asceptic loosening of cemented femoral components

7. Acceptance of the current position of the ankle

8. Open reduction and fixation in the epiphysis only

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

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

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

<. Resection arthroplasty and local radiation

=. In situ fusion of the hip

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

?. Excision of heterotopic bone and local radiation

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

A. Closed reduction of both fractures and immediate spica casting

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

C. External fixation of both femora

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

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

F. Synovial sarcoma

G. Soft-tissue abcess

H. Rhabdomyosarcoma

I. Eosinophilic granuloma

J. Nodular pigmented villonodular synovitis

K. Changing to a titanium nail

L. Changing to a nonslotted nail

M. Changing the cross-sectional shape of the nail

N. Increasing the diameter of the nail by 3 mm

O. Increasing the diameter of the interlocking screws

P. Fracture healing

Q. Chondrosarcoma

R. Periosteal chondroma

S. Periosteal osteosarcoma

T. Dysplasia epiphysealis hemimelica

U. Demonstrate competence in the subject of the case

V. Be fellowship trained in the subject of the case

W. Be paid on a contingency basis

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

Y. Have been involved in the case as a consultant

Z. 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

A. Popliteal tendon

B. Fibular collateral ligament

C. Posterior oblique ligament

D. Radial tear

E. Parrot-beak tear

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

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

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

I. 0 degrees of abduction, with neural rotation

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

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

L. 90 degrees of abduction with neutral rotation

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

N. Sural

O. Saphenous and its branches

P. Posterior tibial and its branches

Q. Deep peroneal and its branches

R. Superficial peroneal and its branches

S. Strength

T. Stiffness

U. Shelf life

V. Antigenicity

W. Risk of HIV transmission

X. Indemnification

Y. Occurrence

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

. 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

. I

¡. II

¢. III

£. decreased tissue tension

¤. decreased abductor lever arm

¥. decreased joint reaction force

¦. increased body weight over lever arm

§. increased polyethylene wear rate

¨. recurrent traumatic anterior dislocation

©. recurrent traumatic posterior dislocation

ª. traumatic subluxation with no previous dislocation

«. traumatic anterior subluxation

¬. atraumatic involuntary subluxation

. radial

®. axillary

¯. suprascapular

°. thoracodorsal

±. long thoracic

². Flexion

³. Extension

´. Axial rotation

Μ. Left lateral bending

¶. Right lateral bending

·. Skin

¸. Lung

¹. Brain

º. Heart

». Kidney

¼. Thoracoacromial, lateral thoracic, subscapular

½. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

¾. Posterior humeral circumflex, subscapular, thoracacromial

¿. Subscapular, thoracacromial, anterior humeral circumflex

À. Lateral thoracic, anterior humeral circumflex, thoracacromial

Á. Respondeat superior

Â. Indemnity agreement

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

Ä. Comparative negligence-% of involvement

Å. Contributory negligence- resident contributed to the negligence

Æ. t-type

Ç. both column

È. transverse

É. anterior column

Ê. anterior column posterior hemitransverse

Ë. Posterior interosseous

Ì. Anterior interosseous

Í. Radial

Î. Median

Ï. Ulnar

Ð. Shock from hypovolemia

Ñ. Associated rupture of the bladder

Ò. Arterial bleeding on pelvic angiogram

Ó. Presence of a hematoma in the perineum and scrotum

Ô. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Spinal shock

Explanation

Question 10277

Topic: 2. Trauma

Figures 59a and 59b show the plain radiographs, and Figures 59c and 59d show the CT scan of a 77-year-old woman who has had pain in her back and both buttocks for the past 6 months. She reports that the pain radiates down her right thigh and leg when she is standing. What is the most likely diagnosis?

. Lumbar spinal stenosis

. Metastatic disease of the spine

. Rheumatoid lumbar spondylitis

. Isthmic spondyloloisthesis

. Degenerative spondylolisthesis at L4-5 and L5-S1

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

!. Percutaneous Kirschner wire fixation

". Percutaneous injection of autogenous bone marrow

#. Nerve roots

$. Spinal cord

%. Sciatic nerve

&. Peroneal nerve

'. Conus medullaris

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

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

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

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

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

-. Early and late infection

.. Periprosthetic fracture of the femur

/. Failure of the patellofemoral and extensor mechanisms

0. Aseptic loosening of cementing tibial components

1. Asceptic loosening of cemented femoral components

2. Acceptance of the current position of the ankle

3. Open reduction and fixation in the epiphysis only

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

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

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

7. Resection arthroplasty and local radiation

8. In situ fusion of the hip

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

:. Excision of heterotopic bone and local radiation

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

<. Closed reduction of both fractures and immediate spica casting

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

>. External fixation of both femora

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

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

A. Synovial sarcoma

B. Soft-tissue abcess

C. Rhabdomyosarcoma

D. Eosinophilic granuloma

E. Nodular pigmented villonodular synovitis

F. Changing to a titanium nail

G. Changing to a nonslotted nail

H. Changing the cross-sectional shape of the nail

I. Increasing the diameter of the nail by 3 mm

J. Increasing the diameter of the interlocking screws

K. Fracture healing

L. Chondrosarcoma

M. Periosteal chondroma

N. Periosteal osteosarcoma

O. Dysplasia epiphysealis hemimelica

P. Demonstrate competence in the subject of the case

Q. Be fellowship trained in the subject of the case

R. Be paid on a contingency basis

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

T. Have been involved in the case as a consultant

U. Diagnostic arthroscopy

V. Arthroscopy and subacromial decompression

W. Reduction and fixation of the proximal humeral epiphysis

X. Temporary cessation of throwing

Y. Physical therapy for rotator cuff strengthening

Z. Oblique popliteal ligament

[. Lateral capsule

\. Popliteal tendon

]. Fibular collateral ligament

^. Posterior oblique ligament

_. Radial tear

`. Parrot-beak tear

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

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

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

D. 0 degrees of abduction, with neural rotation

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

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

G. 90 degrees of abduction with neutral rotation

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

I. Sural

J. Saphenous and its branches

K. Posterior tibial and its branches

L. Deep peroneal and its branches

M. Superficial peroneal and its branches

N. Strength

O. Stiffness

P. Shelf life

Q. Antigenicity

R. Risk of HIV transmission

S. Indemnification

T. Occurrence

U. Excess liability

V. Claims-made

W. Nose

X. Lateral Y

Y. Scapular AP

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

. 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

. I

. II

. III

. decreased tissue tension

. decreased abductor lever arm

. decreased joint reaction force

¡. increased body weight over lever arm

¢. increased polyethylene wear rate

£. recurrent traumatic anterior dislocation

¤. recurrent traumatic posterior dislocation

¥. traumatic subluxation with no previous dislocation

¦. traumatic anterior subluxation

§. atraumatic involuntary subluxation

¨. radial

©. axillary

ª. suprascapular

«. thoracodorsal

¬. long thoracic

. Flexion

®. Extension

¯. Axial rotation

°. Left lateral bending

±. Right lateral bending

². Skin

³. Lung

´. Brain

Μ. Heart

¶. Kidney

·. Thoracoacromial, lateral thoracic, subscapular

¸. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

¹. Posterior humeral circumflex, subscapular, thoracacromial

º. Subscapular, thoracacromial, anterior humeral circumflex

». Lateral thoracic, anterior humeral circumflex, thoracacromial

¼. Respondeat superior

½. Indemnity agreement

¾. Hold harmless agreement- attempt to shift liability from company to physician

¿. Comparative negligence-% of involvement

À. Contributory negligence- resident contributed to the negligence

Á. t-type

Â. both column

Ã. transverse

Ä. anterior column

Å. anterior column posterior hemitransverse

Æ. Posterior interosseous

Ç. Anterior interosseous

È. Radial

É. Median

Ê. Ulnar

Ë. Shock from hypovolemia

Ì. Associated rupture of the bladder

Í. Arterial bleeding on pelvic angiogram

Î. Presence of a hematoma in the perineum and scrotum

Ï. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Lumbar spinal stenosis

Explanation

Question 10278

Topic: 2. Trauma

A 65-year-old man has had “catching” in front of his knee since he had a total knee arthroplasty 9 months ago. Examination reveals a palpable and audible snap in the anterior aspect of the knee at about 40 degrees of flexion as the knee is being actively extended. A radiograph of the prosthetic knee will most likely show

. Patella alta

. A metal-backed patella

. Varus malalignment of the knee

. A posterior cruciate-substituting femoral component

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

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

!. Peroneal nerve

". Conus medullaris

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

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

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

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

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

(. Early and late infection

). Periprosthetic fracture of the femur

*. Failure of the patellofemoral and extensor mechanisms

+. Aseptic loosening of cementing tibial components

,. Asceptic loosening of cemented femoral components

-. Acceptance of the current position of the ankle

.. Open reduction and fixation in the epiphysis only

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

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

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

2. Resection arthroplasty and local radiation

3. In situ fusion of the hip

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

5. Excision of heterotopic bone and local radiation

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

7. Closed reduction of both fractures and immediate spica casting

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

9. External fixation of both femora

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

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

<. Synovial sarcoma

=. Soft-tissue abcess

>. Rhabdomyosarcoma

?. Eosinophilic granuloma

@. Nodular pigmented villonodular synovitis

A. Changing to a titanium nail

B. Changing to a nonslotted nail

C. Changing the cross-sectional shape of the nail

D. Increasing the diameter of the nail by 3 mm

E. Increasing the diameter of the interlocking screws

F. Fracture healing

G. Chondrosarcoma

H. Periosteal chondroma

I. Periosteal osteosarcoma

J. Dysplasia epiphysealis hemimelica

K. Demonstrate competence in the subject of the case

L. Be fellowship trained in the subject of the case

M. Be paid on a contingency basis

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

O. Have been involved in the case as a consultant

P. Diagnostic arthroscopy

Q. Arthroscopy and subacromial decompression

R. Reduction and fixation of the proximal humeral epiphysis

S. Temporary cessation of throwing

T. Physical therapy for rotator cuff strengthening

U. Oblique popliteal ligament

V. Lateral capsule

W. Popliteal tendon

X. Fibular collateral ligament

Y. Posterior oblique ligament

Z. 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

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

B. 90 degrees of abduction with neutral rotation

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

D. Sural

E. Saphenous and its branches

F. Posterior tibial and its branches

G. Deep peroneal and its branches

H. Superficial peroneal and its branches

I. Strength

J. Stiffness

K. Shelf life

L. Antigenicity

M. Risk of HIV transmission

N. Indemnification

O. Occurrence

P. Excess liability

Q. Claims-made

R. Nose

S. Lateral Y

T. Scapular AP

U. Neutral rotation AP

V. Internal rotation AP

W. External rotation AP

X. Trauma

Y. Hemophilia

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

. 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

. I

. II

. III

. decreased tissue tension

. decreased abductor lever arm

. decreased joint reaction force

. increased body weight over lever arm

. increased polyethylene wear rate

. recurrent traumatic anterior dislocation

. recurrent traumatic posterior dislocation

. traumatic subluxation with no previous dislocation

¡. traumatic anterior subluxation

¢. atraumatic involuntary subluxation

£. radial

¤. axillary

¥. suprascapular

¦. thoracodorsal

§. long thoracic

¨. Flexion

©. Extension

ª. Axial rotation

«. Left lateral bending

¬. Right lateral bending

. Skin

®. Lung

¯. Brain

°. Heart

±. Kidney

². Thoracoacromial, lateral thoracic, subscapular

³. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

´. Posterior humeral circumflex, subscapular, thoracacromial

Μ. Subscapular, thoracacromial, anterior humeral circumflex

¶. Lateral thoracic, anterior humeral circumflex, thoracacromial

·. Respondeat superior

¸. Indemnity agreement

¹. Hold harmless agreement- attempt to shift liability from company to physician

º. Comparative negligence-% of involvement

». Contributory negligence- resident contributed to the negligence

¼. t-type

½. both column

¾. transverse

¿. anterior column

À. anterior column posterior hemitransverse

Á. Posterior interosseous

Â. Anterior interosseous

Ã. Radial

Ä. Median

Å. Ulnar

Æ. Shock from hypovolemia

Ç. Associated rupture of the bladder

È. Arterial bleeding on pelvic angiogram

É. Presence of a hematoma in the perineum and scrotum

Ê. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. Patella alta

Explanation

Question 10279

Topic: 2. Trauma

Which of the following radiographic findings indicates that the injury to the great toe shown in Figures 60a and 60b should be reducible by closed manipulation?

. The sesamoids are separated

. The sesamoid is fractured

. The proximal phx is on the neck of the metatarsal

. The dislocation is dorsal and centered

. The proximal phalanx is hyperextended

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

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

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

#. Early and late infection

$. Periprosthetic fracture of the femur

%. Failure of the patellofemoral and extensor mechanisms

&. Aseptic loosening of cementing tibial components

'. Asceptic loosening of cemented femoral components

(. Acceptance of the current position of the ankle

). Open reduction and fixation in the epiphysis only

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

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

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

-. Resection arthroplasty and local radiation

.. In situ fusion of the hip

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

0. Excision of heterotopic bone and local radiation

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

2. Closed reduction of both fractures and immediate spica casting

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

4. External fixation of both femora

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

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

7. Synovial sarcoma

8. Soft-tissue abcess

9. Rhabdomyosarcoma

:. Eosinophilic granuloma

;. Nodular pigmented villonodular synovitis

<. Changing to a titanium nail

=. Changing to a nonslotted nail

>. Changing the cross-sectional shape of the nail

?. Increasing the diameter of the nail by 3 mm

@. Increasing the diameter of the interlocking screws

A. Fracture healing

B. Chondrosarcoma

C. Periosteal chondroma

D. Periosteal osteosarcoma

E. Dysplasia epiphysealis hemimelica

F. Demonstrate competence in the subject of the case

G. Be fellowship trained in the subject of the case

H. Be paid on a contingency basis

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

J. Have been involved in the case as a consultant

K. Diagnostic arthroscopy

L. Arthroscopy and subacromial decompression

M. Reduction and fixation of the proximal humeral epiphysis

N. Temporary cessation of throwing

O. Physical therapy for rotator cuff strengthening

P. Oblique popliteal ligament

Q. Lateral capsule

R. Popliteal tendon

S. Fibular collateral ligament

T. Posterior oblique ligament

U. Radial tear

V. Parrot-beak tear

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

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

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

Z. 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

A. Posterior tibial and its branches

B. Deep peroneal and its branches

C. Superficial peroneal and its branches

D. Strength

E. Stiffness

F. Shelf life

G. Antigenicity

H. Risk of HIV transmission

I. Indemnification

J. Occurrence

K. Excess liability

L. Claims-made

M. Nose

N. Lateral Y

O. Scapular AP

P. Neutral rotation AP

Q. Internal rotation AP

R. External rotation AP

S. Trauma

T. Hemophilia

U. Reiter’s syndrome

V. Rheumatoid arthritis

W. Systemic lupus erythematosus

X. Cast immobilization for 6 weeks

Y. Activity modification and re-evaluation in 2 months

Z. 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

. immobilization for 25 days

. Cystinosis

. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

. 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

. I

. II

. III

. decreased tissue tension

. decreased abductor lever arm

. decreased joint reaction force

. increased body weight over lever arm

. increased polyethylene wear rate

. recurrent traumatic anterior dislocation

. recurrent traumatic posterior dislocation

. traumatic subluxation with no previous dislocation

. traumatic anterior subluxation

. atraumatic involuntary subluxation

. radial

. axillary

. suprascapular

¡. thoracodorsal

¢. long thoracic

£. Flexion

¤. Extension

¥. Axial rotation

¦. Left lateral bending

§. Right lateral bending

¨. Skin

©. Lung

ª. Brain

«. Heart

¬. Kidney

. Thoracoacromial, lateral thoracic, subscapular

®. Thoracoacromial, anterior humeral circumflex, posterior humeral circumflex

¯. Posterior humeral circumflex, subscapular, thoracacromial

°. Subscapular, thoracacromial, anterior humeral circumflex

±. Lateral thoracic, anterior humeral circumflex, thoracacromial

². Respondeat superior

³. Indemnity agreement

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

Μ. Comparative negligence-% of involvement

¶. Contributory negligence- resident contributed to the negligence

·. t-type

¸. both column

¹. transverse

º. anterior column

». anterior column posterior hemitransverse

¼. Posterior interosseous

½. Anterior interosseous

¾. Radial

¿. Median

À. Ulnar

Á. Shock from hypovolemia

Â. Associated rupture of the bladder

Ã. Arterial bleeding on pelvic angiogram

Ä. Presence of a hematoma in the perineum and scrotum

Å. Fractures of both the anterior and posterior pelvic ring

Correct Answer & Explanation

. The sesamoids are separated

Explanation

Question 10280

Topic: 2. Trauma

Osteolysis, after total knee arthroplasty performed without cement, most often occurs in the

. Patella

. Tibial stem

. Distal femoral interface

. Posterior femoral interface

. Sites of screw fixation for the tibia

. Hallux rigidus

. Fracture of the sesamoid

. Disruption of the plantar plate

. Osteonecrosis of the metatarsal head

. Rupture of the flexor hallucis longus

. Gout

. Sepsis

. Old trauma

. Rheumatoid arthritis

. Charcot arthroplasty

. Aspiration and steroid injection

. Biopsy, curettage, and allograft bone grafting

. Percutaneous Kirschner wire fixation

. Percutaneous injection of autogenous bone marrow

. Nerve roots

. Spinal cord

. Sciatic nerve

. Peroneal nerve

. Conus medullaris

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

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

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

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

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

. Early and late infection

. Periprosthetic fracture of the femur

. Failure of the patellofemoral and extensor mechanisms

!. Aseptic loosening of cementing tibial components

". Asceptic loosening of cemented femoral components

#. Acceptance of the current position of the ankle

$. Open reduction and fixation in the epiphysis only

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

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

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

(. Resection arthroplasty and local radiation

). In situ fusion of the hip

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

+. Excision of heterotopic bone and local radiation

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

-. Closed reduction of both fractures and immediate spica casting

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

/. External fixation of both femora

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

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

2. Synovial sarcoma

3. Soft-tissue abcess

4. Rhabdomyosarcoma

5. Eosinophilic granuloma

6. Nodular pigmented villonodular synovitis

7. Changing to a titanium nail

8. Changing to a nonslotted nail

9. Changing the cross-sectional shape of the nail

:. Increasing the diameter of the nail by 3 mm

;. Increasing the diameter of the interlocking screws

<. Fracture healing

=. Chondrosarcoma

>. Periosteal chondroma

?. Periosteal osteosarcoma

@. Dysplasia epiphysealis hemimelica

A. Demonstrate competence in the subject of the case

B. Be fellowship trained in the subject of the case

C. Be paid on a contingency basis

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

E. Have been involved in the case as a consultant

F. Diagnostic arthroscopy

G. Arthroscopy and subacromial decompression

H. Reduction and fixation of the proximal humeral epiphysis

I. Temporary cessation of throwing

J. Physical therapy for rotator cuff strengthening

K. Oblique popliteal ligament

L. Lateral capsule

M. Popliteal tendon

N. Fibular collateral ligament

O. Posterior oblique ligament

P. Radial tear

Q. Parrot-beak tear

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

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

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

U. 0 degrees of abduction, with neural rotation

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

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

X. 90 degrees of abduction with neutral rotation

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

Z. Sural

[. Saphenous and its branches

\. Posterior tibial and its branches

]. Deep peroneal and its branches

^. Superficial peroneal and its branches

_. Strength

`. Stiffness

A. Shelf life

B. Antigenicity

C. Risk of HIV transmission

D. Indemnification

E. Occurrence

F. Excess liability

G. Claims-made

H. Nose

I. Lateral Y

J. Scapular AP

K. Neutral rotation AP

L. Internal rotation AP

M. External rotation AP

N. Trauma

O. Hemophilia

P. Reiter’s syndrome

Q. Rheumatoid arthritis

R. Systemic lupus erythematosus

S. Cast immobilization for 6 weeks

T. Activity modification and re-evaluation in 2 months

U. Internal fixation with or without bone grafting

V. Retrograde drilling of the defect without articular cartilage penetration

W. Drilling of the defect directly through the articular cartilage

X. repair or reconstruction of the medial collateral ligament

Y. repair or reconstruction of the medialand lateral collateral ligaments

Z. immobilization for 5 days or less

{. immobilization for 14 days

|. immobilization for 25 days

}. Cystinosis

~. Hypophosphatemia

. Renal osteodystrophy

. Primary hyperparathyroidism

. Nutritional vitamin D deficiency

. Lateral meniscus tear

. Popliteus tenosynovitis

. Iliotibial band friction syndrome

. Peroneal nerve entrapment

. Biceps tendinitis

. Observation

. 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

. I

. II

. III

. decreased tissue tension

. decreased abductor lever arm

. decreased joint reaction force

. increased body weight over lever arm

. increased polyethylene wear rate

. recurrent traumatic anterior dislocation

. recurrent traumatic posterior dislocation

. traumatic subluxation with no previous dislocation

. traumatic anterior subluxation

. atraumatic involuntary subluxation

. radial

. axillary

. suprascapular

. thoracodorsal

. long thoracic

. Flexion

. Extension

. Axial rotation

¡. Left lateral bending

¢. Right lateral bending

£. Skin

¤. Lung

¥. Brain

¦. Heart

§. Kidney

¨. Thoracoacromial, lateral thoracic, subscapular

ª. Posterior humeral circumflex, subscapular, thoracacromial

«. 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

². t-type

³. both column

´. transverse

Μ. anterior column

¶. anterior column posterior hemitransverse

·. Posterior interosseous

¸. Anterior interosseous

¹. Radial

º. Median

». Ulnar

¼. Shock from hypovolemia

½. Associated rupture of the bladder

¾. Arterial bleeding on pelvic angiogram

¿. Presence of a hematoma in the perineum and scrotum

À. Fractures of both the anterior and posterior pelvic ring

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. Patella

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2. Trauma MCQs

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