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8. Foot and Ankle MCQs

Practice Set 260 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 5181

Topic: 8. Foot and Ankle

A 10-year-old male presents with a bony prominence on the medial side of his ankle. Radiographs reveal an irregular, multi-lobulated ossified mass arising from the medial epiphysis of the distal tibia. What is the estimated incidence of this specific developmental disorder?

. 1 in 1,000
. 1 in 10,000
. 1 in 100,000
. 1 in 1,000,000
. 1 in 10,000,000

Correct Answer & Explanation

. 1 in 1,000,000

Explanation

Correct Answer: 1 in 1,000,000The patient's presentation is consistent with Dysplasia Epiphysealis Hemimelica (DEH) of the distal tibia. DEH is a very rare skeletal developmental disorder with an estimated incidence of 1 in 1,000,000.

Question 5182

Topic: 8. Foot and Ankle

A 10-year-old male presents with ankle stiffness and a palpable mass. The MRI and CT scans are shown below. Based on the provided text, which of the following statements regarding this condition is true?




. It most frequently involves the upper limbs.
. The lesion typically arises from the metaphysis.
. It is characterized by asymmetric epiphyseal enlargement with multiple ossification centers.
. Females are affected twice as frequently as males.

Correct Answer & Explanation

. It is characterized by asymmetric epiphyseal enlargement with multiple ossification centers.

Explanation

Correct Answer: It is characterized by asymmetric epiphyseal enlargement with multiple ossification centers.The imaging shows DEH localized on the lateral side of the talus. Radiographically, DEH is characterized by asymmetric epiphyseal enlargement with multiple ossification centers. It primarily affects the lower limbs, arises from the epiphysis, and males are affected twice as frequently as females.

Question 5183

Topic: 8. Foot and Ankle

Review the advanced imaging of the hindfoot in an 8-year-old child presenting with a stiff, painful ankle. Based on the typical behavior of this pathology, which radiographic feature is most characteristic?




. Symmetrical epiphyseal overgrowth
. Asymmetric epiphyseal enlargement with multiple ossification centers
. Central lytic lesion with a sclerotic rim
. Metaphyseal flaring with cortical thinning
. Diaphyseal periosteal reaction

Correct Answer & Explanation

. Asymmetric epiphyseal enlargement with multiple ossification centers

Explanation

Correct Answer: Asymmetric epiphyseal enlargement with multiple ossification centersThe MRI and CT slides show DEH localized on the lateral side of the talus. Characteristically, DEH presents on radiographs as asymmetric epiphyseal enlargement with multiple ossification centers. The involvement is typically hemimelic, meaning it is confined to either the medial or lateral side of the epiphysis.

Question 5184

Topic: 8. Foot and Ankle

Dysplasia Epiphysealis Hemimelica (DEH) most commonly affects the lower extremities. Which of the following bones is considered one of the most frequently involved sites?

. Proximal femur
. Patella
. Talus
. Calcaneus
. Cuboid

Correct Answer & Explanation

. Talus

Explanation

Correct Answer: TalusDEH usually occurs in the lower limb. The most commonly affected sites are the distal femur, distal tibia, and the talus. Upper limb involvement is extremely rare.

Question 5185

Topic: 8. Foot and Ankle

A 6-year-old boy presents with the clinical finding shown below. The mass is bone-hard and painless. Given the most likely diagnosis, which of the following bones is most frequently affected by this condition?



. Proximal humerus
. Distal radius
. Talus
. Proximal femur
. Calcaneus

Correct Answer & Explanation

. Talus

Explanation

Correct Answer: TalusThe clinical image demonstrates a bone-hard swelling at the lateral side of the ankle, characteristic of Dysplasia Epiphysealis Hemimelica (DEH) or Trevor's disease. DEH usually occurs in the lower limb, with the distal femur, distal tibia, and talus being the most commonly affected sites. Upper limb involvement is extremely rare.

Question 5186

Topic: 8. Foot and Ankle

A 10-year-old child presents with limited range of motion in the ankle. The imaging studies are shown below. Which of the following radiographic features is most characteristic of this pathology?



. Symmetrical epiphyseal enlargement
. Asymmetric epiphyseal enlargement with multiple ossification centers
. Diaphyseal cortical thickening with a radiolucent nidus
. Metaphyseal expansile lytic lesion with cortical thinning
. Epiphyseal collapse and fragmentation

Correct Answer & Explanation

. Asymmetric epiphyseal enlargement with multiple ossification centers

Explanation

Correct Answer: Asymmetric epiphyseal enlargement with multiple ossification centersThe imaging shows DEH localized on the lateral side of the talus. Characteristically, DEH lesions show on radiographs as asymmetric epiphyseal enlargement with multiple ossification centers. The involvement is typically hemimelic (affecting either the medial or lateral side of the epiphysis).

Question 5187

Topic: 8. Foot and Ankle

A pediatrician refers a patient with an asymmetric, bone-hard swelling of the medial ankle. You suspect Dysplasia Epiphysealis Hemimelica (DEH). What is the most common age range for the onset of this condition?

. Birth to 1 year
. 2 to 14 years
. 15 to 25 years
. 30 to 45 years
. Over 50 years

Correct Answer & Explanation

. 2 to 14 years

Explanation

Correct Answer: 2 to 14 yearsDysplasia epiphysealis hemimelica (DEH) is a rare skeletal developmental disorder affecting the epiphyses in young children. The age of onset is usually between 2 and 14 years.

Question 5188

Topic: 8. Foot and Ankle

The imaging below demonstrates a lesion characteristic of Dysplasia Epiphysealis Hemimelica. Which of the following best describes the typical anatomical distribution of this disease?



. It most commonly affects the proximal humerus and distal radius.
. It usually occurs in the lower limb, with the distal femur, distal tibia, and talus being most commonly affected.
. It is a polyostotic disease affecting the axial skeleton primarily.
. It predominantly involves the diaphysis of long bones.
. It is characterized by symmetrical, bilateral joint involvement.

Correct Answer & Explanation

. It usually occurs in the lower limb, with the distal femur, distal tibia, and talus being most commonly affected.

Explanation

Correct Answer: It usually occurs in the lower limb, with the distal femur, distal tibia, and talus being most commonly affected.The provided MRI and CT images show DEH localized on the lateral side of the talus. DEH usually occurs in the lower limb, with the distal femur, distal tibia, and talus being the most commonly affected sites. Upper limb involvement is extremely rare, and the disease is characteristically asymmetric (hemimelic).

Question 5189

Topic: 8. Foot and Ankle

The original term "tarso-epiphyseal aclasis" was used by Trevor in 1950 to describe this condition because it most frequently involves which tarsal bone?

. Calcaneus
. Cuboid
. Navicular
. Talus
. Medial Cuneiform

Correct Answer & Explanation

. Talus

Explanation

The talus is the most frequently affected tarsal bone in DEH. Trevor originally described the condition in the foot and ankle, hence the historical name Trevor's disease or tarso-epiphyseal aclasis.

Question 5190

Topic: 8. Foot and Ankle

In a patient diagnosed with Dysplasia Epiphysealis Hemimelica, which of the following anatomic locations is most frequently affected?

. Distal radius
. Proximal femur
. Talus
. Calcaneus
. Proximal humerus

Correct Answer & Explanation

. Talus

Explanation

The lower extremity is predominantly involved in DEH. The talus, distal femur, and proximal tibia are the most frequent sites, typically affecting the medial aspect of the joint.

Question 5191

Topic: 8. Foot and Ankle

According to the Azouz classification for Dysplasia Epiphysealis Hemimelica, which of the following defines the "classic" (or regional) form of the disease?

. Single epiphysis involvement
. Bilateral symmetric epiphyseal involvement
. More than one epiphysis in a single lower extremity
. Entire lower limb involvement from pelvis to foot
. Metaphyseal and epiphyseal involvement of a single joint

Correct Answer & Explanation

. Single epiphysis involvement

Explanation

The Azouz classification divides DEH into three types: localized (single epiphysis), classic/regional (more than one epiphysis in a single extremity), and generalized (entire lower limb).

Question 5192

Topic: 8. Foot and Ankle

A 4-year-old male presents with painless swelling over the medial aspect of the ankle and a progressive varus deformity. Radiographs demonstrate irregular, multicentric ossification centers arising from the medial aspect of the talar epiphysis. What is the most likely diagnosis?

. Dysplasia Epiphysealis Hemimelica
. Chondroblastoma
. Synovial Chondromatosis
. Multiple Hereditary Exostoses
. Ollier Disease

Correct Answer & Explanation

. Dysplasia Epiphysealis Hemimelica

Explanation

Dysplasia Epiphysealis Hemimelica (DEH), or Trevor disease, typically presents in young children as an asymmetrical epiphyseal overgrowth, most commonly affecting the medial talus or distal femur. The irregular epiphyseal ossification is pathognomonic.

Question 5193

Topic: 8. Foot and Ankle

According to the Azouz classification for Dysplasia Epiphysealis Hemimelica, a patient presenting with multiple lesions confined to a single lower extremity has which type of the disease?

. Localized
. Classic
. Generalized
. Polyostotic
. Syndromic

Correct Answer & Explanation

. Localized

Explanation

The Azouz classification divides DEH into three forms: Localized (single bone), Classic (multiple bones in a single lower limb), and Generalized (entire lower limb from pelvis to foot).

Question 5194

Topic: 8. Foot and Ankle

A 4-year-old girl is incidentally found to have a small, asymptomatic DEH lesion on her medial talus. She has full range of motion and no clinically evident deformity. What is the most appropriate management plan?

. Immediate en bloc resection
. Observation and serial clinical and radiographic follow-up
. Intra-articular corticosteroid injection
. Prophylactic epiphysiodesis of the distal tibia
. Chemotherapy to prevent malignant transformation

Correct Answer & Explanation

. Observation and serial clinical and radiographic follow-up

Explanation

Asymptomatic DEH lesions without significant deformity or mechanical block should be managed with observation. Surgical intervention is reserved for pain, deformity, or restricted motion.

Question 5195

Topic: 8. Foot and Ankle

A 4-year-old boy presents with ankle pain and the radiographic finding shown below.

Which bone/joint complex is most commonly affected by this condition overall?

. Proximal femur
. Proximal humerus
. Talus/Ankle
. Distal radius
. Calcaneus

Correct Answer & Explanation

. Talus/Ankle

Explanation

The ankle (specifically the talus and distal tibia) is the most common anatomical location affected by Dysplasia Epiphysealis Hemimelica (Trevor disease), followed closely by the knee.

Question 5196

Topic: 8. Foot and Ankle

An 8-year-old patient has DEH involving the ipsilateral proximal femur, distal femur, talus, and navicular bone. According to the Azouz classification, this wide distribution is termed:

. Multifocal
. Classic
. Generalized
. Syndromic
. Disseminated

Correct Answer & Explanation

. Generalized

Explanation

The Generalized form in the Azouz classification describes DEH involving the entire lower limb, spanning from the pelvis (or hip) down to the foot on the affected side.

Question 5197

Topic: 8. Foot and Ankle

A 6-year-old boy undergoes surgical excision of a symptomatic DEH lesion from the medial talus. Two years later, the swelling returns and joint motion becomes restricted again. What is the most common reason for this recurrence?

. Malignant transformation of residual cells
. Incomplete excision of the original lesion
. New mutation in the EXT1 gene
. Spontaneous seeding of the synovial membrane
. Natural progression to the generalized form

Correct Answer & Explanation

. Incomplete excision of the original lesion

Explanation

Recurrence of DEH after surgical excision is relatively common and is almost always due to incomplete removal of the cartilaginous cap or underlying epiphyseal lesion.

Question 5198

Topic: 8. Foot and Ankle

A 6-year-old boy presents with an asymmetric cartilaginous overgrowth affecting the medial aspect of the distal femur, proximal tibia, and talus of the right lower extremity. Clinical and radiographic evaluation confirms the absence of lesions in the left lower extremity and upper limbs. According to the Azouz classification for Dysplasia Epiphysealis Hemimelica (DEH), how is this specific pattern categorized?

. Localized
. Classic (Regional)
. Generalized
. Bilateral symmetrical
. Disseminated

Correct Answer & Explanation

. Classic (Regional)

Explanation

The Azouz classification divides DEH into three types: localized (involving a single epiphysis), classic/regional (involving multiple epiphyses within a single limb), and generalized (involving multiple limbs). This patient's presentation of multiple lesions in the right lower extremity fits the 'classic' or 'regional' category, which is the most common presentation.

Question 5199

Topic: 8. Foot and Ankle

A 4-year-old boy presents with asymmetric enlargement of the right ankle joint. Radiographs confirm a diagnosis of Dysplasia Epiphysealis Hemimelica of the distal tibia.

Regarding the characteristic anatomical distribution of this pathology within a single affected long bone epiphysis, which pattern is overwhelmingly the most common?

. Complete uniform epiphyseal enlargement
. Primary involvement of the metaphyseal center
. Exclusive involvement of the diaphysis
. Predilection for the lateral half of the epiphysis
. Predilection for the medial half of the epiphysis

Correct Answer & Explanation

. Predilection for the medial half of the epiphysis

Explanation

Dysplasia Epiphysealis Hemimelica typically affects only one half of the epiphysis (hemimelica). In the lower extremities, which are the most common sites of involvement, the medial half of the epiphysis is affected roughly twice as often as the lateral half.

Question 5200

Topic: Midfoot & Hindfoot
A 55-year-old diabetic male presents with an acute, red, hot, swollen foot. Radiographs demonstrate bone fragmentation, subluxation, and periarticular debris around the midfoot. According to the Eichenholtz classification of Charcot arthropathy, which stage does this represent?
. Stage 0 (Pre-clinical)
. Stage II (Coalescence)
. Stage I (Developmental)
. Stage III (Consolidation)
. Stage IV (Remodeling)

Correct Answer & Explanation

. Stage I (Developmental)

Explanation

Eichenholtz Stage I (Developmental/Fragmentation stage) is characterized by acute inflammation, joint laxity, bone fragmentation, and debris formation. The foot mimics infection clinically but represents acute neuropathic breakdown.

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