8. Foot and Ankle MCQs

On an AP radiograph, tibiofibular overlap should be > 6 mm. On a mortise radiograph, the normal tibiofibular overlap should be > 1 mm. The tibiofibular clear space (measured 1 cm proximal to the plafond) should be < 5 mm on both AP and mortise views.

On a standard AP view of the foot, the medial border of the 2nd metatarsal aligns with the medial border of the middle cuneiform. On the 30-degree internal oblique view, the medial border of the 4th metatarsal should align with the medial border of the cuboid. Any step-off indicates a midfoot dislocation/Lisfranc injury.

The sustentaculum tali is referred to as the 'constant fragment' because it remains strongly tethered to the talus despite massive displacement of the rest of the calcaneus. This relationship is maintained primarily by the very strong interosseous talocalcaneal ligament (along with contributions from the medial talocalcaneal ligament and deltoid ligament). Recognizing the position of this fragment is essential for surgical reduction, as the tuberosity fragment is brought to the constant fragment.

During the remodeling phase of tendon healing, which begins around 6 weeks post-injury, the initially deposited disorganized Type III collagen is gradually replaced by stronger, longitudinally oriented Type I collagen.

Maximal ankle dorsiflexion (approximately 10 to 15 degrees) occurs during terminal stance, just before heel-off. This position allows the body's center of mass to advance smoothly over the planted foot.

The sequence of injury according to the Lauge-Hansen classification system in supination-external rotation injuries is AITFL disruption, spiral oblique fracture of the lateral malleolus, PITFL disruption or posterior malleolus fracture, and finally stage IV, which is a deltoid ligament disruption or medial malleolus fracture.

Figure D shows a pronation abduction ankle fracture according to the Lauge-Hansen classification. This injury pattern is associated with a comminuted fibula fracture above the level of the syndesmosis and frequently has a concominant syndesmotic injury.Lauge-Hansen's classic article describes in detail his proposed classification of ankle fractures based on both the position of the foot (supination or pronation) and an externally applied deforming force (adduction, abduction, external rotation). The Lauge-Hansen classification system is based on cadaveric experiments using manually applied forces and roentographs performed at each stage of injury.Edwards and DeLee review their results in managing diastasis of the tibiofibular joint without an associated fracture. The authors propose a classification system of this uncommon injury and and theorize that the injury results from a pronation abduction mechanism.Incorrect Answers:Answer 1: Figure A represents a supination adduction fracture based on the vertical medial malleolar fracture, medial dislocation on the talus, and low transverse fibula fracture.Answer 2: Figure B represents a pronation external rotation injury; note the high oblique fibula fracture and corresponding transverse medial malleolus fracture.Answer 3: Figure C represents a supination external rotation ankle injury based on the oblique fibula fracture at the level of syndesmosis and the associated transverse medial malleolar fracture.Answer 4: Figure E represents a pilon fracture based on the significant articular comminution signifiying an axial loading mechanism instead of a rotational injury.

Weakness of the tibialis anterior can be noted with a tendency of the foot to slap the floor at heel strike. Extension of the toes during the swing phase of gait may be due to the toe extensors attempting to substitute for weakness of the tibialis anterior. Because this patient is young and has flexible deformities, avoiding arthrodesis is recommended and soft-tissue procedures are recommended to balance the foot. The plantar fascia release helps decrease the cavus. Transfer of the tibialis posterior tendon to the dorsum of the foot is necessary to provide dorsiflexion and limit the slapping of the foot on the floor.Transfer of the extensor hallucis longus to the metatarsal neckaddresses the claw toe deformity of the great toe and the flexor digitorum longus transfer provides additional dorsiflexion assist. Because the patient has a flexible deformity, osteotomies are unlikely to be needed.

This patient most likely has an acute attack of gout. The prior episodes of foot pain and the sudden onset lasting 5 days for each bout is characteristic. The ankle is not a common location for gout (the most frequent site is the hallux metatarsophalangeal joint). The treatment should consist of injection of a corticosteroid into the joint and administration of appropriate oral anti-inflammatory medication.

Osteochondrosis of the tarsal navicular (Kohler's disease) is most commonly identified between the ages of 2 and 9 years. The condition is benign and self-limited in nature. Management usually consists of observation or a supportive orthotic.

for this finding?6. 1- The arthritis has stabilized.7. 2- The C1-2 joint has fused.8. 3- The patient has been wearing a cervical collar.9. 4- Medical advancements have been made in the management of arthritis.10. 5- Basilar impression (atlantoaxial impaction) has developed.1. answer1. back1. Question 01.872. Answer = 51. back to this question1. next question1. Reference(s)2. Oda T, Fujiwara K, Yonenobu K, Azuma B, Ochi T: Natural course of cervical spine lesions in rheumatoid arthritis. Spine 1995;20:1128-1135.1. 01.88 A woman with degenerative arthritis and a fixed genu valgum deformity of 17°2. undergoes primary total knee arthroplasty under general anesthesia. In the3. recovery room, she is unable to dorsiflex her foot. Immediate management4. should include5. 1- fasciotomies.6. 2- surgical nerve decompression.7. 3- flexion of the knee.8. 4- continuous passive motion.9. 5- electromyography.1. answer1. back1. Question 01.882. Answer = 31. back to this question1. next question1. Reference(s)2. Mont MA, Dellon AL, Chen F, Hungerford MW, Krackow KA, Hungerford DS: The operative treatment of peroneal nerve palsy. J Bone Joint Surg Am 1996;78:863-869. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 559-582.1. 01.89 A 30-year-old professional soccer player sustains a midshaft fracture of the tibia2. and fibula. History reveals that the patient underwent a successful anterior3. cruciate ligament reconstruction with central one third bone-patellar tendon-bone4. autograft and graft fixation with interference screws 2 years ago. Figures 22a and5. 22b show the pre-and postoperative radiograph. What is the most likely6. postoperative complication in this patient?7. 1- Loss of graft fixation8. 2- Fracture through the tibial9. tunnel10. 3- Galvanic corrosion11. (battery effect)12. 4- Anterior knee pain13. 5- Saphenous neuralgia1. answer1. back1. A1. B1. Figures 221. Question 01.892. Answer = 41. back to this question1. next question1. Reference(s)2. Keating JF, Orfaly R, O'Brien PJ: Knee pain after tibial nailing. J Orthop Trauma 1997;11:10-13. Roberts C, John C, Seligson D: Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture. Arthroscopy 1998;14:779-783.1. 01.90 Which of the following muscles protracts the shoulder?2. 1- Serratus anterior3. 2- Rhomboid major4. 3- Trapezius5. 4- Latissimus dorsi6. 5- Subscapularis1. answer1. back1. Question 01.902. Answer = 11. back to this question1. next question1. Reference(s)2. Kahn JF, Plancher KD, Hawkins RJ: Scapular winging. J Am Acad Orthop Surg 1995;3:319-325.1. 01.91 Which of the following pharmacologic agents may antagonize the2. anticoagulation effect of warfarin?3. 1- Cefamandole4. 2- Cimetidine5. 3- Phenytoin6. 4- Trimethoprim7. 5- Phenobarbital1. answer1. back1. Question 01.912. Answer = 51. back to this question1. next question1. Reference(s)2. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 487-517.1. 01.92 Figures 23a and 23b show an AP open mouth view and a CT scan at C1-2.2. Because this is an acute injury with no neurologic deficit, the best course of3. action should be4. 1- acute occipital-cervical fusion with rigid instrumentation.5. 2- use of a soft collar.6. 3- use of a halo vest for 3 months, followed by assessment for C1-2 instability.7. 4- a gradual return to activity with no restrictions.8. 5- flexion-extension radiographs to help determine the need for surgery.1. answer1. back1. A1. B1. Figures 231. Question 01.922. Answer = 31. back to this question1. next question1. Reference(s)2. Levine AM: Orthopaedic Knowledge Update: Trauma. Rosemont. IL. American Academy of Orthopaedic Surgeons, 1996, pp 317-322.1. 01.93 Item deleted after statistical review2. (and no answer or references cited)1. back1. next question1. 01.94 Item deleted after statistical review2. (and no answer or references cited)1. back1. next question1. 01.95 Intradiscal pressure in the third lumbar disk is least in which of the following2. positions?3. 1- Sitting, flexed forward slightly4. 2- Sitting, straight5. 3- Laying, supine6. 4- Standing, straight7. 5- Standing, slightly extended1. answer1. back1. Question 01.952. Answer = 31. back to this question1. next question1. Reference(s)2. Nachemson A: The lumbar spine: An orthopaedic challenge. Spine 1976;1:59-71. White AA II, Panjabi MM (eds): Clinical Biomechanics of the Spine, ed 2. Philadelphia, PA, JB Lippincott, 1990, pp 454-461.1. 01.96 A 35-year-old man who sustained a grade II open fracture of the right tibia 92. months ago underwent reamed intramedullary nailing. The patient continues to3. have pain with weight bearing. Laboratory studies show a normal WBC and4. erythrocyte sedimentation rate, and there has been no change in the radiographs5. in the past 3 months. Current radiographs are shown in Figures 24a and 24b.6. What is the most likely diagnosis?7. 1- Delayed union8. 2- Aseptic nonunion9. 3- Infected nonunion10. 4- Synovial pseudarthrosis11. 5- Failure of the internal fixation device1. answer1. back1. A1. B1. Figures 241. Question 01.962. Answer = 21. back to this question1. next question1. Reference(s)2. Browner BD, Jupiter JB, Levine AM, Trafton PB (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 68-72. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 25-35.1. 01.97 Figure 25 shows the AP radiograph of a 20-year-old man who sustained a2. twisting injury to his foot. An attempt at closed reduction is unsuccessful, most3. likely because of4. 1- buttonholing of the talar head through the extensor retinaculum.5. 2- osteochondral fracture of the posterior facet of the talus.6. 3- interpositioning of the peroneal tendons.7. 4- interpositioning of the posterior tibial tendon.8. 5- fracture of the talar neck.1. answer1. back1. Figure 251. Question 01.972. Answer = 41. back to this question1. next question1. Reference(s)2. Bellabarba C, Sanders R: Dislocation of the foot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 1519-1573. Hansen ST 1r: Foot injuries, in Browner BD, Jupiter JB, Levine AM, Trafton PB (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 2405-2438. DeLee JC, Curtis R: Subtalar dislocation of the foot. J Bone Joint Surg Am 1982;64:433-437.1. 01/. 98 A 65-year-old man has had progressively worsening pain and limited motion in2. the left shoulder for the past year. History reveals that he sustained a3. nondisplaced fracture of the surgical neck of the humerus 10 years ago. Plain4. radiographs are shown in Figures 26a and 26b. What is the most likely5. diagnosis?6. 1- Osteonecrosis7. 2- Posttraumatic osteoarthritis8. 3- Rheumatoid arthritis9. 4- Gouty arthritis10. 5- Chondrocalcinosis1. answer1. back1. A1. B1. Figures 261. Question 01.982. Answer = 21. back to this question1. next question1. Reference(s)2. Matsen FA III, Rock-wood CA Jr, Wirth MA, Lippitt SB: Glenohumeral arthritis and its management, in Rockwood CA Jr, Matsen FA III, Wirth MA, Harryman DT II (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1998, pp 840-964.1. 01.99 A 14-year-old basketball player has had activity-related low back pain for the2. past 6 weeks. Plain radiographs are unremarkable. Selected coronal single-3. photon emission computed tomography scans are shown in Figure 27. The best4. course of action should be5. 1- bilateral facet blocks.6. 2- brace immobilization for 3 to 6 months.7. 3- instrumented posterior spinal fusion.8. 4- a CT-guided needle biopsy.9. 5- an open incisional biopsy.1. answer1. back1. Figure 271. Question 01.992. Answer = 21. back to this question1. next question1. Reference(s)2. Loder RT, Hensinger RN: Fractures of the thoracic and lumbar spine, in Rockwood CA, Wilkins KE, Beaty 1H (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 1062-1096. Lonstein JE: Spondylolysis and spondylolisthesis, in Morrissy RT, Weinstein SL (eds): Lovell and Winter's Pediatric Orthopaedics, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 717-737. Congeni J, McCulloch J, Swanson K: Lumbar spondylolysis: A study of natural progression in athletes. Am J Sports Med 1997;25:248-253. Lonstein JE: Spondylolisthesis in children: Cause. natural history, and management. Spine 19994:2640-2648. Anderson K, Sarwark JF, Conway JJ, Logue ES, Schafer WI: Quantitative assessment with SPELT imaging of stress injuries of the pats interarticularis and response to bracing. J Pediatr Orthop 2000;20:28-33.1. 01.100 Which of the following is considered an advantage of the inside-out technique2. for meniscal repairs compared with the outside-in technique?3. 1- Improved ultimate knee motion4. 2- Increased rate of healing5. 3- Diminished infection rates6. 4- The ability to achieve proper suture orientation in posterior horn tears7. 5- Decreased risk of neurologic injury1. answer1. back1. Question 01.1002. Answer = 41. back to this question1. next question1. Reference(s)2. Rodeo SA: Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect 2000;49:195-206. Post WR, Akers SR, Kish V: Load to failure of common meniscal repair techniques: Effects of suture technique and suture material. Arthroscopy 1997;13:731-736.1. 01.101 An anterior (Smith-Peterson) approach to the hip joint uses what internervous2. plane?3. 1- Superior gluteal and femoral4. 2- Superior gluteal and inferior gluteal5. 3- Femoral and obturator6. 4- Sciatic and superior gluteal7. 5- Sciatic and femoral1. answer1. back1. Question 01.1012. Answer = 11. back to this question1. next question1. Reference(s)2. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia, PA, Lippincott Williams & Wilkins, 1984, pp 303-32I.1. 01.102 A 21-year-old man sustains the acetabular fracture shown in Figures 28a2. through 28c. The best outcomes following surgical treatment of this fracture3. have been reported with which4. of the following surgical5. approaches?6. 1- Posterior (Kocher-Langenbeck)7. 2- Triradiate8. 3- Extended iliofemoral9. 4- Modified extensile lateral10. 5- Ilioinguinal1. answer1. back1. A1. B1. Figures 281. C1. Question 01.1022. Answer = 51. back to this question1. next question1. Reference(s)2. Letournel E: The treatment of acetabular fractures through the ilioinguinal approach. Clip Orthop 1993;292:62-76.1. 01.103 What type of injury is shown in Figure 29?2. 1- Compression fracture3. 2- Burst fracture4. 3- Flexion-distraction5. 4- Extension injury6. 5- Fracture-dislocation1. answer1. back1. Figure 29 (all three)1. Question 01.1032. Answer = 21. back to this question1. next question1. Reference(s)2. Dents F: The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 1983;8:817-831.1. 01.104 A 55-year-old patient underwent a total hip arthroplasty with a diaphyseal -2. locking, fully porous-coated cementless femoral prosthesis 8 years ago.3. Radiographs reveal a distally fixed stem with distal spot welds and proximal4. bone loss. The femoral head is located concentrically within the acetabulum.5. What is the most likely etiology of the bone loss?6. 1- Bone hypertrophy7. 2- Stress shielding8. 3- Osteoporosis9. 4- Osteolysis10. 5- Osteonecrosis1. answer1. back1. Question 01.1042. Answer = 21. back to this question1. next question1. Reference(s)2. Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American3. Academy of Orthopaedic Surgeons, 1995, pp 127-138.1. 01.105 Endurance strength training has been shown to have which of the following2. demonstrated physiologic effects?3. 1- Decreases aerobic capacity4. 2- Decreases bone mineral density with weight-bearing activities5. 3- Decreases type II muscle fiber cross-sectional area6. 4- Increases heart rate at rest7. 5- Improves blood lipid profiles1. answer1. back1. Question 01.1052. Answer = 51. back to this question1. next question1. Reference(s)2. Miszko T, Cress M: A lifetime of fitness, in Clinics in Sports Medicine. Philadelphia, PA, WB Saunders, 2000, vol 19, pp 215-232. Blumenthal JA, Emery CF, Madden DJ, et al: Cardiovascular and behavioral effects of aerobic exercise training in healthy older men and woman. J Gerontol3. 1989;44:147-157.1. 01.106 What organ secretes calcitonin?2. 1- Parathyroid3. 2- Thyroid4. 3- Kidney5. 4- Bone6. 5- Skin1. answer1. back1. Question 01.1062. Answer = 21. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Silver JJ, Majeska RJ, Einhorn TA: An update on bone cell biology. Curr Opin Orthop 1994;5:50-59.1. 01.107 The volar radioscapholunate ligament (ligament of Testut) functions primarily2. as a3. 1- neurovascular conduit.4. 2- stabilizing ligament of the scapholunate interval.5. 3- stabilizing ligament of the radiocarpal joint.6. 4- stabilizing ligament of the midcarpal joint.7. 5- septal ligament contiguous with the interfossal ridge.1. answer1. back1. Question 01.1072. Answer = 11. back to this question1. next question1. Reference(s)2. Berger RA, Landsmeer JM: The palmar radiocarpal ligaments: A study of adult and fetal human wrist joints. J Hand Surg Am 1990;15:847-854. Hixson ML, Stewart C: Microvascular anatomy of the radioscapholunate ligament of the wrist. J Hand Surg Am 1990;15:279-282.1. 01.108 A 19-year-old man reports groin pain after undergoing antegrade nailing of a2. femoral shaft fracture 3 weeks ago. Figures 30a and 30b show the current3. radiograph and tomogram. The next most appropriate step in management4. should consist of5. 1- observation.6. 2- electrical stimulation.7. 3- resection of8. heterotopic9. ossification.10. 4- exchange nailing.11. 5- screw fixation12. around the nail.1. answer1. back1. A1. B1. Figures 11. Question 01.1082. Answer = 51. back to this question1. next question1. Reference(s)2. Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL, American Academy of Orthopaedic3. Surgeons, 2000, pp 177-190.1. 01.109 What is the most common mechanism of injury to the adult spinal cord?2. 1- Gunshot wounds3. 2- Falls4. 3- Motor vehicle accidents5. 4- Sporting injuries6. 5- Suicide attempts1. answer1. back1. Question 01.1092. Answer = 31. back to this question1. next question1. Reference(s)2. Slucky AV, Eismont FJ: Treatment of acute injury of the cervical spine. Instr Course Lect 1995;44:67-80. Vaccaro AR, An HS, Betz RR, Coder JM, Balderston RA: The management of acute spinal trauma: Prehospital and in-hospital emergency care. Instr Course Lect 1997;46:113-125.1. 01.110 A 33-year-old woman has had progressive rheumatoid arthritis for the past 122. years. Figure 31 shows the postoperative radiograph. What is the most likely3. long-term symptomatic complication following this procedure?4. 1- Nonunion of the first metatarsophalangeal joint5. 2- Chronic infection6. 3- Plantar callosities7. 4- Recurrent hammer toe deformity8. 5- Interphalangeal joint arthritis of the great toe1. answer1. back1. Figure 311. Question 01.1102. Answer = 31. back to this question1. next question1. Reference(s)2. Coughlin MJ: Rheumatoid forefoot reconstruction: A long-term follow-up study. J Bone Joint Surg Am 2000;82:322-341. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998,3. pp 293-303.1. 01.111 A 12-year-old boy is referred for evaluation of a spinal deformity. Examination2. and history reveal that he and one of his two sisters have numerous light brown3. birthmarks distributed on all areas of the body. The radiograph shown in Figure4. 32 reveals a curve that measures 70°. The best course of action should include5. 1- MRI of the entire spine.6. 2- brace treatment with a thoracolumbosacral7. orthosis.8. 3- posterior spinal fusion and observation for9. possible crankshaft progression of the curve.10. 4- a period of observation to determine whether the11. curve may progress.12. 5- a renal ultrasound and echocardiogram.1. answer1. back1. Figure 321. Question 01.1112. Answer = 11. back to this question1. next question1. Reference(s)2. Crawford AH: Neurofibromatosis, in Weinstein SL (ed): The Pediatric Spine: Principles and Practice. New York, NY, Raven Press, 1994, pp 619-650. Crawford AH, Gabriel KR: Dysplastic scoliosis: Neurofibromatosis, in Bridwell KH, DeWald RL (eds): The Textbook of Spinal Surgery, ed 2. Philadelphia, PA,3. Lippincott-Raven, 1997, pp 276-298.1. 01.112 A 33-year-old man fell from a height of 25 feet and sustained a fracture-2. dislocation of the right elbow. Following closed reduction of the elbow in the3. emergency department, plain radiographs show a displaced radial neck and a4. type II coronoid fracture. Examination reveals elbow swelling and wrist5. tenderness. The neurologic examination is normal. Treatment of the elbow6. should include7. 1- excision of the radial head and coronoid fragment.8. 2- excision of the radial head and open reduction and internal fixation of the coronoid.9. 3- open reduction and internal fixation of the radial head and excision of the coronoid10. fragment.11. 4- open reduction and internal fixation of the radial head and coronoid.12. 5- replacement of the radial head and excision of the coronoid fragment.1. answer1. back1. Question 01.1122. Answer = 41. back to this question1. next question1. Reference(s)2. Hotchkiss RN: Displaced fractures of the radial head: Internal fixation or excision? Am Acad Orthop Surg 1997;5:1-10. Money BF: Acute and chronic instability of the elbow. J Am Acad Orthop Surg 1996;4:117-128. Began W, Money B: Fractures of the coronoid process of the ulna,. J Bone Joint Surg Am 1989;71:1348-1354.1. 01.113 A 21-year-old patient sustains a fracture of the humeral shaft that is treated as2. shown in Figures 33a and 33b. The reported incidence of shoulder problems3. following this method of fracture stabilization is approximately what percent?4. 1- 0% to 5%5. 2- 6% to 10%6. 3- 11% to 15%7. 4- 16% to 20%8. 5- 21 % to 25 %1. answer1. back1. A1. B1. Figures 331. Question 01.1132. Answer = 11. back to this question1. next question1. Reference(s)2. Chapman JR, Henley MB, Agel J, Benca PJ: Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma 2000;14:162-166. McCormack RG, Briers D, Buckley RE, McKee MD, Powell J, Schemitsch EH: Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg Br 2000;82:336-339.1. 01.114 A revision total knee arthroplasty was performed on a patient who was2. presumed to have aseptic loosening. Antibiotic-impregnated cement was used3. at the time of reimplantation. Interface membrane cultures taken routinely at4. the time of the revision revealed coagulase-negative staphylococci 2 days after5. surgery. Appropriate management should consist of6. 1- antibiotic therapy alone.7. 2- surgical debridement with polyethylene exchange.8. 3- one-staged exchange of both components.9. 4- two-staged exchange of both components.10. 5- knee fusion.1. answer1. back1. Question 01.1142. Answer = 11. back to this question1. next question1. Reference(s)2. Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB: Infection after total knee arthroplasry: A retrospective study of the treatment of eighty-one infections.3. J Bone Joint Sur- Am 1999;81:1434-1445.1. 01.115 A 38-year-old man underwent anterior cruciate ligament reconstruction 122. weeks ago. Examination of the knee now reveals active arc of motion from 15°3. to 80°. Patellar mobility is limited. Radiographs reveal appropriate tunnel4. placement. Management should now consist of5. 1- physical therapy.6. 2- continuous passive motion.7. 3- open debridement.8. 4- arthroscopic debridement.9. 5- manipulation under anesthesia.1. answer1. back1. Question 01.1152. Answer = 41. back to this question1. next question1. Reference(s)2. Lindenfeld TN, Wojtys EM, Husain A: Surgical treatment of arthrofibrosis of the knee. Instr Course Lect 2000;49:211-221. Richmond JC, al Assal M: Arthroscopic management of arthrofibrosis of the knee, including infrapatellar contraction syndrome. Arthroscopy 1991;7:144-147.1. 01.116 Which of the following radiographic findings is most helpful in differentiating2. chordoma from chondrosarcoma of the sacrum?3. 1- Bright signal intensity on T1-weighted MRI scan4. 2- Lytic destruction5. 3- Midline location6. 4- Uptake on bone scan7. 5- Soft-tissue extension1. answer1. back1. Question 01.1162. Answer = 31. back to this question1. next question1. Reference(s)2. Smith J, Ludwig RL, Marcove RC: Sacrococcygeal chordoma: A clinicoradiological study of 60 patients. Skeletal Radiol 1987: 16:37-44. Firooznia H, Pinto RS, Lin JP, Baruch HH, Zausner J: Chordoma: Radiologic evaluation of 20 cases. Am J Roentgenol 1976;127:797-805. Temple WJ: Sacral bone tumors. Can J Surg 1994;37:446.1. 01.117 A 21-year-old student sustains a twisting injury to the ankle. Examination2. reveals some tenderness over the anteromedial ankle and significant pain and3. tenderness over the lateral malleolus. A stress radiograph in external rotation is4. shown in Figure 34. Definitive treatment should consist of5. 1- weight bearing as tolerated in a functional brace.6. 2- a short leg cast with no weight bearing for 6 weeks.7. 3- a long leg cast with no weight bearing for 6 weeks.8. 4- open reduction and internal fixation of the lateral malleolus.9. 5- open reduction and internal fixation of the lateral malleolus and repair of the deltoid10. ligament.1. answer1. back1. Figure 341. Question 01.1172. Answer = 11. back to this question1. next question1. Reference(s)2. Principles of orthopaedic practice, in Dee R (ed): Ankle Injuries. New York, NY, McGraw Hill, 1997, pp 538-543. Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL, American Academy of Orthopaedic3. Surgeons, 2000, pp 203-225.1. 01.118 The mother of a 1-month-old infant reports that he seems to sniff and snort2. persistently and his temperature has been very labile. Examination reveals a3. depressed nasal bridge, mild jaundice, and hepatosplenomegaly. Radiographs4. are shown in Figures 35a and 35b. To help confirm the diagnosis, the best5. course of action would be to order6. 1- a rapid plasma reagin (RPR) test.7. 2- a technetium Tc 99m total body bone scan.8. 3- CT of the skull and upper cervical spine.9. 4- needle aspiration of both tibiae.10. 5- bilateral hip ultrasound studies.1. answer1. back1. A1. B1. Figures 351. Question 01.1182. Answer = 11. back to this question1. next question1. Reference(s)2. Richards BS (ed): Orthopaedic Knowledge Update: Pediatrics. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 35-46. Brion LP, Manuli M, Rai B, Kresch MJ, Pavlov H, Glaser J: Long-bone radiographic abnormalities as a sign of active congenital syphilis in asymptomatic newborns. Pediatrics 1991;88:1037-10401. 01.119 Figure 36 shows an axial T1-weighted MRI scan at L4-5. The arrow is2. pointing to what structure?3. 1- Spinous process4. 2- Herniated disk5. 3- Epidural fat6. 4- Ligamentum flavum7. 5- Facet joint1. answer1. back1. Question 01.1192. Answer = 31. back to this question1. next question1. Reference(s)2. Author states there is no reference.1. 01.120 What is the most severe side effect of doxorubicin (Adriamycin)?2. 1- Neurotoxicity3. 2- Ototoxicity4. 3- Cardiac toxicity5. 4- Hemorrhagic cystitis6. 5- Pulmonary fibrosis1. answer1. back1. Question 01.1202. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty 1H (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 167-189. Burgert EO Jr, Nesbit ME, Garnsey LA, et al: Multimodal therapy for the management of nonpelvic, localized Ewing's sarcoma of bone: Intergroup study IESS-II J Clin Oncol 1990;8:1514-1524.1. 01.121 Which of the following procedures is most likely to result in a hooked nail2. deformity following fingertip amputation?3. 1- Split-thickness skin grafting4. 2- Reimplantation of the avulsed skin5. 3- Local advancement flap6. 4- Nail removal for associated nail bed repair7. 5- Primary closure1. answer1. back1. Question 01.1212. Answer = 51. back to this question1. next question1. Reference(s)2. Zook EG, Brown RE: The perionychium, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill3. Livingstone, 1999, pp 1353-1380. Zook EG, Russell RC: Reconstruction of a functional and esthetic nail. Hand Clin 1990;6:59-68.1. 01.122 Which of the following shoe insert (orthosis) materials has the greatest shock-2. absorbing properties?3. 1- Cross-linked polyethylene foam4. 2- Rubberized cork5. 3- Polypropylene6. 4- Carbon epoxy resin7. 5- Natural leather1. answer1. back1. Question 01.1222. Answer = 11. back to this question1. next question1. Reference(s)2. Shiba N, Kitaoka HB, Cahalan TD, Chao EY: Shock-absorbing effect of shoe insert materials commonly used in management of lower extremity disorders. Clin Orthop 1995;310:130-136. Wapner KL: Conservative treatment of the foot, in Coughlin MJ, Mann RA (eds): . Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 115-130.1. 01.123 What type of major pelvic ring injury has the greatest average transfusion2. requirement?3. 1- Lateral compression4. 2- Vertical shear5. 3- Anteroposterior compression6. 4- Fractures through the sacrum7. 5- Fractures through the iliac wing1. answer1. back1. Question 01.1232. Answer = 31. back to this question1. next question1. Reference(s)2. Turen CH, Dube MA, LeCroy MC: Approach to the polytraumatized patient with musculoskeletal injuries. J Am Acad Orthop Surg 1999;7:154-165. Dalal SA, Burgess AR, Siegel JH, et al: Pelvic fracture in multiple trauma: Classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989;29:981-1002.1. 01.124 Where does the nutrient artery to the tibia most commonly enter the bone?2. 1- Anteriorly above the pes anserinus3. 2- Anteriorly 4 cm above the ankle4. 3- Laterally above the fibular head5. 4- Posteriorly below the posterior cruciate ligament insertion6. 5- Posteriorly in the medial malleolus1. answer1. back1. Question 01.1242. Answer = 41. back to this question1. next question1. Reference(s)2. Brinker MR, Cook SD, Dunlap IN, Christakis P, Elliott MN: Early changes in nutrient artery blood flow following tibial nailing with and without reaming: A preliminary study. J Orthop Trauma 1999;13:129-133.1. 01.125 An 11-year-old soccer player has had left lateral ankle pain for the past 62. months. Examination shows increased heel valgus and decreased subtalar3. motion on the left side. Ankle range of motion and stability are symmetric.4. Radiographs of the foot and ankle are normal. The next most appropriate step5. in management should consist of6. 1- observation with follow-up in 6 months.7. 2- a full shoe orthosis with medial heel posting left.8. 3- left sinus tarsi injections with local anesthetic.9. 4- comparative stress radiographs of both ankles.10. 5- CT of the left foot.1. answer1. back1. Question 01.1252. Answer = 51. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL., American Academy of Orthopaedic Surgeons, 1999, pp 583-595. Wechsler RJ, Schweitzer ME, Deely DM, Horn BD, Pizzutillo PD: Tarsal coalition: Depiction and characterization with CT and MR imaging. Radiology3. 1994;193:447-452.1. 01.126 What complication is significantly more common among octogenarians who2. undergo concomitant bilateral total knee arthroplasty than those who undergo3. unilateral total knee arthroplasty?4. 1- Deep wound infection5. 2- Aseptic loosening6. 3- Periprosthetic fracture7. 4- Congestive heart failure8. 5- Pneumonia1. answer1. back1. Question 01.1262. Answer = 41. back to this question1. next question1. Reference(s)2. Lynch NM, Trousdale RT, Ilstrup DM: Complications after concomitant bilateral total knee arthroplasty in elderly patients. Mayo Clin Proc 1997;72:799-805. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 559-582.1. 01.127 A 53-year-old man has had low back pain2. and perineal fullness for the past 183. months. A plain radiograph is shown in4. Figure 37a, a CT scan is shown in Figure5. 37b, and a biopsy specimen is shown in6. Figure 37c. What is the most likely7. diagnosis?8. 1- Chordoma9. 2- Plasmacytoma10. 3- Fibrosarcoma11. 4- Liposarcoma12. 5- Metastatic carcinoma1. answer1. back1. A1. B1. Figures 371. C1. Question 01.1272. Answer = 11. back to this question1. next question1. Reference(s)2. Primary bone tumors, in McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiographic Correlation. Philadelphia, PA, WB Saunders, 1998, pp 195-276. Bruckner 1D, Conrad EU: Spine, in Simon MA. Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 435-450.1. 01.128 What is the most common soft-tissue tumor in children?2. 1- Ganglion3. 2- Hemangioma4. 3- Fibroma5. 4- Lipoma6. 5- Sarcoma1. answer1. back1. Question 01.1282. Answer = 21. back to this question1. next question1. Reference(s)2. Conrad EU, Enneking WR: Clinical Symposium: Common Soft Tissue Tumors, ed 2. New York, NY, Ciba-Geigy, 1990.1. 01.129 Which of the following is considered the most important factor in fracture2. healing in adults?3. 1- Age of the patient4. 2- Gender of the patient5. 3- Neurologic status of the extremity6. 4- Blood supply7. 5- Fracture pattern1. answer1. back1. Question 01.1292. Answer = 41. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American3. Academy of Orthopaedic Surgeons, 2000, pp 372-399.1. 01.130 A 67-year-old woman reports progressively worsening buttock pain.2. Examination reveals a mass affixed to the region of the posterior ilium. Figures3. 38a through 38d show a plain radiograph, a posterior view bone scan, a CT4. scan, and a biopsy specimen. What is the most likely diagnosis?5. 1- Dedifferentiated chondrosarcoma6. 2- Malignant fibrous histiocytoma7. 3- Fibrosarcoma8. 4- Pagetoid osteosarcoma9. 5- Osteomyelitis1. back1. A1. B1. Figures 381. Go to next slide for remaining2. figures and3. answer link1. Figures 381. D1. C1. answer1. back to question1. Question 01.1301. Question 01.1302. Answer = 41. back to this question1. next question1. Reference(s)2. Grimer RJ, Carter SR, Tillman RM, et al: Osteosarcoma of the pelvis. J Bone Joint Surg Br 1999;81:796-802. Harrington KD: Surgical management of neoplastic complications of Paget's disease. J Bone Miner Res 1999;2:45-48.1. 01.131 A 23-year-old woman has had chronic swelling in the ankle for the past year2. with no history of injury. Plain radiographs are normal. At ankle arthroscopy,3. the articular surfaces appear normal. The synovial tissue is inflamed and friable;4. a biopsy specimen of the synovium is shown in Figure 39. What is the most5. likely diagnosis?6. 1- Tuberculosis7. 2- Synovial cell sarcoma8. 3- Pigmented villonodular synovitis9. 4- Rheumatoid arthritis10. 5- Chondrocalcinosis1. answer1. back1. Figure 391. Question 01.1312. Answer = 31. back to this question1. next question1. Reference(s)2. Ghert MA, Scully SP, Harrelson JM: Pigmented villonodular synovitis of the foot and ankle: A review of six cases. Foot Ankle Int 1999;20:326-330. Rao AS, Vigorita VJ: Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane): A review of eighty-one cases. J Bone Joint Surg Am 1984;66:76-94.1. 01.132 Figure 40 shows the radiograph of a 24-year-old woman who has ulnar-sided2. wrist pain. Nonsurgical management consisting of splinting, physical therapy,3. and activity modifications has failed to provide relief. Examination reveals a4. stable distal radioulnar joint and a negative triangular fibrocartilage complex5. grind. Pain is reproduced when the wrist is dorsiflexed and the forearm is then6. supinated but not when the forearm is7. pronated. Treatment should now consist of8. 1- partial ulnar styloidectomy.9. 2- triangular fibrocartilage complex rim repair.10. 3- debridement of the extensor carpi ulnaris tendon11. sheath.12. 4- a radial lengthening osteotomy.13. 5- an ulnar shortening osteotomy.1. answer1. back1. Figure 401. Question 01.1322. Answer = 11. back to this question1. next question1. Reference(s)2. Topper SM, Wood MB, Ruby LK: Ulnar styloid impaction syndrome. J Hand Surg Am 19972:699-704. Topper SM, Wood MB, Ruby LK Ulnar styloid impaction syndrome, in Sulfar P, Amadio PC, Foucher G (eds): Current Practice in Hand Surgery. London, England, Martin Dunitz, 1997, pp 261-268.1. 01.133 A patient with diabetes mellitus has an ulcer on the plantar aspect of the foot.2. Which of these test results best correlates with the patient's ability to heal this3. ulcer?4. 1- Toe pressures of greater than 45 mm Hg5. 2- An arterial brachial index of 0.406. 3- Capillary refill time in the toes of greater than 3 seconds7. 4- Ability to detect greater than a 5.07 Semmes -Weinstein monofilament8. 5- A hemoglobin A3 level of greater than 4%1. answer1. back1. Question 01.1332. Answer = 11. back to this question1. next question1. Reference(s)2. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 113-121. Brodsky JW: The diabetic foot. in Coughlin MJ. Mann RA (eds)- Surgery of the root and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 895-969.1. 01.134 A 42-year-old woman who has had a low-grade aching pain in her forearm for2. the past 4 years recently fell on the arm and now reports markedly increased3. pain. A plain radiograph and biopsy specimen are shown in Figures 41a and4. 41b. What is the most likely diagnosis?5. 1- Chondroblastoma6. 2- Chondrosarcoma7. 3- Chondromyxoid fibroma8. 4- Adamantinoma9. 5- Enchondroma1. answer1. back1. A1. Figures 411. B1. Question 01.1342. Answer = 21. back to this question1. next question1. Reference(s)2. Weis L: Common malignant bone tumors: Chondrosarcoma, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 275-286. Primary bone tumors, in McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiographic Correlation. Philadelphia, PA, WB Saunders, 1998, pp 195-276.1. 01.135 To prevent abnormal patellofemoral contact loading after insertion of a2. retrograde femoral nail through an intra-articular starting portal, the surgeon3. should4. 1- seat the nail beneath the articular surface.5. 2- use a patellar tendon-splitting approach.6. 3- use an unreamed technique.7. 4- perform a lateral release.8. 5- perform a medial parapatellar arthrotomy.1. answer1. back1. Question 01.1352. Answer = 11. back to this question1. next question1. Reference(s)2. Moed B, Watson JT: Retrograde nailing of the femoral shaft. J Am Acad Orthop Surg 1999;7:209-216. Morgan E, Ostrum RF, DiCicco J, McElroy J, Poka A: Effects of retrograde femoral intramedullary nailing on the patellofemoral articulation. J Orthop Trauma 1999;13:13-16.1. 01.136 A woman who is in the 20th week of her pregnancy seeks an orthopaedic2. consultation after undergoing an ultrasound. The findings reveal that the fetus3. has bilateral clubfeet and both femurs measure less than two standard4. deviations below normal. What is the most likely diagnosis?5. 1- Myelomeningocele6. 2- Bilateral proximal focal femoral deficiency7. 3- Diastrophic dysplasia8. 4- Achondroplasia9. 5- Spondylometaphyseal dysplasia1. answer1. back1. Question 01.1362. Answer = 31. back to this question1. next question1. Reference(s)2. Horton WA, Hall JG, Scott CI, Pyeritz RE, Rimoin DL: Growth curves for height for diastrophic dysplasia, spondyloepiphyseal dysplasia congenita, and pseudoachondroplasia. Am J Dis Child 1982;136:316-319. Ryoppy S, Poussa M, Merikanto J, Marttinen E, Kaitila I: Foot deformities in diastrophic dysplasia: An analysis of 102 patients. J Bone Joint Surg Br 1992;74:441-44.4.1. 01.137 A 47-year old woman has right groin pain. An AP radiograph of the pelvis and2. a biopsy specimen are shown in Figures 42a and 42b. What is the most likely3. diagnosis?4. 1- Ollier's disease5. 2- Paget's disease6. 3- Metastatic carcinoma7. 4- Aneurysmal bone cyst8. 5- Fibrous dysplasia1. answer1. back1. A1. B1. Figures 421. Question 01.1372. Answer = 51. back to this question1. next question1. Reference(s)2. Primary bone tumors, in McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiographic Correlation. Philadelphia, PA, WB Saunders, 1998, pp 195-276. Gitelis S, McDonald DJ: Common benign bone tumors and usual treatment, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 275-286.1. 01.138 Acute hypotension, hypoxemia, cardiac arrest, and sudden death are events that2. are most commonly encountered in what stage of total hip arthroplasty?3. 1- Exposure4. 2- Acetabular reaming5. 3- Broaching the femur6. 4- Impaction of the acetabular component7. 5- Cementing of the femoral component1. answer1. back1. Question 01.1382. Answer = 51. back to this question1. next question1. Reference(s)2. Pitto RP, Koessler M, Kuehle JW: Comparison of fixation of the femoral component without cement and fixation with use of a bone-vacuum cementing technique for the prevention of fat embolism during total hip arthroplasry: A3. prospective, randomized clinical trial. J Bone Joint Surg Am 1999;81:831-843.1. 01.139 A 35-year-old woman falls on the ice and sustains an isolated minimally2. displaced radial head fracture. Management should include3. 1- use of a posterior splint and sling at all times for 6 weeks.4. 2- use of a sling until radiologic union is achieved.5. 3- application of a cast in 7 to 10 days.6. 4- application of a hinged elbow orthosis in 3 weeks.7. 5- a program of active range of motion in 1 week.1. answer1. back1. Question 01.1392. Answer = 51. back to this question1. next question1. Reference(s)2. Morrey BF: Radial head fractures, in Morrey BF (ed): The Elbow and Its Disorders. Philadelphia, PA, WE Saunders, 1985, pp 355-381. Levine AM (ed): Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 47-55.1. 01.140 An asymptomatic 10-year-old boy is referred for evaluation of a limb-length2. discrepancy that measures less than 2 cm. Examination reveals that the most3. lateral ray of the ipsilateral foot is absent, and the ipsilateral knee is unstable to4. Lachman and anterior drawer tests. Figure 43 shows an AP radiograph of the5. ankle. Management of the knee should consist of6. 1- anterior cruciate ligament reconstruction using a7. quadruple hamstring technique.8. 2- anterior cruciate ligament reconstruction using an9. allograft in the over-the-top position.10. 3- observation.11. 4- an aggressive physical therapy program that12. emphasizes open chain techniques.13. 5- functional knee bracing until skeletal maturity,14. followed by anterior cruciate ligament reconstruction.1. answer1. back1. Figure 431. Question 01.1402. Answer = 31. back to this question1. next question1. Reference(s)2. Achterman C, Kalamchi A: Congenital deficiency of the fibula. J Bone Joint Surg Br 1979;61:133-137. Roux MO, Cariioz H: Clinical examination and investigation of the cruciate ligaments in children with fibular hemimelia. J Pediatr Orthop 1999;19:247-251. Stevens PM, Arms D: Postaxial hypoplasia of the lower extremity. J Pediatr Orthop 2000;20:166-172.1. 01.141 A nonrandomized prospective study of the efficacy of a new diagnostic test to2. detect deep venous thrombosis has just been completed. Each patient had3. venography as the definitive test to detect the thrombosis. Of the 100 patients4. tested, 10 were true positives, 30 were false negatives, 40 were true negatives,5. and 20 were false positives. What is the sensitivity of the new test?6. 1- 25 %7. 2- 30%8. 3- 50 %9. 4- 59%10. 5- 67 %1. answer1. back1. Question 01.1412. Answer = 11. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American3. Academy of Orthopaedic Surgeons, 2000, pp 308-316.1. 01.142 When treating tibial plateau fractures, the most important reason that proximal2. tibial transfixation wires should be placed at least 14 mm from the articular3. surface is to4. 1- obtain good fixation in subchondral bone.5. 2- allow radiographic visualization of the joint reduction.6. 3- minimize the risk that septic arthritis will develop.7. 4- increase the range of knee flexion.8. 5- compress the articular fragments.1. answer1. back1. Question 01.1422. Answer = 31. back to this question1. next question1. Reference(s)2. DeCoster TA, Crawford M.K, Kraut VIA: Safe extracapsular placement of proximal tibia transfixation pins. J Orthop Trauma 1999;13:236-240. Reid JS, Van Slyke MA, Moulton MJ, Mann TA: Safe placement of proximal tibial transfixation wires with respect to intracapsular penetration. J Orthop Trauma 2001;15:10-17.1. 01.143 A 17-year-old girl reports a 4-month history of progressively worsening left2. arm pain. A plain radiograph and biopsy specimen are shown in Figures 44a3. and 44b. After complete staging, management should consist of4. 1- forequarter amputation alone.5. 2- radiation therapy and chemotherapy.6. 3- radiation therapy and wide surgical excision.7. 4- chemotherapy and wide surgical excision.8. 5- wide surgical excision alone.1. answer1. back1. A1. B1. Figures 441. Question 01.1432. Answer = 41. back to this question1. next question1. Reference(s)2. Primary bone tumors, in McCarthy EF, Frassica FJ (eds): Pathology of Bone and Joint Disorders with Clinical and Radiographic Correlation. Philadelphia., PA.3. WB Saunders, 1998, pp 195-276. Weis L: Common malignant bone tumors: Osteosarcoma, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA, Lippincott-Raven, 1998, pp 265-274. Goorin A: Chemotherapy for osteosarcoma and Ewing's sarcoma, in Simon MA, Springfield D (eds): Surgery for Bone and Soft-Tissue Tumors. Philadelphia, PA,4. Lippincott-Raven, 1998, pp 239-244.1. 01.144 Figure 45 shows the initial clinical photograph of a 70-year-old woman. The2. deformity of the second toe may recur after attempted surgical reconstruction.3. Dysfunction of what structure allows for recurrence?4. 1- Dorsal capsule5. 2- Plantar plate6. 3- Medial collateral ligament7. 4- Lateral collateral ligament8. 5- Transverse intermetatarsal ligament1. answer1. back1. Figure 451. Question 01.1442. Answer = 21. back to this question1. next question1. Reference(s)2. Yao L, Cracchiolo A, Farahani K, Seeger LL: Magnetic resonance imaging of plantar plate rupture. Foot Ankle Int 1996;17:33-36. Deland JT, Sung IH: The medial crossover toe: A cadaveric dissection. Foot Ankle Int 2000;21:375-378.1. 01.145 A 25-year-old rugby player who sustained blunt trauma to the right dominant2. long finger 2 days ago now reports pain over the dorsum of the digit and3. clicking when he flexes and extends the digit. Examination reveals swelling4. and ecchymosis over the metacarpophalangeal joint, as well as a palpable5. subluxation of the extrinsic extensor tendon over the metacarpophalangeal6. joint with joint flexion and extension. Management should consist of7. 1- surgical repair of the sagittal band.8. 2- surgical repair of the spiral oblique retinacular ligament.9. 3- surgical repair of the triangular ligament.10. 4- splinting the metacarpophalangeal joint at 70° of flexion.11. 5- a program of early active motion with buddy taping.1. answer1. back1. Question 01.1452. Answer = 11. back to this question1. next question1. Reference(s)2. Ishizuki M: Traumatic and spontaneous dislocation of extensor tendon of the long finger. J Hand Surg Am 1990;15:967-972. Rayan GM, Murray D: Classification and treatment of closed sagittal band injuries. J Hand Surg Am 1994;19:590-594.1. 01.146 When placing lateral mass screws in the midcervical spine, where is the2. vertebral artery located in relation to the starting point for screw insertion?3. 1- Medial4. 2- Lateral5. 3- Anterior6. 4- Posterior7. 5- Superior1. answer1. back1. Question 01.1462. Answer = 31. back to this question1. next question1. Reference(s)2. Levine AM: Orthopaedic Knowledge Update: Trauma. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 335-339.1. 01.147 A 30-year-old man underwent an arthroscopic Bankart repair with suture2. anchors 6 months ago. While the patient reports that the shoulder is stable, he3. notes anterior shoulder pain and crepitation. Figure 46 shows an arthroscopic4. view of the anterior shoulder joint. The next most appropriate step in5. management should consist of6. 1- an intra-articular culture.7. 2- rotator cuff repair.8. 3- removal of the anchors.9. 4- arthroscopic releases.10. 5- exchange of the metallic11. anchor for a bioabsorbable12. device.1. answer1. back1. Figure 461. Question 01.1472. Answer = 31. back to this question1. next question1. Reference(s)2. Kaar TY, Schenck RC Jr, Worth MA, Rockwood CA Jr.- Complications of metallic suture anchors in shoulder surgery: A report of 8 cases. Arthroscopy 2001;17:31-37. Zuckerman JD, Matsen FA III: Complications about the glenohumeral joint related to the use of screws and staples. J Bone Joint Surg Am 1984;66:175-1801. 01.148 A 32-year-old man notes a lump on the side of his neck and undergoes a lymph2. node biopsy. Following the procedure, the patient reports pain in the shoulder3. girdle and is unable to elevate his shoulder. Which of the following structures4. has most likely been injured?5. 1- Trapezius muscle6. 2- Sternocleidomastoid muscle7. 3- Axillary nerve8. 4- Cranial nerve XI9. 5- Suprascapular nerve1. answer1. back1. Question 01.1482. Answer = 41. back to this question1. next question1. Reference(s)2. Leffert RD: Neurologic problems, in Rockwood CA, Matsen FA (eds): The Shoulder. Philadelphia, PA, WB Saunders, 1990, p 759. Bigliani LU, Perez-Sanz JR, Wolfe IN: Treatment of trapezius paralysis. J Bone Joint Surg Am 1985;67:871-877.1. 01.149 A 40-year-old woman with steroid-dependent Crohn's disease has had pain and swelling2. of the left ankle for the past 5 days. She has a plugged central line for parenteral feeding.3. Examination of the ankle reveals focal inflammation and limited range of motion. She is4. sensitive to the 4.17 Semmes-Weinstein monofilament test. Radiographs are shown in5. Figures 47a and 47b. The next most appropriate step in management should consist of6. 1- a biopsy of the talus.7. 2- a bone scan.8. 3- aspiration and culture of the ankle.9. 4- no weight bearing and a total contact cast for 1 week.10. 5- a brace with calipers.1. answer1. back1. A1. B1. Figures 471. Question 01.1492. Answer = 31. back to this question1. next question1. Reference(s)2. Mielants H, Veys EM: The gut in the pondyloarthropathies. J Rheumatol 1990;17:7-10. Myerson M: Foot and Ankle Disorders. Philadelphia, PA, WB Saunders, 2000, pp 1215-1216.1. 01.150 What structures are located within the femoral canal as it passes beneath the2. inguinal ligament?3. 1- Femoral artery, femoral vein, and femoral nerve4. 2- Femoral artery and femoral vein5. 3- Femoral artery, femoral vein, and lymphatics6. 4- Femoral artery, femoral vein, femoral nerve, and lymphatics7. 5- Internal iliac artery, internal iliac vein, and femoral nerve1. answer1. back1. Question 01.1502. Answer = 31. back to this question1. next question1. Reference(s)2. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach. ed 2. Philadelphia. PA. JB Lippincott, 1994. pp 362-275.1. 01.151 A 6-month-old boy with L1 myelomeningocele has bilateral dislocated hips.2. Examination reveals that the hips are clinically reducible, and there are no3. significant hip or knee joint contractures. The best course of action for both4. hips should consist of5. 1- observation.6. 2- application of a Pavlik harness.7. 3- application of a rigid hip abduction orthosis.8. 4- closed reduction with a hip spica cast.9. 5- open reduction via an adductor approach.1. answer1. back1. Question 01.1512. Answer = 11. back to this question1. next question1. Reference(s)2. Heeg M, Broughton NS, Menelaus MB: Bilateral dislocation of the hip in spins bifida: A long-term follow-up study. J Pediatr Orthop 1998;18:434-436. Broughton NS, Menelaus MB, Cole WG, Shurtleff DB: The natural history of hip deformity in myelomeningocele. J Bone Joint Surg Br 1993;75:760-763.1. 01.152 Sterilization of ultra-high molecular-weight polyethylene by irradiation in an2. inert environment (argon, nitrogen, or vacuum) is recommended because it3. 1- increases crystallinity.4. 2- prevents free radical formation.5. 3- prevents immediate oxidative degradation.6. 4- prevents component shrinkage.7. 5- provides better sterility.1. answer1. back1. Question 01.1522. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 47-53. Deng M, Shalaby SW: Lang-term gamma irradiation effects on ultrahigh molecular weight polyethylene. J Biomed Mater Res 2001;54:428-435.1. 01.153 A 13-year-old girl reports activity-related pain in her left leg with no history of2. trauma. Figures 48a through 48d show a plain radiograph, T1- and T2-weighted3. MRI scans, and a biopsy specimen. What is the most likely diagnosis?4. 1- Ewing's sarcoma5. 2- Osteomyelitis6. 3- Fibrous dysplasia7. 4- Adamantinoma8. 5- Tibial stress fracture1. back1. A1. B1. Figures 481. Go to next slide for remaining figures and answer link1. Figures 481. D1. C1. answer1. back to question1. Question 01.1531. Question 01.1532. Answer = 51. back to this question1. next question1. Reference(s)2. Jeske JM, Lomasney LM, Demos TC, Vade A, Bielski RJ: Longitudinal tibial stress fracture. Orthopedics 1996;19:263,66,68,70. Shearman CM, Brandser EA, Parman LM, et al: Longitudinal tibial stress fractures: A report of eight cases and review of the literature. J Comput Assist Tomogr 1998;22:265-269.1. 01.154 A 30-year-old woman who underwent total hip arthroplasty for osteonecrosis 62. months ago is now seeking a second opinion for her limp. What is the most3. significant radiographic finding shown in Figure 49?4. 1- Contralateral osteonecrosis5. 2- Prosthetic loosening6. 3- Heterotopic ossification7. 4- Stress shielding8. 5- Limb-length inequality1. answer1. back1. Figure 491. Question 01.1542. Answer = 51. back to this question1. next question1. Reference(s)2. Woolson ST: Leg length equalization during total hip replacement. Orthopedics 1990;13:17-21. Shaw JA, Greet RB III: Complications of total hip replacement, in Epps CH Jr (ed): Complication in Orthopaedic Surgery. Philadelphia, PA, JB Lippincott,3. 1994, pp 1013-1056.1. 01.155 Figure 50 shows the radiograph of a 24-year-old patient who has a slightly painful swollen distal finger. What is the most likely diagnosis?2. 1- Glomus tumor3. 2- Giant cell tumor4. 3- Intraosseous ganglion5. 4- Foreign body granuloma6. 5- Inclusion cyst1. answer1. back1. Question 01.1552. Answer = 51. back to this question1. next question1. Reference(s)2. Schajowicz F, Aiello CL, Slullitel I: Cystic and pseudocystic lesions of the terminal phalanx with special reference to epidermoid cysts. Clip Orthop 1970;68:84-92. Athanasian EA: Bone and soft-tissue tumors, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 2223-2253.1. 01.156 A 4-year-old boy has a painful spinal deformity. Figures 51a through 51d show2. a lateral spine radiograph, whole body bone scan, a lateral T1-weighted MRI3. scan, and a needle biopsy specimen. What is the most likely diagnosis?4. 1- Tuberculosis5. 2- Metastatic neuroblastoma6. 3- Chordoma7. 4- Diskitis8. 5- Ewing's sarcoma1. back1. A1. B1. Figures 511. Go to next slide2. for remaining3. figures and4. answer link1. Figures 511. D1. C1. answer1. back to question1. Question 01.1561. Question 01.1562. Answer = 11. back to this question1. next question1. Reference(s)2. Mushkin AY, Kovalenko KN: Neurological complications of spinal tuberculosis in children. Int Orthop 1999;23:210-212. Sudarshan K: Tuberculosis of bones and joints. J Bone Joint Surg Am 1997;79:1891.1. 01.157 A 19-year-old man sustained a fracture-dislocation of the ankle and a talar neck2. and body fracture when his foot was run over by a truck. Examination reveals3. no pulse in the ankle and an ischemic foot. The anterior and posterior tibial4. arteries are transected. He has no other injuries. A clinical photograph is shown5. in Figure 52. Treatment should consist of6. 1- repair of the posterior tibial artery and ankle fusion.7. 2- repair of the anterior tibial artery and pantalar fusion.8. 3- repair of both tibial arteries and internal fixation of the talus.9. 4- repair of the posterior tibial artery and nerve and external fixation.10. 5- amputation.1. answer1. back1. Figure 521. Question 01.1572. Answer = 51. back to this question1. next question1. Reference(s)2. Gregory P, Sanders R: The management of severe fractures of the lower extremities. Clip Orthop 1995;318:95-105.3. Tornetta P III, Olson SA (eds): Amputation versus limb salvage. Instr Course Lect 1997;46:511-518.1. 01.158 In an animal model, the use of anabolic steroids on muscle contusion injury has2. been shown to3. 1- be similar to placebo controls.4. 2- be similar to corticosteroids with respect to muscle strength recovery in the long5. term.6. 3- be more effective than corticosteroids with respect to muscle strength recovery in the7. long term.8. 4- be less effective than corticosteroids with respect to muscle strength recovery in the9. long term.10. 5- result in severely disorganized muscle fiber architecture.1. answer1. back1. Question 01.1582. Answer = 31. back to this question1. next question1. Reference(s)2. Beiner JM, Jokl P, Cholewicki J, Panjabi MM: The effect of anabolic steroids and corticosteroids on healing of muscle contusion injury. Am J Sports Med 1999;27:2-9. Tingus SJ, Carlsen RC: Effect of continuous infusion of an anabolic steroid on marine skeletal muscle. Med Sci Sports Exert 1993;25:485-494.1. 01.159 When performing a surgical debridement for a painful irreparable rotator cuff2. tear, it is important to3. 1- tenodese the biceps.4. 2- excise the distal clavicle (Mumford procedure).5. 3- preserve the coracohumeral ligament.6. 4- preserve the coracoacromial ligament.7. 5- advance the deltoid origin.1. answer1. back1. Question 01.1592. Answer = 41. back to this question1. next question1. Reference(s)2. Ellman H, Hanker G, Bayer M: Repair of the rotator cuff: End-result study of factors influencing reconstruction. J Bone Joint Surg Am 1986;68:1136-1144. Hanyman DT II, Mack LA. Wang KY, Jackins SE, Richardson ML, Matsen FA III: Repairs of the rotator cuff: Correlation of functional results with integrity of3. the cuff. J Bone Joint Surg Am 1991;73:982-989.1. 01.160 A patient with developmental dysplasia of the hip is undergoing open2. reduction. Which of the following is considered an advantage of using a medial3. approach compared with an anterior approach?4. 1- A lower incidence of osteonecrosis5. 2- Access for performance of capsulorrhaphy6. 3- Access to the transverse acetabular ligament7. 4- Better ability to reduce an inverted labrum8. 5- Better visualization of the lateral femoral cutaneous nerve1. answer1. back1. Question 01.1602. Answer = 31. back to this question1. next question1. Reference(s)2. Turner Y, Ward WT, Grudziak J: Medial open reduction in the treatment of developmental dislocation of the hip. J Pediatr Orthop 1997;17:176-180. Mankey MG, Arntz GT, Staheli LT: Open reduction through a medial approach for congenital dislocation of the hip: A critical review of the Ludloff approach in sixty-six hips. J Bone Joint Surg Am 1993;75:1334-1345.1. 01.161 A 35-year-old laborer sustains a irreparable fracture of the radial head after2. falling 12 feet. Examination reveals tenderness at the elbow and wrist and pain3. with manipulation of the distal radioulnar joint. In addition to resection of the4. radial head, management should include5. 1- hinged bracing of the elbow.6. 2- immobilization in a long arm cast.7. 3- prosthetic replacement of the radial head.8. 4- repair of the distal radioulnar joint.9. 5- application of a hinged external fixator.1. answer1. back1. Question 01.1612. Answer = 31. back to this question1. next question1. Reference(s)2. Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL,, American Academy of Orthopaedic Surgeons, 2000, pp 39-51. Hotchkiss RN: An KN, Sowa DT, Banta S, Weiland AJ: An anatomic and mechanical study of the interosseous membrane of the forearm: Pathomechanics of proximal migration of the radius. J Hand Surg Am 1989;14:256-261.1. 01.162 Which of the following treatments has been shown to prevent the formation of2. heterotopic ossification after total hip arthroplasty in patients who are at high3. risk?4. 1- Alendronate5. 2- Acetaminophen6. 3- Preoperative radiation7. 4- Calcitonin8. 5- Parathormone1. answer1. back1. Question 01.1622. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kolbl O: Prevention of heterotopic ossification after total hip replacement: A prospective, randomised study using acetylsalicylic acid, indomethacin and fractional or single-dose, irradiation. J Bone Joint Surg Br 1997;79:596-602. Pellegrini VD Jr, Gregoritch SJ: Preoperative irradiation for prevention of heterotopic ossification following total hip arthroplasty. J Bone Joint Sung Am 1996;78:870-881.1. 01.163 A 38-year-old landscaper was treated with internal and external fixation for a2. severe pilon fracture. Radiographs obtained at 3 months and 1 year are shown3. in Figures 53a and 53b. He now reports increasing pain over the past 4 months4. and is unable to walk uphill or stand for more than 2 hours. Examination5. reveals range of motion from neutral to 5° of plantar flexion. Use of a short leg6. brace with a rocker bottom sole after screw removal provides some pain relief,7. but he still has too much pain to work. Management should now consist of8. 1- manipulation of the ankle under anesthesia.9. 2- arthroscopic debridement of the ankle.10. 3- ankle arthroplasty.11. 4- ankle fusion.12. 5- subtalar fusion.1. answer1. back1. A1. B1. Figures 531. Question 01.1632. Answer = 41. back to this question1. next question1. Reference(s)2. Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL, American Academy of Orthopaedic3. Surgeons, 2000, pp 191-202.1. 01.164 Which of the following factors best predicts the increased risk for development2. of a foot ulcer in a patient with diabetes mellitus?3. 1- A history of a previous foot ulcer4. 2- A history of poor blood glucose control5. 3- Type I diabetes for more than 10 years6. 4- Ability to detect a 5.07 Semmes-Weinstein monofilament, on the plantar surface of7. the foot8. 5- Nonpalpable pulses with an ankle-brachial index (ABI) of greater than 0.51. answer1. back1. Question 01.1642. Answer = 11. back to this question1. next question1. Reference(s)2. McDermott JE (ed): The Diabetic Foot. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 1-12. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998,3. pp 113-12I. Brodsky JW: The diabetic foot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 895-969.1. 01.165 A study is being designed to compare the results of two new drugs on bone2. mineral density. The number of subjects needed for this study should be3. determined by4. 1- Student's t test.5. 2- power analysis.6. 3- probability distribution.7. 4- regression analysis.8. 5- Spearman rank correlation.1. answer1. back1. Question 01.1652. Answer = 21. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 2-17.1. 01.166 A 17-year-old basketball player sustains an ankle eversion injury on a fast2. break. She notes immediate anteromedial ankle pain and swelling and is unable3. to bear weight. The next most appropriate step in management should consist4. of5. 1- ice and protected weight bearing.6. 2- functional ankle bracing treatment.7. 3- a short leg cast.8. 4- radiographs.9. 5- MRI.1. answer1. back1. Question 01.1662. Answer = 41. back to this question1. next question1. Reference(s)2. Roberts CS, DeMaio M, Larkin JJ, Paine R: Eversion ankle sprains. Orthopedics 1995;18:299-304. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons 1999, pp 597-612.1. 01.167 Following reinsertion of the distal biceps tendon, early rehabilitation should2. include3. 1- active elbow flexion and active forearm supination.4. 2- active elbow flexion and passive forearm supination.5. 3- active elbow extension and active forearm supination.6. 4- passive elbow extension and active forearm supination.7. 5- passive elbow flexion and passive forearm supination.1. answer1. back1. Question 01.1672. Answer = 51. back to this question1. next question1. Reference(s)2. Money BF: Tendon injuries about the elbow, in Moray BF (ed): The Elbow and Its Disorders, ed 2. Philadelphia, PA, WB Sounders, 1993, pp 492-504. Sotereanos DG, Pierce TD, Varitimidis SE: A simplified method for repair of distal biceps tendon ruptures. J Shoulder Elbow Sung 2000;9:227-233.1. 01.168 In the absence of a visible fracture on radiographs, the presence of a positive2. posterior fat pad sign following trauma of the elbow in a 5-year-old child most3. likely represents4. 1- a normal radiographic finding.5. 2- a soft-tissue contusion.6. 3- nursemaid's elbow.7. 4- an occult fracture.8. 5- synovial hypertrophy.1. answer1. back1. Question 01.1682. Answer = 41. back to this question1. next question1. Reference(s)2. Skaggs DL, Mirzayan R: The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Sung Am 1999;81:1429-1433. Donnelly LF, Klostermeier TT, Klosterman LA: Traumatic elbow effusions in pediatric patients: Are occult fractures the rule? Am J Roentgenol 1998;171:243-245.1. 01.169 Thumb adduction in low ulnar nerve palsy is provided by the2. 1- extensor pollicis longus.3. 2- extensor pollicis brevis.4. 3- flexor pollicis brevis.5. 4- first dorsal interosseous.6. 5- accessory head of the flexor pollicis longus (Gantzer's muscle).1. answer1. back1. Question 01.1692. Answer = 11. back to this question1. next question1. Reference(s)2. Smith RJ: Tendon Transfers of the Hand and Forearm. Boston, MA, Little Brown, 1987, pp 85-102. Hamlin C, Littler JW: Restoration of power pinch. J Hand Surg Am 1980;5:396-401.1. 01.170 The parents of a 6-month-old infant report that she has been unwilling to move2. her left upper extremity for the past 5 hours. An AP radiograph and an MRI3. scan are shown in Figures 54a and 54b. Based on these findings and after4. initial treatment, a consultation should be arranged with5. 1- child protection services.6. 2- a geneticist.7. 3- a nephrologist.8. 4- a rheumatologist.9. 5- an infectious disease10. specialist.1. answer1. back1. A1. B1. Figures 541. Question 01.1702. Answer = 11. back to this question1. next question1. Reference(s)2. DeLee JC, Wilkins KE, Rogers LF, Rockwood CA: Fracture-separation of the distal humeral epiphysis. J Bone Joint Surg Am 1980;62:46-51. Cramer KE, Green NE: Child abuse, in Green NE, Swiontkowski MF (eds): Skeletal Trauma in Children, ed 2. Philadelphia, PA, WB Sounders, 1998, pp 577-594. Nimkin K, Kleinman PK. Teeger S, Spevak MR: Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings. Pediatr Radiol 1995;25:562-565. Kocher MS, Kasser JR: Orthopaedic aspects of child abuse. J Am Acad Orthop Surg 2000;8:10-20.1. 01.171 Where are the sacral roots located within the canal at the L1-2 disk level?2. 1- Random pattern3. 2- Anterior4. 3- Central5. 4- Lateral6. 5- Posterior1. answer1. back1. Question 01.1712. Answer = 31. back to this question1. next question1. Reference(s)2. Wall E1, Cohen MS, Abitbol JJ, Garfin SR: Organization of intrathecal nerve roots at the level of the conus medullaris. J Bone Joint Surg Am 1990;72:1495-1499. Wall FJ, Cohen MS, Massie JB, Rydevik B, Garfin SR: Cauda equina anatomy: L Intrathecal nerve root organization. Spine 1990;15:1244-1247.1. 01.172 University of California Biomechanics Laboratory (UCBL) lower extremity2. orthoses are thought to work by3. 1- supporting the forefoot in rigid deformities.4. 2- supporting the midfoot in rigid deformities.5. 3- controlling the hindfoot in flexible deformities.6. 4- controlling the ankle when instability is present.7. 5- accommodating a forefoot deformity.1. answer1. back1. Question 01.1722. Answer = 31. back to this question1. next question1. Reference(s)2. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 55-64. Wapner KL: Conservative treatment of the foot, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 115-130.1. 01.173 What portion of the calcaneus typically maintains a normal relationship to the2. talus in displaced intra-articular calcaneus fractures?3. 1- Sustentaculum tali4. 2- Tuberosity5. 3- Anterolateral6. 4- Posterior facet7. 5- Lateral wall1. answer1. back1. Question 01.1732. Answer = 11. back to this question1. next question1. Reference(s)2. Olexa TA, Ebraheim NA, Haman SP: The sustentaculum tall: Anatomic, radiographic, and surgical considerations. Foot Ankle Int 2000;21:400-403. Sanders R: Intro articular fractures of the calcaneus: Present state of the art. J Orthop Trauma 1992;6:252-265.1. 01.174 The linear relationship between an applied stress and the resultant deformation2. defines a material's3. 1- modulus of elasticity.4. 2- brittleness.5. 3- yield strength.6. 4- ultimate strength.7. 5- toughness.1. answer1. back1. Question 01.1742. Answer = 11. back to this question1. next question1. Reference(s)2. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 447-486.1. 01.175 In total hip arthroplasty, which of the following characterizes the clinical pain2. pattern seen with a loose femoral component?3. 1- Gluteal4. 2- Night5. 3- Start-up6. 4- Back7. 5- At rest1. answer1. back1. Question 01.1752. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Katz RP, Callaghan JJ, Sullivan PM, Johnston RC: Long-term results of revision total hip arthroplasty with improved cementing technique. J Bone Joint Sung Br 1997;79:322-326. Krishnamurthy AB, MacDonald SJ, Paprosky WG: 5- to 13-year follow-up study on cementless femoral components in revision surgery. J Arthroplasty 1997;12:839-847.1. 01.176 What is the natural history of a nonossifying fibroma?2. 1- Gradual enlargement after skeletal maturity3. 2- Spontaneous resolution with skeletal maturity4. 3- Chronic pain5. 4- Late malignant degeneration6. 5- Angular deformity1. answer1. back1. Question 01.1762. Answer = 21. back to this question1. next question1. Reference(s)2. Jaffe HL, Lichtenstein L: Non-osteogenic fibroma of bane. Am J Pathol 1942;18:205. Unni KK: Conditions that commonly simulate primary neoplasms of bone, in Dahlin's Bone Tumors, ed 5. Philadelphia, PA, 1996, pp 355-432.1. 01.177 What structure is outlined and lies at the tip of the arrow shown in Figure 55?2. 1- Inferior articular facet3. 2- Superior articular facet4. 3- Pedicle5. 4- Lamina6. 5- Spinous process1. answer1. back1. Figure 551. Question 01.1772. Answer = 11. back to this question1. next question1. Reference(s)2. Parke WW: Applied Anatomy of the Spine, in Herkowitz HN, Eismont FJ, Garfin SR, Bell GR, Balderston RA, Wiesel SW (eds): Rothman-Simeone: The Spine, ed 4. Philadelphia, PA, WB Saunders, 1999, pp 27-73. Netter FH (ed): The Ciba Collection of Medical Illustrations: Musculoskeletal System, Part L Anatomy, Physiology, and Metabolic Disorders. Summit, NJ,3. Ciba-Geigy, 1987, vol 8, pp 9-19.1. 01.178 Which of the following systemic conditions is associated with a genetic defect2. in skeletal formation that does not involve abnormal collagen?3. 1- Osteogenesis imperfecta4. 2- Spondyloepiphyseal dysplasia congenita5. 3- Achondroplasia6. 4- Multiple epiphyseal dysplasia7. 5- Kneist dysplasia1. answer1. back1. Question 01.1782. Answer = 31. back to this question1. next question1. Reference(s)2. Dietz FR, Matthews KD: Update on the genetic bases of disorders with orthopaedic manifestations. J Bone Joint Surg Am 1996;78:1583-1598.1. 01.179 What is the most likely cause of mortality within the first 48 hours in patients2. who sustain a pelvic fracture from a lateral compression mechanism?3. 1- Aortic rupture4. 2- Pelvic arterial injury5. 3- Pelvic venous injury6. 4- Hollow viscous injury7. 5- Head injury1. answer1. back1. Question 01.1792. Answer = 51. back to this question1. next question1. Reference(s)2. Dalal SA, Burgess AR, Siegel 3H, et al: Pelvic fracture in multiple trauma: Classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989;29;981-1002.1. 01.180 Following total hip arthroplasty, examination of the patient reveals an ischemic2. leg. A radiograph obtained in the recovery room is shown in Figure 56a, and a3. subtraction arteriogram is shown in Figure 56b. What artery has been injured?4. 1- Profunda femoris5. 2- External iliac6. 3- Obturator7. 4- Superior gluteal8. 5- Inferior gluteal1. answer1. back1. A1. B1. Figures 561. Question 01.1802. Answer = 21. back to this question1. next question1. Reference(s)2. Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE: Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am 1990;72:501-508. Shaw JA, Greer RB III: Complications of total hip replacement, in Epps CH Jr (ed): Complication in Orthopaedic Surgery. Philadelphia, PA, JB Lippincott,3. 1994, pp 1013-1056.1. 01.181 Which of the following axial pattern flaps is best used to repair fingertip2. amputations?3. 1- Axial flag4. 2- First dorsal metacarpal artery5. 3- Second dorsal metacarpal artery6. 4- Reversed dorsal metacarpal artery7. 5- Digital artery island1. answer1. back1. Question 01.1812. Answer = 51. back to this question1. next question1. Reference(s)2. Lai CS, Lin SD, Yang CC: The reverse digital artery flap for fingertip reconstruction. Ann Plant Surg 1989;22:495-500. Lister GD, Pederson WC: Skin flaps, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 1783-1850.1. 01.182 What is the most common complication seen in patients undergoing surgery on2. the Achilles tendon for chronic refractory tendinitis?3. 1- Deep vein thrombosis4. 2- Partial/complete tendon rupture5. 3- Skin edge necrosis6. 4- Infection7. 5- Complex regional pain syndrome1. answer1. back1. Question 01.1822. Answer = 31. back to this question1. next question1. Reference(s)2. Paavola M, Orava S, Leppilahti J, Kannus P, Jarvinen M: Chronic Achilles tendon overuse injury: Complications after surgical treatment: An analysis of 432 consecutive patients. Am J Sports Med 2000;28:77-82. Williams J: Achilles tendon lesions in sport. Sports Med 1986;3:114-135.1. 01.183 Figures 57a and 57b show the radiographs of a college basketball player who2. has had lateral foot pain for the past 3 weeks. Management should consist of3. 1- weight bearing as tolerated with continued play.4. 2- weight bearing as tolerated in a short leg cast.5. 3- restricted weight bearing for 4 weeks, followed by an early return to play.6. 4- electrical bone stimulation.7. 5- percutaneous screw fixation.1. answer1. back1. A1. B1. Figures 571. Question 01.1832. Answer = 51. back to this question1. next question1. Reference(s)2. Mindrebo N, Shelboume KD, Van Meter CD, Rettig AC: Outpatient percutaneous screw fixation of the acute Jones fracture. Am J Sports Med 1993;21:720-723. Weinfeld SB, Haddad SL, Myerson MS: Metatarsal stress fractures. Clip Sports Med 1997;16:319-338.1. 01.184 A 62-year-old man has pain with overhead activities and shoulder weakness.2. History reveals that he sustained an anterior dislocation of the right shoulder 183. months ago and underwent open repair of the subscapularis, supraspinatus, and4. infraspinatus tendons 2 weeks after the injury. Examination reveals active total5. elevation of 160°, active external rotation of 50°, and passive internal rotation6. to T9. He has 5/5 deltoid, 4-/5 external rotation, and 5/5 internal rotation7. strength. What is the most likely cause of his symptoms?8. 1- Residual rotator cuff tear9. 2- Adhesive capsulitis10. 3- Glenohumeral instability11. 4- Axillary neuropathy12. 5- Suprascapular neuropathy1. answer1. back1. Question 01.1842. Answer = 11. back to this question1. next question1. Reference(s)2. Gerber C, Fucks B, Holler J: The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000;82:505-515. Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III: Repairs of the rotator cuff: Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991;73:982-989.1. 01.185 A 6-year-old girl has a right genu varum that has progressed over the last 62. months. Plain radiographs of the knee reveal a sloping medial joint line with an3. obvious bony bar at the medial proximal tibial physis. A CT scan shows that4. this bar involves about 20% of the physis. Treatment at this time should include5. 1- epiphyseodesis of the proximal tibial physis.6. 2- corrective osteotomy of the tibia and fibula.7. 3- corrective osteotomy of the tibia and epiphyseodesis of the left proximal tibial8. physis.9. 4- proximal tibial physeal bar resection and corrective osteotomy of the tibia and fibula.10. 5- elevating osteotomy of the proximal tibial medial plateau.1. answer1. back1. Question 01.1852. Answer = 41. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 505-520. Tachdjian MA: Tibia vara, in Pediatric Orthopaedics. Philadelphia, PA, WB Saunders, 1990, p 2846. Greene WB: Infantile tibia vara. Instr Course Lect 1993;42:525-538.1. 01.186 An 18-year-old patient has the painful lesion shown in Figure 58a. A biopsy2. specimen is shown in Figure 58b. Management should consist of3. 1- preoperative chemotherapy and wide resection.4. 2- wide resection only.5. 3- marginal distal ulna resection.6. 4- curettage and bone grafting.7. 5- low-dose radiation.1. answer1. back1. A1. B1. Figures 581. Question 01.1862. Answer = 41. back to this question1. next question1. Reference(s)2. Martinet V, Sissons HA: Aneurysmal bone cyst: A review of 123 cases including primary lesions and those secondary to other bone pathology. Cancer 1988;61:2291-2304. Biesecker JL, Marcove RC, Huvos AG, Mike V: Aneurysmal bone cysts: A clinicopathologic study of 66 cases. Cancer 1970;26:615-625. Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA: Aneurysmal bone cyst of the extremities: Factors related to local recurrence after curettage with a high-speed burr. J Bone Joint Surg Am 1999;81:1671-1678.1. 01.187 The value of intercondylar notch visualization of the posterior compartment2. during anterior cruciate ligament reconstruction is to identify3. 1- a loose body.4. 2- a popliteus injury.5. 3- meniscal root tears.6. 4- an injury to the ligament of Wrisberg.7. 5- an osteochondral injury.1. answer1. back1. Question 01.1872. Answer = 31. back to this question1. next question1. Reference(s)2. Amin KB, Cosgarea AJ, Kaeding CC: The value of intercondylar notch visualization of the posteromedial and posterolateral compartments during knee arthroscopy. Arthroscopy 1999;15:813-817. Boytim MJ, Smith JP, Fischer DA, Quick DC: Arthroscopic posteromedial visualization of the knee. Clip Orthop 1995;310:82-86.1. 01.188 Figures 59a and 59b show the radiographs of an 8-year-old boy who has2. atraumatic recurrent lateral dislocation of the left patella. Examination reveals3. no fixed genu varum or valgum, and the lower extremity lengths are equal. The4. Q angle is 25°. The extended hips show internal rotation of 40° and external5. rotation of 60°, with a neutral thigh-foot angle. There is no generalized6. ligamentous laxity. Treatment should consist of7. 1- femoral rotational osteotomy.8. 2- tibial rotational osteotomy.9. 3- tibial tuberosity transfer (Fulkerson, Elmslie-Trillat,10. or Hauser).11. 4- tenodesis of the semitendinosus to the patella.12. 5- patellectomy and vastus medialis advancement.1. answer1. back1. A1. B1. Figures 591. Question 01.1882. Answer = 41. back to this question1. next question1. Reference(s)2. Hall JE, Micheli LJ, McManama GB Jr- Semitendinosus tenodesis for recurrent subluxation or dislocation of the patella. Clin Orthop 1979;144:31-35. Sponseller PD, Beaty JH: Fractures and dislocations about the knee, in Rockwood CA, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 1231-1329. Tolo V: Fractures and dislocations about the knee, in Green NE, Swiontkowski MF (eds): Skeletal Trauma in Children, ed 2. Philadelphia, PA, WB Saunders, 1998, pp 431-458. Lefts RM, Davidson D, Beaule P: Semitendinosus tenodesis for repair of recurrent dislocation of the patella in children. J Pediatr Orthop 1999;19:742-747.1. 01.189 The posterior (Thompson) approach to the proximal radial shaft lies between2. the3. 1- extensor carpi ulnaris and anconeus.4. 2- extensor carpi ulnaris and extensor carpi radialis longus.5. 3- extensor carpi radialis longus and extensor carpi radialis brevis.6. 4- extensor carpi radialis brevis and extensor digitorum communis.7. 5- brachioradialis and extensor carpi radialis longus.1. answer1. back1. Question 01.1892. Answer = 41. back to this question1. next question1. Reference(s)2. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach. Philadelphia, PA, Lippincott Williams & Wilkins, 1984, pp 109-139. Thompson BE: Anatomical methods of approach in operations on the long bones of the extremities. Ann Surg 1918;68:309.1. 01.190 Concurrent injuries to which of the following structures results in an increased2. osteogenic response to fracture?3. 1- Head4. 2- Liver5. 3- Chest6. 4- Major artery7. 5- Bladder1. answer1. back1. Question 01.1902. Answer = 11. back to this question1. next question1. Reference(s)2. Kushwaha VP, Garland DG: Extremity fractures in the patient with a traumatic brain injury. J Am Acad Orthop Surg 1998;6:298-307. Spencer RF: The effect of head injury on fracture healing: A quantitative assessment. J Bone Joint Surg Br 1987;69:525-528.1. 01.191 A 29-year-old man sustained a talar neck fracture with an associated2. dislocation of the body of the talus from the subtalar and tibiotalar joints. He3. was treated with immediate open reduction and internal fixation. Twelve weeks4. later, the fracture has united, and lucency is observed in the superior5. subchondral bone of the talar body. The next most appropriate step in6. management should consist of7. 1- bone grafting of the talar neck and body.8. 2- application of an ultrasound bone stimulator.9. 3- a brace with calipers.10. 4- MRI to assess body viability.11. 5- protected weight bearing.1. answer1. back1. Question 01.1912. Answer = 51. back to this question1. next question1. Reference(s)2. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998,3. pp 201-213. Clanton TO: Athletic injuries to the soft tissues of the foot and ankle, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, p 1176.1. 01.192 Within the normal healthy lumbar disk of a young person, proteoglycans2. constitute a3. 1- low percent of dry weight within the annulus, a high percent of dry weight within the4. nucleus, and interact with H2O to primarily resist compression.5. 2- low percent of dry weight within the annulus, a high percent of dry weight within the6. nucleus, and interact with H2O to primarily resist tension.7. 3- high percent of dry weight within the annulus, a low percent of dry weight within the8. nucleus, and interact with H2O to primarily resist compression.9. 4- high percent of dry weight within the annulus, a low percent of dry weight within the10. nucleus, and interact with H2O to primarily resist tension.11. 5- high percent of dry weight within the annulus, a low percent of dry weight within the12. nucleus, and have no interaction with H2O.1. answer1. back1. Question 01.1922. Answer = 11. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 548-556. Buckwalter JA, Pedrini-Mille A, Pedrini V, Tudisco C: Proteoglycans of human infant intervertebral disc: Electron microscopic and biochemical studies. J Bone Joint Surg Am 1985;67:284-294.1. 01.193 A 40-year-old woman has right shoulder pain and limited range of motion.2. History reveals that she sustained a right proximal humerus fracture 10 years3. ago and was treated with a sling and physical therapy. Examination reveals4. active forward elevation of 100°, active external rotation of 0°, and passive5. internal rotation to L5. Passive shoulder motion is the same. Plain radiographs6. of the shoulder are shown in Figures 60a and 60b. Treatment should now7. consist of8. 1- arthroscopic debridement.9. 2- humeral osteotomy.10. 3- core decompression.11. 4- humeral head replacement.12. 5- capsular release.1. answer1. back1. A1. B1. Figures 601. Question 01.1932. Answer = 41. back to this question1. next question1. Reference(s)2. Norris TR, Green A, McGuigan FX: Late prosthetic arthroplasty for displaced proximal humerus fractures. J Shoulder Elbow Surg 1995;4:271-280. Schlegel TF, Hawkins RJ: Displaced proximal humeral fractures: Evaluation and treatment. J Am Acad Orthop Surg 1994;2:54-78.1. 01.194 The lateral crista of the trochlea develops from what secondary ossification2. center?3. 1- Medial condylar epiphysis4. 2- Lateral condylar epiphysis5. 3- Medial epicondylar apophysis6. 4- Lateral epicondylar apophysis7. 5- Olecranon apophysis1. answer1. back1. Question 01.1942. Answer = 21. back to this question1. next question1. Reference(s)2. Wilkins KE: Fractures and dislocations of the elbow region: Part L The elbow region: General concepts in the pediatric patient, in Rockwood CA, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 653-669.1. 01.195 A 40-year-old man sustains a rupture of the Achilles tendon while playing2. recreational basketball. If he undergoes surgical repair rather than nonsurgical3. management, the patient should be told to expect a4. 1- lower skin complication rate and a longer period of rehabilitation.5. 2- lower re-rupture rate and a longer period of rehabilitation.6. 3- higher re-rupture rate and a shorter rehabilitation.7. 4- higher skin complication rate and a higher re-rupture rate.8. 5- higher skin complication rate and a lower re-rupture rate.1. answer1. back1. Question 01.1952. Answer = 51. back to this question1. next question1. Reference(s)2. Coughlin MJ: Disorders of tendons, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 786-861. Troop RL, Losse GM, Lane JG, Robertson DB, Hastings PS, Howard ME: Early motion after repair of Achilles tendon ruptures. Foot Ankle Int 1995;16:705-709.1. 01.196 Which of the following is considered the most sensitive sensory test for2. detecting early carpal tunnel syndrome?3. 1- Light touch sensation4. 2- Pinprick sensation5. 3- Two-point discrimination6. 4- Moving two-point discrimination7. 5- Semmes-Weinstein monofilament1. answer1. back1. Question 01.1962. Answer = 51. back to this question1. next question1. Reference(s)2. American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, B., American Academy of Orthopaedic Surgeons, 1996, pp 221-231. Szabo RM, Gelberman RH, Dimick MD: Sensibility testing in patients with carpal tunnel syndrome. J Bone Joint Surg Am 1984;66:60-64.1. 01.197 A 16-year-old boy has had pain in the lateral ankle and hindfoot after sustaining2. a minor ankle sprain 6 months ago. The pain is worse with any twisting activity3. of the foot. Examination reveals normal alignment of the foot and ankle. An AP4. radiograph of the ankle and foot is normal. A lateral radiograph is shown in5. Figure 61. What is the most likely cause of his persistent pain?6. 1- Fracture of the lateral process of the talus7. 2- Fracture of the anterior process of the calcaneus8. 3- Fracture of the tibial plafond9. 4- Talocalcaneal coalition10. 5- Stress fracture of the calcaneus1. answer1. back1. Figure 611. Question 01.1972. Answer = 41. back to this question1. next question1. Reference(s)2. Richardson EG: Flatfoot in children and adults, in Coughlin MJ, Mate RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science,3. 1999, pp 702-733. Scranton PE Jr: Treatment of symptomatic talocalcaneal coalition. J Bone Joint Surg Am 1987;69:533-539.1. 01.198 A patient who underwent total knee arthroplasty 2 years ago has a range of2. motion of 0° to 60°. The implants are well fixed, and the knee is well aligned3. on AP radiographs. Lateral .radiographs show that the femoral component is4. appropriately sized and the tibial component is in 5° of anterior tilt. Treatment5. should consist of6. 1- revision of the femoral component.7. 2- revision of the tibial component.8. 3- closed knee manipulation.9. 4- open lysis of adhesions.10. 5- open quadricepsplasty.1. answer1. back1. Question 01.1982. Answer = 21. back to this question1. next question1. Reference(s)2. Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 317-322.1. 01.199 When compared to plate fixation, antegrade intramedullary nailing of humeral2. shaft fractures results in3. 1- better elbow function.4. 2- a higher rate of union.5. 3- a higher rate of complications.6. 4- a higher rate of infection.7. 5- longer surgical time.1. answer1. back1. Question 01.1992. Answer = 31. back to this question1. next question1. Reference(s)2. Farragos AF, Schemitsch EH, McKee MD: Complications of intramedullary nailing for fractures of the humeral shaft: A review. J Orthop Trauma 1999;13:258-267. McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH: Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg Br 2000;82:336-339.1. 01.200 Which of the following groups is most at risk for osteoporosis?2. 1- Caucasian men3. 2- Caucasian women4. 3- African-American women5. 4- Hispanic men6. 5- Hispanic women1. answer1. back1. Question 01.2002. Answer = 21. back to this question1. next question1. Reference(s)2. Lane JM, Nydick M: Osteoporosis: Current modes of prevention and treatment. J Am Acad Orthop Surg 1999;7:19-31. Melton LJ III: Epidemiology of spinal osteoporosis. Spine 1997;22:2S-1151. 01.201 A 49-year-old man with advanced glenohumeral arthritis undergoes total2. shoulder replacement. Following surgery, he reports pain relief but now has3. weakness when using his arm for activities in front of his body. He is unable to4. hold the dorsum of his hand away from his back. The weakness is most likely5. related to what muscle?6. 1- Supraspinatus7. 2- Subscapularis8. 3- Infraspinatus9. 4- Deltoid10. 5- Pectoralis major1. answer1. back1. Question 01.2012. Answer = 21. back to this question1. next question1. Reference(s)2. Gerber C, Farrow MD: Isolated tears of the subscapularis tendon. Orthop Trans 1995;19:457. Gerber C, Hersche O, Farron A: Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 1996;78:1015-1023.1. 01.202 An ankle fracture heals with an anatomically aligned mortise and 2 mm of2. displacement of the distal fibula fracture. What affect will these findings have3. on the tibiotalar joint?4. 1- Decreased contact loading5. 2- Increased contact loading6. 3- Increased external rotation7. 4- Increased medial-lateral translation8. 5- Normal loading, rotation, and translation1. answer1. back1. Question 01.2022. Answer = 51. back to this question1. next question1. Reference(s)2. Brown TD, Hurlbut PT, Hale JE, et a1: Effects of imposed hindfoot constraint on ankle contact mechanics for displaced lateral malleolar fractures. J Orthop Trauma 1994;8:511-519. Michelson JD: Fractures about the ankle. J Bone Joint Surg Am 1995;77:142-152.1. 01.203 Figure 62 shows the MRI scan of a 30-year-old male volleyball player who has2. had shoulder pain for the past 6 months. Which of the following physical3. findings in the shoulder would be most consistent with this lesion?4. 1- Weakness of internal rotation5. 2- Weakness of external rotation6. 3- Weakness of abduction7. 4- Positive impingement sign8. 5- Positive apprehension sign1. answer1. back1. Figure 621. Question 01.2032. Answer = 21. back to this question1. next question1. Reference(s)2. Thompson RC Jr, Schneider W, Kennedy T: Entrapment neuropathy of the inferior branch of the suprascapular nerve by ganglia. Clin Orthop 1982;166:185-187. Fehrman DA, Orwin JF, Jennings RM: Suprascapular nerve entrapment by ganglion cysts: A report of six cases with arthroscopic findings and review of the literature. Arthroscopy 1995;11:727-734.1. 01.204 In cemented polyethylene acetabular components, the reported average2. polyethylene wear rate on a yearly basis is how many millimeters?3. 1- 0.014. 2- 0.055. 3- 0.16. 4- 1.07. 5- 2.01. answer1. back1. Question 01.2042. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492. Jasty M, Goetz DD, Bragdon CP, et al: Wear of polyethylene acetabular components in total hip arthroplasty: An analysis of one hundred and twenty-eight components retrieved at autopsy or revision operations. J Bone Joint Surg Am 1997;79:349-358.1. 01.205 The Lisfranc ligament connects what two bones?2. 1- Middle cuneiform and first metatarsal3. 2- Middle cuneiform and second metatarsal4. 3- Medial cuneiform and first metatarsal5. 4- Medial cuneiform and second metatarsal6. 5- Medial cuneiform and middle cuneiform1. answer1. back1. Question 01.2052. Answer = 41. back to this question1. next question1. Reference(s)2. Sanafian SK: Osteology, in Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional, ed 2. Philadelphia, PA, JB Lippincott, 1993, pp 37-112. Clanton TO: Athletic injuries to the soft tissues of the foot and ankle, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. SL Louis, MO, Harcourt Health Science, 1999, pp 1090-1209.1. 01.206 The arrow in the axial MRI scan shown in Figure 63 is pointing to what2. muscle?3. 1- Gracilis4. 2- Adductor brevis5. 3- Sartorius6. 4- Semitendinosus7. 5- Pectineus1. answer1. back1. Figure 631. Question 01.2062. Answer = 11. back to this question1. next question1. Reference(s)2. Hoppenfeld S, deBoer P (eds): Surgical Exposures in Orthopaedics: The Anatomic Approach, ed 2. Philadelphia, PA, JB Lippincott, 1994, pp 401-429.1. 01.207 Item deleted after statistical review2. (and no answer or references cited)1. back1. next question1. 01.208 Which of the following conditions will most likely cause disability at some2. point in the life of a patient with achondroplasia?3. 1- Degenerative joint disease of the knees4. 2- Cervical instability with myelopathy5. 3- Scoliosis of the thoracic or lumbar spine6. 4- Spinal stenosis7. 5- Progressive contractures of the limbs1. answer1. back1. Question 01.2082. Answer = 41. back to this question1. next question1. Reference(s)2. Pyeritz RE, Sack GH Jr, Udvarhelyi GB: Thoracolumbosacral laminectomy in achondroplasia: Long-term results in 22 patients. Am J Med Genet 1987;28:433-444. Tolo VT: Spinal deformity in skeletal dysplasia, in Weinstein SL (ed): The Pediatric Spine: Principles and Practice. New York, NY, Raven Press, 1994, pp 369-393.1. 01.209 The use of calcium supplements should be2. 1- encouraged in girls at puberty to help prevent osteoporosis.3. 2- restricted until menopause to decrease the risk of renal stones.4. 3- left to individual preference until perimenopause, then started routinely.5. 4- started only after a bone mineral density study indicates a deficiency of 2 standard6. deviations.7. 5- started only after a bone mineral density study indicates a deficiency of 1 standard8. deviation.1. answer1. back1. Question 01.2092. Answer = 11. back to this question1. next question1. Reference(s)2. Garfin SR, Vaccaro AR (eds): Orthopaedic Knowledge Update: Spine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 127-139.1. 01.210 The bending strength of fractured long bones fixed with an experimental2. compression plate is compared with unfractured controls. What statistical test3. should be used to compare the mean bending strength of the two groups?4. 1- Student's t test5. 2- Analysis of variance6. 3- Regression analysis7. 4- Chi-square test8. 5- Wilcoxon two-sample test1. answer1. back1. Question 01.2102. Answer = 11. back to this question1. next question1. Reference(s)2. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 397-446.1. 01.211 Which of the following factors has been shown to be an independent risk factor2. for infection after open reduction and internal fixation of the calcaneus through3. an extensile lateral incision?4. 1- Age of greater than 50 years5. 2- History of smoking6. 3- A comminuted posterior facet7. 4- Extension of the fracture into the sustentaculum8. 5- Use of phenytoin1. answer1. back1. Question 01.2112. Answer = 21. back to this question1. next question1. Reference(s)2. Folk JW, Stan AJ, Early JS: Early wound complications of operative treatment of calcaneus fractures: Analysis of 190 fractures. J Orthop Trauma 1999;13:369-372.1. 01.212 Examination of a 65-year-old woman who sustained a stroke 18 months ago2. reveals a clenched fist deformity that is causing significant hygiene problems3. because of skin maceration and malodor. She has no observed voluntary motor4. control of the hand or forearm. Management should consist of5. 1- open phenol blocks.6. 2- botulinum toxin blocks.7. 3- proximal interphalangeal and distal interphalangeal arthrodesis.8. 4- flexor tenotomies.9. 5- a superficialis-to-profundus tendon transfer.1. answer1. back1. Question 01.2122. Answer = 51. back to this question1. next question1. Reference(s)2. Braun RN, Vise GT, Roger B: Preliminary experience with superficialis-to profundus tendon transfer in the hemiplegic upper extremity. J Bone Joint Surg Am 1974;56:466-472. Hisex MS, Keenan MAE: Orthopaedic management of upper extremity dysfunction following stroke or brain injury, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 287-324.1. 01.213 Revision of a failed acetabular component with a bipolar endoprosthesis and2. acetabular bone grafting is most likely to fail because of what mechanism?3. 1- Osteolysis4. 2- Femoral stem loosening5. 3- Recurrent dislocation6. 4- Bipolar head migration7. 5- Bipolar head disengagement1. answer1. back1. Question 01.2132. Answer = 41. back to this question1. next question1. Reference(s)2. Brien WW, Bruce WJ, Salvati EA, Wilson PD 1r, Pellicci PM: Acetabular reconstruction with a bipolar prosthesis and morseled bone grafts. J Bone Joint Surg Am 1990;72:1230-1235. McFarland EG, Lewallen DG, CabaneIa ME: Use of bipolar endoprosthesis and.bone grafting for acetabular reconstruction. Clin Orthop 1991; 268:128-129. Papagelopoulus PJ, Lewallen DG, Cabanela ME, McFarland EG, Wallnichs SL: Acetabular reconstruction using bipolar endoprosthesis and bone grafting in patients with severe bone deficiency. Clin Orthop 1995;314:170-184.1. 01.214 An 18-year-old man sustains the proximal femur fracture shown in Figures 64a2. and 64b. Definitive management should consist of3. 1- traction for 6 weeks.4. 2- a functional brace.5. 3- a 135° angle sliding hip screw.6. 4- a 95° fixed angle plate.7. 5- antegrade nailing with transverse screws.1. answer1. back1. A1. B1. Figures 641. Question 01.2142. Answer = 41. back to this question1. next question1. Reference(s)2. Kinast C, Bolhofner BR, Mast 1W, Ganz R: Subtrochanteric fractures of the femur: Results of treatment with the 95 degrees blade-plate. Clin Orthop 1989;238:122-130.1. 01.215 In the treatment of femoral shaft fractures, the lowest union rate has been2. reported after which of the following types of nailing?3. 1- Reamed antegrade locked4. 2- Reamed antegrade unlocked5. 3- Reamed retrograde locked6. 4- Unreamed antegrade locked7. 5- Unreamed retrograde locked1. answer1. back1. Question 01.2152. Answer = 51. back to this question1. next question1. Reference(s)2. Moed BR, Watson JT, Cramer KE, Karges DE, Teefey JS: Unreamed retrograde intramedullary nailing of fractures of the femoral shaft. J Orthop Trauma 1998;12334-342. Moed BR, Watson JT: Retrograde intramedullary nailing, without reaming, of fractures of the femoral shaft in multiply injured patients. J Bone Joint Surg Am 1995;77:1520-1527.1. 01.216 A 36-year-old man has pain in the metatarsophalangeal (MTP) joint of the2. great toe with all weight-bearing activities, and management consisting of shoe3. modification and an insert has failed to provide relief. Examination reveals a4. painful 10° arc of motion. Radiographs show degenerative changes with dorsal5. and medial osteophytes and joint narrowing. Treatment should now consist of6. 1- excision of the osteophytes and the dorsal third of the metatarsal head.7. 2- a dorsiflexion osteotomy of the metatarsal head.8. 3- resection arthroplasty of the MTP joint.9. 4- a Silastic implant of the MTP joint.10. 5- arthrodesis of the MTP joint.1. answer1. back1. Question 01.2162. Answer = 51. back to this question1. next question1. Reference(s)2. Mann RA, Clanton TO: Hallux rigidus: Treatment by cheilectomy. J Bone Joint Surg Am 1988;70:400-406. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 151-161. Coughlin MJ: Arthritides, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 605-633.1. 01.217 A 14-year-old boy who plays football sustains a valgus force to his knee.2. Examination reveals a 1+ effusion and decreased range of motion. Lachman3. test results are negative. He has no joint line tenderness, but he does have4. tenderness over the proximal origin of the medial collateral ligament and pain5. with valgus stressing. Initial plain radiographs of the knee are normal. Further6. evaluation should include7. 1- arthrography.8. 2- MRI.9. 3- a bone scan.10. 4- emergent arthroscopy.11. 5- stress radiographs.1. answer1. back1. Question 01.2172. Answer = 51. back to this question1. next question1. Reference(s)2. Sponseller PD, Beaty JH: Fractures and dislocations about the knee, in Rockwood CA, Wilkins KE, Beaty JH (eds): Fractures in Children, ed 4. Philadelphia, PA, Lippincott-Raven, 1996, pp 1231-1329. Cook PC, Leit ME: Issues in the pediatric athlete. Orthop Clin North Am 1995;26:453-464.1. 01.218 A 35-year-old man sustained an isolated closed displaced bicondylar tibial2. plateau fracture after being struck by a car. Reduction and internal fixation of3. both condyles can be most safely achieved using which of the following4. surgical approaches?5. 1- Isolated anterior midline6. 2- Isolated lateral parapatellar7. 3- Isolated posteromedial8. 4- Combined anterolateral and posteromedial9. 5- Combined anterior midline and posterior transpopliteal1. answer1. back1. Question 01.2182. Answer = 41. back to this question1. next question1. Reference(s)2. Georgiadis GM: Combined anterior and posterior approaches for complex tibial plateau fixations. J Bone Joint Surg Br 1994;76:285-289.1. 01.219 Which of the following conditions is most commonly associated with2. congenital fibular hemimelia?3. 1- Congenital absence of the patella4. 2- Congenital absence of the first ray5. 3- Genu varum6. 4- Equinovarus ankle7. 5- Talocalcaneal coalition1. answer1. back1. Question 01.2192. Answer = 51. back to this question1. next question1. Reference(s)2. Grogan DP, Holt GR, Ogden JA: Talocalcaneal coalition in patients who have fibular hemimelia or proximal femoral focal deficiency: A comparison of the radiographic and pathological findings. J Bone Joint Surg Am 1994;76:1363-1370. Epps CH Jr, Schneider PL: Treatment of hemimelias of the lower extremity: Long term results. J Bone Joint Surg Am 1989;71273-277.1. 01.220 A 58-year-old woman has severe neck pain after falling at home. Examination2. reveals intact deltoid strength, 2/5 weakness in the rest of the right upper3. extremity, and 2/5 weakness in the left upper extremity, except for a grip4. strength of 3/5. She has 4/5 strength in both lower extremities, good rectal5. tone, and an intact bulbocavernosus reflex. Sensation is intact. Which of the6. following conditions best characterizes her neurologic injury?7. 1- A complete spinal cord injury8. 2- Bilateral brachial plexopathies9. 3- Multilevel cervical radiculopathy10. 4- Anterior cord syndrome11. 5- Central cord syndrome1. answer1. back1. Question 01.2202. Answer = 51. back to this question1. next question1. Reference(s)2. McGuire RA: Physical examination in spinal trauma, in Levine AM, Eismont FJ, Garfin SR, Zigler JE (eds): Spine Trauma. Philadelphia, PA. WB Saunders, 1998, pp 17-27. Bohiman HH, Docker TB: Spine trauma in adults: Spine and spinal cord injuries, in Herkowitz HN, Eismont FJ, Garfin SR, Bell GR, Balderston RA, Wiesel SW (eds): Rothman-Simeone: The Spine, ed 4. Philadelphia, PA, WB Saunders, 1999, pp 889-914.1. 01.221 A 25-year-old construction worker reports a mass on the dorsum of his hand2. that is painful with strenuous use. Examination reveals a 4 x 2 x 1 cm soft mass3. that overlies the proximal portions of the index and middle metacarpals. It4. moves with flexion and extension of those digits, becomes firmer with forceful5. grasp, and does not transilluminate. What is the most likely diagnosis?6. 1- Dorsal wrist ganglion7. 2- Extensor tenosynovitis8. 3- Giant cell tumor of the tendon sheath9. 4- Carpal boss10. 5- Anomalous extensor muscle1. answer1. back1. Question 01.2212. Answer = 51. back to this question1. next question1. Reference(s)2. Tan ST, Smith PJ: Anomalous extensor muscles of the hand: A review. J Hand Sung Am 1999;24:449-455. Doyle JR: Extensor tendons: Acute injuries, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 1950-1987.1. 01.222 Which of the following cytokines have been implicated in the pathogenesis of2. rheumatoid arthritis?3. 1- Fibroblastic growth factor and transforming growth factor4. 2- Parathyroid hormone-related protein and interferon-gamma5. 3- Interleukin- 1 and tumor necrosis factor6. 4- Interleukin-4 and granulocyte-macrophage colony-stimulating factor7. 5- Interleukin- 10 and vascular endothelial growth factor1. answer1. back1. Question 01.2222. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty 3H (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 205-216. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 490-530.1. 01.223 Item deleted after statistical review2. (and no answer or references cited)1. back1. next question1. 01.224 An 11-year-old girl has had progressive medial midfoot pain bilaterally for the2. past 6 months. Her mother states that the child's feet appeared normal until the3. pain started, and she is concerned about the development of flatfeet. What is4. the most likely diagnosis?5. 1- Physiologic pes planus6. 2- Charcot foot7. 3- Posterior tibial tendon insufficiency8. 4- Congenital vertical talus9. 5- Accessory navicular1. answer1. back1. Question 01.2242. Answer = 51. back to this question1. next question1. Reference(s)2. Prichasuk S, Sinphurmsuksknl O: Kidner procedure for symptomatic accessory navicular and its relation to pes planus. Foot Ankle Int 1995;16:500-503.1. 01.225 Which of the following is considered the most important factor in preventing2. failure of fixation of displaced femoral neck fractures?3. 1- Use of a compression screw and side plate4. 2- Use of cannulated screws5. 3- Accuracy of reduction6. 4- Reduction on a traction table7. 5- Release of a capsular hematoma1. answer1. back1. Question 01.2252. Answer = 31. back to this question1. next question1. Reference(s)2. Chug D, Jaglal SB, Schatzker J: Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma 1998;12:230-234. Swiontkowski MF: Intracapsular fractures of the hip. J Bone Joint Surg Am 1994;76:129-138.1. 01.226 Item deleted after statistical review2. (and no answer or references cited)1. back1. next question1. 01.227 The process of host repair following osteonecrosis is referred to as2. 1- haversian remodeling.3. 2- osteogenesis.4. 3- osteoinduction.5. 4- fracture healing.6. 5- creeping substitution.1. answer1. back1. Question 01.2272. Answer = 51. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds)- Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 372-399.1. 01.228 What type of knee dislocation is most likely to be irreducible by closed means?2. 1- Posterior3. 2- Anterior4. 3- Lateral5. 4- Posterolateral6. 5- Posteromedial1. answer1. back1. Question 01.2282. Answer = 41. back to this question1. next question1. Reference(s)2. Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB (eds): Orthopaedic Knowledge Update: Trauma 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 151-155. Quinlan AG, Sharrard WJW: Posterolateral dislocation of the knee with capsular interposition. J Bone Joint Surg Br 1958;40:660-663.1. 01.229 A 16-year-old boy who is 5 ft 4 in tall reports pain in the knees and ankles.2. Examination reveals that his knees are in 15° of valgus. The articular surfaces3. of the knees and ankles are irregular, and the femoral heads are slightly4. flattened. A lateral radiograph shows that the patellae have a double layer.5. What is the most likely diagnosis?6. 1- Kneist syndrome7. 2- Spondyloepiphyseal dysplasia congenita8. 3- Multiple epiphyseal dysplasia9. 4- Achondroplasia10. 5- Dyschondrosteosis1. answer1. back1. Question 01.2292. Answer = 31. back to this question1. next question1. Reference(s)2. Dietz FR, Matthews KD: Update on the genetic bases of disorders with orthopaedic manifestations. J Bone Joint Surg Am 1996;78:1583-1598. Spranger J: The epiphyseal dysplasias. Clip Orthop 1976;114:46-59. Sheffield EG: Double-layered patella in multiple epiphyseal dysplasia: A valuable clue in the diagnosis. J Pediatr Orthop 1998;18:123-128.1. 01.230 What is the most common primary malignancy that metastasizes to the bones2. of the hand?3. 1- Breast4. 2- Prostate5. 3- Renal6. 4- Colon7. 5- Lung1. answer1. back1. Question 01.2302. Answer = 51. back to this question1. next question1. Reference(s)2. American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 369-376. Athanasian EA: Bone and soft-tissue tumors, in Green DP, Hotchkiss RN, Pederson WC (eds): Green's Operative Hand Surgery, ed 4. New York, NY, Churchill Livingstone, 1999, pp 2223-2253.1. 01.231 A 14-year-old girl has been limping and has had pain with weight bearing on2. the right lower leg for the past 48 hours. She has a temperature of 100°F3. (37.7°C). She prefers a prone position with the right hip and knee extended.4. Pain is produced by placing the hip in flexion, abduction, and external rotation.5. Which of the following studies will best confirm the diagnosis?6. 1- Hip joint aspiration7. 2- AP radiograph of the pelvis8. 3- Oblique radiograph of the lumbar spine9. 4- CT of the abdomen10. 5- MRI of the pelvis1. answer1. back1. Question 01.2312. Answer = 51. back to this question1. next question1. Reference(s)2. Bollow M, Braun 1, Biedermann T, et al: Use of contrast-enhanced MR imaging to detect sacroiliitis in children. Skeletal Radiol 1998;27:606-616. Tisserant R, Loeuille D, Pere P, Gancher A, Ponrel J, Blum A: Septic sacroiliitis during the postpartal period: Diagnostic contribution of magnetic resonance imaging. Rev Rheum Engl Ed 1999;66:512-515.1. 01.232 A surgeon who is planning a total elbow arthroplasty would like to use a2. prosthesis that he helped to develop. A royalty payment is received each time3. the prosthesis is used. What is the surgeon's ethical responsibility?4. 1- The prosthesis should not be used.5. 2- The prosthesis can be used, but the royalty payment information should not be6. discussed with the patient.7. 3- The royalty payment information should be included on the informed consent8. document but not discussed with the patient.9. 4- The patient should be informed that the surgeon receives a royalty payment for using10. the prosthesis.11. 5- The surgeon should offer to split the royalty payment with the patient.1. answer1. back1. Question 01.2322. Answer = 41. back to this question1. next question1. Reference(s)2. Wenger NS, Liu H, Lieberman JR: Teaching medical ethics to orthopaedic surgery residents. J Bone Joint Surg Am 1998;80:1125-1131.1. 01.233 In trauma patients older than age 60 years, mortality most closely correlates2. with3. 1- the injury severity score (ISS).4. 2- the extremity abbreviated injury score (AIS).5. 3- the need for orthopaedic surgery.6. 4- the timing of orthopaedic surgery.7. 5- a history of type I diabetes mellitus.1. answer1. back1. Question 01.2332. Answer = 11. back to this question1. next question1. Reference(s)2. Tornetta P BI, Mostafavi H, Riina J, et al: Morbidity and mortality in elderly trauma patients. J Trauma 1999;46:702-706.1. 01.234 A 46-year-old woman has had plantar heel pain for the past 5 months. She2. reports that the pain is most severe when she arises out of bed in the morning3. and when she stands after being seated for a period of time. Initial management4. should consist of5. 1- surgical lengthening of the Achilles tendon.6. 2- surgical release of the plantar fascia.7. 3- a custom orthosis.8. 4- a stretching program and a cushioned heel insert.9. 5- a corticosteroid injection.1. answer1. back1. Question 01.2342. Answer = 41. back to this question1. next question1. Reference(s)2. Pfeffer G, Bacchetti P, Deland J, et al: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int 1999;20:214-221. Richardson EG: Heel pain, in Coughlin MJ, Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 1090-1209.1. 01.235 The triceps reflex is largely a function of what neurologic level?2. 1- C53. 2- C64. 3- C75. 4- C86. 5- T11. answer1. back1. Question 01.2352. Answer = 31. back to this question1. next question1. Reference(s)2. Snider RK (ed): Essentials of Musculoskeletal Care. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1997, pp 491-546.1. 01.236 A 19-year-old female swimmer has had right shoulder pain for the past 5 years.2. Although she had responded previously to physical therapy, she has been in3. rehabilitation for the past 6 months without improvement. Examination reveals4. active total elevation of 170°, active external rotation of 70°, and passive5. internal rotation to T3. There is symmetric 2+ glenohumeral translation in the6. anterior, posterior, and inferior directions and a positive Neer impingement7. sign. Treatment should consist of8. 1- open Bankart repair.9. 2- an inferior capsular shift.10. 3- arthroscopic coracoacromial ligament resection.11. 4- arthroscopic acromioplasty.12. 5- arthroscopic Bankart repair.1. answer1. back1. Question 01.2362. Answer = 21. back to this question1. next question1. Reference(s)2. Neer CS II, Foster CR: Inferior capsular shift for involuntary inferior and multi-directional instability of the shoulder. A preliminary report J Bone Joint Surg Am 1980;62:897-908. Schenk TJ, Brems JJ: Multi-directional instability of the shoulder Pathophysiology, diagnosis, and management. J Am Acad Orthop Surg 1998;6:65-72.1. 01.237 What is the most common complication at a minimum of 1 year after treatment2. with a reamed antegrade nail for a femoral shaft fracture?3. 1- Nonunion4. 2- Malunion5. 3- Trendelenburg gait6. 4- Hip discomfort7. 5- Osteonecrosis of the femoral head1. answer1. back1. Question 01.2372. Answer = 41. back to this question1. next question1. Reference(s)2. Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP: Abduction strength following intramedullary nailing of the femur. J Orthop Trauma 1997;11:93-97.1. 01.238 A 13-year-old boy has nonrigid Scheuermann's kyphosis. Weight-bearing2. radiographs show a kyphosis of 70° from T7 to L1, with scoliosis that3. measures 10° at Risser 2 maturity. Management should consist of4. 1- postural exercises and analgesics.5. 2- a Charleston bending brace.6. 3- an extension-type spinal orthosis.7. 4- posterior spinal fusion with instrumentation.8. 5- anterior spinal release and posterior spinal instrumentation.1. answer1. back1. Question 01.2382. Answer = 31. back to this question1. next question1. Reference(s)2. Lowe TG: Scheuermann disease. J Bone Joint Surg Am 1990;72:940-945. Tribes CB: Scheuermann's kyphosis in adolescents and adults: Diagnosis and management. J Am Acad Orthop Surg 1998;6:36-43.1. 01.239 A 21-year-old male wrestler sustained a right posterolateral elbow dislocation2. with an associated type I coronoid fracture 2 years ago. Management at the3. time of injury consisted of application of a splint for 2 weeks. He now reports4. recurrent elbow subluxation and pain. What is the most likely cause of the5. instability?6. 1- Displaced coronoid process fracture7. 2- Insufficiency of the lateral ulnar collateral ligament8. 3- Insufficiency of the anterior band of the medial collateral ligament9. 4- Insufficiency of the posterior band of the medial collateral ligament10. 5- Anterior capsular insufficiency1. answer1. back1. Question 01.2392. Answer = 21. back to this question1. next question1. Reference(s)2. Josefsson PO, Johnell O, Gentz CF: Long-term sequelae of simple dislocation of the elbow. J Bone Joint Surg Am 1984;66:927-930. Nestor BJ, O'Driscoll SW, Morrey BF: Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 1992;74:1235-1241. O'Driscoll SW, Money BF, Korinek S, An KN: Elbow subluxation and dislocation: A spectrum of instability. Clin Orthop 1992;280:186-197.1. 01.240 The degree of ulnar variance is best defined by2. 1- arthrography.3. 2- MRI.4. 3- cineradiographs.5. 4- stress radiographs.6. 5- plain radiographs.1. answer1. back1. Question 01.2402. Answer = 51. back to this question1. next question1. Reference(s)2. Nagle DJ: Evaluation of chronic wrist pain. J Am Acad Orthop Surg 2000;8:45-55. Epner RA, Bowers WH, Guilford WB: Ulnar variance: The effect of wrist positioning and roentgen filming technique. J Hand Surg Am 1982;7:298-305.1. 01.241 An 18-year-old woman has had left hip pain for the past 2 months.2. Examination reveals audible snapping with extension of a flexed, abducted,3. and externally rotated hip. What study is most likely to establish the diagnosis?4. 1- Bone scan5. 2- Iliopsoas bursography6. 3- Plain radiography7. 4- Hip arthrography8. 5- Hip arthroscopy1. answer1. back1. Question 01.2412. Answer = 21. back to this question1. next question1. Reference(s)2. Schaberg JF, Harper MC, Allen WC: The snapping hip syndrome. Am J Sports Med 1984;12:361-365. Jacobson T, Allen WC: Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990;18:470-474.1. 01.242 What metabolic bone disease is associated with abnormal osteoclastic2. function?3. 1- X-linked hypophosphatemic rickets4. 2- Fanconi's syndrome5. 3- Osteopetrosis6. 4- Osteomalacia7. 5- Paget's disease of bone1. answer1. back1. Question 01.2422. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL. American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Shapiro F: Osteopetrosis: Current clinical considerations. Clin Orthop 1993;294:344.1. 01.243 The Glasgow Coma Scale categorizes the neurologic status of a multiply2. injured patient by assessing verbal response, motor response, and3. 1- orientation.4. 2- response to commands.5. 3- pupillary response.6. 4- withdrawal to pain.7. 5- eye opening response.1. answer1. back1. Question 01.2432. Answer = 51. back to this question1. next question1. Reference(s)2. Turen CH, Dube MA, LeCroy MC: Approach to the polytraumatized patient with musculoskeletal injuries. J Am Acad Orthop Surg 1999;7:154-165. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale. Lancet 1974;2:81-84.1. 01.244 Which of the following is considered the preferred total knee design for a2. patient with a history of a patellectomy?3. 1- Posterior cruciate ligament-retaining4. 2- Posterior cruciate ligament-substituting5. 3- Rotating hinge6. 4- Unicondylar7. 5- Meniscal bearing1. answer1. back1. Question 01.2442. Answer = 21. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 559-582. Paletta GA Jr, Laskin RS: Total knee arthroplasty after a previous patellectomy. J Bone Joint Surg Am 1995;77:1708-1712.1. 01.245 A child with chronic recurrent multifocal osteomyelitis has painful swelling2. and tenderness in the right medial clavicle with no fluctuance. She has a3. temperature of 99°F (37.2°C). The palms and soles show pustular lesions.4. Radiographs reveal periosteal new bone formation in the medial clavicle.5. Management should consist of6. 1- a steroid injection into the medial clavicle.7. 2- oral nonsteroidal anti-inflammatory drugs.8. 3- IV administration of oxacillin for 4 weeks.9. 4- IV administration of gamma globulin.10. 5- incision and drainage of the medial clavicle.1. answer1. back1. Question 01.2452. Answer = 21. back to this question1. next question1. Reference(s)2. Godette GA, Murray DP, Gruel CR, Leonard 1C: Chronic recurrent multifocal osteomyelitis. Orthopedics 1992;15:520-521, 525-526. Bjorksten B, Gustavson K-H, Eriksson B, Lindholm A, Nordstrom S: Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris. J Pediatr 1978;93:227-231. Stanton RP, Lopez-Sosa FH, Doidge R: Chronic recurrent multifocal osteomyelitis. Orthop Rev 1993;22:229-233.1. 01.246 A 32-year-old woman reports right shoulder pain and has difficulty with2. overhead activities. History reveals that she underwent an open anterior labral3. repair and capsular shift to treat anterior glenohumeral instability 3 years ago.4. Examination reveals tenderness over the anterior shoulder, active and passive5. total elevation of 120°, and external rotation of 30°. Shoulder strength is6. normal. Plain radiographs are normal. Physical therapy has failed to provide7. relief. Treatment should now consist of8. 1- arthroscopic acromioplasty.9. 2- biceps tenodesis.10. 3- open subscapularis lengthening and capsular release.11. 4- humeral head replacement.12. 5- derotational humeral osteotomy.1. answer1. back1. Question 01.2462. Answer = 31. back to this question1. next question1. Reference(s)2. Bigliani LU: Glenohumeral instability repairs: Complications and failures, in Bigliani LU (ed): The Unstable Shoulder. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 99-106. MacDonald PB, Hawkins RJ, Fowler PJ, Miniaci A: Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder. J Bone Joint Surg Am 1992;74:734-737.1. 01.247 What statistical test should be used to determine whether a significant2. difference exists between the means of more than two independent samples3. with normal distributions?4. 1- Student's t test5. 2- Analysis of variance6. 3- Regression analysis7. 4- Chi-square test8. 5- Kruskal-Wallis test1. answer1. back1. Question 01.2472. Answer = 21. back to this question1. next question1. Reference(s)2. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 623-665. Freedman KB, Bernstein J: Sample size and statistical power in clinical orthopaedic research. J Bone Joint Surg Am 1999;81:1454-1460.1. 01.248 A female patient is most likely the victim of domestic abuse when the2. 1- injury is inconsistent with the offered explanation.3. 2- spouse does not express any interest in the patient's injuries.4. 3- patient expresses an overly animated affect.5. 4- patient has a lower socioeconomic status.6. 5- patient is eager to leave the hospital or clinic.1. answer1. back1. Question 01.2482. Answer = 11. back to this question1. next question1. Reference(s)2. Zillmer DA: Domestic violence: The role of the orthopaedic surgeon in identification and treatment. J Am Acad Orthop Surg 2000;8:91-96.1. 01.249 A varus malreduction of a comminuted talar neck fracture will result in2. 1- varus hindfoot and decreased subtalar motion.3. 2- increased contact loading of the posterior facet.4. 3- subtalar instability.5. 4- anterior ankle impingement.6. 5- talonavicular subluxation.1. answer1. back1. Question 01.2492. Answer = 11. back to this question1. next question1. Reference(s)2. Daniels TR, Smith JW, Ross TI: Varus malalignment of the talar neck: Its effect in the position of the foot and on subtalar motion. J Bone Joint Surg Am 1996;78:1559-1567. Sangeorzan BJ, Wagner UA, Harrington RIM, Tencer AF: Contact characteristics of the subtalar joint: The effect of talar neck misalignment. J Orthop Res 1992;10:544.-551.1. 01.250 While performing a revision total knee replacement with a trial component in2. place, it is noted that the knee has full extension but is loose in flexion. To3. resolve this flexion-extension discrepancy, the surgeon should4. 1- use a thicker polyethylene insert.5. 2- use a larger femoral component with posterior condyle metallic wedges.6. 3- use a more constrained polyethylene insert.7. 4- release the posterior capsule.8. 5- cut more posterior slope on the tibia.1. answer1. back1. Question 01.2502. Answer = 21. back to this question1. next question1. Reference(s)2. Callaghan JJ, Dennis DA, Paprosky WG, Rosenberg AG (eds): Orthopaedic Knowledge Update: Hip and Knee Reconstruction. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1995, pp 323-327.1. 01.251 During harvest of an anterior iliac crest bone graft, what nerve is at greatest2. risk for injury?3. 1- Lateral femoral cutaneous4. 2- Inguinal5. 3- Genitofemoral6. 4- Ilioinguinal7. 5- Femoral1. answer1. back1. Question 01.2512. Answer = 11. back to this question1. next question1. Reference(s)2. Bridwell KH, DeWald RL (eds): The Textbook of Spinal Surgery, ed 2. Philadelphia, PA, Lippincott-Raven, 1997, p 1736.1. 01.252 What structure is at greatest risk for injury when the anterolateral portal is used2. for ankle arthroscopy?3. 1- Superficial peroneal nerve4. 2- Saphenous nerve5. 3- Sural nerve6. 4- Deep peroneal nerve7. 5- Peroneal artery1. answer1. back1. Question 01.2522. Answer = 11. back to this question1. next question1. Reference(s)2. Ferkel RD: Arthroscopy of the foot and ankle, in Coughlin MJ, Mate RA (eds): Surgery of the Foot and Ankle, ed 7. St Louis, MO, Harcourt Health Science, 1999, pp 1257-1268.1. 01.253 A 53-year-old patient sustains a traumatic anterior dislocation of the2. glenohumeral joint. The glenohumeral joint is reduced, and postreduction3. radiographs show a concentric reduction and no evidence of fracture. One4. week later, the patient cannot actively abduct his arm; however, passive5. abduction is normal. What is the most likely cause for the lack of active6. shoulder abduction?7. 1- Axillary nerve injury8. 2- Brachial plexus injury9. 3- Deltoid muscle avulsion10. 4- Rotator cuff tear11. 5- Glenoid labral tear1. answer1. back1. Question 01.2532. Answer = 41. back to this question1. next question1. Reference(s)2. Stayner LR, Cummings J, Andersen J, Jobe CM: Shoulder dislocations in patients older than 40 years of age. Orthop Clin North Am 2000;31:231-239. Hawkins RJ, Bell RH, Hawkins RH, Koppert GJ: Anterior dislocation of the shoulder in the older patient. Clin Orthop 1986;206:192-195.1. 01.254 What patient-related risk factor is associated with an increased risk of2. dislocation in total hip arthroplasty?3. 1- Obesity4. 2- Smoking5. 3- Alcohol intake6. 4- Male gender7. 5- Use of systemic steroids1. answer1. back1. Question 01.2542. Answer = 31. back to this question1. next question1. Reference(s)2. Espehaug B, Havelin LL Engesaester LB, Langeland N, Vollset SE: Patient related risk factors for early revision of total hip replacements: A population register-based case-control study of 674 revised hips. Acts Orthop Scand 1997;68:207-215. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 455-492.1. 01.255 The poor results following surgical treatment of posterior wall acetabular2. fractures are most commonly associated with3. 1- sciatic nerve injury.4. 2- articular comminution.5. 3- heterotopic ossification.6. 4- deep venous thrombosis.7. 5- osteonecrosis of the femoral head.1. answer1. back1. Question 01.2552. Answer = 21. back to this question1. next question1. Reference(s)2. Browner BD, Jupiter JB, Levine AM Trafton PB (eds): Skeletal Trauma, ed 2. Philadelphia, PA, WB Saunders 1998, pp 1204-1208. Matta JM: Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996;78:1632-1645. Saterbak AM, Marsh JL, Nepola JV, Brandser EA, Turbett T: Clinical failure after posterior wall acetabular fractures: The influence of initial fracture patterns. J Orthop Trauma 2000;14:230-237.1. 01.256 Which of the following conditions is considered a common clinical2. manifestation of multiple hereditary exostoses?3. 1- Radial bowing4. 2- Scoliosis5. 3- Acetabular dysplasia6. 4- Genu varum7. 5- Dwarfism1. answer1. back1. Question 01.2562. Answer = 11. back to this question1. next question1. Reference(s)2. Stanton RP, Hansen MO: Function of the upper extremities in hereditary multiple exostoses. J Bone Joint Surg Am 1969;78:68-573. Arms DM, Strecker WB, Manske PR, Schoenecker PL: Management of forearm deformity in multiple hereditary osteochondromatosis. J Pediatr Orthop 1997;17:450-454. Schmale GA, Conrad EU III, Raskind WH: The natural history of hereditary multiple exostoses. J Bone Joint Surg Am 1994;76:986-992.1. 01.257 When comparing women who sustained a pelvic ring fracture with women2. who have multiple injuries without a pelvic ring fracture, those with a pelvic3. fracture have been found to have a higher subsequent rate of4. 1- miscarriage.5. 2- infertility.6. 3- depression.7. 4- failure to achieve physiologic sexual arousal.8. 5- urinary difficulties.1. answer1. back1. Question 01.2572. Answer = 51. back to this question1. next question1. Reference(s)2. Copeland CE, Bosse MJ, McCarthy ML, et al: Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma 1997;11:73-81.1. 01.258 When performing palmar fasciectomy for Dupuytren's contracture, what other2. procedure should not be performed at the same time?3. 1- Trigger finger release4. 2- Intraoperative digital nerve laceration repair5. 3- Knuckle pad excision6. 4- Proximal interphalangeal joint arthrodesis7. 5- Carpal tunnel release1. answer1. back1. Question 01.2582. Answer = 51. back to this question1. next question1. Reference(s)2. American Society for Surgery of the Hand: Hand Surgery Update. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1996, pp 271-279. Nissenbaum M, Kleinert HE: Treatment considerations in carpal tunnel syndrome with coexistent Dnpuytren's disease. J Hand Surg Am 1980;5:544-547.1. 01.259 A 44-year-old man has persistent anteromedial joint line pain after sustaining2. multiple ankle sprains. At the time of surgery, thickening of the deltoid3. ligament on its most anterior aspect is noted. What fascicle of the deltoid4. ligament is involved with this anterior impingement?5. 1- Anterior tibial6. 2- Anterior tibiotalar7. 3- Tibionavicular8. 4- Tibiocalcaneal9. 5- Talonavicular1. answer1. back1. Question 01.2592. Answer = 21. back to this question1. next question1. Reference(s)2. Egol KA, Parisian JS: Impingement syndrome of the ankle caused by a medial meniscoid lesion. Arthroscopy 1997;13:522-525. Mosier-La Clair SM, Monroe MT, Manoli A: Medial impingement syndrome of the anterior tibiotalar fascicle of the deltoid ligament on the talus. Foot Ankle Int 2000;21:385-391.1. 01.260 What metabolic bone disease is associated with the presence of virus-like2. inclusion bodies found in the osteoclast?3. 1- X-linked hypophosphatemic rickets4. 2- Fanconi's syndrome5. 3- Osteopetrosis6. 4- Osteomalacia7. 5- Paget's disease of bone1. answer1. back1. Question 01.2602. Answer = 51. back to this question1. next question1. Reference(s)2. Beaty 1H (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 149-165. Hadjipavlou A, Lander P: Paget disease of the spine. J Bone Joint Surg Am 1991;73:1376-1381. Delmas PD, Mennier P1: The management of Paget's disease of bone. N Engl J Med 1997;336:58-566.1. 01.261 Pseudoachondroplasia, characterized by disproportionate short-limbed2. dwarfism and ligamentous laxity, is caused by a deletion or alteration in the3. gene encoding what protein?4. 1- Fibroblast growth factor receptor5. 2- Cartilage oligomeric matrix protein6. 3- Type 11 collagen7. 4- Type IX collagen8. 5- Parathyroid hormone receptor1. answer1. back1. Question 01.2612. Answer = 21. back to this question1. next question1. Reference(s)2. Buckwalter JA, Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 112-131.1. 01.262 Semmes-Weinstein monofilaments are used to test the foot for abnormal2. sensory threshold in patients with diabetes mellitus. Loss of protective3. sensation is the inability to feel4. 1- the 4.17 filament.5. 2- the 5.07 filament.6. 3- the 6.10 filament.7. 4- 5 g of pressure.8. 5- 15 g of pressure.1. answer1. back1. Question 01.2622. Answer = 21. back to this question1. next question1. Reference(s)2. Jeng C, Michelson J, Mizel M: Sensory thresholds of normal human feet. Foot Ankle Int 2000;21:501-504. Rith-Najarian SJ, Stolusky T, Gohdes DM: Identifying diabetic patients at him risk for lower-extremity amputation in a primary health care setting: A prospective evaluation of simple screening criteria. Diabetes Care 1992;15:1386-1389.1. 01.263 A 13-year-old girl with scoliosis has mild intermittent back pain. A bone scan,2. CT scan, and an MRI scan would most likely reveal which of the following3. conditions?4. 1- Spondylolysis5. 2- Spondylolisthesis6. 3- Scheuermann's disorder7. 4- Slipped vertebral apophysis8. 5- No other condition1. answer1. back1. Question 01.2632. Answer = 51. back to this question1. next question1. Reference(s)2. Ramirez N, Johnston CE, Browne RH: The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am 1997;79:364-368.1. 01.264 What is the most common cause of failure of the pars interarticularis in2. spondylolysis?3. 1- Repetitive hyperextension4. 2- Repetitive axial loading5. 3- Repetitive torsion6. 4- Single-load extension7. 5- Single-load flexion1. answer1. back1. Question 01.2642. Answer = 11. back to this question1. next question1. Reference(s)2. Bradford D.S: Spondylolysis and spondylolisthesis in children and adolescents: Current concepts in management, in Bradford DS, Hensinger RM (eds): The Pediatric Spine. New York, NY, Thieme, 1985, pp 403-423. Bridwell KH, DeWald RL (eds): The Textbook of Spinal Surgery, ed 2. Philadelphia, PA, Lippincott-Raven, 1997, pp 1337-1347.1. 01.265 What is the advantage of impaction allografting during femoral revision hip2. arthroplasty?3. 1- Lower cost4. 2- Lower incidence of femoral component subsidence5. 3- Lower risk of femoral fracture and perforation6. 4- Ability to reconstitute bone stock7. 5- Delivery of depot antibiotics1. answer1. back1. Question 01.2652. Answer = 41. back to this question1. next question1. Reference(s)2. Leopold SS, Rosenberg AG: Current status of impaction allografting for revision of a femoral component. Inst Course Lect 2000;49:111-118.1. 01.266 Which of the following is considered a characteristic of a prosthesis used for a2. Syme's amputation?3. 1- No auxiliary suspension mechanisms4. 2- Posterior window5. 3- Non-weight-bearing distal portion6. 4- Patellar tendon bearing7. 5- Availability of multiple foot prostheses1. answer1. back1. Question 01.2662. Answer = 11. back to this question1. next question1. Reference(s)2. Coughlin MJ, Mann RA: Surgery of the Foot and Ankle, ed 7. St Louis, MO, Mosby, 1999, pp 1003-1004.1. 01.267 A 62-year-old woman who plays tennis underwent an acromioplasty and2. rotator cuff repair using four suture anchors 1 month ago. Three days ago, she3. was allowed to begin using her arm to lift light weights, but she now reports a4. dramatic increase in pain and is unable to elevate the arm. The next most5. appropriate step in management should consist of6. 1- further immobilization and discontinuation of physical therapy.7. 2- plain radiography.8. 3- MRI.9. 4- arthrography.10. 5- electromyography of the axillary and suprascapular nerves.1. answer1. back1. Question 01.2672. Answer = 21. back to this question1. next question1. Reference(s)2. Hanyman DT II: Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III: Repairs of the rotator cuff: Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991;73:982-989. Barber FA, Herbert MA, Click JN: The ultimate strength of suture anchors. Arthroscopy 1995;11:21-28.1. 01.268 Which of the following factors will increase the rigidity of an external fixator?2. 1- Decreased pin diameter3. 2- Decreased pin number4. 3- Increased pin spread within a segment5. 4- Increased bone-to-rod distance6. 5- Increased distance between fragment pin sets1. answer1. back1. Question 01.2682. Answer = 31. back to this question1. next question1. Reference(s)2. Buckwalter JA. Einhorn TA, Simon SR (eds): Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System, ed 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2000, pp 372-399.1. 01.269 The likelihood of a contralateral slip occurring in a boy with a unilateral2. slipped capital femoral epiphysis is greatest when combined with which of the3. following risk factors?4. 1- An unstable slip5. 2- A chronic slip6. 3- A grade III slip7. 4- Patient age of 11 years8. 5- Patient age of 13 years1. answer1. back1. Question 01.2692. Answer = 41. back to this question1. next question1. Reference(s)2. Stasikelis PJ, Sullivan CM, Phillips WA, Polard JA: Slipped capital femoral epiphysis: Prediction of contralateral involvement. J Bone Joint Surg Am 1996;78:1149-1155. Loder RT, Aronson DD, Greenfield ML: The epidemiology of bilateral slipped capital femoral epiphysis: A study of children in Michigan. J Bone Joint Surg Am 1993;75:1141-1147.1. 01.270 During intramedullary tibial nailing, compartment pressures in the leg are most2. elevated by the use of3. 1- reaming.4. 2- continuous traction.5. 3- a medial starting point.6. 4- a lateral starting point.7. 5- a solid nail.1. answer1. back1. Question 01.2702. Answer = 21. back to this question1. next question1. Reference(s)2. Shakespeare DT, Henderson NJ: Compartmental pressure changes during calcaneal traction in tibial fractures. J Bone Joint Surg Br 1982;64:498-499. McQueen MM, Christie J, Court-Brown CM: Compartment pressures after intramedullary nailing of the tibia. J Bone Joint Surg Br 1990;72:395-397.1. 01.271 Surgical intervention is first indicated for Dupuytren's disease when which of2. the following findings is present?3. 1- A metacarpophalangeal joint contracture that is greater than 60° and a proximal4. interphalangeal joint contracture of any degree5. 2- A metacarpophalangeal joint contracture and a proximal interphalangeal joint6. contracture that are each greater than 40°7. 3- A metacarpophalangeal joint contracture of 30° and a proximal interphalangeal joint8. contracture of any degree9. 4- A metacarpophalangeal joint contracture of any degree and a proximal10. interphalangeal joint contracture that is greater than or equal to 30°11. 5- Any contracture of either the metacarpophalangeal or proximal interphalangeal joints1. answer1. back1. Question 01.2712. Answer = 31. back to this question1. next question1. Reference(s)2. McFarlane RM, Botz JS: The results of treatment, in McFarlane RM, McGrouther DA, Flint MA (eds): Dupuytren's Disease: Biology and Treatment (The hand and upper limb series, vol 5). Edinburgh, Scotland, 1990, pp 387-412.1. 01.272 Following a left-sided approach for surgery on the anterior cervical spine, the2. patient reports a drooping left upper eyelid and dryness on the left side of the3. face. Which of the following structures has most likely been injured?4. 1- Recurrent laryngeal nerve5. 2- Superior laryngeal nerve6. 3- Hypoglossal nerve7. 4- Phrenic nerve8. 5- Sympathetic chain1. answer1. back1. Question 01.2722. Answer = 51. back to this question1. next question1. Reference(s)2. Bridwell KH, DeWald RL (eds): The Textbook of Spinal Surgery, ed 2. Philadelphia, PA, Lippincott-Raven, 1997, pp 1427-1438. Flynn TB: Neurologic complications of anterior cervical interbody fusion. Spine 1982;7:536-539.1. 01.273 An 18-year-old man with recurrent bilateral ankle instability reports that his2. symptoms have been slowly progressing. He denies problems with3. coordination, but he notes easy fatigability when he types. History reveals that4. his grandmother had "disfigured feet." Examination reveals bilateral cavovarus5. feet and peroneal weakness. He has intrinsic muscular weakness in his hands.6. To confirm the diagnosis, which of the following studies should be obtained?7. 1- Radiographs of the spine8. 2- Electrocardiography9. 3- Electromyography10. 4- MRI of the feet11. 5- CBC1. answer1. back1. Question 01.2732. Answer = 31. back to this question1. next question1. Reference(s)2. Beaty JH (ed): Orthopaedic Knowledge Update 6. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp 235-245. Mizel MS, Miller RA, Scioli MW (eds): Orthopaedic Knowledge Update: Foot and Ankle 2. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1998, pp 79-100.1. 01.274 Which of the following is considered the most common complication of an2. extensive medial release for resistant medial epicondylitis?3. 1- Ulnar palsy4. 2- Medial elbow instability5. 3- Wrist flexion weakness6. 4- Forearm pronation weakness7. 5- Elbow flexor weakness1. answer1. back1. Question 01.2742. Answer = 21. back to this question1. next question1. Reference(s)2. Callaway GH, Field LD, Deng ML et al: Biomechanical evaluation of the medial collateral ligament of the elbow. J Bone Joint Surg Am 1997;79:1223-1231. Vangsness CT Jr, Jobe FW: Surgical treatment of medial epicondylitis: Results in 35 elbows. J Bone Joint Surg Br 1991;73:409-411.1. 01.275 What neurosensory receptor is responsible for detecting the sensation of a2. vibration?3. 1- Merkel cells4. 2- Pacinian corpuscles5. 3- Ruffini end organs6. 4- Meissner corpuscles7. 5- Free-ending nerve fibers1. answer1. back1. Question 01.2752. Answer = 31. back to this question1. End of 2001 Exam1. Reference(s)2. Simon SR (ed): Orthopaedic Basic Science. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1994, pp 325-396.for more mcqs in the bankORTHOPEDIC MCQS ONLINE BANK OITE 20ORTHOPEDIC MCQS ONLINE BANK OITE 97ORTHOPEDIC MCQS BANK OITE 96ORTHOPEDIC MCQS BANK OITE 99ORTHOPEDIC MCQS BANK OITE98ORTHOPEDIC MCQS ONLINE OB PATHOLOGY 1AORTHOPEDIC MCQS ONLINE OB HAND 1ALinks For. 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Böhler's angle is formed by a line drawn from the highest point of the anterior process of the calcaneus to the highest point of the posterior facet, and a second line drawn from the posterior facet to the superior edge of the calcaneal tuberosity. The normal angle is 20 to 40 degrees. In intra-articular calcaneus fractures with depression of the posterior facet, Böhler's angle is characteristically decreased or flattened.

The Eichenholtz classification describes the natural history of Charcot neuroarthropathy. Stage 0 is the clinical "red, hot, swollen" foot with normal x-rays. Stage 1 (Development/Fragmentation) is characterized by clinical inflammation and radiographic findings of bone fragmentation, debris, joint subluxation, and dislocation. Stage 2 (Coalescence) shows absorption of fine debris, early fusion of larger fragments, and decreased clinical swelling. Stage 3 (Reconstruction) features remodeling of bone ends, rounding of fragments, and decreased osteopenia without inflammation.

In the assessment of a knee dislocation, vascular injury (particularly to the popliteal artery) must be ruled out. While historically all knee dislocations underwent angiography, current protocols rely on the Ankle-Brachial Index (ABI). An ABI > 0.9 with normal palpable pulses is highly reassuring, and the patient can be observed with serial exams. An ABI < 0.9 is highly sensitive for an arterial injury and mandates further advanced imaging, such as a CT angiogram or arterial duplex ultrasound.

The Lisfranc ligament is a strong interosseous ligament that runs obliquely from the lateral aspect of the medial cuneiform to the medial base of the second metatarsal. The "fleck sign" on an AP radiograph is highly specific for a Lisfranc injury. It represents a bony avulsion of the Lisfranc ligament, typically avulsing from the base of the second metatarsal.

The clinical picture represents the acute fragmentation phase (Eichenholtz stage I) of Charcot arthropathy. The standard initial management is strict immobilization and offloading, typically with a total contact cast, to prevent further deformity while the acute inflammatory process subsides.

Recent high-quality evidence demonstrates that non-operative management with early functional bracing yields re-rupture rates equivalent to surgical repair. It provides the added benefit of avoiding surgical complications such as infection and wound breakdown.

The Lisfranc ligament connects the plantar aspect of the medial cuneiform to the base of the second metatarsal. It is critical for the stability of the tarsometatarsal joint complex, and its rupture leads to midfoot instability.

Modern evidence-based management of Achilles tendon ruptures heavily emphasizes early functional rehabilitation and protected weight-bearing. Compared to prolonged strict immobilization, this approach yields similar re-rupture rates but significantly reduces deep vein thrombosis, muscle atrophy, and tendon elongation.

Eichenholtz Stage 1 (Developmental/Fragmentation) of Charcot arthropathy is characterized clinically by acute inflammation and radiographically by bone fragmentation, joint dislocation, and debris formation. Stage 2 involves early healing and absorption of fine debris.