Menu

8. Foot and Ankle MCQs

Practice Set 340 of 353

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

Question 6781

Topic: 8. Foot and Ankle

While chondroblastoma typically occurs in the epiphyses of long bones, which of the following is the most common location in the foot?

. Metatarsal heads
. Base of the fifth metatarsal
. Talus and calcaneus
. Cuboid
. Navicular

Correct Answer & Explanation

. Talus and calcaneus

Explanation

In the foot, chondroblastomas most commonly arise in the talus and calcaneus. These tarsal bones develop from secondary ossification centers and are considered apophyseal equivalents, which aligns with the tumor's affinity for epiphyseal/apophyseal cartilage.

Question 6782

Topic: 8. Foot and Ankle

A 16-year-old male presents with heel pain. Imaging reveals a well-defined lytic lesion in the posterior calcaneus. Histology confirms chondroblastoma. Why does chondroblastoma occur in this specific location despite not being a long bone epiphysis?

. The calcaneus develops entirely through intramembranous ossification
. The lesion originates from the Achilles tendon insertion and invades bone
. The posterior calcaneus contains a secondary center of ossification (apophysis)
. The tumor arises from a remnant of the notochord
. The calcaneus lacks a physeal barrier, allowing metaphyseal tumor migration

Correct Answer & Explanation

. The posterior calcaneus contains a secondary center of ossification (apophysis)

Explanation

Chondroblastomas almost exclusively arise in secondary centers of ossification. In the foot, the calcaneal apophysis (where the Achilles tendon inserts) acts as an epiphyseal equivalent, making it a classic location.

Question 6783

Topic: 8. Foot and Ankle

A 6-year-old boy presents with a painless, hard swelling on the lateral aspect of his left ankle, as shown in the clinical photograph below. He has a limited range of motion in the affected joint. Given the most likely diagnosis, which of the following is true regarding the typical epidemiological profile of this condition?




. It affects females twice as frequently as males.
. The incidence is approximately 1 in 10,000.
. It typically presents between the ages of 2 and 14 years.
. Upper limb involvement is more common than lower limb involvement.
. It is an acquired inflammatory condition.

Correct Answer & Explanation

. It typically presents between the ages of 2 and 14 years.

Explanation

Correct Answer: CThe clinical image demonstrates a bone-hard swelling typical of Dysplasia Epiphysealis Hemimelica (DEH), also known as Trevor's disease. DEH is a rare skeletal developmental disorder that typically presents in young children between the ages of 2 and 14 years. It has an incidence of 1 in 1,000,000, affects males twice as frequently as females, and predominantly involves the lower limbs (distal femur, distal tibia, and talus).

Question 6784

Topic: 8. Foot and Ankle

Dysplasia epiphysealis hemimelica (DEH) most frequently affects the lower extremities. Which of the following groups of bones represents the most common sites of involvement?

. Proximal femur, patella, and calcaneus
. Distal femur, distal tibia, and talus
. Proximal tibia, fibula, and navicular
. Distal radius, scaphoid, and lunate
. Ilium, ischium, and pubis

Correct Answer & Explanation

. Distal femur, distal tibia, and talus

Explanation

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

Question 6785

Topic: 8. Foot and Ankle

Review the provided MRI and CT images of a pediatric patient presenting with hindfoot pain and restricted motion. The pathology is localized to the lateral side of the affected bone. Based on the typical distribution of this disease, which bone is primarily affected in this image?




. Calcaneus
. Navicular
. Talus
. Cuboid
. Distal Tibia

Correct Answer & Explanation

. Talus

Explanation

Correct Answer: CThe images (MRI frontal plane and CT slides) demonstrate DEH localized on the lateral side of the talus. The talus is one of the three most common locations for DEH, alongside the distal femur and distal tibia.

Question 6786

Topic: 8. Foot and Ankle

Review the coronal MRI and CT images of a pediatric patient's ankle below. The lesion is localized to the lateral aspect of the talus. Which of the following terms best describes this characteristic pattern of involvement?




. Holomelic
. Hemimelic
. Diaphyseal
. Metaphyseal
. Pan-articular

Correct Answer & Explanation

. Hemimelic

Explanation

Correct Answer: HemimelicThe images show Dysplasia Epiphysealis Hemimelica (DEH) localized to the lateral side of the talus. Characteristically, the involvement in this condition is 'hemimelic', meaning it affects only one half (either the medial or lateral side) of the epiphysis.

Question 6787

Topic: 8. Foot and Ankle

Dysplasia epiphysealis hemimelica (DEH) predominantly affects the lower extremities. Which of the following groups of bones represents the most common sites of involvement?

. Proximal femur, patella, and calcaneus
. Distal femur, distal tibia, and talus
. Proximal tibia, fibula, and cuboid
. Distal radius, scaphoid, and lunate
. Ilium, ischium, and pubis

Correct Answer & Explanation

. Distal femur, distal tibia, and talus

Explanation

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

Question 6788

Topic: 8. Foot and Ankle

A resident is reviewing cases of Dysplasia Epiphysealis Hemimelica (DEH) for a departmental presentation. They note a specific pattern regarding the anatomical distribution of the lesions. Which of the following statements is true regarding the anatomical distribution of DEH?

. Upper limb involvement is more common than lower limb involvement.
. Upper limb involvement is extremely rare.
. It typically presents with bilateral, symmetric involvement of the upper limbs.
. The axial skeleton is the primary site of involvement.
. It exclusively affects the diaphysis of long bones.

Correct Answer & Explanation

. Upper limb involvement is extremely rare.

Explanation

Correct Answer: Upper limb involvement is extremely rare.DEH is predominantly a condition of the lower extremities (distal femur, distal tibia, talus). Upper limb involvement is documented in the literature but is considered extremely rare.

Question 6789

Topic: 8. Foot and Ankle

A 6-year-old boy presents with the clinical finding shown below. Based on the most likely diagnosis, what is the typical age of onset for this condition?


. Birth to 1 year
. 2 to 14 years
. 15 to 25 years
. 30 to 40 years
. Over 50 years

Correct Answer & Explanation

. 2 to 14 years

Explanation

Correct Answer: 2 to 14 yearsThe image demonstrates a moderate, painless, bone-hard swelling at the lateral side of the ankle, characteristic of Dysplasia Epiphysealis Hemimelica (DEH). According to the text, the age of onset for DEH is usually between 2 and 14 years.

Question 6790

Topic: 8. Foot and Ankle

Regarding the clinical presentation of Dysplasia Epiphysealis Hemimelica (DEH), which of the following is considered extremely rare?

. Involvement of the distal tibia
. Involvement of the talus
. Involvement of the upper limb
. Presentation with a bone-hard mass
. Presentation with aching pains

Correct Answer & Explanation

. Involvement of the upper limb

Explanation

Correct Answer: Involvement of the upper limbDEH predominantly affects the lower extremities (distal femur, distal tibia, and talus). The text notes that upper limb involvement is extremely rare. Presentation with a bone-hard mass and aching pains are common symptoms.

Question 6791

Topic: 8. Foot and Ankle

A 6-year-old boy presents with the clinical finding shown below. Palpation reveals a bone-hard, painless mass. Given the most likely diagnosis of Dysplasia Epiphysealis Hemimelica (DEH), which of the following statements regarding the epidemiology of this condition is most accurate?


. Females are affected twice as frequently as males.
. The incidence is approximately 1 in 10,000.
. The typical age of onset is between 2 and 14 years.
. Upper limb involvement is more common than lower limb involvement.
. It typically presents as a soft, fluctuant mass.

Correct Answer & Explanation

. The typical age of onset is between 2 and 14 years.

Explanation

Correct Answer: CDysplasia Epiphysealis Hemimelica (DEH), also known as Trevor's disease, typically presents in young children with an age of onset usually between 2 and 14 years. It is extremely rare (incidence of 1 in 1,000,000), affects males twice as frequently as females, and predominantly involves the lower limbs (distal femur, distal tibia, and talus). It presents as a mass with the consistency of bone, not a soft fluctuant mass.

Question 6792

Topic: 8. Foot and Ankle

Review the advanced imaging of the ankle provided below. The pathology is localized to the lateral side of the talus. In a patient with this specific presentation of Dysplasia Epiphysealis Hemimelica (DEH), which of the following clinical symptoms is most likely to be the primary complaint alongside the palpable mass?


. Rapidly progressive sensory loss in the deep peroneal nerve distribution
. Aching pains and limited range of motion in the ankle joint
. Acute, severe nocturnal pain relieved by NSAIDs
. Pathological fracture of the talar neck
. Spontaneous fusion of the subtalar joint

Correct Answer & Explanation

. Aching pains and limited range of motion in the ankle joint

Explanation

Correct Answer: BThe most common presenting symptoms of DEH include the presence of a mass with the consistency of bone, deformity, aching pains, and limited range of motion. Neurological deficits, nocturnal pain relieved by NSAIDs (typical of osteoid osteoma), and pathological fractures are not classic primary presentations of DEH.

Question 6793

Topic: 8. Foot and Ankle

Which of the following bones is statistically the most frequently affected site in Dysplasia Epiphysealis Hemimelica?

. Proximal humerus
. Distal radius
. Talus
. Ilium
. Patella

Correct Answer & Explanation

. Talus

Explanation

The talus is the most commonly affected bone in DEH, followed by the distal femur and proximal tibia. The lower extremities are overwhelmingly more involved than the upper extremities.

Question 6794

Topic: 8. Foot and Ankle
According to the Azouz classification for Dysplasia Epiphysealis Hemimelica, a patient presenting with involvement of the distal femur, proximal tibia, and talus in the same lower extremity is classified as which of the following?
. Type I (Localized)
. Type II (Classic)
. Type III (Generalized)
. Type IV (Syndromic)
. Type V (Bilateral)

Correct Answer & Explanation

. Type II (Classic)

Explanation

In the Azouz classification, Type I is localized (one bone), Type II is classic (more than one bone in a single limb), and Type III is generalized (involving the entire limb or multiple limbs). Multiple bones in a single limb fits Type II.

Question 6795

Topic: 8. Foot and Ankle

A 9-year-old male with untreated DEH of the medial talus presents with worsening pain during ambulation. What is the most likely long-term sequela if the mechanical incongruity of the joint is left unaddressed?

. Pathologic fracture of the talus
. Avascular necrosis of the navicular
. Premature secondary osteoarthritis
. Spontaneous auto-fusion of the subtalar joint
. Transformation to a synovial sarcoma

Correct Answer & Explanation

. Premature secondary osteoarthritis

Explanation

If left untreated, the mechanical block and joint incongruity caused by an enlarging epiphyseal mass in DEH predictably lead to premature secondary osteoarthritis of the affected joint.

Question 6796

Topic: 8. Foot and Ankle

Trevor's disease was originally described in 1950 under a different nomenclature. What historical term did Trevor use to describe this pathology?

. Tarso-epiphyseal aclasis
. Multiple hereditary exostoses
. Epiphyseal chondroblastoma
. Ollier's disease
. Maffucci's syndrome

Correct Answer & Explanation

. Tarso-epiphyseal aclasis

Explanation

Trevor originally named the condition 'tarso-epiphyseal aclasis' in 1950 because he observed it predominantly affecting the tarsal bones and epiphyses. It was later renamed Dysplasia Epiphysealis Hemimelica by Fairbank.

Question 6797

Topic: 8. Foot and Ankle

The Azouz classification system for DEH describes three distinct anatomical forms. A patient presenting with involvement of both the talus and the distal tibia on the ipsilateral side would be classified as which of the following?

. Localized
. Classic (regional)
. Generalized
. Disseminated
. Systemic

Correct Answer & Explanation

. Localized

Explanation

In the Azouz classification, 'Localized' involves a single epiphysis. 'Classic' or 'regional' involves more than one epiphysis within a single lower limb (e.g., distal tibia and talus). 'Generalized' involves the entire lower limb.

Question 6798

Topic: 8. Foot and Ankle

A 5-year-old boy presents with progressive right knee and ankle asymmetry. Radiographs reveal cartilaginous overgrowth involving the medial distal femoral epiphysis, the proximal tibial epiphysis, and the medial aspect of the talus, all confined to the right lower extremity. According to the Azouz classification for Dysplasia Epiphysealis Hemimelica (DEH), which category best describes this patient's presentation?

. Localized
. Classic
. Generalized
. Polyostotic
. Syndromic

Correct Answer & Explanation

. Classic

Explanation

The Azouz classification divides DEH into three types: Localized (one epiphysis), Classic (more than one epiphysis in a single limb), and Generalized (involvement of the entire lower limb from pelvis to foot). This patient has multiple involved epiphyses in a single limb, fitting the Classic form.

Question 6799

Topic: 8. Foot and Ankle

The parents of a 4-year-old boy recently diagnosed with Dysplasia Epiphysealis Hemimelica (Trevor's disease) of the left ankle ask about the risk of their future children inheriting the condition. Which of the following is the most accurate genetic counseling information to provide?

. The condition is autosomal dominant and carries a 50% recurrence risk.
. The condition is autosomal recessive and carries a 25% recurrence risk.
. The condition is strictly X-linked, affecting only male offspring.
. The condition is a spontaneous somatic mutation and is generally non-hereditary.
. The condition is associated with a familial EXT1 gene mutation.

Correct Answer & Explanation

. The condition is a spontaneous somatic mutation and is generally non-hereditary.

Explanation

Unlike Multiple Hereditary Exostoses (which involves EXT1/EXT2 gene mutations and is autosomal dominant), DEH (Trevor's disease) is a sporadic, non-hereditary developmental disorder. The recurrence risk for future siblings is virtually zero.

Question 6800

Topic: 8. Foot and Ankle

A 7-year-old boy presents with an enlarging mass on the medial side of his knee and a progressive varus deformity. You suspect Dysplasia Epiphysealis Hemimelica (DEH). Epidemiologically and anatomically, which of the following best describes the most common presentation of this condition?

. Female predominance, predominantly affecting the lateral compartment of the upper limb.
. Male predominance, predominantly affecting the lateral compartment of the lower limb.
. Male predominance, predominantly affecting the medial compartment of the lower limb.
. Female predominance, predominantly affecting the medial compartment of the upper limb.
. Equal gender distribution, predominantly affecting the spine and pelvis.

Correct Answer & Explanation

. Male predominance, predominantly affecting the medial compartment of the lower limb.

Explanation

DEH predominantly affects males (approximately 3:1 ratio compared to females). It most commonly involves the lower extremity (especially the ankle/talus and knee) and favors the medial side of the epiphysis over the lateral side (2:1 ratio).

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page