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Orthopaedic Surgery Board Exam Review: ABOS Part I & AAOS OITE Prep Questions | Part 22210

Orthopedic Board Prep: High-Yield MCQs for Exam Success

23 Apr 2026 75 min read 105 Views
Illustration of c tpn cmcm - Dr. Mohammed Hutaif

Key Takeaway

Effective Orthopedic Board Exam preparation involves rigorous practice with high-yield multiple-choice questions (MCQs) covering core orthopaedic topics like trauma, infections, and surgical management. Utilizing a dedicated study engine helps simulate exam conditions, identify knowledge gaps, and reinforce critical concepts for successful certification.

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Question 1

A 28-year-old male sustains a comminuted open tibia fracture (Gustilo-Anderson Type IIIB) after a motor vehicle accident. Initial management includes debridement, external fixation, and IV antibiotics. Two weeks later, he presents with persistent pain, fever, and purulent discharge from the wound. Which of the following is the most appropriate next step in management?





Explanation

The clinical presentation (persistent pain, fever, purulent discharge from an open fracture) strongly suggests osteomyelitis. The most appropriate next step is aggressive repeat surgical debridement to remove infected and necrotic tissue, obtain deep tissue cultures to identify the causative organism and guide antibiotic therapy, and continue appropriate IV antibiotics. Simply switching to oral antibiotics or casting without addressing the source of infection is inadequate. Hyperbaric oxygen can be an adjunct but not the primary intervention for active infection. Amputation is a salvage procedure considered after failure of limb preservation attempts.

Question 2

A 65-year-old female with known osteoporosis falls and presents with acute severe back pain. Imaging reveals a T12 compression fracture. She has failed conservative management with pain medication and bracing for 6 weeks. Her pain is significantly impacting her quality of life. Which surgical intervention would be most appropriate at this stage?





Explanation

For painful osteoporotic vertebral compression fractures refractory to conservative management, vertebroplasty or kyphoplasty are minimally invasive procedures designed to stabilize the fracture and alleviate pain by injecting bone cement into the collapsed vertebral body. Spinal fusion is typically reserved for unstable fractures or deformity correction. Laminectomy and discectomy are not indicated for isolated compression fractures without neural compression. Posterior instrumentation without fusion might be used for unstable fractures but is less common for isolated osteoporotic compression fractures failing conservative care.

Question 3

A 35-year-old male presents with sudden onset excruciating left hip pain after a high-energy motor vehicle collision. He is found with his left hip flexed, adducted, and internally rotated. Pulses are palpable distally. Which of the following is the most critical immediate management step?





Explanation

The patient's presentation is classic for a posterior hip dislocation. This is an orthopedic emergency due to the high risk of avascular necrosis (AVN) of the femoral head and sciatic nerve injury. The most critical immediate step after assessing neurovascular status and administering analgesia is emergent closed reduction, ideally within 6 hours, to minimize the risk of AVN. Delay can significantly increase the risk of complications. MRI is useful after reduction to assess for occult fractures or soft tissue injuries, but not before emergent reduction. Open reduction is considered if closed reduction fails. Arthrocentesis is not indicated. Immobilizing in the deformed position will exacerbate complications.

Question 4

Which of the following is a contraindication to total knee arthroplasty (TKA)?





Explanation

Uncontrolled active infection in the knee is an absolute contraindication to total knee arthroplasty because implanting a foreign body into an infected joint significantly increases the risk of periprosthetic joint infection, which is a devastating complication. Obesity, advanced age, previous knee surgery, and mild rheumatoid arthritis are relative contraindications or not contraindications at all, often managed with careful patient selection and optimization.

Question 5

A 7-year-old boy presents with a supracondylar humerus fracture (Gartland Type III). Initial radiographs show significant displacement and rotation. Which neurovascular structure is most commonly at risk in this type of fracture?





Explanation

Gartland Type III supracondylar humerus fractures are severely displaced and rotated, putting the median nerve and brachial artery at significant risk of injury due to their close proximity to the distal humerus. The radial nerve is also at risk but less commonly than the median nerve/brachial artery. Ulnar nerve injury is less common in extension-type supracondylar fractures but can occur with flexion-type fractures or during surgical manipulation. Axillary and musculocutaneous nerves are not typically injured in this fracture pattern.

Question 6

A 50-year-old construction worker complains of right shoulder pain, especially when lifting his arm overhead. He describes a 'catching' sensation and weakness with abduction. Physical exam reveals a positive Neer's and Hawkins' test. Resisted external rotation is weak. What is the most likely diagnosis?





Explanation

The patient's symptoms of pain with overhead activity, weakness with abduction and external rotation, and positive impingement signs (Neer's and Hawkins' tests) are highly suggestive of a rotator cuff tear. Resisted external rotation weakness specifically points to involvement of the supraspinatus or infraspinatus, both part of the rotator cuff. Adhesive capsulitis presents with global stiffness. Glenohumeral osteoarthritis typically causes grinding and limited range of motion, often in older patients. Bicipital tendinitis causes anterior shoulder pain. AC joint arthritis causes localized pain at the top of the shoulder.

Question 7

What is the primary goal of surgical management for an unstable thoracolumbar burst fracture with neurological deficit?





Explanation

For an unstable thoracolumbar burst fracture with neurological deficit, the primary surgical goals are to decompress the neural elements (spinal cord or cauda equina) that are compromised by retropulsed bone fragments or disc material, and to stabilize the spinal column to prevent further injury and allow for neurological recovery. While early ambulation, pain relief, and prevention of kyphosis are important secondary goals, and minimizing blood loss is a surgical principle, they are not the primary aims of the surgery itself in this specific context of instability and neurological compromise.

Question 8

A 4-year-old child presents with a limp and right hip pain that started insidiously. X-rays show fragmentation and collapse of the right femoral head epiphysis. What is the most likely diagnosis?





Explanation

The clinical presentation (limp, hip pain, insidious onset in a young child) combined with radiographic findings of fragmentation and collapse of the femoral head epiphysis is classic for Legg-Calvé-Perthes disease, which is avascular necrosis of the femoral head in children. Septic arthritis has an acute onset with systemic signs. DDH is a developmental abnormality. SCFE typically affects older, obese adolescents. Transient synovitis is a self-limiting inflammatory condition with normal X-rays.

Question 9

Which of the following is a classic clinical triad for a ruptured Achilles tendon?





Explanation

The classic clinical triad for a ruptured Achilles tendon includes posterior heel/calf pain, a palpable gap in the tendon (often 2-6 cm proximal to the calcaneal insertion), and a positive Thompson test (absence of plantarflexion when squeezing the calf muscle). The other options describe symptoms related to different conditions: anterior ankle pain (e.g., impingement), lateral ankle swelling (e.g., ankle sprain), midfoot pain (e.g., posterior tibial tendon dysfunction), or calf pain/numbness/weakness (e.g., nerve impingement or compartment syndrome).

Question 10

In the management of an open fracture, what is the 'golden period' for surgical debridement to minimize infection risk?





Explanation

The 'golden period' for surgical debridement of an open fracture to significantly reduce the risk of infection is generally considered to be within 6 hours of injury. While some studies suggest a broader window, earlier debridement is consistently associated with better outcomes. Beyond this window, the risk of bacterial proliferation and subsequent infection increases substantially.

Question 11

A 22-year-old collegiate athlete sustains an injury to his knee during a soccer match. He reports hearing a 'pop,' followed by immediate swelling and inability to continue playing. Lachman test is positive. What is the most likely diagnosis?





Explanation

The classic presentation of an ACL tear includes a 'pop' at the time of injury, immediate knee swelling (hemarthrosis), inability to continue activity, and a positive Lachman test (anterior translation of the tibia relative to the femur with the knee at 30 degrees flexion). While meniscal tears can also cause popping and swelling, the Lachman test is specific for ACL laxity. MCL and LCL tears present with valgus/varus instability respectively. PCL tears cause posterior instability.

Question 12

Which of the following describes the most common type of Salter-Harris fracture involving the growth plate?





Explanation

Salter-Harris Type II fractures are the most common type, accounting for approximately 75% of all physeal injuries. These fractures extend through the physis and exit into the metaphysis, typically leaving a 'Thurston Holland' fragment. Type I is a separation through the physis. Type III is intra-articular and involves the epiphysis. Type IV is intra-articular, involving metaphysis, physis, and epiphysis. Type V is a rare crush injury with a poor prognosis.

Question 13

A 40-year-old female presents with persistent pain, stiffness, and catching in her right thumb MP joint. Radiographs show significant joint space narrowing and osteophytes. She has failed conservative management. What is the most appropriate surgical intervention?





Explanation

The patient's symptoms and radiographic findings are indicative of osteoarthritis of the thumb metacarpophalangeal (MP) joint. For symptomatic MP joint arthritis refractory to conservative care, surgical options include MP joint arthroplasty (replacement) or fusion, which can provide pain relief and stability. CMC joint arthroplasty is for basilar thumb arthritis. De Quervain's release is for stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. Scaphoidectomy is not relevant here. Flexor pollicis longus tenolysis is for trigger thumb.

Question 14

Which of the following imaging modalities is most sensitive for detecting early osteomyelitis?





Explanation

MRI is generally considered the most sensitive imaging modality for detecting early osteomyelitis, often demonstrating changes within 24-48 hours of infection onset. It provides excellent soft tissue contrast, allowing visualization of marrow edema, abscess formation, and soft tissue involvement. Plain radiographs may take 7-10 days to show changes. CT scans are good for bony detail but less sensitive for early marrow changes. Bone scintigraphy is sensitive but not very specific for infection versus other bone activity. Ultrasound can detect soft tissue abscesses but is not ideal for bone marrow changes.

Question 15

A 55-year-old male develops numbness and tingling in his left hand, specifically affecting the thumb, index, middle, and radial half of the ring finger. Symptoms are worse at night and with repetitive hand activities. Phalen's test is positive. What is the most likely diagnosis?





Explanation

The symptoms described (numbness/tingling in the median nerve distribution, nocturnal exacerbation, worsening with activity, positive Phalen's test) are classic for carpal tunnel syndrome, which is compression of the median nerve at the wrist. Ulnar nerve entrapment affects the small finger and ulnar half of the ring finger. Radial nerve palsy affects the extensors and causes wrist drop. Cervical radiculopathy would likely involve neck pain and weakness. Thoracic outlet syndrome has broader neurovascular symptoms, often involving the entire arm.

Question 16

What is the primary goal of Pilon fracture (distal tibia intra-articular) management?





Explanation

Pilon fractures are high-energy injuries often associated with severe soft tissue compromise. The primary goal of management is to minimize soft tissue swelling and allow for soft tissue recovery before definitive internal fixation, which often involves a staged approach (e.g., initial external fixation followed by definitive ORIF once the soft tissue envelope is favorable). Rushing to definitive fixation in the acute phase significantly increases the risk of wound complications, infection, and skin necrosis. Primary arthrodesis is reserved for severe, unsalvageable cases. External fixation is often used initially but not always exclusively as definitive treatment. Immediate full weight-bearing is contraindicated.

Question 17

Which type of scoliosis typically presents in adolescence, has no identifiable cause, and is the most common form?





Explanation

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, affecting approximately 2-3% of adolescents. It typically presents in children aged 10-18 years, progresses during growth spurts, and has no identifiable underlying cause. Congenital scoliosis is due to vertebral anomalies. Neuromuscular scoliosis is associated with neurological conditions (e.g., cerebral palsy). Syndromic scoliosis is associated with specific syndromes. Degenerative scoliosis occurs in older adults due to spinal degeneration.

Question 18

A 60-year-old male with chronic low back pain and bilateral leg pain, worse with standing and walking, and relieved by sitting or leaning forward (shopping cart sign), most likely has which of the following conditions?





Explanation

The classic symptoms of neurogenic claudication, including bilateral leg pain worse with standing and walking, and relieved by sitting or leaning forward (the 'shopping cart sign'), are highly suggestive of lumbar spinal stenosis. This condition involves narrowing of the spinal canal, compressing the cauda equina. Lumbar disc herniation typically causes more acute radicular pain, often unilateral. Spondylolisthesis can cause back and leg pain but the claudication pattern is distinct to stenosis. Sacroiliac joint dysfunction causes localized buttock pain. Piriformis syndrome causes sciatic-like pain but usually without the classic claudication pattern.

Question 19

What is the most common primary malignant bone tumor in children and young adults?





Explanation

Osteosarcoma is the most common primary malignant bone tumor in children and young adults (typically second decade of life). It is characterized by the production of osteoid by malignant cells. Ewing sarcoma is the second most common. Chondrosarcoma and fibrosarcoma are generally less common, and multiple myeloma is a malignancy of plasma cells affecting older adults, not a primary bone tumor in children.

Question 20

The anterior drawer test of the ankle assesses the integrity of which ligament?





Explanation

The anterior drawer test of the ankle specifically assesses the integrity of the anterior talofibular ligament (ATFL), which is the most commonly injured ligament in ankle sprains. The test involves stabilizing the tibia and fibula with one hand and drawing the foot anteriorly with the other. Excessive anterior translation or a 'clunk' indicates ATFL laxity/tear. The calcaneofibular ligament and posterior talofibular ligament are assessed by other maneuvers.

Question 21

Which of the following is a key management principle for compartment syndrome?





Explanation

Compartment syndrome is a surgical emergency characterized by increased pressure within a confined osteofascial compartment, compromising blood flow and leading to tissue ischemia. The definitive treatment is emergent fasciotomy to decompress the compartments. Applying compression bandages, elevating the limb, or applying ice packs are all contraindicated as they can worsen ischemia. Analgesics might mask symptoms, delaying crucial diagnosis and treatment.

Question 22

A 10-year-old obese male presents with a painful limp and external rotation of the affected leg, which worsens with activity. Radiographs show a widening and irregularity of the physis, with posterior and inferior displacement of the femoral head relative to the femoral neck. What is the most likely diagnosis?





Explanation

The presentation of a painful limp, external rotation deformity, and classic radiographic findings (widening/irregularity of physis, posterior/inferior displacement of femoral head) in an obese adolescent male is pathognomonic for Slipped Capital Femoral Epiphysis (SCFE). Legg-Calvé-Perthes disease affects younger children and involves fragmentation/collapse of the femoral head. Transient synovitis is self-limiting and has normal X-rays. Septic arthritis presents acutely with fever and systemic signs. DDH is a neonatal/infant condition.

Question 23

What is the primary indication for surgical intervention in patients with a herniated lumbar disc?





Explanation

The primary indication for urgent surgical intervention in patients with a herniated lumbar disc is the presence of a progressive neurological deficit, especially cauda equina syndrome (bowel/bladder dysfunction, saddle anesthesia, bilateral leg weakness). While failed conservative management (typically 6-12 weeks) is a common indication for elective surgery, it is not the most urgent. Chronic back pain alone is not a surgical indication for disc herniation. Radiographic evidence without correlating symptoms is insufficient.

Question 24

Which bone is most commonly fractured in the wrist after a fall onto an outstretched hand?





Explanation

The scaphoid is the most commonly fractured carpal bone, typically occurring after a fall onto an outstretched hand (FOOSH) with the wrist hyperextended and radially deviated. Due to its precarious blood supply, scaphoid fractures are prone to nonunion and avascular necrosis, especially if not recognized and treated appropriately.

Question 25

The 'terrible triad' of the elbow involves injury to which structures?





Explanation

The 'terrible triad' of the elbow consists of a posterior elbow dislocation, a radial head fracture, and a coronoid process fracture. These injuries combine to create a highly unstable elbow, often requiring surgical intervention for stability. The associated ligamentous injury in this context is typically the lateral collateral ligament (LCL) complex, not the MCL. The other options describe different injury patterns.

Question 26

What is the primary characteristic that distinguishes osteosarcoma from Ewing sarcoma on histopathology?





Explanation

The defining characteristic of osteosarcoma is the production of osteoid (immature bone matrix) by malignant tumor cells. Ewing sarcoma is characterized by small, round, blue cells (similar to lymphoma or neuroblastoma) and often associated with the EWS-FLI1 translocation. Chondrosarcoma produces a cartilaginous matrix. Multinucleated giant cells are seen in giant cell tumors. Spindle cell morphology is less specific and seen in various soft tissue sarcomas and some bone tumors.

Question 27

A 70-year-old male with long-standing bilateral knee osteoarthritis reports severe pain and functional limitation. He has undergone multiple intra-articular injections and physical therapy with minimal relief. Radiographs show tricompartmental severe degenerative changes. Which of the following is the most appropriate definitive treatment option?





Explanation

For severe tricompartmental knee osteoarthritis that has failed extensive conservative management, total knee arthroplasty (TKA) is the gold standard definitive treatment. High tibial osteotomy is typically for younger, active patients with isolated medial compartment osteoarthritis. Arthroscopic debridement has limited long-term efficacy for advanced osteoarthritis. Patellectomy is rarely performed. Unicompartmental knee arthroplasty is for isolated single-compartment disease.

Question 28

Which of the following is a contraindication for an MRI in a patient with suspected spinal cord injury?





Explanation

The presence of a pacemaker or certain ferrous metallic implants (e.g., older aneurysm clips, some shrapnel) is an absolute contraindication to MRI due to the strong magnetic field, which can interfere with device function or cause movement/heating of the metallic object. While pregnancy, claustrophobia, renal insufficiency (relevant for contrast), and obesity can be challenges, they are not absolute contraindications that preclude the MRI if critically indicated for spinal cord injury.

Question 29

What is the most common cause of osteonecrosis (avascular necrosis) of the femoral head in adults?





Explanation

Among the systemic causes, corticosteroid use is the most common non-traumatic cause of osteonecrosis of the femoral head in adults, often in a dose-dependent manner. Trauma (e.g., hip dislocation, femoral neck fracture) is also a significant cause, but corticosteroid use leads the list of atraumatic causes. Alcohol abuse, sickle cell disease, and Gaucher's disease are also risk factors but less common overall than corticosteroid use.

Question 30

A patient undergoing total hip arthroplasty for osteoarthritis is at highest risk for which of the following complications in the immediate postoperative period?





Explanation

Patients undergoing major orthopedic surgery, especially total hip arthroplasty, are at highest risk for deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) in the immediate postoperative period. Prophylactic anticoagulation is standard to mitigate this risk. Periprosthetic fracture, avascular necrosis (of the patient's remaining bone, not a complication of the replaced head), heterotopic ossification, and loosening are also potential complications, but DVT/PE represents the most critical and life-threatening immediate postoperative risk requiring strict preventative protocols.

Question 31

Which surgical approach for total hip arthroplasty typically carries the lowest risk of dislocation?





Explanation

The direct anterior approach for total hip arthroplasty is generally associated with the lowest risk of postoperative dislocation compared to posterior or lateral approaches. This is because it spares the posterior soft tissue structures (posterior capsule, short external rotators) which are critical for hip stability. The posterior approach traditionally has the highest dislocation rate, while anterolateral and direct lateral approaches have intermediate rates.

Question 32

What is the most appropriate initial management for a stable type I odontoid fracture?





Explanation

A Type I odontoid fracture is an oblique fracture of the odontoid tip, which is typically stable. It usually heals well with non-operative management, often with a rigid cervical collar (like a Miami J or Philadelphia collar) for 6-12 weeks. Halo vest immobilization or surgical fixation are generally reserved for more unstable Type II or Type III odontoid fractures. Traction is not indicated, and atlantoaxial fusion is a definitive surgical treatment for instability, not initial management for a stable Type I.

Question 33

Which type of fracture is most susceptible to developing a nonunion due to its poor blood supply?





Explanation

Fractures of the navicular bone (talonavicular joint in the foot) are known for their high rates of nonunion and avascular necrosis due to the bone's limited and often retrograde blood supply. Other bones with notoriously poor blood supply prone to nonunion include the scaphoid in the wrist and the femoral neck. Distal radius, tibial shaft, clavicle, and femoral shaft fractures, while they can nonunion, are not typically as prone as the navicular or scaphoid.

Question 34

In the management of septic arthritis, what is the most critical initial step after diagnosis?





Explanation

Septic arthritis is a joint emergency. The most critical initial step after suspicion is emergent joint aspiration to confirm the diagnosis (cell count, Gram stain, culture) and immediately initiate empiric intravenous antibiotics. Delay in treatment can lead to rapid cartilage destruction and long-term joint damage. Oral antibiotics are insufficient initially. Intra-articular corticosteroids are contraindicated. Immobilization provides comfort but doesn't treat the infection. Elective arthroscopy might be needed for drainage/debridement but only after aspiration and antibiotics are started.

Question 35

A 16-year-old male presents with worsening nocturnal pain in his right femur, which is relieved by aspirin. Radiographs show a small radiolucent nidus surrounded by sclerotic bone. What is the most likely diagnosis?





Explanation

The classic presentation of an osteoid osteoma is nocturnal pain that is characteristically relieved by NSAIDs (like aspirin), along with radiographic findings of a small radiolucent nidus surrounded by dense reactive sclerosis. This is a benign bone tumor. Osteosarcoma and Ewing sarcoma are malignant and would not typically respond so dramatically to aspirin. Chondroblastoma is an epiphyseal lesion. An aneurysmal bone cyst is expansile and lytic.

Question 36

What is the primary anatomical structure involved in De Quervain's tenosynovitis?





Explanation

De Quervain's tenosynovitis is a painful condition affecting the tendons on the thumb side of the wrist, specifically involving stenosing tenosynovitis of the first dorsal compartment. This compartment contains the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons. Finkelstein's test is typically positive. The other tendons are located in different compartments or have different functions.

Question 37

Which physical examination finding is highly specific for a meniscus tear in the knee?





Explanation

Joint line tenderness combined with pain or a 'click' during specific twisting maneuvers (like the McMurray test) is highly suggestive of a meniscus tear. The McMurray test attempts to trap the torn meniscal fragment between the femur and tibia. A positive Lachman test indicates ACL injury. Valgus instability indicates MCL injury. Patellofemoral crepitus suggests patellofemoral arthritis or chondromalacia. Generalized knee effusion can be present with many knee pathologies.

Question 38

In the context of spinal cord injury, what is Brown-Séquard syndrome characterized by?





Explanation

Brown-Séquard syndrome results from hemisection of the spinal cord (e.g., due to penetrating trauma). It is characterized by ipsilateral loss of motor function, proprioception, and vibratory sense (due to corticospinal and dorsal column pathway damage), and contralateral loss of pain and temperature sensation (due to spinothalamic tract damage), typically 1-2 levels below the lesion. Complete loss of function is complete cord injury. Loss of motor with preserved sensation is anterior cord syndrome. Flaccid paralysis is spinal shock or cauda equina. Loss of pain/temp with preserved motor/proprioception can be central cord syndrome if only crossing fibers are affected or pure spinothalamic lesion.

Question 39

What is the most appropriate initial management for acute calcific tendinitis of the shoulder?





Explanation

Acute calcific tendinitis of the shoulder can be exquisitely painful. Initial management often involves conservative measures such as rest, NSAIDs, and a subacromial corticosteroid injection, which can effectively reduce inflammation and pain. Surgical excision is reserved for chronic, refractory cases. Physical therapy for strengthening is not appropriate in the acute painful phase. Aggressive massage and heat can exacerbate symptoms. Arthroscopic debridement is a surgical intervention for failed conservative care.

Question 40

A patient presents with persistent symptoms of cervical radiculopathy (C6 distribution) despite 8 weeks of conservative management including physical therapy, NSAIDs, and epidural steroid injections. MRI shows a large C5-C6 soft disc herniation. Which surgical procedure is typically considered the gold standard for this condition?





Explanation

For cervical radiculopathy caused by a soft disc herniation that has failed conservative management, anterior cervical discectomy and fusion (ACDF) is widely considered the gold standard. It involves removing the herniated disc and fusing the vertebrae, providing excellent decompression and stability. Posterior laminectomy is more for myelopathy or diffuse stenosis. Laminoplasty is for multi-level stenosis. Posterior foraminotomy is for lateral foraminal stenosis. Artificial disc replacement is an alternative to fusion for select cases, but ACDF remains the most common and established approach.

Question 41

Which of the following describes a 'stress fracture'?





Explanation

A stress fracture is a partial or complete fracture of a bone that occurs due to repetitive submaximal loads or abnormal stresses on a bone that otherwise has normal elastic resistance. It is an overuse injury. A complete fracture from a single event is an acute fracture. A fracture in pathologically weakened bone is a pathological fracture. A direct impact causes a traumatic fracture. An open fracture involves a break in the skin.

Question 42

What is the most common site for a 'boxer's fracture'?





Explanation

A 'boxer's fracture' is a fracture of the neck of the fifth metacarpal bone, typically occurring from punching a hard object with a closed fist. It is often characterized by volar angulation and shortening. The distal radius is involved in Colles' fractures. First metacarpal base is a Bennett's or Rolando fracture. Navicular and hamate are carpal bones.

Question 43

Which complication is most concerning after a high-energy pelvic fracture, particularly involving the posterior arch?





Explanation

High-energy pelvic fractures, especially those involving the posterior arch (sacroiliac joint or sacrum), are often associated with massive hemorrhage due to injury to the presacral venous plexus and internal iliac arterial branches. This can be life-threatening and requires immediate attention. While DVT, sciatic nerve injury, urethral injury (especially in males with anterior arch fractures), and infection are all possible complications, massive hemorrhage is the most immediate and critical concern.

Question 44

What is the primary role of vitamin D in bone health?





Explanation

The primary role of vitamin D in bone health is to enhance the absorption of calcium and phosphate from the gastrointestinal tract. This ensures adequate mineral availability for bone mineralization. While it has some indirect effects on osteoblasts and parathyroid hormone, its most direct and significant action is on intestinal absorption. Collagen synthesis is a role of vitamin C and other factors, not directly vitamin D.

Question 45

A patient presents with persistent foot drop and weakness in ankle dorsiflexion after a knee injury. There is also numbness in the dorsum of the foot. Which nerve is most likely injured?





Explanation

Foot drop (inability to dorsiflex the ankle and extend the toes) and sensory loss on the dorsum of the foot are classic signs of common fibular (peroneal) nerve injury. This nerve is particularly vulnerable at the fibular head due to its superficial course. The tibial nerve controls plantarflexion. The sural and saphenous nerves are purely sensory. The femoral nerve controls knee extension and hip flexion.

Question 46

Which condition is characterized by progressive, non-inflammatory thickening and shortening of the palmar fascia, leading to fixed flexion deformities of the fingers, most commonly the ring and small fingers?





Explanation

Dupuytren's contracture is a fibromatosis characterized by progressive, non-inflammatory thickening and shortening of the palmar fascia, forming nodules and cords that lead to fixed flexion deformities of the fingers, predominantly the ring and small fingers. Trigger finger is a stenosing tenosynovitis. Ganglion cysts are fluid-filled sacs. Carpal tunnel syndrome is median nerve compression. Flexor tenosynovitis is inflammation of the tendon sheath.

Question 47

What is the primary concern for a patient with a pathological fracture?





Explanation

A pathological fracture occurs through bone weakened by an underlying disease process (e.g., metastatic cancer, primary bone tumor, osteoporosis, osteomyelitis). The primary concern for a patient with a pathological fracture is to identify and manage the underlying cause of the bone weakening, as this dictates the definitive treatment strategy for the patient, not just the fracture itself. While pain and immobilization are concerns, they are secondary to addressing the root pathology. Compartment syndrome is generally not a direct risk of a pathological fracture.

Question 48

What is the most appropriate initial management for an acute, non-displaced scaphoid fracture?





Explanation

For an acute, non-displaced scaphoid fracture, the most appropriate initial management is immobilization in a short arm thumb spica cast. Due to the high risk of nonunion and avascular necrosis, prolonged immobilization (typically 6-12 weeks, sometimes longer) is often required. Surgical fixation is considered for displaced fractures, proximal pole fractures, or delayed unions. Observation alone is inappropriate, and revascularization surgery is not an initial step for a non-displaced fracture.

Question 49

Which of the following conditions is characterized by anterior knee pain, particularly aggravated by ascending/descending stairs or prolonged sitting, and often associated with crepitus?





Explanation

Patellofemoral pain syndrome (PFPS), also known as 'runner's knee,' is characterized by anterior knee pain, often worse with activities that load the patellofemoral joint (stairs, squatting, prolonged sitting - 'theater sign'). Crepitus is also a common finding. Patellar tendinopathy causes localized pain at the inferior pole of the patella. Osgood-Schlatter disease affects adolescents with pain at the tibial tubercle. Medial plica syndrome has specific medial knee pain and snapping. IT band syndrome causes lateral knee pain.

Question 50

In the context of the spine, what is the 'Hangman's fracture'?





Explanation

A 'Hangman's fracture' is a traumatic spondylolisthesis of the axis (C2), specifically a bilateral fracture of the C2 pars interarticularis (pedicles). It typically occurs from hyperextension and distraction injuries. Odontoid fractures are Type I, II, or III. A burst fracture of C1 is a Jefferson fracture. The other options describe different, less specific cervical spine injuries.

Question 51

What is the most common presenting symptom of a patient with a stress fracture of the metatarsals?





Explanation

Stress fractures, including those of the metatarsals, are characterized by a gradual onset of localized pain that worsens with activity (e.g., running, prolonged walking) and is relieved by rest. There is typically no acute traumatic event, and visible deformity or systemic symptoms are usually absent. Acute, sharp pain after trauma suggests an acute fracture. Numbness/tingling suggests nerve involvement. Fever/chills suggest infection.

Question 52

Which of the following is a classic indication for surgical repair of a full-thickness rotator cuff tear?





Explanation

Surgical repair of a full-thickness rotator cuff tear is typically indicated for highly active, younger patients (under 60-65 years) who experience significant pain, weakness, or functional deficits that have failed conservative management, even for smaller tears, to prevent progression and restore function. Asymptomatic tears, partial tears with minimal symptoms, or irreparable tears in patients with advanced arthritis are generally managed conservatively or with alternative procedures (e.g., reverse total shoulder arthroplasty for cuff tear arthropathy).

Question 53

What is the primary goal of surgical treatment for hallux valgus (bunion deformity)?





Explanation

The primary goal of surgical treatment for hallux valgus is to correct the underlying bony deformity, specifically the increased intermetatarsal angle (IMA) between the first and second metatarsals, and the increased hallux valgus angle (HVA). This bony realignment aims to relieve pain, improve foot mechanics, and prevent recurrence. While pain relief is a significant outcome, restoring 'normal' mechanics can be challenging. Fusion is reserved for severe arthritis or failed previous surgeries. Cosmetic improvement is a secondary benefit, not the primary goal. Amputation is not a standard treatment.

Question 54

What is the primary role of the anterior cruciate ligament (ACL) in the knee joint?





Explanation

The anterior cruciate ligament (ACL) is the primary restraint to anterior translation of the tibia on the femur and also limits internal and external rotation of the tibia. It is crucial for knee stability, especially during rotational and pivoting movements. The medial collateral ligament (MCL) prevents valgus stress. The lateral collateral ligament (LCL) prevents varus stress. The posterior cruciate ligament (PCL) prevents posterior translation of the tibia. Hyperextension is limited by various capsular and ligamentous structures.

Question 55

A 5-year-old child sustains a low-energy buckle fracture (torus fracture) of the distal radius. What is the most appropriate treatment?





Explanation

A buckle (torus) fracture is a stable, incomplete fracture of the metaphysis common in children, characterized by cortical buckling without a true fracture line. These are very stable and heal well with minimal immobilization. A short arm cast or removable wrist splint for 3-4 weeks is typically sufficient. Open reduction and internal fixation, long arm casts, or percutaneous pinning are overly aggressive for such a stable injury. Observation only is insufficient for adequate healing and pain control.

Question 56

Which of the following conditions is a common cause of chronic anterior shin pain in athletes, often termed 'shin splints,' that is distinct from a stress fracture?





Explanation

Medial tibial stress syndrome (MTSS), commonly known as 'shin splints,' is a common overuse injury in athletes causing chronic anterior or anteromedial shin pain. It is distinct from a stress fracture (though it can progress to one) and compartment syndrome. Acute compartment syndrome is an emergency with severe pain, swelling, and neurovascular compromise. Peroneal tendinopathy causes lateral ankle pain. ACL tears affect the knee. Achilles tendinopathy causes posterior heel/calf pain.

Question 57

What is the primary principle of managing an irreducible pediatric forearm fracture?





Explanation

For an irreducible pediatric forearm fracture (meaning closed reduction attempts have failed or are impossible), the primary principle is to perform open reduction and internal fixation. This is necessary to restore proper alignment and rotation to prevent malunion, which can severely impact forearm function. Repeated forceful closed reductions can cause more soft tissue damage. Traction or immobilization in the irreducible position are not acceptable long-term solutions, as they will lead to significant functional impairment.

Question 58

What is the characteristic deformity observed in a Monteggia fracture-dislocation?





Explanation

A Monteggia fracture-dislocation is characterized by a fracture of the ulna shaft (often in the proximal or mid-third) associated with a dislocation of the radial head. The most common type is an anterior dislocation of the radial head with an anteriorly angulated ulnar fracture (Bado Type I). A Galeazzi fracture-dislocation involves a radial shaft fracture with distal radioulnar joint dislocation. Fracture of both radius and ulna is a both-bone forearm fracture. Distal radius fracture is a Colles' or Smith's fracture. Olecranon fracture with posterior elbow dislocation is a variant of terrible triad or simple dislocation.

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