Orthopedic Board Review: 100 High-Yield MCQs - Practice Exam Set 631

The incidence of ipsilateral phrenic nerve blockade after an interscalene block approaches

What complication is most likely to develop after right total hip arthroplasty in the patient shown in Figure 5?

When performing the exposure for an anterior approach to the cervical spine, excessive retraction of the trachea and esophagus should be avoided to prevent injury of the

Fully dense alumina and zirconia materials have been used as bearing materials in hip arthroplasty to provide greater wear resistance than polished metallic surfaces. Although both have shown reduced wear clinically, what concerns continue to exist about the use of zirconia?

What is the most common result if the acetabulum is rotated too far anteriorly during a periacetabular osteotomy?

Figure 19 shows an arthroscopic view from the anterior lateral portal of the knee looking into the suprapatella pouch. The use of an electrothermal device during this procedure most commonly causes significant postoperative complications by damaging which of the following structures?

A 22-year-old professional ballet dancer reports a 3-month history of posterior ankle pain that occurs when she changes from a flat foot to pointe (hyperplantar flexed position). Examination does not elicit the pain with forced passive plantar flexion. A radiograph is shown in Figure 8. What is the most likely cause of the pain?

Figure 37 shows the radiograph of a 23-year-old football player who sustained a blow to the anterior aspect of his shoulder. Examination reveals pain and limited rotation. He is unable to flex the arm above the shoulder. Management should include which of the following studies?

A 19-year-old college cross-country runner is amenorrheic and has recurrent stress fractures. Long-term management should consist of

What muscle is most often encountered during surgical approaches to C5-6?

A 15-year-old high school soccer player collides with an opponent and is unconscious when the trainer arrives on the field. He is conscious within 15 seconds, breathing appropriately, and denies any headache, neck pain, or nausea. It is his first head injury. Provided that the athlete is free of symptoms, when should he be allowed to return to athletic activity?

What is the second most common primary bone malignancy in children?

What patient factor is predictive of better outcomes for surgical management of a displaced calcaneal fracture compared to nonsurgical management?

What nerve is most likely to be injured during the anterior exposure of C2-3?

What is the most common clinically significant preventable complication secondary to the treatment of a displaced talar neck fracture?

An 83-year-old woman with diabetes mellitus has a history of recurrent infection over the medial aspect of her great toe and has had a painless bunion for the past 45 years. Shoe wear modifications have failed to provide relief. Pedal pulses are palpable. Figures 30a and 30b show the clinical photograph and radiograph. Management should now consist of

Which of the following is most commonly associated with an open clavicular fracture?

A 35-year-old man reports the development of a painful 2-cm nodule on his dorsal wrist over the past 3 years. A surgeon excised the lesion with a presumptive diagnosis of a ganglion cyst. Histology sections from the excision are shown in Figures 11a and 11b. What is the most likely diagnosis?

A 45-year-old woman with a long-standing history of diabetes mellitus has a large draining plantar ulcer of the right foot. Examination reveals some local cellulitis and erythema surrounding the ulcer. A clinical photograph is shown in Figure 7. Based on these findings, what is the most appropriate antibiotic?

A 38-year-old woman with metastatic thyroid carcinoma has had increasing pain in the left hip for the past 3 months. An AP radiograph and coronal T1-weighted MRI scan are shown in Figures 28a and 28b. Management should consist of

A 61-year-old woman with a long-standing history of rheumatoid arthritis reports progressive elbow pain for the past 12 months. She denies any recent trauma to the elbow; however, she notes increasing pain and decreased joint motion that are now compromising her function. Radiographs are shown in Figures 57a and 57b. What is the most appropriate treatment at this time?

Which of the following factors has the greatest effect on the pull-out strength of a lumbar pedicle screw?

A 55-year-old woman with polyarticular rheumatoid arthritis has had progressively increasing left shoulder pain for the past 2 years despite nonsurgical management. No focal weakness is noted during examination of the shoulder. AP and axillary radiographs are shown in Figures 47a and 47b. Treatment should consist of

Figure 35 shows the radiograph of a 35-year-old weightlifter who has had pain with overhead lifts for the past 7 months. Cortisone injections in the acromioclavicular joint provided only temporary relief. A bone scan reveals increased activity of the acromioclavicular joint. Treatment should now consist of

What is the recommended insertion torque for halo pins in adults?

A 14-year-old girl reports hip pain that is exacerbated by weight bearing. A radiograph and biopsy specimen are shown in Figures 16a and 16b. The best course of management should be

A patient with degenerative osteoarthritis of the sternoclavicular (SC) joint reports constant pain, discomfort, and marked prominence and instability of the SC joint following medial clavicle resection. Which of the following procedures is most likely to produce these signs and symptoms?

Figure 14 shows an intra-articular gadolinium-enhanced MRI scan of a 52-year-old woman who has stopped playing tennis because of pain in her left shoulder while serving. What is the most likely diagnosis?

The great medullary artery, also known as the Adamkiewicz artery, originates from which of the following arteries?

A 42-year-old man reports a 12-month history of a painful fusiform swelling of the Achilles tendon. Physical therapy, heel lifts, and anti-inflammatory drugs have failed to provide relief. MRI scans are shown in Figures 44a and 44b. What is the treatment of choice?

Figure 31 shows the AP and lateral radiographs of the elbow of a 56-year-old man with chronic polyarticular rheumatoid arthritis. His function continues to be limited by pain with activities of daily living. Examination shows that his total arc of motion is 110 degrees. Nonsurgical management has failed to provide relief. Treatment should now consist of

A 51-year-old woman has had progressively increasing right knee pain for the past 6 months. She has a history of metastatic renal cell carcinoma to the lung and the skeletal system. Radiographs are seen in Figures 18a and 18b. The next step in management of the right distal femur lesion should consist of

An 82-year-old woman reports right buttock pain after a car trip. Laboratory studies show an erythrocyte sedimentation rate of 30 mm/h and WBC of 4,600/mm3. Figure 34a shows a plain AP radiograph of the pelvis, and Figure 34b shows a delayed technetium Tc 99m bone scan. Management should consist of

A 61-year-old man reports right hip pain and limited motion after undergoing total hip arthroplasty for posttraumatic arthritis 1 year ago. Figure 6 shows an AP radiograph of the pelvis. To improve motion and relieve pain, management should consist of

The use of multiagent adjuvant chemotherapy is associated with a clear survival benefit in which of the following diseases?

What is the treatment of choice for the injury shown in Figures 20a through 20c?

A 72-year-old man who underwent total shoulder arthroplasty 2 years ago slipped on ice and fell on his shoulder 3 weeks ago. Immediately after falling he was unable to elevate his arm. Motor examination reveals deltoid 5-/5, subscapularis 5-/5, external rotation 4-/5, and supraspinatus 2/5. Radiographs are shown in Figures 8a and 8b. What is the most likely diagnosis?

Figures 57a through 57c show the radiographs of a patient who has pain, discomfort, and a popping sensation localized to the posterior aspect of the knee after undergoing primary left total knee arthroplasty 6 months ago. Examination reveals that the patient is able to ambulate without a limp. There is no significant swelling, erythema, or effusion. Range of motion is 0 degrees to 115 degrees, and a palpable crepitation or snapping is detected at the posterior lateral joint line. What is the most likely diagnosis?

Patients with rheumatoid arthritis may exhibit an increase in viral load for which of the following viruses?

Long bone fracture repair following intramedullary stabilization occurs primarily through which of the following healing mechanisms?

A newborn girl is referred for evaluation of suspected hip instability. What information from her history would place her in the highest risk category?

The safest surgical approach to the insertion of the tibial posterior cruciate ligament uses the interval between which of the following muscles?

Figure 24 shows the radiograph of a 47-year-old woman who has severe right hip pain and a limp. Management should consist of

An 11-year-old boy has right shoulder pain and has been unwilling to use the arm after throwing a baseball in a Little League game 3 weeks ago. Examination reveals upper arm and shoulder tenderness with swelling. A radiograph and MRI scan are shown in Figures 27a and 27b. Management should consist of

A 32-year-old runner has pain in the medial arch that radiates into the medial three toes. He reports the presence of pain only when running. Examination reveals normal hindfoot alignment. There is a weakly positive Tinel's sign over the posterior tibial nerve. Tenderness is noted with palpation over the plantar medial area in the vicinity of the navicular tuberosity. What is the most likely diagnosis?

A 58-year-old woman with rheumatoid arthritis and a severe hindfoot valgus deformity now reports recurrent lateral ankle pain. Examination reveals pain over the fibula and sinus tarsi, with a valgus hindfoot that is passively correctable. Despite the use of an ankle-foot orthosis, this is the second time this problem has occurred. Radiographs and a clinical photograph are shown in Figures 28a through 28c. What is the next most appropriate step in treatment?

The sartorius muscle is innervated by which of the following nerves?

An 18-year-old hockey player sustains an acute anterior shoulder dislocation that requires manual reduction. At arthroscopy, the lesion shown in Figure 24 will be observed in what percent of patients?

A study is conducted to measure the difference in bone mineral density between postmenopausal women taking a drug treatment versus those taking a placebo. What is the most important result to be reported from this study?

A 52-year-old man underwent arthroscopic repair of a 1-cm supraspinatus tendon tear 3 weeks ago. He was doing well until he fell down three stairs. One week after the fall he continues to report pain similar to his preoperative pain. An MRI scan reveals a minimally retracted 1-cm supraspinatus tendon tear in the same location as his original tear. Management should now consist of

A 28-year-old professional football player reports painless loss of ankle motion after sustaining a "severe" ankle sprain 12 months ago. A mortise radiograph is shown in Figure 1. Surgical treatment should be reserved for which of the following conditions?

During total shoulder replacement for rheumatoid arthritis, fracture of the humeral shaft occurs. An intraoperative radiograph shows a displaced short oblique fracture at the tip of the prosthesis. At this point, the surgeon should

A 13-year-old girl sustained an isolated midshaft left femoral fracture in a motor vehicle accident. The fracture was treated with a rigid, antegrade intramedullary nail placed through the piriformis fossa. The fracture healed uneventfully, as shown in Figure 46a; however, at 12 months postoperatively she now reports left hip pain. A current AP radiograph and MRI scan are shown in Figures 46b and 46c. What complication occurred in this patient?

A posterolateral approach to the tibial plafond proceeds between what two muscles?

A 72-year-old woman with rheumatoid arthritis who underwent primary total knee arthroplasty 2 years ago has had diffuse knee pain that developed shortly after the surgery. The patient has difficulty with stair descent and arising from chairs. Evaluation for infection is negative. AP and lateral radiographs are shown in Figure 26. Management should now consist of

Figures 45a through 45c show the radiograph, CT scan, and MRI scan of a 15-year-old boy who has lateral ankle pain. What is the most likely diagnosis?

Which of the following factors is associated with decreases in active periprosthetic osteolysis in total hip arthroplasty?

The illustration shown in Figure 19 shows a Chamberlain line. What is the most likely diagnosis?

Which of the following conditions is considered a relative contraindication to interscalene nerve block for patients scheduled to undergo shoulder surgery?

What are the proposed biomechanical advantages of the Grammont reverse total shoulder arthroplasty when compared to a standard shoulder arthroplasty?

A 78-year-old woman undergoes her third lumbar decompression and fusion from L3 to L5 without complication. On the morning of postoperative day 3, examination reveals painless, flaccid weakness of both lower extremities. She also has an absent bulbocavernous reflex and a mild saddle paresthesia. MRI scans of the lumbar spine are shown in Figures 26a and 26b. What is the most appropriate management at this time?

A 21-year-old college student reports hearing a pop and has acute pain laterally over the ankle after twisting it during a recreational basketball game. Examination 1 hour after the injury reveals minimal swelling and ecchymosis. The anterior drawer sign is positive. Radiographs reveal no evidence of a fracture. What is the best course of action?

Ewing's sarcoma of bone most commonly occurs in which of the following locations?

A 22-year-old female collegiate javelin thrower has shoulder pain. She notes that her pain is primarily located in the posterior aspect of her shoulder, is exacerbated with throwing, and she experiences maximal tenderness in the extreme cocking phase of the throwing cycle. On examination, she reports deep posterior shoulder pain when the arm is abducted 90 degrees and maximally externally rotated to 110 degrees. This reproduces her symptoms precisely. Shoulder radiographs are normal. What is the most likely diagnosis?

Clinical evidence suggests that grafts for replacing a torn anterior cruciate ligament often stretch after surgery. What is the most probable mechanism for this behavior?

A 16-year-old cheerleader reports an ache in the right shoulder and arm that is worse after activity. She denies any history of acute trauma. Examination reveals a positive sulcus sign and an AP glide test with a posterior and anterior apprehension sign. To confirm a diagnosis of multidirectional instability, which of the following imaging studies is most appropriate?

A 22-year-old man who sustained a Gustilo-Anderson grade IIIC open fracture of the right tibia and fibula was treated with an immediate open transtibial amputation. After two serial debridements, he underwent wound closure with a posterior myocutaneous soft-tissue flap. What is the preferred method of early rehabilitation?

The use of nasotracheal intubation for airway management is contraindicated in the acute multiply injured patient when the patient has

Which of the following treatment regimens for thromboembolic prophylaxis meets the American College of Chest Physicians Guidelines for 10-day treatment after total hip arthroplasty and total knee arthroplasty?

A 47-year-old woman falls and sustains a direct blow to her middle finger. She notes pain and swelling and is unable to move the proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. Radiographs are shown in Figures 8a through 8c. Proper management should consist of

Figures 13a and 13b show the MRI scans of a 70-year-old patient who has a posterior calf mass. Examination reveals that the mass extends to the midcalf level. A biopsy specimen reveals a high-grade soft-tissue sarcoma. Metastatic work-up shows no lesions. Management should consist of

Posterior sternoclavicular dislocations are most commonly associated with which of the following complications?

A 47-year-old man has acute right shoulder pain after falling off a ladder. The MRI scan shown in Figure 9 reveals

A 79-year-old woman reports a history of left leg pain with walking. Her pain is exacerbated with walking and stair climbing, and her symptoms are improved by standing after she stops walking. Lumbar flexion does not provide any significant improvement of the symptoms and sitting does not significantly change symptoms. Her leg pain is worse at night and she obtains relief by hanging her leg over the side of the bed. The neurologic examination is essentially normal. Examination of the lower extremities demonstrates mild early trophic changes, and her pulses distally are palpable but are diminished bilaterally. Radiographs are shown in Figures 15a and 15b. What is the next most appropriate step in management?

Figure 50 shows the radiograph of a 26-year-old man who sustained an isolated open injury to his foot. Examination reveals no gross contamination in the wound. There is a palpable dorsalis pedis pulse and sensation is present on the dorsal and plantar aspects of the foot. Initial treatment should consist of wound debridement, antibiotics, and

A 45-year-old woman who recently underwent biopsy of a lymph node in the right posterior cervical triangle now finds it difficult to hold objects overhead and has diffuse aching in the right shoulder region. What is the most likely diagnosis?

Which of the following surgical techniques is associated with an increased incidence of patellar complications after total knee arthroplasty?

A knock-out mouse for the Vitamin D receptor has which of the following phenotypes?

A previously asymptomatic 40-year-old man injures his shoulder in a fall. Examination shows that he is unable to lift the hand away from his back while maximally internally rotated. An axial MRI scan of the shoulder is shown in Figure 14. What is the most likely diagnosis?

Figure 27 shows the radiograph of a 26-year-old man who sustained a closed head injury and a closed elbow dislocation 6 weeks ago. Examination reveals 65 degrees to 115 degrees of flexion, and intensive physical therapy has resulted in no improvement. A decision regarding the timing of surgical correction of the contracture should be based on

A 16-year-old girl has a painful foot mass. A radiograph, MRI scan, and biopsy specimens are shown in Figures 35a through 35d. What is the most likely diagnosis?

Figures 20a through 20d show the radiographs and MRI scans of a 59-year-old woman who has had symptoms consistent with progressive neurogenic claudication and back pain for the past 9 months. In the last 6 months, nonsurgical management consisting of nonsteroidal anti-inflammatory drugs, physical therapy, and a series of epidural steroid injections have been used; however the injections, while beneficial, have provided only temporary relief of her symptoms. What is the most appropriate management at this time?

A 26-year-old professional rodeo bull rider sustained a grade III midshaft femoral fracture after being thrown from his bull. He underwent closed interlocking intermedullary nailing with a titanium rod, and his recovery was uneventful. Prior to returning to competition, the patient must

The inheritance of the deformity shown in Figure 1 is most commonly

A 47-year-old man with Charcot-Marie-Tooth (CMT) disease was treated with a fifth metatarsal head resection for a symptomatic bunionette 2 years ago. What is the most likely complication seen at this time?

What is the most important factor regarding the risk of recurrent instability in a patient with an acute anterior dislocation of the shoulder?

An 18-year-old football player lands on a flexed knee and ankle after being tackled. Examination reveals increased external rotation and posterior translation and varus at 30 degrees of flexion, which decreases as the knee is flexed to 90 degrees. What is the most likely diagnosis?

A 35-year-old woman reports an 8-week history of neck pain radiating to her right upper extremity. She denies any history of trauma or provocative event. Examination reveals decreased pinprick sensation in her right middle finger, otherwise sensation is intact bilaterally. Finger flexors and interossei demonstrate 5/5 motor strength bilaterally. Finger extensors are 4/5 on the right and 5/5 on the left. The triceps reflex is 1+ on the right and 2+ on the left. The most likely diagnosis is a herniated nucleus pulposus at what level?

A 40-year-old man who is an avid weight lifter has had chronic pain in the proximal anterior shoulder for the past year. He denies any history of trauma. Examination reveals tenderness at the intertubercular groove, a positive speed test, and a positive Neer impingement sign. Nonsurgical management has failed to provide relief, and he is now considering surgery. Arthroscopic findings in the glenohumeral joint are shown in Figure 31. Based on these findings, treatment should consist of

A 32-year-old man who works as a laborer has had left trapezius wasting and lateral scapular winging after injuring his shoulder when a cargo box fell onto his neck 8 months ago. He now reports posterior shoulder pain and fatigue, and he has difficulty shrugging his shoulder. Examination reveals marked scapular winging, impingement signs, and an asymmetrical appearance when the patient attempts a shoulder shrug. Primary scapular-trapezius winging is the result of damage to the

An 8-year-old girl was treated for a Salter-Harris type I fracture of the right distal femur 2 years ago. Examination reveals symmetric knee flexion, extension, and frontal alignment compared to the contralateral knee. She has 1-cm of shortening of the right femur. History reveals that she has always been in the 50th percentile for height, and her skeletal age matches her chronologic age. Radiographs are shown in Figure 9. What is the expected consequence at maturity?

A football player sustains a traumatic anterior inferior dislocation of the shoulder in the last game of the season. It is reduced 20 minutes later in the locker room. The patient is neurologically intact and has regained motion. If the patient undergoes arthroscopic evaluation, what finding is seen most consistently?

A 37-year-old laborer falls 12 feet and sustains a comminuted tibial plafond fracture. Three years after treatment using standard techniques, what will be the most likely outcome?

A 16-year-old cheerleader reports an ache in the right shoulder and arm that is worse after activity. She denies any history of acute trauma. Examination reveals a positive sulcus sign and an AP glide test with a posterior and anterior apprehension sign. To confirm a diagnosis of multidirectional instability, which of the following imaging studies is most appropriate?

What are the four most common soft-tissue sarcomas to spread via the lymph node system?

Figure 42 shows the sagittal T2-weighted MRI scan of a patient's right knee. These findings are most commonly seen with a complete tear of the

The dorsal (Thompson) approach to the proximal forearm uses which of the following intermuscular intervals?

A 25-year-old construction worker lands on his outstretched hand in a fall. The position of his wrist at the time of impact causes a force that leads to hyperextension, ulnar deviation, and intercarpal supination. Radiographs are shown in Figures 48a and 48b. What type of injury pattern is shown?

An elderly patient falls and sustains an extension injury to the neck that results in upper extremity weakness, spared perianal sensation, and lower extremity spasticity. These findings best describe what syndrome?

In the arthroscopic photograph shown in Figure 5, the structure labeled "A" functions primarily as a restraint to translation of the humeral head in what direction?