AAOS Orthopedic MCQs (Set 1): Spine Disorders, Sports Medicine & Arthroplasty | 2026 Board Review

A 37-year-old woman has had intermittent paresthesias and numbness in the plantar foot for the past 6 months. She reports that the symptoms are worse with activity, and the paresthesias are beginning to awaken her at night. MRI scans are shown in Figures 6a and 6b. What is the most likely diagnosis?

A 36-year-old woman sustained a tarsometatarsal joint fracture-dislocation in a motor vehicle accident. The patient is treated with open reduction and internal fixation. What is the most common complication?

Figure 51 shows the radiograph of a 42-year-old construction worker who has pain and limited motion in his dominant elbow. Management consisting of nonsteroidal anti-inflammatory drugs and cortisone has failed to provide relief. What is the next most appropriate step in treatment?

Which of the following muscle tendons inserts just lateral to the long head of biceps tendon on the proximal humerus?

Which of the following findings can cause a dorsal bunion in a patient with neuromuscular disease?

Examination of a 23-year-old female college basketball player who has had anterior knee pain for the past 3 weeks reveals tenderness and fullness over the inferior patella and proximal patellar tendon. There is no patellofemoral crepitus, patella apprehension sign, or anterior or posterior instability. Initial management should include

What artery provides the only direct vascularizaton to both the intraneural and extraneural blood supply of the ulnar nerve just proximal to the cubital tunnel?

A 14-year-old boy sustains a twisting injury to his right shoulder and recalls feeling a snap during a wrestling match. Examination shows hesitancy to raise the arm away from the side, diffuse tenderness and swelling of the upper arm, and no evidence of neurovascular compromise. Figures 6a and 6b show an AP radiograph and MRI scan. What is the most likely diagnosis?

In 1980, a 32-year-old woman was found to have right breast mass, and a biopsy revealed adenocarcinoma. She underwent a mastectomy at that time, with no other treatment. Five years later, she noticed a lump in the left breast and underwent a left mastectomy. Seven lymph nodes were positive. In 2006, she now reports hip and thigh pain for the past 3 months. Figures 69a and 69b show AP and lateral radiographs of the femur. A bone scan shows a solitary lesion. Following radiographic staging, what is the next most appropriate step in management?

What is the most prevalent adverse event associated with allogeneic blood transfusion?

Which of the following parameters is considered most important when assessing an acetabular fracture for surgical indications?

A 7-year-old boy sustains an acute injury to the distal radial metaphysis, along with a completely displaced Salter-Harris type I fracture of the ulnar physis, as shown by the arrows in Figure 12. After satisfactory reduction of both injuries, what is the major concern?

Figure 3 shows the radiographs of a 32-year-old man who fell 12 feet onto his outstretched arm and sustained a fracture-dislocation of the elbow. Initial management consisted of closed reduction of the dislocation. Surgical treatment should now include repair or reduction and fixation of the

When planning scoliosis surgery for a patient with a 50-degree thoracolumbar curve and spinal muscular atrophy, it is most important to include

Which of the following methods is considered effective in decreasing the dislocation rate following a total hip arthroplasty using a posterior approach to the hip?

Which of the following changes of calcium metabolism accompany the loss of bone during menopause?

A 68-year-old woman who underwent a right total hip arthroplasty 1 year ago has dislocated her hip five times since surgery. Radiographs show a retroverted acetabular component. What is the best treatment for this patient?

Figure 48 shows an MRI scan of the knee. The arrow is pointing to what structure?

Figure 46 shows the AP radiograph of a patient with right shoulder pain. What is the most likely diagnosis?

Which of the following agents increases the risk for a nonunion following a posterior spinal fusion?

The dose of the chemotherapeutic agent doxorubicin (Adriamycin) is limited by which of the following factors?

A 56-year-old woman sustained the fracture shown in Figures 30a and 30b in a motor vehicle accident. What mechanism is most likely responsible for the injury?

A 45-year-old man with a painful varus knee is being considered for an upper tibial osteotomy. Which of the following factors is considered the most compelling argument against this procedure?

A previously healthy 29-year-old man reports a 2-day history of severe atraumatic lower back pain. He denies any bowel or bladder difficulties and no constitutional signs. Examination is consistent with mechanical back pain. No focal neurologic deficits or pathologic reflexes are noted. What is the most appropriate management?

In surgically treating hand and finger infections in patients with diabetes mellitus, what factor is associated with higher amputation rates?

A 9-year-old child has right groin pain after falling from a tree. Examination reveals that the right leg is held in external rotation, and there is significant pain with attempts at passive range of motion. Radiographs are shown in Figures 43a and 43b. Management should consist of

A 53-year-old man with a history of severe left hip pain has a significant limp that is the result of a 5-cm limb-length discrepancy. An AP radiograph is shown in Figure 48. The underlying etiology is most likely related to a history of

Figure 50 shows the AP radiograph of an asymptomatic 82-year-old woman who underwent total hip arthroplasty 16 years ago. What is the most likely diagnosis?

A 6-year-old boy with spastic diplegic cerebral palsy has a crouched gait. Examination reveals hip flexion contractures of 15 degrees and popliteal angles of 70 degrees. Equinus contractures measure 10 degrees with the knees extended. Which of the following surgical procedures, if performed alone, will worsen the crouching?

A 6-year-old child has a fixed flexion deformity of the interphalangeal (IP) joint of the right thumb. The thumb is morphologically normal, with a nontender palpable nodule at the base of the metacarpophalangeal joint. Clinical photographs are shown in Figures 42a and 42b. Based on these findings, what is the treatment of choice?

A 62-year-old patient is seen for routine follow-up after undergoing cementless total hip arthroplasty 2 years ago. The patient reports limited range of motion that severely affects daily activities. A radiograph is shown in Figure 51. Management should now consist of

What is the most common organism found following a nail puncture wound through tennis shoes in a host without immunocompromise?

A 37-year-old patient with type I diabetes mellitus has a flexor tenosynovitis of the thumb flexor tendon sheath following a kitchen knife puncture wound to the volar aspect of the thumb. Left unattended, this infection will likely first spread proximally creating an abscess in which of the following spaces of the palm?

A 16-year-old high school pitcher notes acute pain on the medial side of his elbow during a pitch. Examination that day reveals medial elbow tenderness, pain with valgus stress, mild swelling, and loss of extension. Plain radiographs show closed physes and no fracture. Which of the following diagnostic studies will best reveal his injury?

A 23-year-old woman reports right knee pain and fullness. The pain is worse with activity but also present at rest. Radiographs are shown in Figures 20a and 20b. What is the most likely diagnosis?

Following preoperative chemotherapy, the percent of tumor necrosis has been shown to be of prognostic value for which of the following tumors?

Creatine is currently being used by athletes as a dietary supplement in an attempt to enhance performance. What is the physiologic basis for its use?

A 25-year-old man has chronic back pain that has been slowly worsening. He has no constitutional symptoms, and he denies any previous medical problems. Examination shows a tall lean build with no objective neurologic findings or skin lesions. Figure 32 shows a T2-weighted sagittal MRI scan. What is the most likely diagnosis?

Which of the following findings is most prognostic for the ability of a young child with cerebral palsy to walk?

A 14-year-old boy has an anteromedial distal thigh mass. A radiograph and MRI scan are shown in Figures 39a and 39b. An open biopsy of the mass should include

Linazolid exerts its antimicrobial action by inhibiting bacterial

A 42-year-old woman sustained a closed, displaced talar neck fracture in a motor vehicle accident. Which of the following is an avoidable complication of surgical treatment?

Which of the following factors is responsible for causing the distal femur to pivot about a medial axis as the knee moves from full extension into early flexion?

A 14-year-old competitive gymnast has had activity-related low back pain for the past month. Examination reveals no pain with forward flexion, but she has some discomfort when resuming an upright position. She also has pain with extension and lateral bending of the spine. The neurologic examination is normal. Popliteal angles measure 20 degrees. AP, lateral, and oblique views of the lumbar spine are negative. What is the next most appropriate step in management?

Figures 17a and 17b show the AP and lateral radiographs of a 75-year-old woman who reports giving way and shifting of the knee, particularly when she is descending stairs or ambulating on level surfaces. History reveals a total knee replacement 5 years ago. Treatment should consist of

Figures 43a and 43b show the AP and lateral radiographs of the radius and ulna of a 9-year-old patient. The fracture is manipulated and placed in a long arm cast with the elbow flexed to 90 degrees and the forearm to neutral rotation. Figures 43c and 43d show the alignment of the fracture after the manipulation. What is the next most appropriate step in management?

A 28-year-old cowgirl was injured while herding cattle 1 week ago. A radiograph and CT scans are shown in Figures 13a through 13c. What is the most appropriate management for this injury?

A 10-year-old boy has a painful thigh mass. A radiograph, MRI scan, and biopsy specimen are shown in Figures 42a through 42c. What is the most likely diagnosis?

An 11-year-old boy stepped on a nail and sustained a puncture to the right forefoot 6 days ago. He was wearing tennis shoes at the time of injury. Treatment in the emergency department consisted of local debridement and tetanus prophylaxis; a radiograph was negative for foreign body, chondral defect, or fracture. He was discharged with a 3-day prescription of amoxicillin and clavulanate. The patient now has increasing pain and tenderness at the puncture site. What is the best course of action?

A 16-year-old high school football player has diffuse pain with attempted digital flexion after injuring the ring finger of the dominant hand 1 week ago. Examination reveals that he is unable to flex the distal interphalangeal joint. Management should consist of

Figure 16 shows the radiograph of a 56-year-old man who has neck pain after a rollover accident on his lawnmower. The injury appears to be isolated, and he is neurologically intact. Management of the fracture should consist of

A 15-year-old baseball pitcher who reports increasing pain in his right shoulder over the past 3 weeks states that the pain increases the more he pitches. Radiographs of both shoulders are shown in Figures 35a and 35b. What is the next most appropriate step in management?

Figures 8a through 8d show the radiographs and CT scans of a 14-year-old girl who has a painful, rigid planovalgus foot. Management consisting of arch supports and anti-inflammatory drugs failed to provide relief. A below-knee walking cast resulted in pain resolution, but she now reports that the pain has recurred. Management should now consist of

Figures 32a and 32b show the AP and lateral radiographs of an 11-year-old boy who has a severe limp, a fever, and swelling and tenderness of the thigh. Aspiration of the bone reveals purulent material. The patient has most likely been symptomatic for

Figure 34 shows the standing AP radiograph of a 2-year-old girl who has a left bowleg deformity. Her mother states that she first noticed the problem when the child began walking at age 10 months, and the deformity has worsened over the past 6 months. Examination reveals a definite lateral thrust of the knee during the stance phase of gait. Management should consist of

Figure 10 shows the radiograph of an 18-year-old woman who sustained a spinal cord injury in a motor vehicle accident. Based on the radiographic findings, her injury is best described as

The use of radiation therapy is most effective in metastatic bone disease from which of the following tumors?

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?

A 40-year-old man has a palpable mass over the dorsum of the ankle. He reports no history of direct trauma but notes that he sustained a laceration to the middle of his leg 6 weeks ago. Examination reveals a 4-cm x 1-cm mass. T1- and T2-weighted MRI scans are shown in Figures 12a and 12b. An intraoperative photograph and biopsy specimen are shown in Figures 12c and 12d. What is the most likely diagnosis?

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 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?

The presence of S100B tumor marker typically corresponds with which of the following as being the most likely source of the metastasis?

A 75-year-old woman who fell on her right knee now reports pain and is unable to bear weight. History reveals that she underwent total knee arthroplasty on the right knee 6 years ago. Radiographs are shown in Figure 5. Management should now consist of

A 2-year-old child has marked hypotonia and depressed reflexes. History reveals that the child was normal at birth and developed normally for the first year. The child also began to ambulate, but lost this ability during the next 6 months. Laboratory studies show a creatine phosphokinase level that is within the normal range. DNA testing confirms a deletion in the survival motor neuron (SMN) gene. What is the most likely diagnosis?

Which of the following anatomic structures is often difficult to visualize during elbow arthroscopy?

Which of the following malignant tumors most commonly contains soft-tissue calcifications seen on radiographs or CT?

Which of the following is considered a physiologic effect of anemia?

What is the most common primary malignant tumor of bone in childhood?

In a patient who has had low back pain for less than 2 weeks, which of the following findings is an indication for continued observation and symptomatic treatment rather than more aggressive evaluation and/or treatment?

Which of the following methodologies has been proven to be effective in reducing the use of homologous blood transfusion following total hip arthroplasty (THA)?

A 27-year-old woman with Down syndrome has a severe bunion with pain and deformity in the left forefoot. Nonsurgical management has failed to provide relief. She does not use any assistive ambulatory devices. A radiograph is shown in Figure 21. Treatment should now consist of

Which of the following procedures is not part of the routine evaluation of a patient with suspected metastatic disease to bone?

A 17-year-old woman seen in the emergency department reports right knee pain and swelling that has progressively worsened over the past several weeks. Radiographs are shown in Figures 31a and 31b. What is the most likely diagnosis?

A 6-year-old boy with severe spastic quadriplegic cerebral palsy is nonambulatory. Examination reveals 10 degrees of hip abduction on the left and 30 degrees on the right with the hips and knees extended. The Thomas test shows 20 degrees of flexion bilaterally, and Ely test results are 3+/4 bilaterally. Radiographs show a center edge angle of 0 degrees on the left and -10 degrees on the right. The neck shaft angles are 170 degrees bilaterally. Which of the following procedures would offer the best results?

A 10-year-old girl was thrown over the handlebars of her bicycle and landed directly on her left shoulder. She was treated with a figure-of-8 strap and analgesics. Follow-up examination 2 weeks later reveals that the lateral end of the clavicle is superiorly dislocated relative to the acromion. A radiograph of the shoulder shows calcification lateral to the coracoid process at the level of the acromion, and the clavicle is superiorly displaced. Management should consist of

Figures 5a and 5b show the radiographs of an 11-year-old boy who felt a pop and immediate pain in his right knee as he was driving off his right leg to jam a basketball. Examination reveals that the knee is flexed, and the patient is unable to actively extend it or bear weight on that side. There is also a large effusion. Management should include

A 45-year-old man who smokes reports the rapid onset of color changes and coolness in the fingers. Examination shows an abnormal Allen test. Plain radiographs of the hand and wrist are normal. Which of the following studies will best aid in diagnosis?

An acetabular reinforcement cage is most often indicated for which of the following conditions?

Figure 16a shows the radiograph of a 34-year-old woman who sustained a basicervical fracture of the femoral neck. The fracture was treated with a compression screw and side plate. Seven months postoperatively, she continues to have significant hip pain and cannot bear full weight on her hip. A recent radiograph is shown in Figure 16b. Management should now consist of

A right-handed 44-year-old construction worker reports pain and limited range of motion in his right elbow that has limited his ability to work for the past year. Examination reveals range of motion from 60 to 90 degrees, and he has pain at the extremes of flexion and extension. Pronation and supination are minimally restricted. Anti-inflammatory drugs have failed to provide relief. A radiograph is shown in Figure 8. Management should now consist of

A patient sustained a sharp laceration to the base of his left, nondominant thumb 4 months ago. Examination reveals no active flexion but full passive motion of the interphalangeal joint. What is the best treatment option?

A 41-year-old man who plays golf regularly has had ulnar-sided wrist pain for the past several days after striking a tree root with a golf club. Examination reveals significant pain with resisted flexion of the ring and small fingers and tenderness over the hook of the hamate. Which of the following radiographic views would be most helpful in identifying the pathology of this injury?

The additional risk of complications in organ transplant patients receiving a total joint arthroplasty is attributed to

A 7-month-old girl has had a severe flatfoot deformity since birth. The talar head is prominent in the medial plantar arch of the foot. No other deformities of the spine or extremities are present. Motor and sensory examinations of the extremities are normal. Figures 37a through 37c show simulated weight-bearing AP and lateral radiographs and a planter flexion lateral view. What is the most likely diagnosis?

A woman with a neck and chest tumor has weakness in the biceps and paresthesias in the thumb. Brachioradialis and infraspinatus function are normal. The lesion is affecting which of the following structures?

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 24-year-old man sustained a grade IIIb open tibial fracture and an ipsilateral grade IIIa femoral fracture in a motorcycle accident. He is unresponsive, intubated, and has a Glasgow Coma Scale score of 8. He is resuscitated and taken to the operating room for definitive orthopaedic care. Which of the following intraoperative problems will most likely adversely affect his long-term outcome?

A patient underwent anterior stabilization of the shoulder 6 months ago, and examination now reveals lack of external rotation beyond 0 degrees. The patient has a normal apprehension sign and normal strength, and the radiographs are normal. Based on these findings, the patient is at greater risk for the development of

A 25-year-old competitive skier sustains a twisting injury to the right ankle while skiing. She is unable to continue the activity secondary to severe lateral ankle pain. Examination reveals ecchymosis and fullness over the lateral malleolus with pain and weakness on active ankle dorsiflexion and external rotation. There is no medial-sided pain. Neurovascular examination is normal. An AP radiograph and MRI scan are shown in Figures 17a and 17b, respectively. Management should consist of

A 35-year-old man has had a mass on the bottom of his foot for the past 6 months. He reports that initially the mass was exquisitely painful but now is minimally tender. Examination reveals a 2.5- x 2.0-cm firm, noncompressible, nonmobile mass contiguous with the plantar fascia in the distal arch. The mass is particularly prominent with passive dorsiflexion of the ankle and toes. What is the best course of action?

Baseball pitchers who have internal impingement will most likely demonstrate what changes in range of motion?

A 45-year-old tennis player undergoes surgery for chronic lateral epicondylitis. After returning to play, he notes increasing lateral elbow pain with mechanical catching and locking. Examination shows positive supine posterolateral rotatory instability. What ligament has been injured?

A 52-year-old woman slipped on ice in her driveway. Radiographs are shown in Figures 19a and 19b. The patient was treated in a short leg cast with weight bearing as tolerated for 6 weeks. Due to persistent tenderness at the fracture site, a CAM walker was used for an additional 8 weeks. Nine months after the injury, the patient still walks with a limp and reports pain with deep palpation at the fracture site. What is the next most appropriate step in management?

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?

Figures 48a through 48c show the lateral radiograph and MRI scans of a 60-year-old man who has had pain in his thigh for 1 month. The next most appropriate step in management should consist of

In the majority of patients with chronic anterior cruciate ligament (ACL)-deficient knees, analysis of the gait pattern during level walking will most likely reveal which of the following changes?

A 55-year-old woman fell and sustained an elbow dislocation with a coronoid fracture and a radial head fracture. The elbow is reduced and splinted. What is the most common early complication?

A patient with a left-sided C6-7 herniated nucleous pulposis would likely have which of the following constellation of findings?

A 16-year-old girl has had pain and swelling along the medial arch of her left foot for the past 3 months. She also reports pain from shoe wear and while running. Nonsteroidal anti-inflammatory drugs have failed to provide relief. Radiographs are shown in Figures 40a through 40c. What is the next most appropriate step in management?

A 40-year-old man sustains a fracture-dislocation of C4-5. Examination reveals no motor or sensory function below the C5 level. All extremities are areflexic. The bulbocavernosus reflex is absent. The prognosis for this patient's neurologic recovery can be best determined by