100 Orthopedic MCQs: Trauma, Spine, Sports & Arthroplasty | Mock Exam Set #874

A study is being designed to compare the effectiveness of an antibiotic. The choice of the number of patients (ie, the sample size) depends on several factors. What type of calculation assesses the potential of the study to successfully address the effectiveness of the antibiotic?

Figure 21 shows the radiograph of an 18-year-old man who was brought to the emergency department with shoulder pain following a rollover accident on an all-terrain vehicle. Examination reveals a fracture with massive swelling; however, the skin is intact and not tented over the fracture. Based on these findings, initial management should consist of

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

A college football player performs bicep curls as part of his weight lifting routine. During the flexion phase of the curl, what term defines the type of muscle contraction?

A 20-year-old woman with a history of subtotal meniscectomy has a painful knee. What associated condition is a contraindication to proceeding with a meniscal allograft?

Figure 44 shows the radiograph of a 65-year-old man who underwent a revision arthroplasty to remove a loose, cemented femoral stem. When planning the postoperative restrictions, the surgeon should be aware that

Following fixation of a displaced intra-articular fracture of the distal humerus through a posterior approach, what is the expected outcome?

Figure 40 shows the radiograph of a 30-year-old woman who has a painful elbow. Examination reveals a deformed skull, multiple cafe-au-lait spots, and bone deformities. What is the most likely diagnosis?

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

What is the first ossification center to appear radiographically in the pediatric elbow?

What complication is more likely following excessive medial retraction of the anterior covering structures during the anterolateral (Watson-Jones) approach to the hip?

When compared to traditional open repair through a posterior incision, percutaneous Achilles tendon repair clearly results in a reduction of what complication?

What is the current 5-year survival rate for patients with classic nonmetastatic, high-grade osteosarcoma of the extremity?

An 18-month-old boy with obstetric brachial plexus palsy is being evaluated for limited right shoulder motion. Physical therapy for the past 6 months has failed to result in improvement of the contracture. Which of the following studies is necessary prior to any shoulder reconstruction?

A 52-year-old woman underwent open reduction and internal fixation for radial and ulnar shaft fractures 2 months ago. In a second fall she refractured her forearm and required revision surgery with bone grafting. One month after the second operation she notes erythema, swelling, and drainage from the volar radial incision. In addition to antibiotic treatment, management should consist of

Which of the following factors will adversely affect bone ingrowth in a revision porous-coated stem?

Examination of a 10-year-old girl with a hypoplastic breast and atrophic pectoralis major may also reveal which of the following findings?

Pain associated with a proximal medial tibial osteochondroma in a 10-year-old patient is most commonly the result of

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

Figure 7 shows the radiograph of a 64-year-old man who has neck pain and weakness of the upper and lower extremities following a motor vehicle accident. Examination reveals 3/5 quadriceps and 4/5 hip flexors but no ankle dorsiflexion or plantar flexion. His intrinsics are 1/5, with finger flexors of 3/5. He is awake, alert, and cooperative. Management should consist of

Compared to postoperative radiation therapy, preoperative radiation therapy has a higher rate of what complication?

A 5-year-old girl sustained a comminuted Salter-Harris type IV fracture of the left distal tibia 2 years ago. The AP radiograph shown in Figure 54a reveals a growth arrest and a 1.4-cm limb-length discrepancy. The ankle is in approximately 20 degrees of varus. Figure 54b shows a coronal reconstruction image of the distal tibial physis, and Figure 54c shows a sagittal reconstruction image of the same area. On the sagittal reconstruction image, the bar extends from the 9-mm mark to the 24-mm mark in 3-mm increments. On the coronal image, the bar extends from the 9-mm mark to the 24-mm mark, also in 3-mm increments. A map of the physeal bar based on these measurements is shown in Figure 54d. Initial treatment should consist of

What mechanism is associated with the spontaneous resorption of herniated nucleus pulposus?

When elevating the arm, the ratio of scapulothoracic to glenohumeral motion over the total range of motion is best described as

Which of the following conditions is not associated with an increased risk of developing Achilles tendinopathy?

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?

Which of the following is not a reported mode of failure for a constrained acetabular component?

A 35-year-old runner has pain beneath the second metatarsophalangeal joint. He reports that he has significantly decreased his running distance since the onset of the pain. He denies any history of trauma or injury to the foot. A radiograph is shown in Figure 14. Initial management should consist of

Patients with tarsal tunnel syndrome are most likely to obtain a favorable outcome from decompression of the posterior tibial nerve if which of the following conditions is present?

Figure 8 shows the CT scan of an 11-year-old boy who has had a 1-year history of worsening painful flatfeet. He reports pain associated with physical education at school, especially with running and jumping. Management consisting of activity restriction, anti-inflammatory drugs, and casting has failed to provide relief. Treatment should now consist of

A patient has had a locked posterior dislocation of the shoulder for the past 6 months. After undergoing total shoulder arthroplasty that includes adequate anterior releases and posterior capsulorrhaphy, the patient still exhibits posterior instability intraoperatively. The postoperative rehabilitation regimen should include

A 28-year-old hockey player has a shoulder deformity after being checked into the boards. Examination reveals that swelling has improved, but there is tenderness along the distal clavicle. Radiographs reveal a grade II acromioclavicular joint separation. Initial management should consist of

Which of the following aids in correction of patellar tracking after total knee arthroplasty (TKA)?

The acceleration of an object under the influence of a force depends directly on the mass of the object. The angular acceleration of an object under the influence of a moment depends directly on the

A 27-year-old woman sustained a bilateral C5-6 facet subluxation in a motor vehicle accident. Neurologic evaluation reveals normal motor, sensory, and reflex functions. She is awake, alert, and cooperative. Initial management should consist of

Chronic anterior donor site pain following the harvest of autologous iliac crest bone graft for use during anterior cervical diskectomy and fusion is reported by approximately what percent of patients?

A 13-year-old girl was riding on an all-terrain vehicle when the driver struck a tree. She sustained the injury shown in Figures 45a through 45d. This injury is best described as what type of acetabular fracture pattern?

In the first dorsal compartment of the wrist, what tendon most frequently contains multiple slips?

Figures 28a through 28c show the MRI scans of a 30-year-old woman who weighs 290 lb and has low back and left leg pain. She also reports frequent urinary dribbling, which her gynecologist has advised her may be related to obesity. Examination will most likely reveal

Figures 5a and 5b show the radiograph and MRI scan of a patient who has severe mechanical neck pain but no neurologic problems. Biopsy and work-up show the lesion to be a solitary plasmacytoma. Treatment should consist of

Stability at the atlanto-occipital joint is provided mainly by

A 20-year-old football player sustains a dorsiflexion external rotation injury to his right ankle. During sideline evaluation, which of the following findings best indicates a syndesmosis ankle sprain without diastasis?

A 40-year-old man has a painless mass around his left ankle. He notes minimal growth over the past year. An MRI scan is shown in Figure 73a, and biopsy specimens are shown in Figures 73b and 73c. What is the most likely diagnosis?

In the normal adult, the distance between the basion and the tip of the dens with the head in neutral position is how many millimeters?

An otherwise healthy 35-year-old woman reports dorsal wrist pain and has trouble extending her thumb after sustaining a minimally displaced fracture of the distal radius 3 months ago. What is the next most appropriate step in management?

Examination of a 34-year-old man who has had left leg pain for the past 6 weeks reveals minimal weakness of the left extensor hallucis longus and normal ankle jerk and patellar reflexes. Figure 33 shows an axial MRI scan of the L4-5 disk. Based on these findings, the MRI scan results are consistent with compression of the

The use of posting (a wedge added to the medial or lateral side of an insole) is useful to balance forefoot or hindfoot malalignment. Assuming normal subtalar joint pronation, what is the maximum amount of recommended hindfoot posting?

A 64-year-old man with a history of metastatic lung cancer reports increasing right hip pain over the period of several months. Radiographs are shown in Figures 3a and 3b. Initial management should consist of

An otherwise healthy 25-year-old man sustained a wound with a 1-cm by 1.5-cm soft-tissue loss over the volar aspect of the middle phalanx of his middle finger. After appropriate debridement and irrigation, the flexor digitorum profundus tendon and neurovascular bundles are visible. The wound should be treated with a

What is the 5-year overall survival rate for adults with high-grade soft-tissue sarcomas?

A 58-year-old woman who underwent a successful total hip replacement for degenerative arthritis 8 years ago reports groin pain for the past 6 months. A radiograph of the hip is shown in Figure 32. At revision, severe deficiency of the posterior column is noted. What reconstructive option would be most appropriate for the acetabulum?

A 68-year-old woman with serologically proven rheumatoid arthritis underwent an open synovectomy and radial head resection 10 years ago. She now has severe pain that has failed to respond to nonsurgical management. Examination reveals a flexion arc of greater than 90 degrees. Radiographs are shown in Figures 15a and 15b. What is the most appropriate management?

A 40-year-old man has had hip pain with increased activity over the past year. Examination reveals restriction of motion and tenderness with combined hip flexion, adduction, and internal rotation. An AP radiograph is shown in Figure 34. What is the most likely diagnosis?

In the treatment of acetabular dysplasia, what type of pelvic osteotomy leaves the "teardrop" in its original position and redirects the acetabulum?

Which of the following types of iliac osteotomy provides the greatest potential for increased coverage?

Figures 10a through 10c show the radiographs of an 85-year-old man who underwent a revision total knee arthroplasty for loosening of the tibial component 6 months ago. He now reports a mildly uncomfortable mass on the anterior part of the knee joint. Examination reveals 95 degrees of motion and good quadriceps strength, and he can ambulate with minimal pain with a walker. History reveals chronic lymphocytic leukemia for which he is taking antineoplastic medication. Culture of the mass aspirate grew Candida albicans on two separate occasions. The patient and the family strongly prefer nonsurgical management. If long-term suppression is chosen as treatment, what advice should be given to the patient and family?

Figure 11 shows a consecutive sequence of MRI scans obtained in a 12-year-old boy who has had increasing lateral knee pain and catching for the past 6 months. Examination reveals pain localized to the lateral joint line. Range-of-motion testing reveals a 5-degree lack of full extension on the involved side. Plain radiographs and laboratory values are within normal limits. What is the most appropriate management?

Figure 10 shows the radiograph of a 7-year-old patient who has a bilateral Trendelenburg limp and limited range of hip motion but no pain. His work-up should include

When compared with fresh-frozen bone allograft, freeze-dried bone allograft (FDBA) is characterized by

The main advantage of surgical repair of an acute Achilles tendon rupture, when compared with nonsurgical management, is reduced

A 45-year-old man sustains an acute closed posterolateral elbow dislocation. The elbow is reduced, and examination reveals that the elbow dislocates posteriorly at 35 degrees with the forearm placed in supination. What is the best course of action?

In hip arthroplasty, the location of the medial femoral circumflex artery is best described as

Figures 40a and 40b show the pre- and postoperative radiographs of an 82-year-old woman with bilateral hip pain who has had staged total hip arthroplasties. To minimize potential injury to the sciatic nerve at the time of surgery, the surgeon should

An 8-year-old boy falls and injures his thumb. A radiograph is shown in Figure 23. Initial management should consist of

What arterial vessel is most prone to injury during posterior iliac crest bone graft harvest?

Involvement of what single muscle best distinguishes an L5 radiculopathy from a peroneal neuropathy?

The Keller proximal phalanx resection procedure is most useful for which of the following conditions?

What is the most common long-term complication of the fracture shown in Figure 32?

What is the most common cause of the new onset of amenorrhea in a female endurance athlete who is not sexually active?

Figures 6a through 6d show the radiographs and biopsy specimens of an 8-year-old girl with leg pain. Management of the lesion should consist of

A 29-year-old man who lifts weights states that he injured his left shoulder while performing a bench press 2 days ago. The following morning he noted ecchymosis and swelling in the left chest wall. Examination reveals ecchymosis and tenderness and deformity in the left anterior chest wall and axillary fold that is accentuated with resisted adduction of the arm. Passive range of motion beyond 90 degrees of forward flexion and 45 degrees of external rotation is extremely painful. Glenohumeral stability is difficult to assess because of severe guarding. Figure 29 shows an MRI scan. Management should consist of

A 32-year-old woman has an isolated left posterior wall acetabular fracture in which about 25% of the wall surface is involved. Which of the following criteria would indicate the need for surgical reduction and fixation?

A 42-year-old woman reports that she has low back pain and had a transient loss of consciousness after falling off a horse. She denies having neck pain but notes that she was involved in a motor vehicle accident 2 years ago and had neck pain at that time. Examination reveals full range of motion of the neck and no localized tenderness. The neurologic examination is normal. A lateral radiograph of the cervical spine is obtained. Figures 41a and 41b show CT and MRI scans. What is the most likely diagnosis?

Figure 22 shows the radiograph of a 67-year-old woman who has an infected left total hip arthroplasty. The most efficient means to remove the distal cement mantle includes the use of

Figure 9 shows a cross-sectional view of the spinal cord at the lower cervical level. Injury to the structure indicated by the black arrow will lead to what neurologic deficit?

When counseling a patient with hypophosphatemic rickets, which of the following scenarios will always result in a child with the same disorder?

A 15-year-old diver has had persistent, activity-related low back pain for the past 2 months. He denies any history of trauma. Examination reveals that the pain is localized to the lumbosacral junction, and there are no radicular symptoms. The pain is worse with back extension. Neurologic examination is normal, as are AP, lateral, and oblique radiographs of the lumbosacral spine. Further evaluation should include

A 78-year-old woman falls onto her nondominant left elbow and sustains the injury shown in Figure 5. What treatment option allows her the shortest recovery time and highest likelihood of good function and range of motion?

A 42-year-old man reports the recent onset of right hip pain. A radiograph and MRI scan are shown in Figures 38a and 38b. A WBC count, erythrocyte sedimentation rate, and hip aspiration are within normal limits. Management should now consist of

A 67-year-old woman has had pain in the area of the metatarsal heads and toes bilaterally for the past 18 months. She describes a diffuse discomfort and a constant burning sensation. She notes that the area feels swollen. Examination reveals that her pulses are normal, and there is no frank swelling or focal tenderness. What is the most likely diagnosis?

When harvesting an iliac crest bone graft from the posterior approach, what anatomic structure is at greatest risk for injury if a Cobb elevator is directed too caudal?

A 35-year-old female runner reports progressive vague aching pain involving her midfoot. Her pain is most notable when running. She denies specific injury. Examination reveals minimal swelling and localized tenderness over the dorsal medial midfoot and navicular. Radiographs and an MRI scan are shown in Figures 37a through 37c. What is the most appropriate management?

In Figure 49, line AB connects the anterior arch of C1 to the posterior margin of the foramen magnum. Line CD connects the anterior margin of the foramen magnum to the posterior arch of C1. What is the normal ratio of displacement from CD to AB (Power's ratio)?

Which of the following best describes the mechanical response of the inferior glenohumeral ligament to repetitive subfailure strains?

A 15-year-old girl reports popping and clicking at the sternoclavicular joint and an intermittent asymmetrical prominence of the medial head of the clavicle. She denies any history of trauma or other symptoms. Management should consist of

The mother of a 3-month-old infant states that she has difficulty positioning the infant's legs during diaper changes. Examination reveals limited abduction of both hips and a negative Ortolani sign. A radiograph reveals bilaterally dislocated hips. Initial management consists of guided reduction in a Pavlik harness, with weekly follow-up. Figures 57a and 57b show the radiograph and CT scan obtained after 6 weeks in the harness. Management should now consist of

While lifting weights, a patient feels a pop in his arm. He has the deformity shown in Figure 30. If left untreated, the patient will have the greatest deficiency in

Which of the following conditions is associated with palmoplantar pustulosis?

Which of the following is considered the most accurate test to determine the amount of limb-length discrepancy in a patient with a knee flexion contracture of 35 degrees?

A 37-year-old man has had isolated chronic knee swelling for the past 6 months. He denies any history of specific trauma. Examination reveals a large effusion with a stable knee, but the remainder of the examination is normal. Plain radiographs are unremarkable. An MRI scan reveals a large effusion without meniscal injury. An arthroscopic image of the suprapatellar pouch is shown in Figure 23. What is the most likely diagnosis?

Of the following clinical situations, which is most likely to lead to osteonecrosis associated with a slipped capital femoral epiphysis (SCFE)?

A 45-year-old woman with stage II posterior tibial tendinitis has failed to respond to nonsurgical management. Recommended treatment now includes posterior tibial tendon debridement and medial calcaneal displacement osteotomy along with transfer of what tendon?

A healthy 70-year-old man has a swollen knee after undergoing a knee replacement 10 years ago. Aspiration of the knee reveals cloudy, viscous synovial fluid. Laboratory studies show an erythrocyte sedimentation rate of 10 mm/h and a C-reactive protein level of less than 0.5. What is the most likely diagnosis?

A 40-year-old woman who is an avid tennis player reports the insidious onset of progressive left shoulder pain for the past 2 months. Examination reveals full range of motion with a positive impingement sign. Strength in the supraspinatus and infraspinatus muscles is normal, although stress testing is painful. An earlier subacromial cortisone injection provided good, but only temporary relief. An AP radiograph of the left shoulder is shown in Figure 10. Management should now consist of

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

Preservation or reconstruction of which of the following structures is essential to minimize the risk of hallux valgus developing after removal of part or all of the medial sesamoid?

A 70-year-old woman is brought to the emergency department with a two-part greater tuberosity fracture with an anterior subcoracoid dislocation. One day after successful closed reduction, examination reveals marked swelling of the involved arm, forearm, and hand, as well as large amounts of "weeping" serous fluid but no obvious lacerations. The fingers are warm and pink, and the pulses are normal distally with good refill. Edema is present. There is no pain with passive and active motion of the elbow, wrist, and fingers. What is the next most appropriate step in management?

A 62-year-old woman has back pain and right L2 radicular pain. MRI scans suggest a neoplastic lesion at L2, and a bone scan is negative except at L2. History reveals that she was treated for breast cancer without known metastatic disease 12 years ago and is thought to be free of disease. What is the next most appropriate step in management?

A teenager is undergoing a correction of deformity and lengthening of the femur. Distractions are proceeding as expected; however, during his 6-week follow-up examination, the patient reports that the distraction motors have become harder to turn over for the past 2 to 3 days. Figures 37a and 37b show current radiographs. What is the most likely complication being encountered?

Figure 22 shows the MRI scan of a 20-year-old female basketball player who has pain over the anterior knee that interferes with her performance. Examination reveals phase III Blazina patellar tendinosis. Management should consist of