Orthopedic MCQ Exam: Fracture, Hip & Knee Practice Questions | Part 76

Back pain and ipsilateral knee pain are common long-term sequelae of hip arthrodesis. To limit these problems, what position should be avoided during fusion of the hip?

-Figures a and b are the posteroanterior and lateral radiographs of a 13-year-old girl with a progressive curve despite bracing with a thoracolumbosacral orthosis. Examination reveals no pain or neurologic findings. The lumbar curve measures 59 degrees and the thoracic curve measures 52 degrees.The most appropriate treatment is

Biomechanical in vitro studies of double-row anchor fixation of rotator cuff tears show what initial advantage over single-row anchor fixation? Review Topic

Which of the following factors is associated with improved outcomes following surgery for hip fractures?

Figure 1 is the right hand of a 65-year-old man with a history of hypertension and rheumatoid arthritis. He is taking immunosuppressive disease-modifying antirheumatic drugs (DMARDs) and is seen in the emergency department with rapid progression of erythema from his right thumb to his right arm during the last 12 hours. He is confused, lethargic, and has these vital signs: blood pressure 92/40, respiratory rate 45, temperature 39.7°C, pulse 135, and oxygen saturation 90% on 4 liters of oxygen by face mask. An examination of his right upper extremity reveals black bulla extending from the metacarpophalangeal down to the tip and no capillary refill at the pulp. Immediate treatment should consist of

A patient sustained a puncture wound to the plantar aspect of his foot. He was wearing shoes and socks at the time of the injury. Systemic antibiotic administration with specific coverage for which bacterial species (in addition to Staphylococcus aureus) should be instituted?

He is intubated and being resuscitated. The calf is very swollen with compartment pressures: anterior 25 mm Hg, lateral 24 mm Hg, deep posterior 21 mm Hg, and

Which of the following is most important to acheive a good outcome following a Syme amputation?

A 2-year-old girl was born with the toe deformity shown in Figure 2. She has difficulty wearing shoes despite having adequate room in the toe box. Management at this time should consist of

A 5-year-old girl sustains an isolated injury to the right shoulder area after falling off the monkey bars. Examination reveals intact neurovascular function in the extremity distally, but she is quite uncomfortable. An AP radiograph of the proximal humerus is shown in Figure 24. Her parents state that she is a very talented gymnast. Considering her age and potential athletic career, management should consist of

A 25-year-old woman returns for her first postoperative visit after arthroscopic thermal capsulorrhaphy for recurrent multidirectional instability. Examination reveals that the portals are healed, there is no swelling; and passive range of motion is within the normal range. However, she is unable to actively raise her arm. Shoulder radiographs are normal. What is the most likely cause of these findings?

Figures 9a and 9b show the radiographs of a 4-year-old child who sustained an elbow injury. What is the most likely complication resulting from this fracture if treated in a cast?

A patient presenting with scapulothoracic dissocation and ipsilateral extremity neurologic injury is most likely to have which of the following outcomes?

A 10-year-old boy has a painful, swollen knee after falling off his bicycle. Examination reveals that the knee is held in 45 degrees of flexion, and any attempt to actively or passively extend the knee produces pain and muscle spasms. A lateral radiograph is shown in Figure 4. What is the most likely diagnosis?

The condition seen in Figure 60 is attributable to

A patient underwent a right hip arthroscopy, CAM resection, and labral repair while positioned supine on a fracture table with a perineal post. The leg was in traction for 4 hours, and no intrasurgical complications were noted. At the 2-week follow-up appointment, the patient was experiencing numbness and tingling in the perineum on the surgical side and noted pain predominantly while sitting. What is the likely cause of these symptoms?

An injury to the axillary nerve would result in deltoid muscle weakness. 5 . An injury to the thoracodorsal nerve would result in latissimus dorsi weakness and would not cause scapular winging.

A 40-year-old woman sustains a flexion injury to her neck. Physical examination is normal. A lateral radiograph of the cervical spine is shown in Figure 57a. MRI scans of the cervical spine are shown in Figures 57b and 57c. Treatment should include

Figures 29a and 29b show the radiograph and CT scan of a 48-year-old man who has diffuse spinal pain. What is the most likely diagnosis?

What adaptations occur in the dominant shoulder of throwers compared to their nondominant shoulder? Review Topic

Compared with surgically treated patients, patients with extra-articular distal third humeral shaft fractures that are treated nonsurgically with functional bracing can be expected to show which of the following findings?

All of the following conditions are associated with the female athlete triad EXCEPT? Review Topic

A 12-year-old boy reports limping and chronic knee pain that is now inhibiting his ability to participate in sports. Clinical examination and radiographs of the knee are normal. Additional evaluation should include Review Topic

Which of the following patient factors is associated with recurrent radicular pain following lumbar diskectomy for sciatica?

A 19-year-old football player is taken off the field because of fatigue. Examination reveals a rash shown in Figure A. Oral examination reveals findings shown in Figure B. Posterior cervical glands are palpable. A mass is palpable in the left upper quadrant. Which of the following is true regarding the most likely diagnosis? Review Topic

It is important to avoid which of the following exercises in the immediate postoperative period after humeral head replacement for an acute four-part fracture?

A 24-year-old dancer reports posterior ankle pain when in the “en pointe” position. Examination reveals posteromedial tenderness, no pain reproduction with passive forced planter flexion, and pain with motion of the hallux. What is the most likely diagnosis?

One year after undergoing anterior cervical decompression and fusion, what percentage of patients still have dysphagia?

Mechanical reduction of the pain associated with the condition shown in Figure 6 can be accomplished through the use of a cane on the contralateral side. Similarly, if this patient must carry any type of load in his or her arms, it should be carried

What is the most common cause for late revision (> 2 years post op) total knee arthroplasty? i. Infection

The initiating cellular event in development of posttraumatic osteoarthritis is attributed to which of the following?

Familial (Leiden) thrombophilia is of importance in joint arthroplasty because of an abnormality in the clotting cascade. Which of the following statements best describes the condition?

Figures 1 and 2 show the radiographs obtained from a 68-year-old morbidly obese man who underwent left total hip replacement 7 years ago and did well, with no symptoms prior to the current presentation. He recently rose from a seated position and felt a pop in the hip, with immediate pain and inability to bear weight. Any pressure on the left foot now produces a painful, grinding sensation with loss of left hip stability. What is the best next step?

A 51-year-old male truck driver has had progressive left hip pain for more than 2 years, and he reports that the pain has become severe in the past 9 months. He is now unable to work because of the pain. Examination reveals that range of motion of the hip is limited to 95 degrees of flexion, 0 degrees of internal rotation, and 20 degrees of external rotation. The plain radiograph, MRI scan, and intraoperative gross photographs are shown in Figures 9a through 9d. Management should consist of

A 25-year-old patient presents with a posterior wall/ posterior column acetabular fracture. She is scheduled for open reduction internal fixation through a posterior approach. What position of the leg exerts the least amount of intraneural pressure on the sciatic nerve?

Figures 21a through 21c show the MRI scans of a 21-year-old football player who sustained a valgus knee injury while changing direction. Examination reveals swelling and tenderness along the medial aspect of the knee. There is a positive Lachman test, 3+ valgus laxity at 30 degrees, and 1+ valgus laxity at 0 degrees extension. The anterior drawer test is increased with the tibia in external rotation. The increase in the anterior drawer test with the tibia in external rotation is most likely the result of

A 68-year-old male presents with gait instability, clumsiness of the hands, and the MRI images shown in Figure A. You decide to proceed with surgical decompression. When planning your surgical treatment, it is important to note that compared to a posterior approach, the anterior procedure has: Review Topic

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?

What is the most frequent late complication of cementless fixation in total knee arthroplasty?

A 30-year-old accountant and recreational softball player, who is seen at the end of his baseball season, reports a several month history of pain along the medial side of his dominant elbow. He cannot identify a specific injury and notes it only hurts when he throws the ball in from the outfield. Besides the pain, he remarks that his speed and distance while throwing have diminished considerably. Examination reveals tenderness along the medial elbow but no weakness or gross instability is found. Radiographs are normal. Based on the history, what is the most likely diagnosis? Review Topic

Which of the following is considered a contraindication to functional bracing for the treatment of humeral shaft fractures?

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

A 32-year-old woman has had progressive left foot pain over the first metatarsophalangeal (MTP) joint. Footwear is becoming problematic. There is full range of motion of the first MTP with medial eminence pain. Her weightbearing radiograph reveals a hallux valgus angle (HVA) of 35 degrees and a 1-2 intermetatarsal angle (IMA) of 10 degrees. What is the best next step?

Figures 10a and 10b show the radiographs of a 47-year-old man who reports pain in both shoulders. He has a history of leukemia that was treated with chemotherapy and high-dose cortisone. What is the most reliable treatment option for pain relief in this patient?

The most common reason for proximal femur fracture fixation failure (Figure 15) is secondary to which common deformity?

Compared with retention of the native patella in primary total knee arthroplasty, routine patellar resurfacing is associated with

Figure 7 shows the CT scan of a 22-year-old professional baseball pitcher who has had elbow pain for the past 6 months despite rest from throwing. Management should consist of Review Topic

A 14-year-old boy has had a 3-month history of low back pain with no known trauma. The pain is worse with activity and relieved by rest, although he does report difficulty with prolonged sitting in school. The patient was on the football team but stopped participating because of the back pain during football practice. He reports no history of radicular pain and denies any numbness, tingling, or weakness in the legs. Neurologic examination is normal. Back examination reveals slight tenderness over the lower back area but no swelling or skin defects. Strength testing is 5 over 5 in the lower extremities and the straight leg raise test is negative. Back range of motion is nearly full, but back extension is painful. The hamstrings are slightly tight. Initial radiographs, including AP, lateral and oblique views, are negative. What is the best test to determine the patient's diagnosis? Review Topic

A large circumferential proximal femoral allograft is to be used in the reconstruction of a failed femoral component in a total hip arthroplasty. To enhance fixation of the graft to the implant, which of the following strategies should be used?

Sacral fractures are most likely to be associated with neurologic deficits when they involve what portion of the sacrum?

A 12-year-old girl has back pain after falling 20 feet and landing in the sitting position. She has no fractures or other injuries, and her neurologic examination is normal. A lateral radiograph, transverse CT scan, and reformatted sagittal CT scan are shown in Figures 25a through 25c. Which of the following methods is associated with the best long-term outcome? Review Topic

• Radiographs of the cervical spine of a 73-year-old man who fell down stairs reveal cervical spondylosis without evidence of fracture or dislocation. MRI and CT scans are consistent with the plain radiographs. After 72 hours, neurologic evaluation reveals intact sensation; however, weakness of the upper extremities is greater than that of the lower extremities. What is the most likely diagnosis?

A 25-year-old man is unresponsive at the scene of a high-speed motor vehicle accident and remains obtunded. Initial evaluation in the emergency department reveals a left-sided femoral shaft fracture and a right-sided humeral shaft fracture. The cervical spine remains immobilized in a semi-rigid cervical collar, and the initial AP and lateral radiographs obtained in the emergency department are unremarkable. What is the most appropriate management at this time?

A patient with a documented allergy to nickel requires a total knee arthroplasty. Which of the following prostheses is most likely to provide long-term success in this individual?

Figure 7 shows a sagittal T1-weighted MRI scan. What muscle/tendon is identified by the arrow? Review Topic

Figures 41a and 41b show the radiographs of a 22-year-old woman who has a bunion on her left foot. She denies pain in the foot, but she reports increasing difficulty with shoe wear. Management should consist of

Figures 85a through 85c are the sagittal and axial CT scans and sagittal T2 MR image of a 21-year-old man who was thrown from his motocross bike earlier in the day. He now has significant low-back pain; however, he is neurologically intact and has no trouble voiding urine. A standing plain radiograph obtained the next day is shown in Figure 85d. Treatment should involve A B C D

A 9-year-old boy sustained a traumatic brain injury and right lower extremity trauma in an accident involving a motor vehicle and a pedestrian. Initial evaluation in the emergency department reveals an obtunded patient who is breathing spontaneously and withdraws appropriately to painful stimuli. After initial resuscitation and stabilization, a CT scan reveals a right parietal intracranial hemorrhage. Radiographs of the swollen right thigh are shown in Figures 32a and 32b. Management of the fractured femur should ultimately consist of

A 75-year-old woman notes a slowly enlarging mass in the right anterior thigh. Her medical history is significant only for hypertension. An MRI scan of her thigh is shown in Figures 60a through 60d. Which of the following surgical margins is the most appropriate for removal of this lesion?

below shows the radiograph obtained from a year-old woman who has sharp pain in her groin, thigh, and buttocks that worsens with activity. She has been dealing with this pain for more than a year but is otherwise healthy. Recently, she has begun to notice night pain. The pain no longer responds to NSAIDs. She would like to be able to dance at her daughter's wedding in 4 months and wonders how best to proceed. What is the best next step?

What is the main mechanism for nutrition of the adult disk?

A 63-year-old woman is seen 10 weeks after sustaining a closed minimally displaced distal radius fracture. She has been in a short-arm cast and reports minimal pain but notes that she is having difficulty using her thumb. An extensor pollicis longus (EPL) tendon rupture is suspected. Which examination finding would confirm lack of EPL function?

In the injury shown in Figures 1 and 2, what ligament remains intact?

A 21-year-old football player reports increasing pain and a deformity involving his chest after colliding with another player during a scrimmage. Imaging studies confirm an anterior sternoclavicular dislocation. Management should consist of

Which of the following types of exercise used to increase flexibility is considered most beneficial in increasing joint range of motion?

The preferred surgical approach to the elbow of a child with an irreducible type III supracondylar distal humerus fracture and pulseless extremity is through which of the following muscle intervals?

Figures 38a and 38b show the CT scans of a 64-year-old woman. What is the most likely diagnosis?

..Figures 78a and 78b are the radiographs of a 47-year-old right-hand-dominant woman who has a 3-month history of gradually progressive right shoulder pain. She reports no previous trauma, but does report pain at night and with activity such as weight training. Examination demonstrates active and passive range of motion to be 110 degrees forward elevation, external rotation to 20 degrees, and internal rotation to the sacrum. The next treatment step should include

Of all the pelvic ring injury types, anteroposterior compression type III pelvic ring injuries have the highest rate of which of the following?

Tension force in the anterior cruciate ligament during passive range of motion is highest at

Figure 16 shows an axial MRI scan through the knee joint. What structure is identified by the arrow?

Figure 53 shows the pedigree of a family with an unusual type of muscular dystrophy. This pedigree is most consistent with what type of inheritance pattern?

A 20-year-old college soccer player comes for an evaluation 6 months after an injury during which he landed awkwardly from a jump. Although physical therapy, ice, and activity modification have helped him return to baseline motion, strength, and swelling, he continues to have lateral knee pain. He also notes a popping sensation on the lateral side of his knee with activity. A Lachman test, anterior and posterior drawer tests, a pivot shift test, and McMurray test findings are all negative. MR images reveal a 12-mm x 15-mm osteochondral defect in the lateral femoral condyle with full-thickness cartilage loss and approximately 4 mm of subchondral bone loss.

Figures 20a and 20b are the radiographs of a 19-year-old woman who was involved in a motor vehicle accident. What mechanism of injury is most consistent with the injury?

A 35-year-old woman reports worsening pain after undergoing a neurectomy in the third interspace for a Morton’s neuroma 12 months ago. She states that the pain is sharp and electrical, worse than before her surgery, and prevents her from participating in her usual work and exercise activities. Use of wider shoes and pads used before her surgery have failed to provide relief. Examination does not reveal any deformity or inflammation. Tenderness along with neuritic pain occurs with compression of the plantar aspect of the foot between the third and fourth metatarsal head area. To most reliably alleviate her pain, management should consist of

What spinal nerves in the cauda equina are primarily responsible for innervation of the bladder?

Compared with retention of the native patella in primary total knee arthroplasty, routine patellar resurfacing is associated with

If the structure marked by the tip of the probe in Figure 94 is repaired to the bony glenoid with suture anchors during an arthroscopic stabilization procedure, what is the most likely result? Review Topic

A 55-year-old man reports increasing weakness in his arms that has progressed to his lower limbs, resulting in frequent tripping and falling. Examination reveals weakness in shoulder abduction and external and internal rotation bilaterally. Fasciculation is noted. He also has weakness in elbow flexion and extension bilaterally, and his grip strength is diminished. An electromyogram and nerve conduction velocity studies show decreased amplitude of compound motor action potential, slightly slowed motor conduction velocity, and denervation signs with decreased recruitment in all extremities. The sensory study is normal. Based on these findings, what is the most likely diagnosis?

What is the maximum acceptable amount of divergence of the interference screw in the femoral tunnel from the bone plug of a bone-patellar tendon-bone graft in anterior cruciate ligament (ACL) reconstruction before pull-out strength is statistically decreased?

A 14-year-old boy has medial ankle pain, progressive unilateral flatfoot deformity, and pain with most activities of daily living. He denies any recent injury. His parents recall that at age 7 years he sustained an injury that was treated as a sprain. Examination reveals valgus deformity with painless, unrestricted passive motion of the ankle. He has grossly equal limb lengths. A radiograph of the affected ankle is shown in Figure 48a, and the contralateral ankle is shown in Figure 48b. Management should consist of

A 65-year-old woman fell onto her outstretched right arm and immediately had pain. She has a history of osteoporosis. Examination of the right arm reveals lateral arm swelling, ecchymosis, and she is unable to move the elbow due to pain. Her neurovascular status is intact. Radiographs are shown in Figures 14a and 14b. Appropriate treatment should include

A 38-year-old woman has persistent elbow pain but is unable to recall a specific traumatic event. Examination reveals that the patient exhibits apprehension when the elbow is placed in valgus with forearm supination and axial loading. Because of chronicity and failure to respond to nonsurgical management, what is the most appropriate treatment? Review Topic

Figure 33 shows the oblique radiograph of an 11-year-old boy who has a mild left flatfoot deformity. Examination reveals that subtalar motion is limited and painful. Despite casting for 6 weeks, the patient reports foot pain that limits participation in sport activities. A CT scan shows no subtalar joint abnormalities. Management should now include

Where is the most common site for tuberculosis (TB) spondylitis in children?

A 60-year-old woman with a history of breast cancer has progressive paraparesis. The MRI scan is shown in Figure 28. What form of management is most likely to restore or maintain ambulation?

CLINICAL SITUATION Figures 1 and 2 are the radiographs of a 19-year-old man with a closed right humeral shaft fracture as well as a right femoral shaft fracture and a left ankle fracture-dislocation after a motor vehicle collision. On initial examination, he is noted to have a complete radial nerve palsy of his right upper extremity. Postoperative radiographs are shown in Figures 3 and 4. How does the plate function?

Radiating pain associated with a posterolateral thoracic disk herniation typically follows what pattern? Review Topic

Which of the following clinical tests is used to diagnose medial instability of the elbow? Review Topic

Kyphosis from a vertebral osteoporotic compression fracture often results in progressive kyphosis due to Review Topic

A 6-year-old girl sustains an ankle injury after falling on roller blades. An AP radiograph is shown in Figure 68. Treatment should consist of which of the following?

A 30-year-old patient underwent open reduction internal fixation of a talar neck fracture 8 weeks ago. His current radiographs demonstrate a subchondral radiolucency of the dome of the talus. What is the next most appropriate course of action?

The patient is given a blood transfusion. After starting the transfusion, nurses note that her temperature is 38.8°C and she has shaking and chills. What is the most likely cause of this problem?

Figure 43 shows an arthroscopic view of the posteromedial compartment of a patient’s left knee using a 70-degree arthroscope placed through the intercondylar notch. The arrow is pointing to what structure?

Which of the following activities can improve posterior capsular contractures?

A soccer player who sustained a twisting injury to the right ankle while making a cut is unable to bear weight and has diffuse tenderness over the anterior and lateral aspects of the ankle. Examination also shows a positive squeeze test. Plain radiographs and a stress radiograph are shown in Figures 26a through 26c. Radiographs of the leg and knee are normal. What is the most appropriate management?

What is the most common cause for poor outcomes in patients who undergo total shoulder arthroplasty?

The space available for the cord is an important determinant in neurologic recovery. Recent analysis suggests that the most reliable radiographic predictor for neurologic recovery after surgery in patients with rheumatoid arthritis and paralysis is a preoperative

A 72-year-old man sustains a displaced four-part fracture of the proximal humerus with head split component following a fall. A primary shoulder arthroplasty has been recommended for acute management. In counseling the patient on pros and cons of hemiarthroplasty versus reverse arthroplasty, what statement can be made based on the available literature?

Following ankle arthroscopy performed through a posterolateral portal, a patient notes numbness on the lateral half of the heel pad of the foot. What is the most likely injured structure?