Orthopedic With Answer Pe Review | Dr Hutaif General Or -...

A 65-year-old male presents with massive rotator cuff tear. On physical examination, he demonstrates a positive Hornblower's sign. Which muscle is primarily deficient, and what is the typical pathomorphologic finding?

A 28-year-old athlete sustained a knee injury. The Dial test is performed. The examiner notes >10 degrees of increased external rotation compared to the contralateral knee at 30 degrees of flexion, but equal external rotation at 90 degrees of flexion. This isolated finding is most indicative of injury to which structure?

While evaluating a patient with a suspected nerve palsy, the examiner asks the patient to firmly grasp a piece of paper between the thumb and the index finger. As the examiner pulls the paper away, the patient's thumb interphalangeal (IP) joint hyperflexes. This compensatory maneuver is known as Froment's sign. Which muscle is compensating for the underlying deficit?

A 13-year-old overweight boy presents with a limp and vague knee pain. Upon physical examination, passive flexion of the affected hip results in obligate external rotation and abduction. What is this sign called, and what is the most likely diagnosis?

A patient presents with equinus contracture. The Silfverskiöld test reveals that ankle dorsiflexion is restricted to 0 degrees when the knee is extended, but improves to 15 degrees of dorsiflexion when the knee is flexed. What is the most appropriate surgical intervention for this specific finding?

A patient presents with right-sided neck pain radiating down to the middle finger, along with weakness in triceps extension. Spurling's test is positive. What is the most likely affected nerve root, and what is the classic mechanism of a positive Spurling's maneuver?

The pivot shift test is pathognomonic for ACL insufficiency. During the maneuver, the tibia translates anteriorly in extension and reduces with a 'clunk' as the knee is flexed. Which anatomical structure is primarily responsible for generating the reducing force during flexion?

A 24-year-old patient with Charcot-Marie-Tooth disease presents with bilateral cavovarus feet. The Coleman block test is performed by placing the heel and lateral foot on a block while allowing the first metatarsal to hang off. The hindfoot corrects to neutral. What does this indicate about the deformity, and what is the primary driver?

A 25-year-old hockey player presents with anterior groin pain that worsens with deep flexion. The FADIR (Flexion, Adduction, Internal Rotation) test elicits sharp groin pain. Imaging reveals a substantial alpha angle. This test is highly sensitive for which of the following conditions?

A 40-year-old new mother presents with radial-sided wrist pain. During physical examination, the physician grasps the patient's thumb and sharply ulnar deviates the wrist, eliciting severe pain over the first dorsal compartment. Which specific eponym correctly identifies this provocative maneuver?

During an evaluation for shoulder pain, the patient holds their arm in 90 degrees of flexion, 10 degrees of adduction, and maximal internal rotation (thumb down). Downward force elicits deep shoulder pain. The pain is relieved when the test is repeated in maximal external rotation (palm up). This clinical finding is most specific for pathology of which structure?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain. The moving valgus stress test is performed, producing pain optimally at an arc between 120 and 70 degrees of flexion. Which specific bundle of the Ulnar Collateral Ligament (UCL) is primarily being evaluated by this test?

A 45-year-old male is evaluated for radiating leg pain. Straight leg raise (SLR) elicits pain at 40 degrees. The examiner drops the leg slightly until the pain stops, then abruptly dorsiflexes the foot, which reproduces the radiating pain. What is the name of this confirmatory test?

A 32-year-old male sustains a closed tibial shaft fracture. Six hours post-admission, he develops severe leg pain out of proportion to the injury. Which physical examination finding is considered the most sensitive and earliest clinical indicator of acute compartment syndrome?

A 50-year-old female presents with weakness in her hand. The examiner observes that the patient's small finger remains in an abducted posture and she is unable to actively adduct it. This finding (Wartenberg's sign) is caused by the unopposed action of which muscle, and what is its innervation?

During a gait assessment of a patient with right hip osteoarthritis, the examiner observes the patient's pelvis dropping on the left side during the right stance phase. A positive Trendelenburg sign on the right indicates weakness of the right gluteus medius. Which nerve innervates the deficient muscle, and what is its primary spinal root contribution?

A newborn female undergoes screening for Developmental Dysplasia of the Hip (DDH). The examiner adducts the hip while applying posterior force, resulting in a palpable clunk as the hip dislocates. Which test was performed, and what does it establish?

A 35-year-old male complains of medial knee joint line catching. The examiner stands the patient on the affected leg, flexes the knee to 20 degrees, and asks the patient to internally and externally rotate their body over the knee. This maneuver reproduces the medial pain. What is the name of this test, and what is its primary purpose?

A patient complains of numbness in the ring and small fingers and weakness of finger abduction. Tapping over the volar-ulnar aspect of the wrist produces tingling in the small finger. If the lesion is localized to Zone I of Guyon's canal, which neurological deficits would be expected?

During a low back pain evaluation, the examiner notes that pressing lightly on the patient's head causes severe radiating lumbar pain. The examiner also notes widespread hypersensitivity to light touch over the entire back. These findings fall under Waddell's signs. What is the primary clinical utility of identifying these signs?

A 14-year-old boy presents with a painful, swollen thigh. Radiographs reveal a permeative diaphyseal lesion of the femur with a prominent 'onion-skin' periosteal reaction. Core biopsy is performed. Which of the following cytogenetic abnormalities is most likely to be identified in the neoplastic cells?

During a posterior-stabilized total knee arthroplasty, the surgeon achieves equal and symmetric medial and lateral gaps in extension. However, upon flexing the knee to 90 degrees, the joint is symmetrically too tight to accept the trial polyethylene insert. Which of the following is the most appropriate next step to balance the knee?

During the neurological examination of a 62-year-old man presenting with bilateral hand clumsiness and gait instability, the examiner supports the patient's forearm in a neutral position and strikes the brachioradialis tendon with a reflex hammer. This elicits spontaneous flexion of the fingers and thumb. What does this specific finding suggest?

A 13-year-old obese male presents with a slipped capital femoral epiphysis (SCFE) of the left hip. He undergoes in situ percutaneous pinning. According to the modified Oxford bone age score, which of the following is the strongest indication for prophylactic pinning of the asymptomatic right hip?

A 24-year-old football player sustains an axial load to a plantarflexed foot. Radiographs show a widening of the space between the bases of the first and second metatarsals. Which of the following accurately describes the anatomy of the primary ligament injured in this condition?

Articular cartilage relies on specific structural components for its unique biomechanical properties. Which of the following correctly pairs the zone of articular cartilage with its distinct collagen fiber orientation and primary function?

A 55-year-old male undergoes arthroscopic rotator cuff repair for a massive, retracted tear involving the supraspinatus and infraspinatus. Biologically, which of the following best describes the healing process at the tendon-to-bone interface following a successful repair?

A 68-year-old woman is evaluated 4 weeks after an uncomplicated primary total hip arthroplasty via a posterior approach. She complains of new-onset foot drop. On exam, she has weakness in ankle dorsiflexion and eversion, but inversion and plantarflexion are normal. Which of the following surgical factors most likely contributed to this specific neurological deficit?

A 22-year-old male sustains a scaphoid fracture. The risk of avascular necrosis (AVN) is heavily dependent on the fracture location due to the unique vascular anatomy of the scaphoid. Which of the following accurately describes the primary vascular supply to the proximal pole of the scaphoid?

A 72-year-old woman is started on teriparatide for severe osteoporosis following a fragility fracture of the distal radius. What is the mechanism of action of this medication?

A 4-month-old female is diagnosed with Developmental Dysplasia of the Hip (DDH). She is currently being treated in a Pavlik harness. During a follow-up ultrasound, the alpha angle is measured. What does the alpha angle represent, and what is considered a normal value indicating a mature hip?

In the Young-Burgess classification of pelvic ring injuries, which of the following fracture patterns is most characteristic of an Anteroposterior Compression Type II (APC II) injury?

A 14-year-old girl with Adolescent Idiopathic Scoliosis (AIS) undergoes posterior spinal fusion. Postoperatively, the surgeon evaluates the correction using the Lenke classification criteria. According to the Lenke classification, which of the following determines if a proximal thoracic curve is considered 'structural'?

A 30-year-old carpenter sustains a laceration to the volar aspect of his index finger at the level of the proximal interphalangeal (PIP) joint, resulting in an inability to flex the DIP joint while the PIP joint can still be flexed against resistance. In which flexor tendon zone did this injury occur?

A 19-year-old male complains of dull, aching back pain that is notably worse at night and dramatically relieved by ibuprofen. Radiographs and CT show a 2.5 cm radiolucent nidus in the posterior elements of L4. Histologically, the lesion consists of woven bone trabeculae lined by prominent osteoblasts. What is the most likely diagnosis?

A 21-year-old collegiate wrestler suffers an anterior shoulder dislocation. An MRI arthrogram reveals an avulsion of the anterior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL). The labrum remains attached to the intact periosteum, which is stripped medially down the glenoid neck. What is the eponym for this specific lesion?

A 35-year-old man sustains a closed, displaced fracture of the distal third of the humeral shaft (Holstein-Lewis fracture). On examination, he is unable to extend his wrist or fingers. He undergoes closed reduction and splinting, but post-reduction examination reveals the onset of a new, complete radial nerve palsy. What is the most appropriate next step in management?

In the pathogenesis of periprosthetic joint infections, bacteria often form a biofilm that renders them highly resistant to host defenses and systemic antibiotics. Which of the following best describes the 'quorum sensing' phase of biofilm formation?

During the Ponseti method for the correction of idiopathic clubfoot (talipes equinovarus), the deformities are systematically corrected through a series of specific casts. What is the correct sequence of deformity correction using this technique?

Ceramic-on-ceramic (CoC) bearing surfaces in total hip arthroplasty offer excellent wear characteristics but come with specific complications. Which of the following is a recognized unique complication associated specifically with CoC articulations?

A 42-year-old bodybuilder feels a pop in his anterior elbow during a heavy deadlift. The examiner performs the Hook test. What is the anatomic structure being evaluated, and what constitutes a positive test?

A patient presents with persistent abduction posturing of the small finger. This finding (Wartenberg's sign) is caused by unopposed action of which muscle, and what is the underlying nerve injury?

A 14-year-old with Charcot-Marie-Tooth disease presents with a cavovarus foot deformity. A Coleman block test is performed and the hindfoot completely corrects to neutral. What does this finding indicate regarding the foot's biomechanics?

A patient with chronic, refractory plantar fasciitis undergoes a Silfverskiold test. Ankle dorsiflexion is 0 degrees with the knee extended and 15 degrees with the knee flexed. What is the diagnosis and the most appropriate surgical target?

During the Active Compression Test (O'Brien's test), a patient experiences deep shoulder pain when the arm is in 90 degrees of forward flexion, 10 degrees of adduction, and internal rotation (thumb pointing down). The pain is entirely relieved by external rotation (thumb pointing up). Which structure is most likely injured?

A 55-year-old female complains of weakness and anterior shoulder pain. The examiner places the patient's palm on her contralateral shoulder and asks her to resist as the examiner tries to pull the hand anteriorly away from the shoulder. She is unable to resist the pull. Which tendon is likely torn?

The pivot shift test is utilized to evaluate rotatory instability of the knee. Biomechanically, what occurs during a positive pivot shift test as the knee is brought from full extension into flexion?

A collegiate baseball pitcher complains of medial elbow pain and decreased velocity. The moving valgus stress test is performed. The test is considered positive if pain is reproduced at the medial elbow during which specific arc of elbow motion?

During the Watson scaphoid shift test, a palpable and painful clunk is appreciated as the examiner removes thumb pressure from the scaphoid tubercle. What is the pathomechanical etiology of this clunk?

In evaluating a child with cerebral palsy who exhibits a crouch gait, the examiner places the patient prone and rapidly flexes the knee. The examiner observes spontaneous, involuntary flexion of the ipsilateral hip. This positive Ely's test indicates spasticity or contracture of which muscle?

A patient presents with an inability to make a perfect "OK" sign with their fingers, instead demonstrating a flat pinch using the pulps of the thumb and index finger. Which muscle weakness is primarily responsible for this abnormal posture?

A 20-year-old swimmer undergoes apprehension and relocation tests of the shoulder. Anterior apprehension is noted, which is subsequently relieved when the examiner applies a posteriorly directed force on the proximal humerus (relocation test). The relief of apprehension during this maneuver is most specific for what pathology?

A patient presents with a jammed finger. The examiner flexes the PIP joint to 90 degrees over the edge of a table and asks the patient to extend the DIP joint against resistance. The DIP joint extends rigidly and strongly. What does this positive Elson's test signify?

During a physical exam, a patient demonstrates an inability to maintain maximal external rotation of the shoulder when the examiner places the arm in 20 degrees of abduction and maximum external rotation. Upon release, the arm drifts into internal rotation. Which tendon is most likely involved?

A 24-year-old hockey player complains of insidious onset groin pain. The examiner flexes the hip to 90 degrees, adducts, and internally rotates the thigh (FADIR test), which reproduces sharp anterior groin pain. This test is highly sensitive for which condition?

During physical examination of the forefoot, applying lateral compression to the metatarsal heads while simultaneously palpating the plantar aspect of the third web space elicits a palpable click and sharp pain radiating into the toes. What is the underlying pathology?

The examiner flicks the distal phalanx of a patient's middle finger downward. A positive Hoffmann's sign is noted. What is the expected motor response, and what does it suggest?

A 25-year-old overhead athlete presents with deep anterior shoulder pain. O'Brien's active compression test is positive, eliciting pain with internal rotation that is relieved by external rotation. What is the most likely injured structure?

A 55-year-old man presents with anterior shoulder pain and weakness after a fall. A Belly Press test is equivocal, but the Bear Hug test is strongly positive with inability to hold the hand to the opposite shoulder against resistance. Which portion of the affected muscle is most likely compromised?

During the pivot shift test for anterior cruciate ligament (ACL) insufficiency, the examiner applies a valgus stress and internal rotation while flexing the knee. The distinct clunk observed at 20-30 degrees of flexion represents which biomechanical event?

A patient with a documented ulnar nerve neuropathy exhibits a persistent abduction posture of the small finger at rest (Wartenberg's sign). Which intact muscle is responsible for this unopposed abduction?

A 40-year-old with chronic plantar fasciitis undergoes a Silfverskiold test. Ankle dorsiflexion is limited to 0 degrees with the knee extended, but improves to 15 degrees when the knee is flexed. This finding indicates an isolated contracture of which structure?

A 60-year-old man complains of progressive clumsiness in his hands. During physical examination, the examiner rapidly flicks the distal phalanx of the middle finger, which produces a reflex flexion of the patient's thumb and index finger. What is the name of this sign and its primary clinical implication?

During a Thomas test on the right hip, the patient holds the left knee to the chest, causing the right thigh to elevate off the examination table. When the examiner extends the right knee, the right thigh drops completely to the table. Which muscle is responsible for the initial contracture?

A 22-year-old hockey player presents with chronic anterior groin pain. The examiner flexes the hip to 90 degrees, then adducts and internally rotates it, strictly reproducing the patient's sharp groin pain. This test (FADIR) is most sensitive for diagnosing which condition?

A patient with a complex knee injury demonstrates greater than 10 degrees of increased external rotation at BOTH 30 degrees and 90 degrees of knee flexion during the Dial test, compared to the contralateral side. This specific examination finding indicates combined injury to which structures?

A long-distance runner presents with lateral knee pain. The examiner places the patient in the lateral decubitus position, abducts and extends the affected hip, and then allows the leg to drop passively into adduction. The leg remains abducted in the air. This positive Ober's test primarily implicates tightness in which structure?

In a patient with recurrent anterior shoulder instability, the relocation test is performed by applying a posteriorly directed force on the proximal humerus while the arm is abducted and externally rotated. What specific clinical response constitutes a true positive relocation test?

An athlete suffers an inversion ankle sprain. The anterior drawer test is positive. A subsequent talar tilt test in inversion is also distinctly positive compared to the normal side. Which ligament is primarily assessed by this talar tilt maneuver?

A 55-year-old woman complains of pain at the base of her thumb that worsens with pinching activities. Axial loading, pushing, and rotating the first metacarpal on the trapezium elicits sharp pain and crepitus. Which test was performed, and what is the underlying diagnosis?

To differentiate hip intra-articular pathology from lumbar spine pathology, a patient is asked to actively raise their leg against resistance with the knee extended in the supine position. Pain is forcefully elicited in the groin. This provocative maneuver is known as the:

During an evaluation of a 22-year-old soccer player with a knee injury, a pivot shift test is performed. As the knee is brought from extension to flexion with a valgus stress and internal rotation applied, a clunk is felt at 20-30 degrees of flexion. Which anatomical structure is responsible for the reduction of the tibia during this test?

A 55-year-old patient presents with shoulder pain after a lifting injury. The examiner performs the "bear hug" test by placing the patient's palm on their opposite shoulder and resisting the patient's attempt to press the hand downward. Weakness in this maneuver most specifically indicates a tear of which structure?

A 30-year-old male complains of groin pain with deep hip flexion. The examiner flexes the hip to 90 degrees, adducts it, and internally rotates the thigh, which reproduces the patient's sharp groin pain. This test is highly sensitive for which of the following conditions?

A 45-year-old female presents with right-sided neck pain radiating to her index and middle fingers. The examiner extends and side-bends her neck to the right, applying axial compression, which reproduces the radiating pain. Which nerve root is most likely compressed?

A 34-year-old postpartum woman complains of radial-sided wrist pain. The examiner instructs the patient to clench her thumb inside her fist and ulnarly deviates the wrist, reproducing sharp pain. Which two tendons are being provoked in the first dorsal compartment?

A patient presents with persistent numbness in their ring and small fingers. Upon observation, the examiner notes that the patient's small finger rests in an abducted position. This finding (Wartenberg's sign) is due to unopposed action of which muscle?

A 40-year-old runner presents with chronic Achilles pain. The examiner assesses ankle dorsiflexion with the knee flexed and then with the knee extended. Dorsiflexion is 15 degrees with the knee flexed but limits to 0 degrees with the knee extended. What does this test signify?

A 24-year-old male presents with medial joint line knee pain. The examiner has the patient stand on the affected leg flexed to 20 degrees, and the patient twists their body internally and externally. This maneuver (Thessaly test) is primarily utilized to diagnose injury to which structure?

A baseball pitcher complains of deep shoulder pain. The examiner flexes the shoulder to 90 degrees, adducts it 10 degrees, and maximally internally rotates the arm, asking the patient to resist downward pressure. Pain is elicited but relieved when the arm is externally rotated and tested again. What is the most likely diagnosis?

A 20-year-old collegiate javelin thrower presents with medial elbow pain. The examiner grasps the patient's thumb on the affected side and applies a valgus stress to the elbow while it is flexed beyond 90 degrees. A positive test indicates insufficiency of which structure?

During a newborn examination, the pediatrician flexes the infant's hips and knees to 90 degrees. The examiner then gently abducts the hips while applying an anteriorly directed force on the greater trochanters. A palpable "clunk" is felt. What does this positive test indicate?

An obese 13-year-old boy presents with right knee pain and a limp. During the physical examination of the hip in the supine position, the hip passively goes into obligatory external rotation as it is flexed. What is the most likely diagnosis based on this physical finding?

A basketball player jammed his finger. The PIP joint is flexed to 90 degrees over the edge of a table, and the patient is asked to extend the middle phalanx against resistance. The examiner feels weak PIP extension, and the DIP joint becomes rigidly extended. This indicates a rupture of which structure?

A patient complains of anterior shoulder pain. The examiner asks the patient to flex the elbow to 90 degrees with the forearm pronated. The examiner then resists the patient's active attempt to supinate the forearm and externally rotate the humerus. Pain in the bicipital groove indicates pathology of which structure?

A patient presents with generalized arm pain and weakness. The examiner asks the patient to resist bilateral internal rotation of the shoulders. The examiner then lightly strokes the skin over the patient's cubital tunnel and immediately asks the patient to resist internal rotation again. A sudden, momentary loss of resistance is noted. What does this signify?

A 45-year-old female complains of sharp pain in her forefoot that feels like walking on a pebble. The examiner squeezes the metatarsal heads together while applying plantar and dorsal pressure to the intermetatarsal space, producing a palpable click and reproducing her pain. This finding is highly specific for:

A patient is evaluated for shoulder pain. The examiner elevates the arm to 90 degrees in the scapular plane and maximally internally rotates the arm so the thumb points downward. The examiner applies downward pressure. Weakness compared to the contralateral side is primarily indicative of pathology in which muscle?

During a gait assessment of a 60-year-old female with right hip osteoarthritis, the examiner notes that when the patient stands on her right leg, her left hemipelvis drops. This positive Trendelenburg sign is caused by weakness of which muscle group?

A 38-year-old male presents with lower back pain radiating down his posterior left leg. The examiner performs a straight leg raise, which elicits shooting pain below the knee at 40 degrees of elevation. The examiner lowers the leg slightly and dorsiflexes the foot, which reproduces the pain. Which spinal nerve roots are most likely involved?