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ORTHOPEDICS HYPERGUIDE 2022 MCQ-1151-1200
Transfer of the extensor hallucis longus tendon to the first metatarsal and arthrodesis of the hallux interphalangeal joint is indicated for which of the following deformities:
A 43-year-old diabetic patient has had an ulcer on the plantar aspect of her foot for 9 months. She has no systemic symptoms. There is minimal drainage from the ulcer, and she has no pain in the foot. Initial management of this patient must include:
Slide 1
The primary cause for the deformity shown (Slide) is:
The primary cause for the deformity shown (Slide) is:
Slide 1
A patient had a fixed deformity of the hallux interphalangeal (IP) joint (Slide) for 3 years following forefoot surgery. She complains of pain over the distal aspect of the hallux where rubbing occurs on the shoe. On examination, the hallux is flexible at the metatarsophalangeal (MP) and IP joints, there is no crepitus of the MP joint, and radiographs demonstrate normal alignment of the first metatarsal. The recommended procedure for correcting this deformity is:
A patient had a fixed deformity of the hallux interphalangeal (IP) joint (Slide) for 3 years following forefoot surgery. She complains of pain over the distal aspect of the hallux where rubbing occurs on the shoe. On examination, the hallux is flexible at the metatarsophalangeal (MP) and IP joints, there is no crepitus of the MP joint, and radiographs demonstrate normal alignment of the first metatarsal. The recommended procedure for correcting this deformity is:
Slide 1
A 33-year-old recreational athlete presents for treatment of chronic ankle pain. He recalls multiple ankle sprains that occurred
10 years ago. He has not undergone any surgical treatment. On examination, his ankle is stable, there is no crepitus on range of motion, and pain is present to palpation of the posterior ankle. A computerized axial tomography is presented (Slide). The surgical procedure most consistent with a rapid recovery and predictable outcome is:
A 33-year-old recreational athlete presents for treatment of chronic ankle pain. He recalls multiple ankle sprains that occurred
10 years ago. He has not undergone any surgical treatment. On examination, his ankle is stable, there is no crepitus on range of motion, and pain is present to palpation of the posterior ankle. A computerized axial tomography is presented (Slide). The surgical procedure most consistent with a rapid recovery and predictable outcome is:
Slide 1
A 52-year-old man presents for treatment of acute pain in the forefoot. He notes that the onset of pain started 24 hours ago, and he is unable to walk. Examination of the hallux (Slide) is uncomfortable. The recommended treatment for this condition is:
A 52-year-old man presents for treatment of acute pain in the forefoot. He notes that the onset of pain started 24 hours ago, and he is unable to walk. Examination of the hallux (Slide) is uncomfortable. The recommended treatment for this condition is:
Slide 1 Slide 2
A 43-year-old patient presents for treatment of a chronically painful ankle. He notes pain with ambulation, is unable to exercise, and has had marked swelling of the ankle for the last 6 months. When walking, he notes continued instability of the ankle. Examination of the ankle is unremarkable with the exception of swelling. A plain radiograph and intraoperative photograph are shown (Slide 1 and Slide 2). The most likely cause for this condition is:
A 43-year-old patient presents for treatment of a chronically painful ankle. He notes pain with ambulation, is unable to exercise, and has had marked swelling of the ankle for the last 6 months. When walking, he notes continued instability of the ankle. Examination of the ankle is unremarkable with the exception of swelling. A plain radiograph and intraoperative photograph are shown (Slide 1 and Slide 2). The most likely cause for this condition is:
A patient sustains a crush injury when heavy farm equipment rolls over his foot. He presents to the emergency department 4 hours later with pain and swelling in the foot. Radiographic examination is normal. You examine him for a compartment syndrome. The intracompartmental pressure in the interosseous compartment is 20 mm Hg. The next phase of management may include all of the following except:
Slide 1 Slide 2 Slide 3 Slide 4
A 61-year-old woman presents for treatment of a painful ankle. She reports that 4 years ago, she sustained a fracture of her ankle that was treated with cast immobilization. She has experienced progressively worsening pain over the past 2 years. On examination, she has good range of motion of the ankle with crepitus and pain. Radiographs are presented (Slide 1 and Slide 2). All of the following are acceptable forms of surgical correction except:
A 61-year-old woman presents for treatment of a painful ankle. She reports that 4 years ago, she sustained a fracture of her ankle that was treated with cast immobilization. She has experienced progressively worsening pain over the past 2 years. On examination, she has good range of motion of the ankle with crepitus and pain. Radiographs are presented (Slide 1 and Slide 2). All of the following are acceptable forms of surgical correction except:
This patient developed a peripheral neuropathy of uncertain etiology. She has a partial peroneal nerve palsy with lack of extensor function of the hallux. She repeatedly stubs and catches the hallux when walking. Upon examination, she has good strength of the extensor digitorum longus tendon, as well as the anterior tibial tendon. Flexor strength of the foot is intact. All of the following are acceptable surgical alternatives except:
A 28-year-old professional athlete presents for treatment of foot pain following an inversion injury to her ankle. She has been immobilized in a short leg walker boot for 1 month with minimal relief of symptoms. On examination, pain is present in the sinus tarsi. The patientâs ankle is not painful or unstable. Radiographs demonstrate a calcaneonavicular coalition. Recommended treatment includes:
A 43-year-old woman presents for treatment of pain in her forefoot that has been present for 1 year. The pain is localized to the second toe and radiates out to the tip of the toe with activities. When the patient wears high heel shoes, the pain is associated with numbness and burning of the toe. Your initial treatment consists of:
A 62-year-old man presents for treatment of ankle pain. He suffered a fibular fracture 7 months ago while hiking in the mountains. He was treated with a short leg walking cast. On examination, he has pain on range of motion of the ankle, pain over the distal fibula, and no instability or crepitus to range of motion of the ankle. Pain is present on external rotation of the foot under the leg. Radiographs of the ankle demonstrate a healed fibular fracture with 7 mm of shortening and slight external rotation. There is a 7° valgus tilt of the tibiotalar joint and a widening of the medial clear space. The joint space laterally appears slightly narrowed. Recommended treatment includes:
The most common complication following operative treatment of an acute rupture of the Achilles tendon is:
Slide 1
A 67-year-old obese patient presents for treatment of ankle pain. Twenty-five years ago, he underwent a total ankle replacement. He was asymptomatic for 15 years, and his symptoms have become intolerable. He has limited ankle motion, associated with pain in the ankle. His radiograph is presented (Slide). Which of the following is the preferred surgical procedure:
A 67-year-old obese patient presents for treatment of ankle pain. Twenty-five years ago, he underwent a total ankle replacement. He was asymptomatic for 15 years, and his symptoms have become intolerable. He has limited ankle motion, associated with pain in the ankle. His radiograph is presented (Slide). Which of the following is the preferred surgical procedure:
A 53-year-old woman presents for treatment of recurrent symptoms following excision of a third web space interdigital neuroma. She was asymptomatic for 6 months following surgery. On examination, pain is present in the third web space and reproduced with compression of the forefoot. The likelihood of a good result following revision surgery is:
A patient presents for treatment of a dislocated second metatarsophalangeal joint. Radiographs demonstrate the dislocation. In addition to soft tissue balancing, you perform an oblique shortening osteotomy of the second metatarsal head (Weil). The most common complication following this osteotomy is:
A 26-year-old professional football player presents for evaluation of ankle pain. He was playing in a match 2 days ago and felt a pop in his ankle. On examination, the peroneal tendon is felt to subluxate anterior to the fibula. Magnetic resonance imaging confirms a tear of the superior peroneal retinaculum. Recommended treatment includes:
A patient presents for treatment of a painful hallux. The pain is over the dorsal surface of the hallux metatarsophalangeal joint and is worsened with plantar flexion of the toe. The passive range of motion is 30° of dorsiflexion and 10° of plantarflexion. The radiographs confirm the presence of mild arthritis of the metatarsophalangeal joint, with dorsal osteophytes on the metatarsal head. Which of the following procedures is most likely to be associated with a long-term satisfactory outcome:
Slide 1
This patient is a 17-year-old athlete who presents for treatment of a feeling of giving way of the ankle. The inversion clinical stress is demonstrated below (Slide). Which statement concerning the image presented below is correct:
This patient is a 17-year-old athlete who presents for treatment of a feeling of giving way of the ankle. The inversion clinical stress is demonstrated below (Slide). Which statement concerning the image presented below is correct:
Slide 1
What structure is held in between the forceps in this photograph (Slide):
What structure is held in between the forceps in this photograph (Slide):
Slide 1
A 37-year-old woman injured her ankle 17 weeks ago when stepping off a sidewalk. She has experienced pain in the ankle since that time, and no treatment has yet been initiated. Presented is a view of the ankle performed with external rotation stress (Slide). The recommended treatment at this time is:
A 37-year-old woman injured her ankle 17 weeks ago when stepping off a sidewalk. She has experienced pain in the ankle since that time, and no treatment has yet been initiated. Presented is a view of the ankle performed with external rotation stress (Slide). The recommended treatment at this time is:
Slide 1 Slide 2
A 42-year-old male patient presents with a history of repeated giving way of his ankle. He notes that this has been present for 1 year. He does not experience any pain, even with the episodic bouts of the ankle buckling. On examination, the ankle range of motion is normal, no pain is elicited, and there is no crepitus. A stress radiograph (Slide 1) and a lateral weight-bearing radiograph (Slide 2) are presented. The patient does not want to undergo surgery, but he needs to know the possibility of problems with his ankle in the future. The patient should be advised that:
A 42-year-old male patient presents with a history of repeated giving way of his ankle. He notes that this has been present for 1 year. He does not experience any pain, even with the episodic bouts of the ankle buckling. On examination, the ankle range of motion is normal, no pain is elicited, and there is no crepitus. A stress radiograph (Slide 1) and a lateral weight-bearing radiograph (Slide 2) are presented. The patient does not want to undergo surgery, but he needs to know the possibility of problems with his ankle in the future. The patient should be advised that:
Slide 1
A 73-year-old woman states that she has been tripping over her right foot for the past year (Slide). She walks with a limp, and she states that her foot âslapsâ the ground. On examination, weakness in which muscle is likely present:
A 73-year-old woman states that she has been tripping over her right foot for the past year (Slide). She walks with a limp, and she states that her foot âslapsâ the ground. On examination, weakness in which muscle is likely present:
Slide 1
A 76-year-old man has experienced aching in the anterior aspect of his ankle for 6 months. He felt a sudden onset of soreness 6 months ago. Since then, he has noted weakness of the foot. He walks with a limp, and the foot hits the ground during the heel contact phase of gait. On examination there is a mobile subcutaneous mass in the anterior ankle. The patientâs magnetic resonance image (MRI) is presented (Slide). Which of the following is the most accurate diagnosis:
A 76-year-old man has experienced aching in the anterior aspect of his ankle for 6 months. He felt a sudden onset of soreness 6 months ago. Since then, he has noted weakness of the foot. He walks with a limp, and the foot hits the ground during the heel contact phase of gait. On examination there is a mobile subcutaneous mass in the anterior ankle. The patientâs magnetic resonance image (MRI) is presented (Slide). Which of the following is the most accurate diagnosis:
Slide 1
A 23-year-old carpenter fell off a roof 4 weeks ago. He has pain in the ankle and a deformity. The lateral radiograph is presented (Slide). Which of the following treatments is most likely to return this patient to work with a functioning foot and ankle:
A 23-year-old carpenter fell off a roof 4 weeks ago. He has pain in the ankle and a deformity. The lateral radiograph is presented (Slide). Which of the following treatments is most likely to return this patient to work with a functioning foot and ankle:
Slide 1 Slide 2
A patient underwent an arthrodesis of the hallux metatarsophalangeal joint for correction of painful arthritis (Slide 1 and Slide
2). She remains symptomatic and cannot walk without pain. The most likely cause for her pain is:
A patient underwent an arthrodesis of the hallux metatarsophalangeal joint for correction of painful arthritis (Slide 1 and Slide
2). She remains symptomatic and cannot walk without pain. The most likely cause for her pain is:
Slide 1
A 53-year-old woman presents for treatment of painful toe and metatarsal deformities (Slide). She underwent surgery to the hallux 2 years ago for correction of arthritis of the hallux metatarsophalangeal joint. Pain in the joint persists. She has no systemic disease, and the opposite foot is normal. What is the ideal surgical correction for her forefoot:
A 53-year-old woman presents for treatment of painful toe and metatarsal deformities (Slide). She underwent surgery to the hallux 2 years ago for correction of arthritis of the hallux metatarsophalangeal joint. Pain in the joint persists. She has no systemic disease, and the opposite foot is normal. What is the ideal surgical correction for her forefoot:
A 17-year-old patient presents with pain in the second toe. Pain becomes worse with exercise and has been present for 6 months. On examination, swelling is present around the metatarsophalangeal joint, and pain is present over the joint and upon squeezing the forefoot. Radiographic evaluation demonstrates a lucency in the second metatarsal head. The most likely cause of this condition is:
Slide 1 Slide 2 Slide 3
An 11-year-old girl presents with chronic foot pain. Her mother notes that her daughter has had flatfeet since birth, but the condition is worsening. The patient has aching in her foot, the arch of her foot, and her leg with walking and activities. She has been treated for 3 years with various orthotic arch supports. The foot is mobile and flexible on examination. Radiographs (Slide
1 and Slide 2) and a photograph (Slide 3) of her foot are presented. Which of the following surgical treatment alternatives is unacceptable in this patient:
An 11-year-old girl presents with chronic foot pain. Her mother notes that her daughter has had flatfeet since birth, but the condition is worsening. The patient has aching in her foot, the arch of her foot, and her leg with walking and activities. She has been treated for 3 years with various orthotic arch supports. The foot is mobile and flexible on examination. Radiographs (Slide
1 and Slide 2) and a photograph (Slide 3) of her foot are presented. Which of the following surgical treatment alternatives is unacceptable in this patient:
Slide 1 Slide 2
A 12-year-old girl was successfully treated for a flexible flatfoot deformity on the left foot. A clinical photograph (Slide 1) of her foot and a lateral radiograph (Slide 2) are presented. What is the purpose of the implant noted under the talus in the radiograph:
A 12-year-old girl was successfully treated for a flexible flatfoot deformity on the left foot. A clinical photograph (Slide 1) of her foot and a lateral radiograph (Slide 2) are presented. What is the purpose of the implant noted under the talus in the radiograph:
Slide 1 Slide 2
The patient presented (Slide 1 and Slide 2) has a hereditary sensory motor neuropathy. Based upon the photographs, a surgeon should be able to determine the pattern of muscle weakness. Weakness in which muscle is most likely the cause of this deformity:
The patient presented (Slide 1 and Slide 2) has a hereditary sensory motor neuropathy. Based upon the photographs, a surgeon should be able to determine the pattern of muscle weakness. Weakness in which muscle is most likely the cause of this deformity:
Slide 1 Slide 2
You are planning a tendon transfer to help correct deformity in a patient with hereditary sensory motor neuropathy. Which of the following muscles will be used for the transfer based upon the clinical appearance of the foot (Slide 1 and Slide 2):
You are planning a tendon transfer to help correct deformity in a patient with hereditary sensory motor neuropathy. Which of the following muscles will be used for the transfer based upon the clinical appearance of the foot (Slide 1 and Slide 2):
Which combination of muscle weakness is typically associated with hereditary sensory motor neuropathy:
Slide 1
A 42-year-old man with diabetes presents for treatment of a swollen foot (Slide). He does not recall the onset of swelling, and he states that his foot is not painful. On examination, the foot is hot to touch and swollen. Upon radiographic examination, no deformities are evident. Which of the following treatment options should be used next:
A 42-year-old man with diabetes presents for treatment of a swollen foot (Slide). He does not recall the onset of swelling, and he states that his foot is not painful. On examination, the foot is hot to touch and swollen. Upon radiographic examination, no deformities are evident. Which of the following treatment options should be used next:
Slide 1
A 29-year-old woman presents for treatment of a swollen foot. Although her foot is not painful, it has been swollen for 2 weeks. The patient walks into the office without any assistive device. On examination, the foot is swollen and warm. The patient does not have protective sensation in the foot, and she denies a history of diabetes and does not have a clinically relevant medical
history. A radiograph of her foot is presented (Slide). Which of the following tests will be most helpful in determining the etiology of her condition:
A 29-year-old woman presents for treatment of a swollen foot. Although her foot is not painful, it has been swollen for 2 weeks. The patient walks into the office without any assistive device. On examination, the foot is swollen and warm. The patient does not have protective sensation in the foot, and she denies a history of diabetes and does not have a clinically relevant medical
history. A radiograph of her foot is presented (Slide). Which of the following tests will be most helpful in determining the etiology of her condition:
Slide 1 Slide 2 Slide 3
A patient with diabetes and severe peripheral neuropathy has been treated for a C harcot ankle deformity for 9 months (Slide 1, Slide 2, and Slide 3). An ankle foot orthosis has been used for 4 months. No skin breakdown occurred in the brace. Swelling is present but has decreased over the past month. Ankle range of motion is limited, and crepitus is present upon examination of the ankle. Which surgical procedure is most consistent with the future treatment of this patient:
A patient with diabetes and severe peripheral neuropathy has been treated for a C harcot ankle deformity for 9 months (Slide 1, Slide 2, and Slide 3). An ankle foot orthosis has been used for 4 months. No skin breakdown occurred in the brace. Swelling is present but has decreased over the past month. Ankle range of motion is limited, and crepitus is present upon examination of the ankle. Which surgical procedure is most consistent with the future treatment of this patient:
Slide 1
An 83-year-old woman presents for treatment of a painful second toe deformity. The hallux, the bunion, and the third toe are not painful. A fixed crossover toe deformity is present (Slide), with a dislocation of the second metatarsophalangeal joint noted radiographically. Which procedure is likely to give the patient rapid pain relief:
An 83-year-old woman presents for treatment of a painful second toe deformity. The hallux, the bunion, and the third toe are not painful. A fixed crossover toe deformity is present (Slide), with a dislocation of the second metatarsophalangeal joint noted radiographically. Which procedure is likely to give the patient rapid pain relief:
Slide 1
A 60-year-old man experiences pain under the lesser metatarsal heads. Prominence of the metatarsal heads under the second, third, and fourth metatarsal is noted, as well as associated fixed claw toe deformities (Slide). The etiology of the foot pain is:
A 60-year-old man experiences pain under the lesser metatarsal heads. Prominence of the metatarsal heads under the second, third, and fourth metatarsal is noted, as well as associated fixed claw toe deformities (Slide). The etiology of the foot pain is:
Slide 1
A patient presents with a claw toe deformity (Slide). What is the strongest flexor of the metatarsophalangeal joint, which in this patient is not functioning adequately:
A patient presents with a claw toe deformity (Slide). What is the strongest flexor of the metatarsophalangeal joint, which in this patient is not functioning adequately:
Slide 1
A 54-year-old woman presents for treatment of an ulcer (Slide). She has diabetes, no protective sensation, and slight deformity of the foot. There is no inflammation of the foot and no purulent drainage. Slight serous oozing is present daily. Initial evaluation and treatment should consist of:
A 54-year-old woman presents for treatment of an ulcer (Slide). She has diabetes, no protective sensation, and slight deformity of the foot. There is no inflammation of the foot and no purulent drainage. Slight serous oozing is present daily. Initial evaluation and treatment should consist of:
Slide 1
A 63-year-old patient underwent a triple arthrodesis for correction of flatfoot deformity. He presents with continued ankle pain, as well as a hindfoot valgus deformity. The ankle deformity is flexible, and the joint can be reduced. All of the following are reasonable surgical alternatives as a single or staged procedure with the exception of:
A 63-year-old patient underwent a triple arthrodesis for correction of flatfoot deformity. He presents with continued ankle pain, as well as a hindfoot valgus deformity. The ankle deformity is flexible, and the joint can be reduced. All of the following are reasonable surgical alternatives as a single or staged procedure with the exception of:
A 34-year-old patient presents for treatment of painful ankle arthritis. Deformity of the ankle is present with posttraumatic arthritis and 20° of varus deformity as a result of erosion of the distal tibial plafond. There is minimal motion of the subtalar joint, and the forefoot is plantigrade. You plan an ankle arthrodesis. In addition to the position of the ankle arthrodesis, what additional procedure should you consider:
A 26-year-old woman presents for treatment of ankle arthritis following trauma. She is an active individual despite her arthritis. On examination, her foot is fixed in equinus, no ankle motion is present, and the motion in the subtalar joint is normal. Ankle arthritis is noted radiographically. In a preoperative discussion, she states the desire to have as mobile a foot as possible, wear high heel shoes, and participate in realistic exercise activities. You perform an ankle arthrodesis. What is the ideal position for the arthrodesis:
Slide 1 Slide 2
A 22-year-old man has experienced pain in his foot and ankle for 10 years. His radiographs are presented (Slide 1 and Slide 2). The foot is flexible, and pain is present in the sinus tarsi and along the medial border of the foot. With the subtalar joint held in a reduced neutral position, the forefoot is in 15° of supination. You attempt orthotic arch supports and when these do not
alleviate his pain, a brace is suggested. He refuses to wear a brace. You plan an osteotomy of the calcaneus with lengthening bone graft at the neck of the calcaneus (lateral column lengthening). The most common complication following this procedure is:
A 22-year-old man has experienced pain in his foot and ankle for 10 years. His radiographs are presented (Slide 1 and Slide 2). The foot is flexible, and pain is present in the sinus tarsi and along the medial border of the foot. With the subtalar joint held in a reduced neutral position, the forefoot is in 15° of supination. You attempt orthotic arch supports and when these do not
alleviate his pain, a brace is suggested. He refuses to wear a brace. You plan an osteotomy of the calcaneus with lengthening bone graft at the neck of the calcaneus (lateral column lengthening). The most common complication following this procedure is:
Slide 1 Slide 2 Slide 3
A 44-year-old obese man presents for treatment of acute ankle pain. He does not have a history of trauma or a systemic history of note. His opposite foot has had multiple episodes of acute pain in the past, lasting from 3 to 5 days. On examination, the
ankle is warm, swollen, and exquisitely tender to palpation and any range of motion (Slide1, Slide 2, and Slide 3). C oncerned about the source of pain, you aspirate the joint and send the sample for analysis. You expect to find:
A 44-year-old obese man presents for treatment of acute ankle pain. He does not have a history of trauma or a systemic history of note. His opposite foot has had multiple episodes of acute pain in the past, lasting from 3 to 5 days. On examination, the
ankle is warm, swollen, and exquisitely tender to palpation and any range of motion (Slide1, Slide 2, and Slide 3). C oncerned about the source of pain, you aspirate the joint and send the sample for analysis. You expect to find:
Slide 1
This patient presents for treatment of a painful hallux varus deformity following correction of hallux valgus deformity (Slide). All of the following procedures may be acceptable surgical alternatives for correction of deformity with the exception of:
This patient presents for treatment of a painful hallux varus deformity following correction of hallux valgus deformity (Slide). All of the following procedures may be acceptable surgical alternatives for correction of deformity with the exception of:
Which of the following is true concerning Achilles tendon ruptures:
Which of the following is true concerning the repair of acute Achilles tendon ruptures:
