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Orthopedics Online MCQs
A 28-year-old man has decreased finger proximal interphalangeal (PIP) joint range of motion after open reduction and internal fixation of a proximal phalanx fracture with the use of a side plate. Examination shows greater passive PIP joint flexion with metacarpophalangeal (MP) joint extension, than when the MP joint is flexed. This finding demonstrates contracture/scarring of which of the following structures? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)
A 59-year-old woman seen in the emergency department reports the rapid onset of pain in the left lower quadrant of her abdomen radiating to the anterior thigh that began about 4 to 5 hours ago. She also notes that now her left knee is buckling, causing her to fall to the ground. History reveals that the woman is an alcoholic and takes warfarin for atrial fibrillation. Examination reveals 1/5 quadriceps strength and pain on hip flexion against resistance. What is a likely pathoanatomic cause for her problem that should be rapidly evaluated to prevent permanent damage?
What are the two terminal branches of the lateral cord of the brachial plexus? ](http://www.orthobullets.com/anatomy/10052/brachial-plexus)
The iliopectineal fascia runs between which of the following structures? ](http://www.orthobullets.com/anatomy/10111/femoral-nerve)
The patient in Figure 55 is actively attempting to make a fist. This clinical scenario suggests which of the following anatomic lesions? ](http://www.orthobullets.com/anatomy/10106/median-nerve)
What is the most common anatomic location of the lateral femoral cutaneous nerve? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)
A 29-year-old woman has had a 6-month history of chronic left anterolateral ankle pain after sustaining an inversion ankle sprain while playing soccer. Management consisting of rest, nonsteroidal anti-inflammatory drugs, immobilization, a cortisone injection, and 2 months of physical therapy has failed to allow her to return to her previous level of activities. Examination reveals good strength, motion, and ligamentous stability, with anterolateral ankle tenderness. Radiographs are normal. During an anterolateral approach to the left ankle, the structure labeled with the arrow in Figure 56a is noted to be impinging on the anterolateral dome of the talus and is removed as shown in Figure 56b. Removal of this structure will most likely result in which of the following? ](http://www.orthobullets.com/anatomy/10122/blank)Review Topic
The axis of forearm rotation occurs between what two anatomic points? ](http://www.orthobullets.com/anatomy/10122/blank)
The peroneus tertius is a commonly used landmark for arthroscopic portal placement. What is the function of this tendon? ](http://www.orthobullets.com/anatomy/10082/peroneus-tertius)
A 24-year-old man has a deep knife wound across the dorsal aspect of his wrist, transecting all of his wrist and finger extensor tendons. How does the surgeon determine which of the proximal tendon stumps in the fourth dorsal compartment is the extensor indicis proprius? ](http://www.orthobullets.com/anatomy/10040/extensor-indicis)Review Topic
A sagittal MRI scan of the hindfoot and ankle is shown in Figure 86. The arrow points to what structure? ](http://www.orthobullets.com/anatomy/10122/blank)
A 19-year-old linebacker underwent a coracoid transfer procedure for recurrent anterior glenohumeral instability. At his 1-week postsurgical check-up, his incision is doing well; however, he reports numbness over the lateral aspect of his forearm. What nerve may have been injured during his surgery? ](http://www.orthobullets.com/anatomy/10102/musculocutaneous-nerve)Review Topic
Which of the following muscle tendons inserts just lateral to the long head of biceps tendon on the proximal humerus? ](http://www.orthobullets.com/anatomy/10008/pectoralis-major)
Involvement of what single muscle best distinguishes an L5 radiculopathy from a peroneal neuropathy? ](http://www.orthobullets.com/anatomy/10117/deep-peroneal-nerve)
A patient undergoes open surgical dislocation of the hip to address femoroacetabular impingement. During which stage of the surgical approach is the blood supply to the femoral head at greatest risk? ](http://www.orthobullets.com/anatomy/10123/hip-blood-supply)
An axillary nerve lesion may cause weakness in the deltoid and the ](http://www.orthobullets.com/anatomy/10136/axillary-nerve)Review Topic
A 28-year-old man sustains a distal forearm laceration. Surgical exploration reveals complete ulnar nerve transection but an intact median nerve. Motor examination reveals intact finger abduction and adduction. Sensory examination is likely to reveal ](http://www.orthobullets.com/anatomy/10108/ulnar-nerve)Review Topic
Figure 21 shows a coronal T1-weighted MRI scan of the knee. The arrow indicates what anatomic structure? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)
An 18-year-old rugby player has had pain in his ring finger after missing a tackle 1 week ago. Examination reveals tenderness in the distal palm, and he is unable to actively flex the distal interphalangeal (DIP) joint. Radiographs are normal. What is the most appropriate management? ](http://www.orthobullets.com/anatomy/12300/2017-moc-hand-89-day-study-plan)
A 59-year-old woman seen in the emergency department reports the rapid onset of pain in the left lower quadrant of her abdomen radiating to the anterior thigh that began about 4 to 5 hours ago. She also notes that now her left knee is buckling, causing her to fall to the ground. History reveals that the woman is an alcoholic and takes warfarin for atrial fibrillation. Examination reveals 1/5 quadriceps strength and pain on hip flexion against resistance. What is a likely pathoanatomic cause for her problem that should be rapidly evaluated to prevent permanent damage? ](http://www.orthobullets.com/anatomy/10111/femoral-nerve)Review Topic
The anatomy of the sciatic nerve as it exits the pelvis is best described as exiting through the ](http://www.orthobullets.com/anatomy/10115/sciatic-nerve)
The peroneal division of the sciatic nerve innervates which of the following muscles in the thigh? ](http://www.orthobullets.com/anatomy/10115/sciatic-nerve)
An axial MRI scan of an ankle is shown in Figure 88. The arrow indicates what tendinous structure? ](http://www.orthobullets.com/anatomy/10091/flexor-hallucis-longus-fhl)
Which of the following vascular structures provides the most significant secondary contribution to the blood supply of the femoral head? ](http://www.orthobullets.com/anatomy/10123/hip-blood-supply)
Figure 31 shows an MRI scan of a left shoulder. The arrow is pointing to what structure? ](http://www.orthobullets.com/anatomy/10017/biceps-brachii)
Figure 12a shows a cross section of the pelvis at the level of the greater trochanters. What structure is marked with the arrow? ](http://www.orthobullets.com/anatomy/10075/obturator-internus)
Figure 79a shows the cross-section image of the mid thigh. What structure is marked by the arrow? ](http://www.orthobullets.com/anatomy/10070/semimembranosus)
During the posterolateral approach to the hip, the sciatic nerve is most frequently identified passing between which of the following structures? ](http://www.orthobullets.com/anatomy/10115/sciatic-nerve)
Figure 93 shows an arthroscopic view of a left shoulder (posterior portal, beach chair position). The asterisk indicates what anatomic structure? ](http://www.orthobullets.com/anatomy/10122/blank)
Figure 68 shows the view from a posterosuperior shoulder arthroscopic portal. The muscle associated with the tendinous structure shown is innervated by what nerve? ](http://www.orthobullets.com/anatomy/10017/biceps-brachii)
A 30-year-old elite marathon runner reports chronic pain over the lateral aspect of the distal right leg and dysesthesia over the dorsum of the foot with active plantar flexion and inversion of the foot. Examination reveals a tender soft-tissue fullness approximately 10 cm proximal to the lateral malleolus. The pain is exacerbated by passive plantar flexion and inversion of the ankle. There is also a positive Tinel’s sign over the site of maximal tenderness. There is no motor weakness, and deep tendon reflexes are normal. Radiographs and MRI of the leg are normal. What is the next most appropriate step in management? ](http://www.orthobullets.com/anatomy/10137/superficial-peroneal-nerve)Review Topic
During a lateral approach to the left ankle of a 69-year-old woman with a displaced bimalleolar fracture, the structure labeled with an arrow in Figure 31 is encountered. Which of the following is an accurate statement concerning this structure? ](http://www.orthobullets.com/anatomy/10137/superficial-peroneal-nerve)Review Topic
Which of the following muscles has dual innervation? ](http://www.orthobullets.com/anatomy/10018/brachialis)
In approaching the lateral lumbar spine through the psoas, the lumbosacral plexus is in danger of being injured. The location of the plexus is best described as which of the following? ](http://www.orthobullets.com/anatomy/10053/psoas)
A 32-year-old man undergoes a proximal femoral replacement as part of his care for a sarcoma of the proximal femur. Three-months postoperatively, he returns for a routine follow-up office visit. Which physical exam finding would most likely be positive? ](http://www.orthobullets.com/anatomy/10062/gluteus-medius)
Which of the following tendons is found in the same dorsal compartment of the wrist as the posterior interosseous nerve? ](http://www.orthobullets.com/anatomy/10104/posterior-interosseous-nerve)
A boutonniere deformity is treated with distal extensor tenotomy. What structures allow for active extension at the distal interphalangeal (DIP) joint after tenotomy? ](http://www.orthobullets.com/anatomy/3099/2015-sports-moc-89-day-study-plan)
When performing surgical excision of the lesion shown in the MRI scan in Figure 3, what nerve is most likely at risk? ](http://www.orthobullets.com/anatomy/10106/median-nerve)
What osseous ridge separates the femoral attachments of the anteromedial and posterolateral bundles of the anterior cruciate ligament? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)
During an anterior retroperitoneal approach to the lumbar spine, what nerve is encountered lying on the anteromedial surface of the psoas muscle? ](http://www.orthobullets.com/anatomy/10053/psoas)
During an anterior approach to the shoulder, what is the most likely arterial structure to be encountered in the superior extent of the deltopectoral interval (just distal to the anterior edge of the clavicle)? ](http://www.orthobullets.com/approaches/12009/closed--2016-oite-85-day-study-plan)
Figure 6 shows a sagittal oblique MRI scan of a right shoulder. The asterisk indicates what anatomic structure? ](http://www.orthobullets.com/anatomy/10016/subscapularis)
A 20-year-old man sustains a burst fracture at L1. Examination reveals 3/5 weakness of bilateral ankle plantar flexion and dorsiflexion, and 4/5 quadriceps strength. He is unable to void spontaneously and has diminished rectal tone. Which of the following would best describe the neurologic deficit? ](http://www.orthobullets.com/anatomy/10122/blank)
A 35-year-old man sustained a 1-inch stab incision in his proximal forearm while trying to use a screwdriver 2 weeks ago. The laceration was routinely closed, and no problems about the incision site were noted. He now reports that he has been unable to straighten his fingers or thumb completely since the injury. Clinical photographs shown in Figures 30a and 30b show the man passively flexing the wrist. What is the most appropriate management? ](http://www.orthobullets.com/anatomy/10104/posterior-interosseous-nerve)
Figure 61a shows the cross-sectional anatomy of the pelvis at the level of the femoral heads. What structure is marked by the arrow? ](http://www.orthobullets.com/anatomy/10054/iliacus)
Which of the following neurovascular structures is closest to the posterior capsule of the knee? ](http://www.orthobullets.com/anatomy/10122/blank)
The main blood supply to the capital femoral epiphysis in a 10-year-old child is supplied from the ](http://www.orthobullets.com/anatomy/10123/hip-blood-supply)
A 23-year-old patient with lateral epicondylitis underwent a routine elbow arthroscopy and an anterolateral portal was used. The patient now has complications associated with nerve injury in this area. What symptoms will most likely be present? ](http://www.orthobullets.com/anatomy/10103/radial-nerve)
What vessel is marked with an asterisk in Figure 44? ](http://www.orthobullets.com/anatomy/10122/blank)
Figure 53 shows the arteriogram of a 45-year-old man who has severe vasculitis. What do the findings show? ](http://www.orthobullets.com/anatomy/10120/medbullets-onboarding--draft-html)
Extended exposure of the posteromedial aspect of the knee can be obtained using the interval between the medial border of the gastrocnemius and the posterior border of the semimembranosus tendon. Further exposure of the posteromedial tibial surface or the posterior cruciate ligament (PCL) fossa requires dissection of what structure? ](http://www.orthobullets.com/anatomy/10088/popliteus-l5)
An L3 radiculopathy is best differentiated from a femoral neuropathy by testing what muscle? ](http://www.orthobullets.com/anatomy/10065/adductor-longus)
Figures 16a and 16b show the radiographs of a 2-year-old boy who has right arm swelling and pain. He also has multiple scalp lesions and chronic ear pain that has failed to respond to antibiotics. A biopsy specimen is shown in Figure 16c. Figure 16d shows an immunohistochemical stain with CD1a. What is the most likely diagnosis?
During surgical hip dislocation for the management of femoral acetabular impingement, preservation of what structure is paramount to maintaining vascularity to the femoral head? ](http://www.orthobullets.com/anatomy/10123/hip-blood-supply)
A 21-year-old man sustains multiple gunshot wounds to his right upper extremity. He can not extend his digits or his thumb but can extend and radially deviate his wrist. An injury to the radial nerve or one of its branches has most likely occurred at which of the following locations? ](http://www.orthobullets.com/anatomy/10103/radial-nerve)
Which of the following statements best describes the anatomy of the sartorial branch of the saphenous nerve during medial meniscal repair? ](http://www.orthobullets.com/anatomy/10122/blank)
Following a posterior approach to the radius (dorsal Thompson), the patient is unable to extend his thumb and index finger at the metacarpophalangeal joint. He has sensation to the radial forearm and dorsal thumb and can extend his wrist but with radial deviation. What nerve was injured? ](http://www.orthobullets.com/anatomy/10104/posterior-interosseous-nerve)
Following fixation of a comminuted both-bone forearm fracture, the patient has weakness of the flexor pollicis longus and flexor digitorum profundus to the index finger. Which of the following structures has most likely been injured?
Figure 38a shows the cross-sectional anatomy of the proximal thigh. What structure is indicated by the arrow? ](http://www.orthobullets.com/anatomy/10065/adductor-longus)
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