Free Orthopedics Review | Dr Hutaif General Orthopedics -...

QUESTION 1

Macrodactyly that is present at birth is termed:

1

Birth advancing macrodactyly (BAM)

2

Static macrodactyly

3

Progressive macrodactyly

4

Simple macrodactyly

5

C omplex macrodactyly

QUESTION 2

The most accepted theory for the cause of macrodactyly is:

1

Idiopathic

2

Neural

3

Vascular

4

Humoral

5

C ongenital

QUESTION 3

Syndromes that may be associated with macrodactyly include:

1

Proteus syndrome

2

Freeman-Sheldon syndrome

3

Madelungâs deformity

4

Holt-Oram syndrome

5

Poland syndrome

QUESTION 4

Macrodactyly affects:

1

Only bones

2

Bones and fat

3

Bones, fat, and nerves

4

Bones, fat, nerves, and blood vessels

5

Bones, fat, nerves, blood vessels, and tendons

QUESTION 5

A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. After examination of the patient, you recommend:

1

Scheduling the patient for immediate surgery

2

Telling the parents to return when the child develops functional abnormalities

3

Performing surgery within 1 week of diagnosis

4

Scheduling surgery to coincide with the patient beginning school

5

Performing additional testing

QUESTION 6

A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. The childâs parents inform you that they would like you to amputate the affected digits as soon as possible. You should:

1

Begin radiation therapy to arrest the growth of the affected digits

2

Proceed with amputation because you have the parentsâ consent

3

Send the patient to another hand surgeon

4

Explain the typical course of macrodactyly and order additional testing

5

Schedule the patient for a debulking procedure

QUESTION 7

You discover that a patient who you have been treating for macrodactyly has been followed by the Proteus Syndrome
Foundation. Exhaustive work-up has been completed and radiographs of the hand reveal:

1

Multiple enchondromas in the affected fingers

2

Enlarged bones in length only

3

Enlarged bones in length and width

4

Enlarged bones in width only

5

Normal appearing bones

QUESTION 8

A 2-year-old child is brought to your office for evaluation of a "big hand." Upon examination, you notice that the child has mildly enlarged ring and small fingers. There is full range of motion without instability. After examination of the patient, you discuss the diagnosis of macrodactyly with the parents. The parents feel assured after your discussion of the disease process and your review of the radiographs. You should next see the patient:

1

Never

2

In 1 year

3

When functional abnormalities develop

4

When the enlargement of the digits has ceased

5

When the patient is old enough to consent for surgery

QUESTION 9

Which of the following is not a complication of macrodactyly surgery:

1

Nerve injury

2

Bony malunion

3

Decreased sensation

4

Joint laxity

5

Infection

QUESTION 10

Epiphysiodesis for macrodactyly should be performed at the following location:

1

Proximal phalanx only

2

Proximal phalanx and middle phalanx

3

Proximal phalanx, middle phalanx, and distal phalanx

4

Middle phalanx only

5

Proximal phalanx and distal phalanx

QUESTION 11

When ruptured, which portion of the scapholunate ligament leads to scaphoid-lunate diastasis:

1

Distal

2

Proximal

3

Intermediate

4

Dorsal

5

Volar

QUESTION 12

Which of the following radiographic views is not routinely used to diagnose scapholunate injury:

1

Semisupination oblique view

2

C lenched fist view

3

Lateral view

4

Anteroposterior (AP) view

5

Oblique view

QUESTION 13

Which of the following treatments is not used for acute scapholunate ligament ruptures:

1

Open repair with bone sutures

2

Proximal row carpectomy

3

C losed reduction and long arm cast

4

Arthroscopically assisted reduction and pinning

5

Open repair with suture anchors

QUESTION 14

Which of the following is considered indicative of a scaphoid-lunate ligament tear on posteroanterior radiograph:

1

Terry Thomas sign

2

Volar intercalated segmental instability (VISI) pattern

3

Spilled tea cup sign

4

Watson-Jones scaphoid shift

5

Dorsal intercalated segment instability (DISI) pattern

QUESTION 15

The Terry Thomas sign, which is considered indicative of scaphoid-lunate ligament rupture, is best described as:

1

Scapholunate diastases larger than 3 mm

2

Scapholunate angle more than 30Âº to 60Âº on lateral radiographs

3

Reduction and exaggeration of scapholunate diastases on radial and ulnar deviation motion studies

4

Exaggeration and reduction of scaphoid-lunate diastases on radial and ulnar deviation radiographs, respectively

5

Scaphoid flexion with lunate extension

QUESTION 16

The most important requirement for a diagnostic magnetic resonance image (MRI) study in cases of scaphoid-lunate ligament injury is:

1

2 mm thin slices

2

Tangential cuts

3

Gallium-enhanced scan

4

Dedicated wrist coil

5

MRI in neutral, radial, and ulnar deviation

QUESTION 17

In cases of subacute scaphoid-lunate ligament injury with no arthrosis, all of the following are acceptable options except:

1

Herbert screw (reduction association of the scapholunate)

2

Scaphotrapeziotrapezoid (STT) fusion

3

Scaphoid-lunate ligament reconstruction using bone-ligament-bone autograft

4

Allograft ligament

5

Repair with capsulodesis

QUESTION 18

Mallet finger injuries refer to:

1

Fractures of the bony tuft

2

Flexor tendon injuries

3

Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint

4

Fractures of the middle phalanx

5

Intrinsic tightness

QUESTION 19

In mallet finger injuries, the distal phalanx posture is:

1

Hyperextended

2

Flexed

3

Neutral

4

Radially deviated

5

Ulnarly deviated

QUESTION 20

Mallet finger injuries are typically:

1

Secondary to hyperextension injuries

2

Secondary to forced flexion injuries

3

Secondary to torsion injuries

4

Secondary to fingertip amputations

5

Asymptomatic

QUESTION 21

Treatment of a type I mallet finger is typically closed. This involves:

1

C ast immobilization of the affected digit in extension

2

Dorsal block splint of the affected digit

3

Early active motion of the affected joint

4

Splinting of the affected distal interphalangeal joint (DIP) joint in flexion

5

Splinting of the affected DIP joint in extension

QUESTION 22

Type I mallet finger injuries must be immobilized constantly for a minimum of:

1

4 weeks

2

5 weeks

3

6 weeks

4

7 weeks

5

8 weeks

QUESTION 23

The most common mallet finger injuries are:

1

Type I

2

Type II

3

Type III

4

Type IV

5

Type V

QUESTION 24

On physical examination, a mallet finger assumes a:

1

Resting flexed posture with active and passive extension

2

Resting flexed posture without passive extension

3

Resting flexed posture without active extension

4

Resting flexed posture without active or passive extension

5

Resting flexed posture with active extension

QUESTION 25

The following mallet finger injuries always require tendon repair:

1

Type I and type II

2

Type II and type III

3

Type III and type IV

4

Type IV and type V

5

Type I and type IV

QUESTION 26

After placing a type I mallet finger in a splint at the initial visit, next follow-up should be:

1

The following day

2

In 1 week

3

In 2 weeks

4

In 1 month

5

At the end of the 8-week regimen

QUESTION 27

The most common bone tumor of the upper extremity is:

1

Enchondroma

2

Osteoblastoma

3

Osteochondroma

4

Giant cell tumor

5

C hondromyxoid tumor

QUESTION 28

The most common benign bone tumor of the hand is:

1

Enchondroma

2

Osteoblastoma

3

Osteochondroma

4

Giant cell tumor

5

C hondromyxoid tumor

QUESTION 29

Osteochondromas are benign but can have a malignant transformation in which of the following cases:

1

Diaphyseal achalasia

2

Ollierâs disease

3

Osteochondromatosis malignant transformans

4

Osteochondroma larger than 5 cm

5

Mafucci's syndrome

QUESTION 30

The risk of malignant transformation in patients with multiple hereditary exostoses is:

1

0%

2

Less than 1%

3

1% to 2%

4

Greater than 5%

5

0.5% to 25%

QUESTION 31

Recurrence of osteochondroma is likely if:

1

The cartilage cap is incompletely excised

2

The overlying bursa is incompletely excised

3

The bony stalk is incompletely excised

4

The tumor is incompletely excised

5

Its connection with the medullary canal is not obliterated

QUESTION 32

Malignant transformation of osteochondroma commonly occurs to:

1

High-grade osteosarcoma

2

High-grade chondrosarcoma

3

Low-grade chondrosarcoma

4

Low-grade osteosarcoma

5

Parosteal osteosarcoma

QUESTION 33

All of the following suggest a possibility of malignant transformation in multiple hereditary exostoses except:

1

Recent onset of pain

2

Growth after skeletal maturity

3

C artilaginous cap thickness greater than 3 cm

4

Soft tissue extension

5

C alcific stippling in the cap on radiograph

QUESTION 34

Enchondromas are commonly involved in which of the following sites:

1

Metacarpals

2

C arpus

3

Radius

4

Ulna

5

C lavicle

QUESTION 35

The most common forearm deformity in patients with hereditary multiple osteochondromatosis is:

1

Ulnar shortening

2

Radial shortening

3

Radial head dislocation

4

Madelungâs deformity

5

Translocation of carpus

QUESTION 36

Slide 1
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the patientâs forearm. The anteroposterior radiograph is shown (Slide). The next step is to order a:

1

Skeletal radiograph survey

2

Magnetic resonance imaging (MRI)

3

Magnetic resonance imaging (MRI) with wrist arthrogram

4

Genetic evaluation

5

C omputed tomography (C T) scan

QUESTION 37

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
An immediate appointment for magnetic resonance imagine (MRI) and computed tomography (C T) scan are not available, and a genetic evaluation has been carried out previously. As you await the report from the geneticist office, you decide to get a skeletal radiograph series on the patient. The radiograph of the opposite forearm (Slide 1) and right leg are shown (Slide 2).
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 3). Your suspected diagnosis is:

1

Diaphyseal achalasia

2

Madelungâs deformity

3

Multiple enchondromatosis

4

Multiple epiphyseal dysplasia

5

Infection

QUESTION 38

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The genetic pattern seen in patients with this type of presentation is:

1

Autosomal recessive

2

Autosomal dominant

3

Sex-linked recessive

4

Sex-linked dominant

5

Sporadic

QUESTION 39

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
Which of the following areas is unlikely to be involved:

1

Phalanges

2

Pelvis

3

C lavicle

4

Femur

5

Talus

QUESTION 40

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The chance of hand involvement in this child is:

1

0%

2

10%

3

25%

4

Greater than 25%

5

Undetermined

QUESTION 41

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The most likely complication in this child is:

1

Malignant degeneration

2

C arpal translocation

3

Posterior interosseous neuropathy (PIN) palsy

4

Peroneal nerve palsy

5

Elbow dislocation

QUESTION 42

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
The difference between Madelungâs deformity and this boyâs condition is:

1

The ulna is shorter

2

The radius is shorter

3

There is radial head dislocation

4

There is bilateral involvement

5

It is not congenital

QUESTION 43

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
All of the following are acceptable options, either alone or in combination, for management of this childâs condition, except:

1

Excision of osteochondromas

2

Ulnar lengthening

3

Hemiphyseal stapling

4

Radial osteotomy

5

Observation

QUESTION 44

Slide 1 Slide 2 Slide 3
A 12-year-old boy is brought to the clinic by his concerned parents. The boyâs forearm is bowed, and his parents are confused as to the possible diagnosis and treatment options. You notice that the right forearm of the child is bowed ulnarwards and is shorter compared to the left forearm. The pronosupination is markedly decreased on the right side but is also limited on the left side. The patient has a good grip, pinch, and grasp. He is neurologically intact as well.
The parents say that they first noticed the deformity around 6 or 7 years ago, and the mother informs you that she had noticed a hard bump on the forearm. She has recently noticed another bump on his right leg. The child does not complain of pain and is using both of his hands quite well. The parents were informed by a previous physician that the child has Madelungâs deformity and are concerned that the disease is now involving other areas of his body.
You order a radiograph of the forearm. The anteroposterior radiograph is shown (Slide 1). The childâs skeletal radiograph survey is also presented (Slide 2 and Slide 3).
Which of the following is not true regarding the possibility of malignant degeneration in this child:

1

There is a risk of up to 25%

2

Bone scan can differentiate

3

Most common secondary malignancy is chondrosarcoma

4

Risk of malignancy varies between families

5

Malignant change occurs in adulthood

QUESTION 45

Hornerâs syndrome includes all of the following except:

1

Miosis

2

Anhidrosis

3

Enophthalmosis

4

Exophthalmosis

5

Diplopia

QUESTION 46

Axonotmesis involves injury to the:

1

Epineurium

2

Endoneurium

3

Perineurium

4

Axon

5

Vasonervorum

Axontmesis, as described in Seddonâs classification, implies injury to the axon and myelin sheath. Neurontmesis involves injury to all three layers.
■Correct Answer:Axon

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Free Orthopedics Review | Dr Hutaif General Orthopedics -...

Key Medical Takeaway

FREE Orthopedics MCQS 2022 1451-1500