Free Orthopedics Review | Dr Hutaif General Orthopedics -...
Updated: Feb 2026
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Key Medical Takeaway
Learn more about FREE Orthopedics MCQS 2022 1701-1750. and how to manage it. Effective management of supracondylar humerus fractures focuses on restoring function and facilitating early range of motion, while preventing complications. Initial steps address vascular compromise via closed reduction, with open exploration if needed. Common nerve injuries involve the anterior interosseous nerve. Preventing cubitus varus primarily requires accurate fracture reduction and management, as malalignment during healing is the most frequent cause of this deformity.
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FREE Orthopedics MCQS 2022 1701-1750.
QUESTION 1
The nerve most commonly injured at the time of a supracondylar fracture is:
1
Radial nerve
2
Median nerve
3
Ulnar nerve
4
Anterior interosseous nerve
5
Posterior interosseous nerve
The anterior interosseous nerve is the most commonly injured nerve. The anterior interosseous nerve can be tested by asking the patient to make an "O" with the thumb and index fingers, and watching for active flexion of the distal interphalangeal joints.
The radial nerve is the second most commonly injured, after the anterior interosseous nerve.
The ulnar nerve is not the most commonly injured at time of fracture but is the most commonly injured at time of treatment.
The posterior interosseous nerve is rarely injured.
QUESTION 2
A 9-year-old child presents one year after a supracondylar humerus fracture is healed. The elbow is in 15° more varus than the other side. Which of the following statements to the family is true:
1
This is likely to be due to growth plate damage in the distal humerus.
2
This is likely to correct fully before the end of growth.
3
The deformity is probably due to hyperemia and overgrowth of the capitellum.
4
The deformity is likely due to malposition of the fracture during healing.
5
The varus will likely lead to an increased likelihood of degenerative joint disease.
Fracture malalignment is the most common cause of cubitus varus.
Physeal damage is rare after supracondylar fractures.
Angular malalignment corrects slowly and incompletely in the distal humerus, especially in the coronal plane. There is no reason for selective hyperemia of the capitellum in this fracture.
There is no evidence of predisposition to degenerative joint disease in cubitus varus.
QUESTION 3
In what region of the United States is Lyme disease most prevalent:
1
Hawaii
2
Alaska
3
Northeastern United States
4
Lower Midwestern United States
5
Southern United States
Lyme disease is most common in the northern United States, Wisconsin, and C alifornia; however, the disease can occur anywhere. Vector ticks identified in Europe transmit several variations of Lyme disease.
Hawaii, Alaska, the lower midwestern states, and southern states do not have an increased incidence of Lyme diseaseC orrect
Answer: Northeastern United States
QUESTION 4
Which of the following tests is most specific for the diagnosis of Lyme disease:
1
Elevated erythrocyte sedimentation rate (ESR)
2
Elevated C -reactive protein (C RP)
3
Negative antinuclear antibody (ANA)
4
Negative rheumatoid factor
5
Elevated antibody titer to Borrelia burgdorferi
The most specific laboratory finding is an elevated antibody titer to Borrelia burgdorferi. This test is commonly referred to as a
Lyme titer.
All of the mentioned tests are generally seen in Lyme disease, however, elevated erythrocyte sedimentation rate, elevated C - reactive protein, negative antinuclear antibody, and negative rheumatoid factor are all nonspecific.
QUESTION 5
Which of the following statements is true regarding Lyme disease:
1
C ardiac and neurologic symptoms are the most common manifestations of the disease.
2
Arthritic symptoms primarily affect large joints and a majority of patients are cured with antibiotic therapy.
3
The characteristic skin rash occurs late in the disease and can be permanently disfiguring.
4
Arthritic symptoms often do not fully resolve with antibiotic treatment, with a majority of patients progressing on to a rheumatoid-like destructive arthritis.
5
Lyme disease is easy to diagnose and a majority of cases are picked up after a few weeks.
Approximately 60% of patients develop arthritic symptoms that primarily affect large joints. The prognosis for most patients is good after treatment with antibiotics.
C ardiac and neurologic symptoms occur in a minority of patients, however, they can be the most serious symptoms. Erythema chronicum migrans is the characteristic skin rash. The rash tends to remit with antibiotic treatment and permanent disfigurement is not typically a problem.
Only 1%-2% of pediatric patients develop chronic arthritis.
Lyme disease may be difficult to diagnose because of the numerous possible presentations.
QUESTION 6
Lyme disease is caused by which of the following organisms or mechanisms:
1
Group A Streptococcus
2
Borrelia burgdorferi
3
Vibrio vulnificus
4
Group B Streptococcus
5
Autoimmune disorder of unknown etiology
Lyme disease was initially thought to be an idiopathic autoimmune disorder; however, in the 1970s, researchers at Yale University identified Borrelia burgdorferi as the cause of the disease. The disease is transmitted by a deer tick known as Ixodes ricinusi.
Group A streptococcal pharyngitis may be followed by rheumatic fever, but not Lyme disease.
Vibrio vulnificus is the organism responsible for severe soft tissue infections in patients who are exposed to fresh-water shellfish. Group B Streptococcus is a common etiologic agent for necrotizing fasciitis.
QUESTION 7
The most serious long-term sequela of rheumatic fever is:
1
Skin disfiguration from migratory rash
2
Disabling arthritis in affected joints
3
Rheumatic valvular heart disease
4
Need for long-term prophylaxis for the prevention of relapses
5
Decreased lung capacity secondary to fibrosis
The most serious potential long-term sequela of rheumatic fever is rheumatic valvular heart disease.
Patients do not develop any permanent skin lesions or joint disability from the disease.
Some patients require long-term prophylaxis to prevent recurrences, however, this is an inconvenience and not a sequela. The lungs are not affected in the acute fever or subsequent relapses.
QUESTION 8
Joint pain in rheumatic fever:
1
Affects 2 to 4 large joints over several months
2
Responds to aspirin therapy
3
Results in long-term disability with joint destruction
4
Is best treated with penicillin G
5
Is a major criterion for diagnosis
Joint pain is common in rheumatic fever. It is an intensely painful arthralgia that migrates from joint to joint within hours. The pain responds to aspirin therapy, as well as rest. Although oral penicillin G is used for treatment of the disease, it will not produce rapid resolution of the joint pain. In untreated cases, it can affect up to 16 joints. Most patients are left with no long-term sequelae or disability of the musculoskeletal system from rheumatic fever. Joint arthralgias are minor criteria for diagnosis.
QUESTION 9
Patients with homocystinuria phenotypically resemble patients with:
1
Achondroplasia
2
Larsen's syndrome
3
Marfan syndrome
4
Gaucher's disease
5
Noonan's syndrome
Patients with homocystinuria may phenotypically resemble patients with Marfan syndrome. Patients with homocystinuria and
Marfan syndrome are tall with long limbs, arachnodactyly, scoliosis, chest wall deformities, and lens dislocations.
Achondroplasia is characterized by short stature, frontal bossing, and rhizomelic shortening of the limbs. Larsen's syndrome is a disorder characterized by short stature and multiple joint dislocations.
Gaucher's disease is a lysosomal storage disease characterized by accumulation of cerebroside in cells of the reticuloendothelial system. As in patients with homocystinuria, patients with Gaucher's disease have osteoporosis, however, they do not develop any of the other phenotypic features seen in homocystinuria.
Noonan's syndrome effects boys and clinical features include short stature, a webbed neck, and cubitus valgus deformities.
QUESTION 10
A genetic defect found in some types of Ehlers-Danlos syndrome (EDS) is:
1
Fibrillin
2
Type I collagen
3
Fibroblast growth factor (FGF) receptor 3
4
Dystrophin
5
Hypoxanthine-guanine phosphoribosyl transferase
Ehlers-Danlos syndrome (EDS) was once described as a single gene disorder affecting type I collagen, but it has since been discovered that EDS is a family of heterogeneous disorders with many described mutations. Type I collagen is defective in EDS type VII and collagen type III is defective in EDS type IV and VIII.
Fibrillin and fibroblast growth factor (FGF) receptor 3 are defective in Marfan syndrome and achondroplasia, respectively. Dystrophin is deficient in muscular dystrophy.
Hypoxanthine-guanine phosphoribosyl transferase is defective in Lesch-Nyhan syndrome.
QUESTION 11
Which of the following features differentiates Marfan syndrome from Ehlers-Danlos syndrome (EDS):
1
Joint hypermobility
2
Scoliosis
3
Lens dislocation
4
Vascular problems
5
Joint dislocations
Patients with Ehlers-Danlos syndrome (EDS) and Marfan syndrome may have joint hypermobility, scoliosis, vascular problems, and recurrent joint instability. Patients with Marfan syndrome also develop lens dislocations, and while some patients with EDS exhibit eye problems, it is related to ocular globe fragility. Lens dislocation is not a feature of EDS.
QUESTION 12
Which of the following statements concerning Ehlers-Danlos syndrome (EDS) is true:
1
EDS type III is the most severe form of the disease.
2
EDS is primarily inherited as an autosomal dominant disorder.
3
EDS type VII is characterized by dislocated hips and/or knees at birth.
4
Demonstrating joint hyperlaxity or voluntary dislocation in EDS patients does not damage the joint.
5
Knowing the subtype of the disease does not affect the overall management of the patient.
Ehlers-Danlos syndrome (EDS) types I, II, III, and VII are commonly seen by orthopedic surgeons. Type VII is characterized by congenital hip and knee dislocations.
EDS type III is the mildest form of the disease; the main symptom of this type is hyperlaxity. EDS may be inherited via any of the Mendelian patterns.
C hildren with EDS should be encouraged not to use their hyperlaxity as a âtrickâ because of potential long-term joint damage that may occur.
Knowing the subtype of the disease is often helpful in management and perioperative planning because than the surgeon may anticipate operative risks and potential complications.
QUESTION 13
Which subtype of Ehlers-Danlos syndrome (EDS) is caused by lysyl hydroxylase deficiency:
1
EDS type I
2
EDS type II
3
EDS type III
4
EDS type IV
5
EDS type VII
Many of the mutations responsible for the differing subtypes of Ehlers-Danlos syndrome (EDS) have not been identified (EDS types I, II, and III). Lysyl hydroxylase deficiency has been identified as the cause of type IV. A mutation in type I collagen has been identified as the cause of EDS VII.
QUESTION 14
The most common type of chronic inflammatory arthritis in childhood is:
1
Pauciarticular juvenile rheumatoid arthritis
2
Polyarticular juvenile rheumatoid arthritis
3
Systemic juvenile rheumatoid arthritis
4
Seronegative spondyloarthropathy
5
Reactive arthropathy
Forty percent to 60% of children afflicted with juvenile rheumatoid arthritis (JRA) have the pauciarticular subtype. Polyarticular JRA is the second most common type occurring in 30%-40%. Systemic onset JRA is the least common form and occurs in approximately 20% of children. Seronegative spondyloarthropathy is more rare in patients 8 years of age. It is associated with haplotype HLA-B27. The long-term prognosis in these children is generally good.
QUESTION 15
A 4-year-old child injures his elbow and presents with swelling and limitation of voluntary movement. The radiographs show no obvious fracture, but it does show a Baumann angle of 71° and an elevation of the posterior fat pad. You tell the parents that this most likely represents:
1
A congenital anomaly with a valgus deformity of the elbow
2
A medial epicondyle fracture
3
A Salter I physeal separation
4
An occult supracondylar fracture
5
A variation of normal
Occult supracondylar fracture was the most common diagnosis assigned after careful study of a clinical series of elevated pediatric posterior fat pads.
The value for Baumann angle is normally 81° - 64°. Nothing in this description suggests a congenital anomaly. Medial epicondyle fractures are extremely rare before 9 years of age.
Although a Salter I physeal separation is a possibility, it is a rare injury.
With an elevation of the posterior fat pad, there is increasing recognition that a fracture exists.
QUESTION 16
A 6-year-old boy sustains a supracondylar fracture of the humerus. The 2 fragments are not completely displaced, but there is some overlap of the medial column and a gap on the lateral column of the distal humerus. Baumannâs angle measures 85Â
°-89º.The alignment on the lateral film shows no significant translation, but approximately 15° of increased extension. The recommended treatment is:
1
Accept this and treat in a long arm cast
2
C losed reduction with supination of the forearm and application of long arm cast
3
C losed reduction with the elbow in extension to better monitor the angulation
4
C losed reduction and percutaneous pin fixation
5
Open reduction and medial and lateral plate fixation
C losed reduction should allow regain of alignment and percutaneous pin fixation will allow it to be maintained.
The elbow is in 10°-15° of varus and this will be an objectionable appearance in the future. Supination will increase the varus.
Extension will exacerbate the deformity seen on the lateral and will cause further loss of contact of the fracture fragments. Medial and lateral plate fixation is needed in adolescents and adults with intercondylar fractures to allow early range of movement but is excessive treatment for this fracture in young children.
QUESTION 17
A 6-year-old girl presents with a fracture of the radial neck that is angulated 25° compared to the other side. No other abnormalities are seen. The recommended treatment is:
1
Sling and early range of motion
2
Reduction using an intramedullary K-wire introduced from a retrograde approach (Metaizeau technique)
3
Reduction using a percutaneously placed K-wire with intraosseous fixation
4
Open reduction without internal fixation
5
Open reduction and internal fixation
Fractures with angulation 30°.
Reduction using a percutaneously placed K-wire with intraosseous fixation, while effective, is not needed unless the fracture is angulated >30°.
Open reduction and internal fixation are indicated only if the fracture is angulated >50° and does not reduce by one of the manipulative techniques.
QUESTION 18
A 7-year-old boy falls and suffers a Salter type IV fracture of the proximal radius. The size of the displaced fragment is 40% of the radial head, and it is translated distally by 2 mm. The optimum treatment is:
1
Immobilization for 2 weeks with early range of motion
2
Immobilization for 6 weeks with early range of motion
3
Percutaneous fixation in situ to prevent further displacement
4
Excision of the radial head fragment
5
Open reduction, internal fixation
Because the displacement is likely to be >2 mm, open reduction may lessen the risk of problems with growth and mobility. This is suggested by clinical series.
The displacement is likely to be greater than the radiograph shows, and growth disturbance is likely. Range of motion at two weeks is too early.
Percutaneous fixation in situ would still carry a risk of growth disturbance, because the displacement is likely to be more than the plain radiographs show due to the largely cartilaginous nature of the radial head.
Excision of a fragment this large is likely to produce incongruity of the radio-capitellar joint.
QUESTION 19
A 12-year-old boy sustains a Salter type II fracture of the proximal humerus during a fall. The fracture has an apex angulation of 40° anteriorly and laterally. The neurovascular examination is normal. The recommended treatment is:
1
Longitudinal traction in abduction followed by slowly bringing the arm into an abduction (airplane) splint
2
C losed reduction and percutaneous pin fixation
3
Open reduction and plate fixation
4
Skeletal traction in abduction with an olecranon pin
5
No formal reduction attempt, rather placement of the arm in a sling
Recommended treatment involves no formal reduction attempt, rather placement of the arm in a sling. This simple treatment is adequate for all patients with at least 2 years of growth remaining. This is due to the tendency to self-align, the remodeling potential, and the ability to tolerate some deformity in the region with no functional consequence.
The abduction splint is cumbersome. It is not necessary because simpler means are effective due to the young age and remodeling potential.
C losed reduction and pin fixation are not needed because adequate remodeling is expected. Any residual deformity is well tolerated in this region. The pins can sometimes cause significant soft tissue irritation in the bulky area of the shoulder. Plate fixation is not feasible because of the open physis. It is also not necessary because simpler means are available. Skeletal traction is not needed because the humerus will align itself better with time in a dependent position.
QUESTION 20
The most common cause of a pediatric pathologic fracture of the proximal humerus is:
1
Osteochondroma
2
Osteogenic sarcoma
3
Unicameral bone cyst
4
C odman tumor (chondroblastoma)
5
Fibrous cortical defect
The most common cause of a pathologic fracture of the proximal humerus is unicameral bone cyst. This fluid-filled cyst expands and weakens the humerus, often causing a fracture as its first evidence of existence.
Although the proximal humerus is one of the more common sites of their occurrence, osteochondromas do not significantly weaken the humerus.
Osteogenic sarcoma is a relatively rare bone tumor, and it does not weaken the bone until it is at an advanced stage. C odman tumor (chondroblastoma) is classically described in the proximal humerus, it is rare and typically epiphyseal in location, and does not appreciably weaken the bone.
Although fibrous cortical defects are common tumors, they rarely present in this way.
QUESTION 21
A 6-year-old boy has a painful elbow, with swelling over the region of the olecranon. Radiographs reveal a thin sliver of bone that is displaced 4 mm from the proximal border of the olecranon. Treatment should consist of:
1
C losed treatment in a cast in 90° of flexion
2
C losed treatment in a cast in extension
3
Open excision of the osseous fragment
4
Open reduction and tension band fixation
5
No immobilization; early range of motion
Open reduction and tension band fixation is the best method to hold the proximal ulnar apophysis.
The patient has a âsleeveâ fracture that should be reduced because it is attached to the olecranon apophysis.
The osseous fragment is attached to the entire olecranon apophysis, which develops a secondary ossification center at age
9.
With early range of motion, further displacement and/or nonunion may develop.
QUESTION 22
Which of the following statements is true about the radiographic development of the proximal ulna:
1
A small sliver of a secondary ossification center is present at birth.
2
A secondary ossification center appears at 5 years of age.
3
A secondary ossification center appears at 7 years of age.
4
A secondary ossification center appears at 9 years of age.
5
There is no secondary ossification center for this region.
There is a secondary ossification center developing in children approximately 9 years of age. There is no ossification center in the proximal ulna until the child reaches 9 years old.
QUESTION 23
A 14-year-old boy sustains an intercondylar fracture of the distal humerus. There is a single fracture line into the joint between the capitellum and the trochlea. The medial column of the distal humerus is comminuted, but the lateral column is not. All fragments are highly displaced. Neurovascular status is normal. The recommended treatment is:
1
Olecranon pin traction overhead for 2 weeks and long arm cast
2
C losed reduction and long arm cast
3
C losed reduction and pin fixation
4
Open reduction and dual plate fixation through an anterior incision
5
Open reduction and dual plate fixation through a posterior approach
A posterior approach (Bryan-Morrey or olecranon osteotomy) will facilitate anatomic reduction and rigid fixation sufficient for early range of motion.
Prolonged traction and cast will result in an incomplete reduction and excessive stiffness. A cast alone will result in an incomplete reduction and excessive stiffness.
Rigid fixation with plates, rather than pins, is required to maintain reduction of these fractures and allow early range of motion.
An anterior approach will not allow adequate exposure of the distal humerus for articular fixation.
QUESTION 24
In treating which of the following elbow fractures is it most important to begin early range of motion:
1
Salter I physeal fracture of distal humerus
2
Intercondylar (T-condylar) fracture of distal humerus
3
Supracondylar fracture of distal humerus
4
Lateral condyle fracture
5
Lateral epicondyle fracture
Intercondylar fractures have a significant risk of loss of motion because of the magnitude of injury, intra-articular extension, and older age of patient.
Salter I physeal fractures typically occur in young children. They usually pose no difficulty with regaining motion after 4 to
6 weeks of immobilization.
Supracondylar fractures usually are followed by regaining motion after healing despite immobilization of up to 6 weeks or more.
Patients with this fracture usually regain their motion after healing. Because this is a nonarticular fracture, loss of motion is not a high risk.
QUESTION 25
A previously healthy 3-year-old girl presents with 3 weeks of painful torticollis and facial asymmetry. A birth history reveals a normal vaginal delivery with no perinatal complications. The girl has no history of esophagitis or gastrointestinal problems. Her mother reports that approximately 1 month ago, the young girl had an upper respiratory tract infection that has since resolved. The most likely diagnosis is:
1
Muscular torticollis
2
Os odontoideum
3
Grisel syndrome
4
Sandifer syndrome
5
Pseudosubluxation of C 2 on C 3
Grisel syndrome is an abnormal rotation of the atlantoaxial joint that produces painful torticollis and often follows an upper respiratory tract infection.
Muscular torticollis is unlikely in this patient because this condition is usually attributed to a difficult delivery, breech presentation, or some type of in utero positioning problem. Furthermore, muscular torticollis usually presents itself within the first 4-6 weeks and has no association with respiratory infections.
Symptoms associated with os odontoideum consist of neck pain, paresthesia, transient paresis, or myelopathy. Patients with os odontoideum do not have torticollis.
Sandifer syndrome is a painful torticollis and the abnormal trunk rotation is associated with gastroesophageal reflux disease.
Pseudosubluxation does not produce painful torticollis.
QUESTION 26
A computerized tomography (C T) scan of the neck reveals an atlantoaxial rotatory displacement with 6 mm of anterior translation. The most likely associated anatomic defect is:
1
Disruption of both the transverse ligament of C 1 and the alar ligaments
2
Odontoid fracture
3
Disruption of the anterior and posterior longitudinal ligaments
4
Disruption of the ligamentum flavum between C 1 and C 2
5
Ossiculum terminale
In order to have anterior displacement of C 1 on C 2 >5 mm, there must be disruption of both the transverse ligament of C 1 and the alar ligaments.
Odontoid fracture does not disrupt the articulation between the dens and the atlas, therefore, there would be no abnormal diastasis between the atlas and the dens.
The anterior and posterior longitudinal ligaments attach to the anterior and posterior aspects of the vertebral bodies respectively. Insufficiency does not affect the atlantoaxial articulation.
Disruption of the ligamentum flavum alone is not thought to result in translation of C 1 on C 2.
An ossiculum terminale is a persistent growth center at the tip of the odontoid, but is not indicative of any pathological condition.
QUESTION 27
A 14-year-old ice hockey player had a jersey pulled over his head in a brawl during a game. He finished the game without incident and denies any other traumatic event. The boy presents the following day with a stiff neck tilted to the right side and an inability to bring his head to a neutral position. On more careful physical examination, the boyâs head is tilted to the right 20°, rotated to the left 20°, and slightly flexed. Attempts at passive rotation to a neutral position produce pain. The exam is otherwise unremarkable. C omputerized tomography scans show atlantoaxial rotatory displacement with no anterior displacement of C 1 on C 2. Treatment should include:
1
Urgent C 1 to C 2 fusion
2
Use of a soft collar, exercises, and nonsteroidal anti-inflammatory drugs (NSAIDs)
3
Head halter traction and NSAIDs
4
Philadelphia collar, Minerva casting, and NSAIDs
5
Occiput to C 2 fusion
A soft collar, exercises, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be tried for 1 week if the diagnosis of atlantoaxial rotatory displacement is made within a week of its onset. The patientâs progress must be followed closely. If NSAIDs and a collar do not work after 1 week, the patient should be hospitalized and head halter traction should be administered along with muscle relaxants. If head halter traction successfully reduces the deformity, the patient should be placed in a Philadelphia collar with Minerva casting for 6 weeks. If the patient has no neurologic findings and no anterior displacement, the condition is likely to resolve with conservative measures alone. If surgery becomes necessary, the occiput should not be included in surgical treatment of atlantoaxial rotatory displacement.
QUESTION 28
C ongenital pseudarthrosis of the clavicle occurs most commonly on which side:
1
Bilateral
2
Right
3
Left
4
The side more involved with fibrous dysplasia
5
The side with the proximal focal femoral dysplasia
Ninety percent of cases are noted on the right side. Ten percent of cases are bilateral and have been associated with bilateral cervical ribs. Only a few cases of left-sided pseudarthrosis have been described and have been associated with dextrocardia.
Only
