Orthopedic Surgery Mock Exam - Set D14A91

A 5-year-old boy presents to the emergency department after falling from monkey bars. He sustained a displaced extension-type supracondylar humerus fracture. Examination reveals an inability to flex the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. Which of the following nerves is most likely injured?

A 75-year-old woman sustains a displaced femoral neck fracture after a mechanical fall. Which of the following is the predominant blood supply to the femoral head that is at risk of disruption in this injury?

A 15-year-old boy presents with progressive knee pain and swelling for two months. Radiographs demonstrate a metaphyseal lesion in the distal femur with a 'sunburst' periosteal reaction and Codman's triangle. A biopsy confirms a high-grade primary bone sarcoma. Which of the following genetic alterations is most closely associated with this condition?

A 68-year-old man presents with bilateral leg pain and cramping that worsens with walking and prolonged standing, but improves when he leans forward over a shopping cart or sits down. What is the most likely pathophysiologic mechanism for his symptom relief with flexion?

A 40-year-old recreational basketball player feels a sudden 'pop' in his posterior ankle while jumping. On examination, he has a positive Thompson test. If non-operative management is chosen, what is the most appropriate initial immobilization position?

A 35-year-old mechanic presents with a swollen, painful index finger 3 days after sustaining a puncture wound. The finger is held in a flexed posture, is uniformly swollen, tender along the volar aspect, and exquisitely painful with passive extension. What is the most appropriate next step in management?

A 6-week-old female infant is evaluated for developmental dysplasia of the hip (DDH). Ultrasound is performed, and an alpha angle of 45 degrees is noted on the right hip. She is prescribed a Pavlik harness. Which of the following complications is most likely to occur if the harness is placed in excessive hip flexion (greater than 120 degrees)?

A 13-year-old overweight boy presents with a 3-week history of right groin and knee pain. He walks with a limp. On examination, when his right hip is flexed, it obligatorily externally rotates. Radiographs show a slip of the proximal femoral epiphysis. Which radiographic line is used to diagnose this condition?

A 22-year-old female soccer player sustains a twisting injury to her left knee. An AP radiograph demonstrates a small vertical avulsion fracture of the lateral tibial plateau, distal to the joint line. This fracture is considered pathognomonic for an injury to which of the following structures?

A 55-year-old carpenter presents with right shoulder pain and weakness after attempting to lift a heavy tool box. On physical examination, he demonstrates a positive drop-arm test and profound weakness with active abduction in the scapular plane. An MRI confirms a massive, retracted tear of the supraspinatus and infraspinatus tendons. Fatty infiltration of these muscles is graded. Which classification system is most commonly used to grade fatty infiltration of the rotator cuff muscles on imaging?

A 45-year-old construction worker falls from a 15-foot scaffold and sustains a highly comminuted, intra-articular distal tibia (Pilon) fracture. Severe soft tissue swelling and fracture blisters are present on presentation. What is the most appropriate initial management for this injury?

A 30-year-old woman presents with worsening knee pain. Radiographs reveal an eccentric, lytic, expansile lesion located in the epiphysis of the proximal tibia, extending to the subchondral bone. There is no sclerotic margin. Histology demonstrates mononuclear cells and numerous uniformly distributed osteoclast-like multinucleated giant cells. Which of the following is the most effective targeted medical therapy for advanced, unresectable cases of this tumor?

A 25-year-old male is involved in a high-speed motorcycle accident. Pelvic radiographs demonstrate symphysis pubis diastasis of 3.5 cm and widening of the anterior sacroiliac joints bilaterally. The posterior sacroiliac ligaments are determined to be intact. According to the Young-Burgess classification, what type of pelvic ring injury does this patient have?

A 34-year-old man suffers an ankle injury after slipping on ice. Radiographs reveal a transverse fracture of the medial malleolus and a short oblique fracture of the lateral malleolus starting at the level of the joint line. According to the Lauge-Hansen classification, what is the most likely mechanism of injury?

A 48-year-old female secretary presents with numbness and tingling in her thumb, index, and middle fingers that wakes her up at night. She has noted weakness in her grip and visible flattening of her thenar eminence. She is diagnosed with severe carpal tunnel syndrome. Which of the following thenar muscles is NOT innervated by the median nerve and would therefore be spared in this condition?

A 20-year-old college student falls onto an outstretched hand and presents with anatomic snuffbox tenderness. Initial radiographs are negative, but an MRI obtained 3 days later confirms a non-displaced fracture of the proximal pole of the scaphoid. The patient is at high risk for avascular necrosis due to the scaphoid's retrograde blood supply. Which of the following vessels provides the primary blood supply to the proximal pole of the scaphoid?

A 6-year-old boy presents with a painless limp of several months' duration. Examination reveals restricted hip abduction and internal rotation. Radiographs demonstrate sclerosis and flattening of the capital femoral epiphysis consistent with Legg-Calve-Perthes disease. According to the Waldenström classification, what is the sequence of radiographic stages in this disease?

A 60-year-old woman presents 4 weeks after sustaining a nondisplaced distal radius fracture, which was managed in a short arm cast. She now complains of a sudden inability to actively extend the interphalangeal joint of her thumb. Which of the following represents the most likely etiology of this complication?

A 70-year-old man presents with progressive bilateral hand clumsiness, difficulty buttoning his shirt, and gait instability. Examination reveals a positive Hoffman's sign bilaterally, inverted radial reflex, and hyperreflexia in the lower extremities. An MRI of the cervical spine is ordered. What is the most likely diagnosis?

A 28-year-old man sustains a closed, highly comminuted tibia fracture. He is admitted for observation. Several hours later, he reports escalating leg pain that is out of proportion to his injury and is not relieved by opioid analgesics. Passive stretching of his toes elicits severe pain. Compartment pressures are measured. What criteria strongly indicates the need for an emergent four-compartment fasciotomy?

A 35-year-old male is involved in a high-speed motor vehicle collision. Radiographs demonstrate a traumatic spondylolisthesis of the axis (Hangman's fracture) with severe angulation and >3 mm of translation. The C2-C3 disc space is disrupted, and the C2 articular facets are dislocated anteriorly. According to the Levine and Edwards classification (Type III), what is the most appropriate management?

A 45-year-old male presents after a motorcycle accident with an anteroposterior compression (APC) Type III pelvic ring injury. He is hemodynamically unstable despite initial resuscitation, massive transfusion protocol, and application of a pelvic binder.

What is the next most appropriate step in management?

A patient with a chronic high median nerve palsy requires tendon transfers to restore function. Which of the following combinations of tendon transfers is most appropriate to restore thumb flexion, thumb opposition, and index/long finger flexion?

The Lisfranc ligament is a critical stabilizing structure of the midfoot. Between which two bones does the primary interosseous Lisfranc ligament traverse?

A 13-year-old obese male underwent in situ single-screw pinning for a severe, unstable slipped capital femoral epiphysis (SCFE) 6 months ago. He now complains of progressive hip stiffness and pain. Radiographs demonstrate marked concentric joint space narrowing of the affected hip without evidence of avascular necrosis.

What is the most likely diagnosis?

Demineralized bone matrix (DBM) is commonly used as a bone graft extender in spinal fusion surgery. Which of the following correctly describes the biologic properties of DBM?

A 14-year-old girl presents with pain and swelling over her distal femur. Radiographs show an eccentric, expansile, lytic lesion in the metaphysis. MRI demonstrates multiple fluid-fluid levels. A biopsy confirms an aneurysmal bone cyst (ABC).

What is the classic genetic translocation associated with primary ABCs?

A 68-year-old female undergoes a total hip arthroplasty via a posterior approach. She subsequently sustains a posterior dislocation. Which of the following component positions most increases the risk of posterior dislocation?

During reconstruction of the posterolateral corner (PLC) of the knee, identifying the insertion of the popliteofibular ligament (PFL) is crucial. Where does the PFL anatomically insert?

A 72-year-old female sustains a 3-part proximal humerus fracture. She is indicated for an open reduction and internal fixation (ORIF) with a locking plate via a deltopectoral approach.

To avoid injury to the axillary nerve, what is the generally accepted 'danger zone' for plate placement distal to the tip of the greater tuberosity?

A 15-year-old female gymnast complains of chronic lower back pain. Lateral lumbar radiographs reveal an isthmic spondylolisthesis at L5-S1 with 65% anterior translation of L5 on S1.

According to the Meyerding classification, what grade is this slip?

A 32-year-old manual laborer presents with dorsal wrist pain and decreased grip strength. Radiographs show sclerosis and fragmentation of the lunate, with proximal migration of the capitate and a loss of carpal height. There is no evidence of radiocarpal or midcarpal osteoarthritis. What is the Lichtman classification stage of this patient's Kienböck's disease?

A 55-year-old female presents with medial ankle pain and a progressive flatfoot deformity. On examination, she has a flexible flatfoot, valgus hindfoot that corrects on a toe-raise, and she is unable to perform a single-limb heel rise on the affected side.

According to the Johnson and Strom classification (modified by Myerson), what stage of Posterior Tibial Tendon Dysfunction (PTTD) does she have?

When treating a rigid idiopathic clubfoot using the Ponseti method of serial casting, what is the correct sequence of deformity correction?

In normal articular cartilage, which structural zone contains the largest diameter collagen fibrils oriented perpendicular to the joint surface and provides the highest resistance to compressive forces?

A 65-year-old male presents with severe, atraumatic mid-back pain. Radiographs reveal a compression fracture of T8. Laboratory workup shows anemia, hypercalcemia, and an elevated creatinine. Serum protein electrophoresis demonstrates a monoclonal spike. Which of the following is the most sensitive and appropriate imaging modality to detect additional osteolytic bone lesions in this patient?

During a total knee arthroplasty in a patient with a severe fixed varus deformity, the medial soft tissues are exceedingly tight in both flexion and extension. After releasing the deep medial collateral ligament (MCL) and removing all medial osteophytes, the joint remains tight medially. What is the next most appropriate sequential step for medial release?

A 24-year-old professional baseball pitcher presents with vague anterior shoulder pain and a 'dead arm' sensation. MR arthrogram reveals a bucket-handle tear of the superior labrum that extends into the long head of the biceps tendon, resulting in an unstable biceps anchor. According to the Snyder classification, what type of SLAP tear is this?

A 62-year-old female underwent volar locked plating for a comminuted distal radius fracture 3 months ago. She now presents with a sudden inability to actively flex the interphalangeal joint of her thumb. Which of the following factors most likely contributed to this complication?

A 28-year-old chef sustains a knife laceration over the palmar aspect of his proximal phalanx of the ring finger. Examination reveals an inability to actively flex both the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints of the ring finger. In which flexor tendon zone did this injury occur?