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Question 1

Which digit is most commonly affected by macrodactyly:

Explanation

The index finger is most frequently affected, although multiple digital enlargement is actually more commonly seen.

Question 2

Syndactyly is present in what percentage of patients with macrodactyly:

Explanation

The majority of patients (90%) present with unilateral macrodactyly, and men are more often affected than women. Macrodactyly is most frequently found in the index finger, followed by the long finger, thumb, ring, and little fingers. Typically, two digits are affected â most commonly the thumb and index or the index and long. Syndactyly may be present in 10% of patients with macrodactyly.

Question 3

Macrodactyly that is present at birth is termed:

Explanation

Barsky described macrodactyly as either static or progressive. Static macrodactyly is present at birth, and the affected digit grows larger as the child develops. In the progressive type of macrodactyly, growth begins soon after birth. This form of the disorder is more common than static macrodactyly.

Question 4

The most accepted theory for the cause of macrodactyly is:

Explanation

Some surgeons believe that macrodactyly is a variant of neurofibromatosis. Although macrodactyly is not an inherited anomaly, there are syndromes that may be associated with enlarged digits such as Proteus syndrome. Although numerous causes have been suggested, the most accepted theory was described by Inglis in 1950. He theorized that the abnormal nerves exert influence on the local tissues to stimulate growth.

Question 5

Syndromes that may be associated with macrodactyly include:

Explanation

Some surgeons believe that macrodactyly is a variant of neurofibromatosis. Although macrodactyly is not an inherited anomaly, there are syndromes that may be associated with enlarged digits such as Proteus syndrome. Theoretical causes for macrodactyly include a neural cause, a vascular cause, as well as a humoral mechanism. The most accepted theory is that abnormal nerves exert some influence on the local tissues to stimulate growth.7

Question 6

Macrodactyly affects:

Explanation

Although this is controversial, the majority of surgeons believe that macrodactyly affects bones, fat, and nerves.

Question 7

Explanation

The child is not ready for surgery. Although surgery may coincide with the patient beginning school, this does not always occur. At this time, additional examination and testing are recommended.

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. The childâ s parents inform you that they would like you to amputate the affected digits as soon as possible. You should:

Explanation

Although amputation may be necessary in some patients with macrodactyly, it is too early in the course of this case to begin entertaining such a drastic measure. A debulking procedure is not recommended for a 2-year-old child. Radiation therapy is not an option in uncomplicated cases of macrodactyly. The surgeon must educate the parents about the disease process and order additional testing.

Question 9

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:

Explanation

In patients with macrodactyly, surgeons do not typically find enchondromas, especially not multiple enchondromas in the affected fingers. Enlargement of the bones is found in all dimensions â not only in the length and width. If the bones appear normal on radiograph, then they are not affected by macrodactyly.

Question 10

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:

Explanation

Patients with macrodactyly should be followed up yearly. Although the parents may be difficult, this is not a reason to stop seeing a patient. The other answers choices are incorrect because treatment would be too late.

Question 11

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

Explanation

Complications of macrodactyly surgery include poor healing of flaps secondary to devascularization or undue tension, nerve injury or decreased sensation, infection, stiffness, bony nonunion or malunion, and failure of the epiphysiodesis.

Question 12

Epiphysiodesis for macrodactyly should be performed at the following location:

Explanation

Treatment by epiphysiodesis for macrodactyly is ineffective if only single phalanges are treated. Therefore, treatment of the proximal phalanx, distal phalanx, or the middle phalanx alone is incorrect. The author prefers to perform epiphysiodesis only on the proximal and distal phalanges. The middle phalanx is not treated to preserve motion at the proximal interphalangeal joint.

Question 13

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

Explanation

The dorsal section of the scapholunate ligament is the strongest portion, requiring 300 N of load for failure. The volar (150 N) and intermediate portions (25 N to 50 N) contribute less to overall stability.

Question 14

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

Explanation

The semisupination oblique view is used to visualize the pisiform and pisotriquetral joint. The PA oblique and lateral views are the primary films used to diagnose scapholunate instability. The clenched fist view is used as a provocative view to bring out dynamic instability.

Question 15

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

Explanation

Proximal row carpectomy is a salvage procedure for chronic instability with focal radioscaphoid arthritis. Open repair with sutures through bone tunnels, open repair with suture anchors, and arthroscopically assisted reduction and pinning have been used successfully in acute cases.

Question 16

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

Explanation

The VISI, DISI, and spilled tea cup signs are seen on lateral radiographs, whereas the Watson-Jones scaphoid shift test is a clinical sign. The classic pattern after scaphoid-lunate ligament injury is a DISI pattern as the lunate extends and the scaphoid flexes. The spilled tea cup sign is present in perilunate dislocations.

Question 17

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

Explanation

The Terry Thomas sign refers to scapholunate diastases that may be apparent on posteroanterior radiographs of the wrist and is indicative of rupture if the diastases are larger than 3 mm. It is named after the famous comedian who had a gap between his front teeth.

Question 18

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

Explanation

MRI is not considered the technique of choice for the evaluation of the scaphoid-lunate ligament. Standard MRI coils are not adequate for the evaluation of the ligaments of the wrist. To maximize the yield from a wrist MRI, high-field strength and highresolution images must be obtained using dedicated wrist coils. Only with such dedicated coils can detailed information be derived regarding the continuity of the scapoid-lunate ligament. Physical examination and wrist arthroscopy remain the gold standards for the evaluation of a torn scaphoid-lunate ligament.

Question 19

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

Explanation

In cases of subacute scaphoid-lunate ligament injury without arthrosis, it is acceptable to attempt reconstruction with bone anchors, allograft ligament repair, capsulodesis, bone-ligament-bone autograft, and the RASL procedure with a Herbert screw. In the presence of localized arthritis, one might consider one of the limited wrist fusions such as scaphotrapeziotrapezoid fusion.

Question 20

Mallet finger injuries refer to:

Explanation

Mallet finger injuries may be associated with fractures of the bony tuft, fractures of the middle phalanx, flexor tendon injuries, and intrinsic tightness. However, mallet injuries refer to lack of continuity at the DIP joint.

Question 21

In mallet finger injuries, the distal phalanx posture is:

Explanation

The characteristic deformity is â droopingâ at the distal interphalangeal (DIP) joint. The DIP is flexed. It is not hyperextended, neutral, or deviated.

Question 22

Mallet finger injuries are typically:

Explanation

Mallet finger usually results from a blow to the tip of the extended finger. This forces distal phalanx flexion and disruption of the extensor mechanism at the distal interphalangeal joint. Open injuries to the extensor mechanism can also cause mallet finger.

Question 23

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

Explanation

Cast immobilization is excessive and will cause undue stiffness in the affected finger. Dorsal blocking splints, splinting in flexion, and early active motion are contraindicated in these injuries. Only the affected joint should be splinted in extension.

Question 24

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

Explanation

Eight weeks of immobilization is preferred. If the finger is immobilized for a shorter period of time, the clock is reset and immobilization is started again.

Question 25

The most common mallet finger injuries are:

Explanation

Type I mallet injuries are by far the most common mallet injuries. There is no such classification as a type V injury.

Question 26

On physical examination, a mallet finger assumes a:

Explanation

The distal phalanx assumes a resting flexed posture. The patient is not able to actively extend the fingertip, but it can be passively extended.

Question 27

The following mallet finger injuries always require tendon repair:

Explanation

Type II and III injuries have absolute requirements for tendon repair as there is a laceration or loss of tendon substance.

Question 28

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

Explanation

After placement of the splint, the patient should follow-up in the next week to make sure the finger is still maintained in full extension. Loosening of the splint will occur as swelling decreases.

Question 29

The most common bone tumor of the upper extremity is:

Explanation

Osteochondromas are the most common primary benign bony tumors.

Question 30

The most common benign bone tumor of the hand is:

Explanation

Unlike the entire upper extremity, enchondromas are the most common tumors of the hand.

Question 31

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

Explanation

Diaphyseal achalasia, also known as multiple hereditary exostoses, has a risk of malignant degeneration in up to 25% patients. Olliers disease and Mafucciâ s syndrome are associated with enchondromas. There is no lesion called an osteochondromatosis malignant transformans.

Question 32

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

Explanation

The rate of malignant transformation in patients with multiple hereditary exostoses is variable and is generally reported between 0.5% to 25%.

Question 33

Recurrence of osteochondroma is likely if:

Explanation

The cartilaginous portion of an osteochondroma is the neoplastic part; its complete excision is essential to avoid recurrences.

Question 34

Malignant transformation of osteochondroma commonly occurs to:

Explanation

Osteochondroma is a cartilaginous tumor and malignant transformation is to a low-grade chondrosarcoma.

Question 35

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

Explanation

Stippling on radiographs in the cap is due to calcification and is a common characteristic of cartilaginous tumors.

Question 36

Enchondromas are commonly involved in which of the following sites:

Explanation

Metacarpals and phalanges are the most common areas of hand involvement, and the hand is involved in 40% to 65% of cases. Enchondromas are also the most common primary benign bone tumor of the hand (90% cases).

Question 37

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

Explanation

Ulnar involvement and shortening frequently occurs in patients with hereditary multiples osteochondromatosis because the distal ulnar growth plate is smaller than that of the radius, consequently its length is affected more. The ulnar shortening causes radial bowing or radial head dislocation.

Question 38

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungâ s deformity and are concerned that the disease is now involving other areas of his body. You order a radiograph of the patientâ s forearm. The anteroposterior radiograph is shown (Slide). The next step is to order a:

Explanation

The next step is to order a skeletal survey to rule out involvement of other areas.

Question 39

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungs 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:

Orthopedic Prometric Exam Question

Explanation

Diaphyseal achalasia, also called multiple hereditary exostoses, classically presents in a young individual with multiple sites of involvement. The more involved the disease, the more likely hand involvement becomes. Forearm involvement is also common. The radius is bowed due to the shortened ulna. The risk of radial head dislocation is higher if the radius does not bow. While infection or traumatic injury could have produced early physeal arrest as seen in the first radiograph, presence of lesions elsewhere indicates multiple hereditary exostoses and should be investigated with skeletal surveys. Multiple epiphyseal dysplasia is not a possible diagnosis as only the ulna is involved in the first radiograph and radius alone in the left forearm. No enchondromas are present.

Question 40

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The genetic pattern seen in patients with this type of presentation is:

Orthopedic Prometric Exam Question

Explanation

Multiple hereditary exostoses is inherited in an autosomal-dominant manner with 90% penetrance.

Question 41

A 12-year-old boy is brought to the clinic by his concerned parents. The boy s 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). Which of the following areas is unlikely to be involved:

Orthopedic Prometric Exam Question

Explanation

The clavicle is a membranous bone, and osteochondromas do not arise in membranous bones.

Question 42

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungâ s 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The chance of hand involvement in this child is:

Explanation

The hand is involved in 30% to 80% of cases.

Question 43

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The most likely complication in this child is:

Orthopedic Prometric Exam Question

Explanation

Ulnar carpal translocation occurs due to the steep radial articular angulation that occurs due to the tethering effect of a shortened ulna and is already apparent in early stages in the first radiograph. While peroneal palsy is possible due to a proximal fibula lesion, it is less common. Malignant transformation occurs, risk varies with families.

Question 44

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The difference between Madelungâ s deformity and this boyâ s condition is:

Orthopedic Prometric Exam Question

Explanation

The ulna is elongated or dorsally subluxed in Madelung's deformity.

Question 45

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s 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 childâ s condition, except:

Orthopedic Prometric Exam Question

Explanation

Although hemiphyseal stapling is an acceptable option to correct radial articular angulation, in this boy the distal radial physis is already fused as is seen in the first radiograph.

Question 46

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s 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:

Orthopedic Prometric Exam Question

Explanation

Bone scan cannot differentiate between an active lesion and a malignant transformation.

Question 47

Horners syndrome includes all of the following except:

Explanation

Horners syndrome is caused by disruption of sympathetic innervation and is characterized by enophthalmosis, not exophthalmosis. Other symptoms include anhidrosis, miosis, and ptosis.

Question 48

Axonotmesis involves injury to the:

Explanation

Axontmesis, as described in Seddonâ s classification, implies injury to the axon and myelin sheath. Neurontmesis involves injury to all three layers.

Question 49

All of the following may be seen with preganglionic lesion except:

Explanation

Tinels sign is seen with postganglionic lesions.

Question 50

Weakness is not seen with root avulsion in the:

Explanation

The trapezius is innervated by spinal accessory nerve and thus will not be involved in a brachial plexus lesion. In the case of a preganglionic lesion, all muscles innervated by the nerve roots will be affected.

Full Question & Answer Text (for Search Engines)

Question 1:

Which digit is most commonly affected by macrodactyly:

Options:

Thumb
Index
MIddle
Ring
Small

Correct Answer: Index

Explanation:

The index finger is most frequently affected, although multiple digital enlargement is actually more commonly seen.

Question 2:

Syndactyly is present in what percentage of patients with macrodactyly:

Options:

Correct Answer: 10%

Explanation:

Question 3:

Macrodactyly that is present at birth is termed:

Options:

Birth advancing macrodactyly (BAM)
Static macrodactyly
Progressive macrodactyly
Simple macrodactyly
C omplex macrodactyly

Correct Answer: Static macrodactyly

Explanation:

Question 4:

The most accepted theory for the cause of macrodactyly is:

Options:

Idiopathic
Neural
Vascular
Humoral
C ongenital

Correct Answer: Neural

Explanation:

Question 5:

Syndromes that may be associated with macrodactyly include:

Options:

Proteus syndrome
Freeman-Sheldon syndrome
Madelungâ s deformity
Holt-Oram syndrome
Poland syndrome

Correct Answer: Proteus syndrome

Explanation:

Some surgeons believe that macrodactyly is a variant of neurofibromatosis. Although macrodactyly is not an inherited anomaly, there are syndromes that may be associated with enlarged digits such as Proteus syndrome. Theoretical causes for macrodactyly include a neural cause, a vascular cause, as well as a humoral mechanism. The most accepted theory is that abnormal nerves exert some influence on the local tissues to stimulate growth.7

Question 6:

Macrodactyly affects:

Options:

Only bones
Bones and fat
Bones, fat, and nerves
Bones, fat, nerves, and blood vessels
Bones, fat, nerves, blood vessels, and tendons

Correct Answer: Bones, fat, and nerves

Explanation:

Although this is controversial, the majority of surgeons believe that macrodactyly affects bones, fat, and nerves.

Question 7:

Options:

Scheduling the patient for immediate surgery
Telling the parents to return when the child develops functional abnormalities
Performing surgery within 1 week of diagnosis
Scheduling surgery to coincide with the patient beginning school
Performing additional testing

Correct Answer: Performing surgery within 1 week of diagnosis

Explanation:

The child is not ready for surgery. Although surgery may coincide with the patient beginning school, this does not always occur. At this time, additional examination and testing are recommended.

Question 8:

Options:

Begin radiation therapy to arrest the growth of the affected digits
Proceed with amputation because you have the parentsâ consent
Send the patient to another hand surgeon
Explain the typical course of macrodactyly and order additional testing
Schedule the patient for a debulking procedure

Correct Answer: Explain the typical course of macrodactyly and order additional testing

Explanation:

Question 9:

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:

Options:

Multiple enchondromas in the affected fingers
Enlarged bones in length only
Enlarged bones in length and width
Enlarged bones in width only
Normal appearing bones

Correct Answer: Enlarged bones in length only

Explanation:

Question 10:

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:

Options:

Never
In 1 year
When functional abnormalities develop
When the enlargement of the digits has ceased
When the patient is old enough to consent for surgery

Correct Answer: In 1 year

Explanation:

Question 11:

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

Options:

Nerve injury
Bony malunion
Decreased sensation
Joint laxity
Infection

Correct Answer: Joint laxity

Explanation:

Question 12:

Epiphysiodesis for macrodactyly should be performed at the following location:

Options:

Proximal phalanx only
Proximal phalanx and middle phalanx
Proximal phalanx, middle phalanx, and distal phalanx
Middle phalanx only
Proximal phalanx and distal phalanx

Correct Answer: Proximal phalanx only

Explanation:

Question 13:

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

Options:

Distal
Proximal
Intermediate
Dorsal
Volar

Correct Answer: Dorsal

Explanation:

Question 14:

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

Options:

Semisupination oblique view
C lenched fist view
Lateral view
Anteroposterior (AP) view
Oblique view

Correct Answer: Semisupination oblique view

Explanation:

Question 15:

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

Options:

Open repair with bone sutures
Proximal row carpectomy
C losed reduction and long arm cast
Arthroscopically assisted reduction and pinning
Open repair with suture anchors

Correct Answer: Proximal row carpectomy

Explanation:

Question 16:

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

Options:

Terry Thomas sign
Volar intercalated segmental instability (VISI) pattern
Spilled tea cup sign
Watson-Jones scaphoid shift
Dorsal intercalated segment instability (DISI) pattern

Correct Answer: Terry Thomas sign

Explanation:

Question 17:

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

Options:

Scapholunate diastases larger than 3 mm
Scapholunate angle more than 30º to 60º on lateral radiographs
Reduction and exaggeration of scapholunate diastases on radial and ulnar deviation motion studies
Exaggeration and reduction of scaphoid-lunate diastases on radial and ulnar deviation radiographs, respectively
Scaphoid flexion with lunate extension

Correct Answer: Scapholunate diastases larger than 3 mm

Explanation:

Question 18:

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

Options:

2 mm thin slices
Tangential cuts
Gallium-enhanced scan
Dedicated wrist coil
MRI in neutral, radial, and ulnar deviation

Correct Answer: Dedicated wrist coil

Explanation:

Question 19:

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

Options:

Herbert screw (reduction association of the scapholunate)
Scaphotrapeziotrapezoid (STT) fusion
Scaphoid-lunate ligament reconstruction using bone-ligament-bone autograft
Allograft ligament
Repair with capsulodesis

Correct Answer: Scaphotrapeziotrapezoid (STT) fusion

Explanation:

Question 20:

Mallet finger injuries refer to:

Options:

Fractures of the bony tuft
Flexor tendon injuries
Lack of conjoined tendon continuity at the distal interphalangeal (DIP) joint
Fractures of the middle phalanx
Intrinsic tightness

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

Explanation:

Question 21:

In mallet finger injuries, the distal phalanx posture is:

Options:

Hyperextended
Flexed
Neutral
Radially deviated
Ulnarly deviated

Correct Answer: Flexed

Explanation:

The characteristic deformity is â droopingâ at the distal interphalangeal (DIP) joint. The DIP is flexed. It is not hyperextended, neutral, or deviated.

Question 22:

Mallet finger injuries are typically:

Options:

Secondary to hyperextension injuries
Secondary to forced flexion injuries
Secondary to torsion injuries
Secondary to fingertip amputations
Asymptomatic

Correct Answer: Secondary to hyperextension injuries

Explanation:

Question 23:

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

Options:

C ast immobilization of the affected digit in extension
Dorsal block splint of the affected digit
Early active motion of the affected joint
Splinting of the affected distal interphalangeal joint (DIP) joint in flexion
Splinting of the affected DIP joint in extension

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

Explanation:

Question 24:

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

Options:

4 weeks
5 weeks
6 weeks
7 weeks
8 weeks

Correct Answer: 8 weeks

Explanation:

Eight weeks of immobilization is preferred. If the finger is immobilized for a shorter period of time, the clock is reset and immobilization is started again.

Question 25:

The most common mallet finger injuries are:

Options:

Type I
Type II
Type III
Type IV
Type V

Correct Answer: Type I

Explanation:

Type I mallet injuries are by far the most common mallet injuries. There is no such classification as a type V injury.

Question 26:

On physical examination, a mallet finger assumes a:

Options:

Resting flexed posture with active and passive extension
Resting flexed posture without passive extension
Resting flexed posture without active extension
Resting flexed posture without active or passive extension
Resting flexed posture with active extension

Correct Answer: Resting flexed posture with active and passive extension

Explanation:

The distal phalanx assumes a resting flexed posture. The patient is not able to actively extend the fingertip, but it can be passively extended.

Question 27:

The following mallet finger injuries always require tendon repair:

Options:

Type I and type II
Type II and type III
Type III and type IV
Type IV and type V
Type I and type IV

Correct Answer: Type II and type III

Explanation:

Type II and III injuries have absolute requirements for tendon repair as there is a laceration or loss of tendon substance.

Question 28:

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

Options:

The following day
In 1 week
In 2 weeks
In 1 month
At the end of the 8-week regimen

Correct Answer: In 1 week

Explanation:

After placement of the splint, the patient should follow-up in the next week to make sure the finger is still maintained in full extension. Loosening of the splint will occur as swelling decreases.

Question 29:

The most common bone tumor of the upper extremity is:

Options:

Enchondroma
Osteoblastoma
Osteochondroma
Giant cell tumor
C hondromyxoid tumor

Correct Answer: Osteochondroma

Explanation:

Osteochondromas are the most common primary benign bony tumors.

Question 30:

The most common benign bone tumor of the hand is:

Options:

Enchondroma
Osteoblastoma
Osteochondroma
Giant cell tumor
C hondromyxoid tumor

Correct Answer: Enchondroma

Explanation:

Unlike the entire upper extremity, enchondromas are the most common tumors of the hand.

Question 31:

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

Options:

Diaphyseal achalasia
Ollierâ s disease
Osteochondromatosis malignant transformans
Osteochondroma larger than 5 cm
Mafucci's syndrome

Correct Answer: Diaphyseal achalasia

Explanation:

Question 32:

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

Options:

0%
Less than 1%
1% to 2%
Greater than 5%
0.5% to 25%

Correct Answer: 0%

Explanation:

The rate of malignant transformation in patients with multiple hereditary exostoses is variable and is generally reported between 0.5% to 25%.

Question 33:

Recurrence of osteochondroma is likely if:

Options:

The cartilage cap is incompletely excised
The overlying bursa is incompletely excised
The bony stalk is incompletely excised
The tumor is incompletely excised
Its connection with the medullary canal is not obliterated

Correct Answer: The cartilage cap is incompletely excised

Explanation:

The cartilaginous portion of an osteochondroma is the neoplastic part; its complete excision is essential to avoid recurrences.

Question 34:

Malignant transformation of osteochondroma commonly occurs to:

Options:

High-grade osteosarcoma
High-grade chondrosarcoma
Low-grade chondrosarcoma
Low-grade osteosarcoma
Parosteal osteosarcoma

Correct Answer: Low-grade chondrosarcoma

Explanation:

Osteochondroma is a cartilaginous tumor and malignant transformation is to a low-grade chondrosarcoma.

Question 35:

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

Options:

Recent onset of pain
Growth after skeletal maturity
C artilaginous cap thickness greater than 3 cm
Soft tissue extension
C alcific stippling in the cap on radiograph

Correct Answer: C alcific stippling in the cap on radiograph

Explanation:

Stippling on radiographs in the cap is due to calcification and is a common characteristic of cartilaginous tumors.

Question 36:

Enchondromas are commonly involved in which of the following sites:

Options:

Metacarpals
C arpus
Radius
Ulna
C lavicle

Correct Answer: Metacarpals

Explanation:

Question 37:

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

Options:

Ulnar shortening
Radial shortening
Radial head dislocation
Madelungâ s deformity
Translocation of carpus

Correct Answer: Ulnar shortening

Explanation:

Question 38:

Options:

Skeletal radiograph survey
Magnetic resonance imaging (MRI)
Magnetic resonance imaging (MRI) with wrist arthrogram
Genetic evaluation
C omputed tomography (C T) scan

Correct Answer: Skeletal radiograph survey

Explanation:

The next step is to order a skeletal survey to rule out involvement of other areas.

Question 39:

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungs 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:

Options:

Diaphyseal achalasia
Madelungâ s deformity
Multiple enchondromatosis
Multiple epiphyseal dysplasia
Infection

Correct Answer: Diaphyseal achalasia

Explanation:

Question 40:

Options:

Autosomal recessive
Autosomal dominant
Sex-linked recessive
Sex-linked dominant
Sporadic

Correct Answer: Autosomal dominant

Explanation:

Multiple hereditary exostoses is inherited in an autosomal-dominant manner with 90% penetrance.

Question 41:

A 12-year-old boy is brought to the clinic by his concerned parents. The boy s 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). Which of the following areas is unlikely to be involved:

Options:

Phalanges
Pelvis
C lavicle
Femur
Talus

Correct Answer: C lavicle

Explanation:

The clavicle is a membranous bone, and osteochondromas do not arise in membranous bones.

Question 42:

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungâ s 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The chance of hand involvement in this child is:

Options:

0%
10%
25%
Greater than 25%
Undetermined

Correct Answer: 25%

Explanation:

The hand is involved in 30% to 80% of cases.

Question 43:

A 12-year-old boy is brought to the clinic by his concerned parents. The boyâ s 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The most likely complication in this child is:

Options:

Malignant degeneration
C arpal translocation
Posterior interosseous neuropathy (PIN) palsy
Peroneal nerve palsy
Elbow dislocation

Correct Answer: C arpal translocation

Explanation:

Question 44:

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s skeletal radiograph survey is also presented (Slide 2 and Slide 3). The difference between Madelungâ s deformity and this boyâ s condition is:

Options:

The ulna is shorter
The radius is shorter
There is radial head dislocation
There is bilateral involvement
It is not congenital

Correct Answer: The ulna is shorter

Explanation:

The ulna is elongated or dorsally subluxed in Madelung's deformity.

Question 45:

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s 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 childâ s condition, except:

Options:

Excision of osteochondromas
Ulnar lengthening
Hemiphyseal stapling
Radial osteotomy
Observation

Correct Answer: Hemiphyseal stapling

Explanation:

Although hemiphyseal stapling is an acceptable option to correct radial articular angulation, in this boy the distal radial physis is already fused as is seen in the first radiograph.

Question 46:

A 12-year-old boy is brought to the clinic by his concerned parents. The boys 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 Madelungs 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 childâ s 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:

Options:

There is a risk of up to 25%
Bone scan can differentiate
Most common secondary malignancy is chondrosarcoma
Risk of malignancy varies between families
Malignant change occurs in adulthood

Correct Answer: Bone scan can differentiate

Explanation:

Bone scan cannot differentiate between an active lesion and a malignant transformation.

Question 47:

Horners syndrome includes all of the following except:

Options:

Miosis
Anhidrosis
Enophthalmosis
Exophthalmosis
Diplopia

Correct Answer: Exophthalmosis

Explanation:

Horners syndrome is caused by disruption of sympathetic innervation and is characterized by enophthalmosis, not exophthalmosis. Other symptoms include anhidrosis, miosis, and ptosis.

Question 48:

Axonotmesis involves injury to the:

Options:

Epineurium
Endoneurium
Perineurium
Axon
Vasonervorum

Correct Answer: Axon

Explanation:

Axontmesis, as described in Seddonâ s classification, implies injury to the axon and myelin sheath. Neurontmesis involves injury to all three layers.

Question 49:

All of the following may be seen with preganglionic lesion except:

Options:

Horners syndrome
Hemidiaphragmatic palsy
Positive histamine test
Tinelâ s sign
Root avulsion sleeve on myelogram

Correct Answer: Tinelâ s sign

Explanation:

Tinels sign is seen with postganglionic lesions.

Question 50:

Weakness is not seen with root avulsion in the:

Options:

Rhomboids
Serratus anterior
Supraspinatus
Trapezius
Infraspinatus

Correct Answer: Trapezius

Orthopedic Prometric Exam Preparation MCQs - Part 1

Orthopedic Prometric Exam Preparation MCQs - Part 10

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Orthopedic Prometric MCQs - Chapter 3 Part 49

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Chapter Index